Ambulance payment responsibilities, authorisations and concessions

Concession classification eligibility

Concession patients receive free, clinically necessary ambulance coverage throughout Australia. This coverage provides free emergency and medically authorised non-emergency ambulance transport to the nearest and most appropriate hospital.

Concession classification

For the purpose of ambulance transport, the Concession classification includes:

• a person holding a current Victorian Pensioner Concession Card (includes dependent children listed on the card but not spouses)
• a current Health Care Card holder and their dependents including spouses listed on the card (does not include Health Care Card for carer allowance and foster care issued in the name of the child)
• a child holding a current Child Disability Health Care Card or Foster Child Health Care Card, but not their guardians/families listed on the card
• a child under a Family reunification, Care by Secretary or Long-term care order including children on interim accommodation orders
• a person who is subject to an order under the Mental Health and Wellbeing Act 2022, Sentencing Act 1991, or Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 requiring them to be compulsorily assessed or treated in a designated mental health service. This includes compulsory, security and forensic patients.
• asylum seekers including people fleeing the Israel-Palestine conflict who arrived in Australia on a visa subclass 600 (Visitor visa).

Concession transport from a private healthcare facility

If a concession card holder is transported from a private healthcare facility the sending private facility is responsible for payment. This includes registered private hospitals and registered private day procedure centres.

The private healthcare facility decides whether or not to pass this cost onto the patient.

Concession benefits do not apply

Concession benefits do not apply when:

• a patient only holds a Commonwealth Seniors Health Card and they do not have one of the concession cards listed above
• a patient requests to be repatriated or relocated to or from Victoria for non-clinical reasons or when the transport is not clinically necessary (repatriation back to Victoria must be authorised as clinically necessary and there must be a demonstrated clinical requirement for ambulance transport)
• another party is responsible for the account.

The other party responsible could be:

• the Department of Veterans’ Affairs (DVA) where a person holds a Gold Card or a White Card (subject to the conditions of the card)
• the Transport Accident Commission (TAC) (subject to the conditions under the scheme)
• the Victorian WorkCover Authority (VWA) (subject to the conditions under the scheme).

Approving clinically necessary patient transport

Authorisation of clinically necessary transport is limited to health professionals who can make an informed decision about whether there is a genuine clinical need for a patient to be transported by ambulance instead of any other way.

The health professionals who can authorise ambulance transport are:

• a registered medical practitioner
• an Ambulance Victoria paramedic/authorised employee of the Emergency Services Telecommunications Authority
• a registered division 1 nurse (under the Non-Emergency Patient Transport Regulations 2016)

Booking process

When booking ambulance transport, the location of the patient is an important factor. Ambulance Victoria considers this when making the decision on how best to transport the patient.

Inter-hospital and patient discharge transports

Bookings for inter-hospital and patient discharge transports are initiated by the sending hospital or health service. The choice of road or air service is a decision made by Ambulance Victoria based on the most appropriate transport for the patient at the time.

Community transports

For people in the community who need to attend public specialist clinics or public health independence programs, the booking and authorisation of ambulance transport must be completed by the relevant health service. This includes ambulance transports back to the community.

For people being transported from a private healthcare facility, the booking and authorisation of the ambulance transport must be completed by the private healthcare facility.

Payment responsibility

Responsibility for payment of services provided by Ambulance Victoria is outlined in the Ambulance services payment guidelines.

Where Ambulance Victoria is identified as responsible for payment, the patient transport must be booked through Ambulance Victoria.

Ambulance Victoria is not responsible for payment if the transport is booked with a provider other than Ambulance Victoria.

Overseas visitors inter-hospital transports

For all inter-hospital transfers of overseas visitors that are clinically necessary, the transferring hospital is responsible for payment and will be billed by the patient transport provider.

All other transports of overseas visitors

For all clinically necessary transports of overseas visitors that are not an inter-hospital transfer (for example, from the community into a public hospital), the overseas patient is responsible for payment and will be billed by the patient transport provider.

Asylum seekers

People seeking asylum are eligible for free emergency ambulance transport.

Asylum seeker status can be verified as per the following guidance note for Victorian Government services Identifying a person seeking asylum – Guidance Note.

Where an individual cannot provide sufficient evidence to verify their status as an asylum seeker, the following agencies can verify a person’s circumstances:

• Asylum Seeker Resource Centre
• Australian Red Cross
• Ballarat Community Health Service Refugee Health Program
• Baptcare Sanctuary
• Barwon Health Refugee Health Program
• Bendigo Community Health Refugee Health Program
• Brigidine Asylum Seeker project
• Cabrini Asylum Seeker and Refugee Health Hub
• Cohealth Refugee Health Program
• Djerriwarrh Refugee Health Program
• DPV Health Refugee Health Program
• EACH Refugee Health Program
• Monash Health Refugee Health Program
• Hotham Mission-Asylum Seeker Project
• IPC Refugee Health Program
• Primary Care Connect Refugee Health Program
• Royal Children’s Hospital Immigrant Clinic
• Salvation Army
• Springvale Community Aid and Advice Bureau
• Sunraysia Mallee Ethnic Communities Council (Mildura)
• Swan Hill District Health Service Refugee Health Program
• Victorian Foundation for Survivors of Torture (Foundation House)

People seeking asylum do not have consistent forms of identification, and so at times Ambulance Victoria staff will need to exercise discretion.

Asylum seekers in community detention and detention centres

Charges for asylum seekers in the Community Detention Program or for people in a detention centre (SRSS Bands 1-3) will be directed to the International Health and Medical Service (IHMS) funded by the Department of Immigration and Border Protection (DIBP) for full fee reimbursement.

Further information on asylum seeker health can be found at Diversity in Health, and the Victorian Refugee Health Network.

Veterans

Veterans may be entitled to free transport. An eligible Department of Veterans’ Affairs (DVA) patient includes:

• persons holding a Repatriation Health Card - for All Conditions (Gold Card)
• some holders of a Repatriation Health Card - for Specific Conditions (White Card).

Eligibility for free transport is subject to the conditions of the card.

Prisoners and people in police custody

Prisoners

Prisoners are not charged for patient transport. Fees for prisoners are charged to the responsible primary healthcare provider at each prison.Note that for inter-hospital transports, consistent with funding arrangements,prisoners are considered to be general type patients.

People in police custody

Victoria Police will be responsible for the payment of ambulance attendance or patient transport to and from hospital for persons in, or returning to police custody when:

• the injury was a consequence of the person’s arrest
• the injury was sustained in police custody.

Victoria Police is not responsible for the payment of ambulance attendance or patient transport to and from hospital when the ambulance transport is in relation to:

• a person’s general health issue such as asthma, heart problems or drug withdrawal
• any pre-existing medical condition, including drug withdrawal, or any concerns raised while in custody that require ambulance attendance or transport to hospital
• a person who is subject to an Inpatient Assessment Order, Inpatient Temporary Treatment Order or Inpatient Treatment Order under the Mental Health and Wellbeing Act 2022 and also needs concurrent medical attention.

Payment for these transports is in line with the payment responsibilities for community ambulance transports.

People in youth justice

The Department of Justice and Community Safety is responsible for the statutory provision of young people in the criminal justice system. This includes payment responsibility for ambulance transport of people in youth justice.

TAC and VWA

For patients who are eligible under the Transport Accident Commission (TAC) or the Victorian WorkCover Authority (VWA), transport costs may be covered.

Transport of a person under a provision of the Mental Health and Wellbeing Act 2022

A person who is subject to an order under the Mental Health and Wellbeing Act 2022, Sentencing Act 1991, or Crimes (Mental Impairment and Unfitness to be Tried) Act 1997, requiring them to be compulsorily assessed or treated in a designated mental health service, is now included under the concessions definition for the purposes of the guidelines.

This includes compulsory, security and forensic patients, and persons being transported by ambulance under section 232 and 241 of the Mental Health and Wellbeing Act 2022.

Cross-border arrangements for mental health patients

Victoria has agreements with the Australian Capital Territory (ACT), New South Wales (NSW) and South Australia (SA) covering the interstate treatment, transfer and apprehension of compulsory patients.

Victoria also has agreements with the ACT, NSW and Queensland covering the apprehension and return of forensic and security patients.

Public health service home birth patients

Under a public hospital home birth program, a woman who is having a home birth is an admitted ‘patient’ during labour. If an ambulance transfer (from home to hospital) is requested by the midwife during the admitted episode, health services are responsible for covering the cost of the transfer.

Health services should inform women about their own liability for any costs associated with ambulance transport outside the admitted episode.

For further information, download the Implementing a public home birth program document.

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