DVA funding arrangements
Funding and pricing arrangements for veteran patients are detailed annually in Volume 2, Chapter 2 of the Department of Health and Human Services Policy and Funding Guidelines.
Eligibility
There are two types of cards held by entitled veterans which cover the cost of medical treatments:
- Gold card which covers all conditions, or
- White card for specific conditions only.
All Gold card holders are automatically eligible for public hospital treatment as veterans but a White card holder's eligibility for their recognised condition, must be established on each admission. If the White card holder does not have the documentation showing DVA prior approval, hospitals will to need to contact DVA to establish eligibility at the time of admission or on the next business day if the patient is admitted over a weekend.
Hospitals can contact the DVA, on ph. 1300 550 457; (metropolitan areas); 1800 550 457 (non-metropolitan areas), between the hours of 9.00am and 5.00pm, Monday to Friday.
If an eligible veteran is also covered under TAC or WorkSafe arrangements or chooses to be treated as a private patient, then those arrangements take priority.
DVA also requires notification of Vietnam veterans and their dependants, who are not otherwise eligible under DVA (and therefore may hold no card), but who are entitled to medically-urgent inpatient treatment in rural public hospitals or the Austin and Repatriation Medical Centre.
DVA fees are now indexed on 1 July annually. Refer to the DVA for more information.
Pricing
All DVA specific prices are as published in the Victorian Policy and Funding Guidelines Volume 2 Chapter 3 for throughput based funding. Public patient prices will apply where there is no specific DVA price listed.
Prostheses
The cost of surgically implanted prostheses is included in the WIES payment and DVA will not be billed separately by hospitals for surgically implanted prostheses.
Fees
The Department of Veterans’ Affairs agreement prohibits organisations from raising any charges directly on an eligible veteran except where provided for under Commonwealth legislation. This prohibition does not, however, prevent organisations from charging a cost for providing personal services such as television access or telephone services at the facility.
Health services should collect any co-payment for nursing home type patient from the patient with the exception of Victoria Cross or Prisoners of War recipients. For this group, health services should make a claim directly based on prior approval to Department of Veterans’ Affairs for reimbursement using MBS item number NH05.
Payment for interfacility transport (excluding Secondary Aeromedical retrieval) is included in the payment arrangements for services
The Department of Veterans’ Affairs agreement recognises that the provision of treatment to Department of Veterans’ Affairs patients may occasionally be sub-contracted to a private hospital or facility. Where that private hospital or facility is contracted to the Department of Veterans’ Affairs, and claims for the service, the Department of Veterans’ Affairs will pay the facility directly through their payment arrangements with Medicare Australia. Under these circumstances, the public hospital cannot also claim payment separately for the treatment provided.
Subcontracting for Transition Care is exempt from this requirement as public hospitals do not directly bill the Department of Veteran’s for this service
Pharmaceuticals
Health services should ensure medication reviews (including self-management) are completed prior to discharge by the clinical pharmacist or doctor for patients.
The Veteran Affairs Pharmaceutical Advisory Centre can be contacted on 1800 552 580
Discharge planning
To arrange home and personal care services for eligible veterans, health services must contact the National Veterans’ Home Care assessment agency (1300 550 450). Discharge aids and equipment for veteran patients must be provided to facilitate safe discharge for a period of thirty days post discharge. For further information contact the Rehabilitation Appliances Program (RAP) schedule at the Department of Veterans’ Affairs or phone 1300 550 457 (metro) or 1800 550 457 (rural).
For more information, see policy and funding guidelines.
Reviewed 24 February 2016