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8.2.1 Moving a person between Treatment Pathways
Initially a person may be placed on Treatment Pathway 1 and be issued with a Treatment Authority letter if their treatment needs are short-term or they are in the acute phase of treatment. However, the intention is that persons with ongoing treatment needs will be put on Treatment Pathway 2 and provided with a White Repatriation Health Card.
Prior to making a decision that a client should receive a White Repatriation Health Card, delegates should check if existing treatment providers will accept DVA's payment arrangements for Repatriation Health Card holders and continue to treat the person on that basis. Similarly delegates should check whether the nature of any ongoing treatment is likely to be covered by the treatment arrangements available through the MRCA Treatment Principles (including the MRCA Private Patient Principles and the MRCA Pharmaceutical Benefits Scheme) for Repatriation Health Card holders. If these conditions are not met then it may be inappropriate to change treatment pathways, until the current period of treatment has concluded.
At the time of a person's discharge from the ADF, delegates should consider issuing a White Repatriation Health Card. Frequently, full time serving members relocate at the time of their discharge from the ADF and this may present an ideal opportunity for the person, who is already locating new treatment providers post discharge, to select providers who will accept the DVA payment arrangements.
In the case of medical discharge, we should ascertain what treatment and which treating providers will be needed immediately post-discharge. This information should be used during the Needs Assessment and help inform any decision on treatment path.
Where the client has a White Repatriation Health Card, it is open to the MRCA delegate to change the Treatment Pathway back to Treatment Pathway 1. In order to do this, the delegate must conduct a needs assessment in accordance with section 325 of the MRCA, and make a determination under section 327 that the claimant is entitled to reasonable medical treatment under section 271 and is issued with a Treatment Authority letter, as distinct from a White Repatriation Health Card provided via section 280. This action should only be taken when there is no other avenue for ensuring the person receives the treatment they require for their accepted medical condition/s. Therefore, before deciding to take such action the delegate should ascertain whether or not the item can be provided via prior approval from the Medical and Allied Health section in Primary Health Group.
Where the Repatriation Health Card holder requires treatment that is not obviously available through the MRCA Treatment Principles (including the MRCA Private Patient Principles and the MRCA Pharmaceutical Benefits Scheme) the delegate should ascertain whether or not the item can be provided via prior approval from the Medical and Allied Health section. Some examples of the type of treatment that may receive prior approval include prescription medications and continence aids for paraplegics.
Delegates should be aware that although the Repatriation Health Card system will not automatically provide for all treatment modalities, exceptions can be made in special circumstances. In these cases, the treatment provider should submit their justification for a particular treatment (in writing) for prior approval to the Medical and Allied Health section. Requests for approvals of treatment outside the Treatment Principles can be emailed to “DVA PH Medical and Allied Health Manager”. Similarly, only medications listed on the Pharmaceutical Benefits Scheme or additional medications and dressings listed on the Repatriation Schedule will be provided via the Repatriation Health Card system. Treating providers may seek prior approval from the Veterans' Affairs Pharmaceutical Advisory Centre (VAPAC) via email to "DVA Primary Health VAPAC" or via telephone on 1800 552 580 if they consider that special circumstances exist.
A decision as to whether a MRCA person is entitled to reimbursement or payment for the cost of reasonable medical treatment under Treatment Pathway 1 or a White Repatriation Health Card under Treatment Pathway 2 remains a discretionary one for MRCA delegates to consider. However, it is Departmental policy to issue a Repatriation Health Card, rather than provide treatment via Treatment Pathway 1, wherever practical.