Effective from 12 December 2019.
Simplifying access to medical treatment for MRCA veterans
On 12 December 2019, a change to the treatment pathways occurred through the passage of the Military Rehabilitation and Compensation Amendment (Single Treatment Pathway) Act 2019. It amends the Military Rehabilitation and Compensation Act 2004 (MRCA) to simplify treatment pathways for medical treatment.
There is now only one treatment pathway – a DVA Veteran Card (White Card). The legislative amendment replaced the dual MRCA treatment pathway (that is, Treatment Pathway 1 and Treatment Pathway 2) with a single treatment pathway. The change streamlines access to medical treatment for MRCA veterans without the need for claim forms, upfront costs or being out of pocket while waiting to be reimbursed.
From 12 December 2019, all MRCA veterans now receive medical treatment for accepted conditions through a DVA Veteran Card (White or Gold Card). As a MRCA veteran who was previously on the Treatment Pathway 1 (also known as the reimbursement pathway) is identified, a DVA Veteran Card (White Card) will be issued, allowing them to access medical treatment for their accepted conditions without paying upfront. All future MRCA veterans will be automatically issued a DVA Veteran Card (White or Gold Card) on acceptance of a medical condition.
The above arrangement aligns the MRCA treatment options to the Veterans' Entitlements Act 1986 and the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988.
Special Circumstances
There are a number of special circumstances where a veteran can be reimbursed for medical treatment.
Treatment obtained before liability accepted
Where a veteran sought medical treatment before their claim for that condition was determined, they can be reimbursed for that treatment if:
- liability for the condition has been accepted;
- the veteran has made a claim for compensation under section 319; and
- it was reasonable for the veteran to obtain the treatment.
The claim for compensation does not have to be determined in order to reimburse the veteran. See Section 8.3.1 Reasonable Reimbursement.
Treatment obtained prior to a service death
Where a veteran sought medical treatment for an injury or disease and subsequently dies, the cost of this treatment can be reimbursed if:
- the person’s death is a service death for which the Commission has accepted liability;
- a claim for compensation has been made under section 319 by the veteran’s legal personal representative; and
- it was reasonable to obtain the treatment in the circumstances.
The claim for compensation does not have to be determined in order to reimburse the veteran. See Section 8.3.1 Reasonable Reimbursement.
Other special circumstances
A veteran’s medical treatment can be reimbursed in other circumstances if:
- the Commission has accepted liability for the condition;
- the veteran has made a claim for compensation under section 319; and
- the Commission is satisfied that special circumstances exist in relation to the person and the treatment obtained.
In consider whether special circumstances apply a delegate should consider:
- whether a veteran has complex health care needs;
- a veteran’s existing relationship and length of relationship with a treatment provider;
- a veteran’s ability to reasonably access another treatment provider.
DVA may consider the use of prior approval for services for the treatment of accepted medical condition/s. For example, where a MRCA veteran has high or unusual health care needs there may be arrangements to directly pay the health care provider.
For policy on prior approval arrangements see Section 8.3.1. Please contact Policy with any questions regarding special circumstances.
The MRCA Treatment Pathway 1 and Treatment Pathway 2 information below has been retained for historical purposes only.
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“Treatment” as defined by Section 13 of the MRCA:
means treatment provided, or action taken, with a view
to:
(a) restoring a person to physical or mental health or
maintaining a person in physical or mental health; or
(b) alleviating a person's suffering; or
(c) ensuring a person's social well-being.
For the purposes of providing treatment under the MRCA:
treatment includes:
(a) providing accommodation in a hospital or other institution,
or providing medical procedures, nursing care, social or
domestic assistance or transport; and
(b) supplying, renewing, maintaining and repairing artificial
replacements, medical aids and other aids and appliances;
and
(c) providing diagnostic and counselling services;
for the purposes of, or in connection with, any treatment.
E — ntitlement to treatment under the MRCA is derived from the acceptance by the MRCC of a claim for compensation following the acceptance of liability for:
- a service injury sustained or a service disease contracted by a person; or
- a service death.
The treatment provisions contained in Chapter 6 of the MRCA provide two Treatment Pathways for former members of the ADF. Part 2 of Chapter 6 provides compensation for the cost of reasonable medical treatment, and is referred to as Treatment Pathway 1. Part 3 of Chapter 6 provides treatment via the Repatriation Health Card system, and is referred to as Treatment Pathway 2.
A person may initially receive treatment for their a — ccepted injury or disease under Defence regulations. However, once a Permanent Forces member discharges (or following acceptance of liability for former members, reservists and Cadets) and if a condition is permanent such that it may require treatment in the future, the person should receive treatment via Treatment Pathway 2 and be provided with a Repatriation Health Card. Deciding a person should receive treatment via Treatment Pathway 2 should only occur after a review of the person's health care needs to ensure that the person's current treatment and any current treating providers are covered by the Repatriation Health Card system.
Delegates should note that it is Departmental Policy to issue a Repatriation Health Card, rather than provide treatment via Treatment Pathway 1, wherever practical. Some people will have an automatic entitlement to a Gold Repatriation Health Card if they meet certain criteria as discussed in paragraph 8.2.2. If a person meets any of these criteria, then the issue of a Gold Repatriation Health Card is automatic, and not discretionary, once a person discharges from the ADF.
A person with MRCA service may also be entitled to treatment under the VEA (paragraph 8.6.1 refers) if they meet the definition of a veteran, as defined in section 5C of the VEA, even if their eligible service is only on or after 1 July 2004.