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8.4.1 Legislative Instruments
The nature and extent of medical treatment provided via Treatment Pathway 2 is governed by three separate legal instruments issued pursuant to section 286 of the MRCA. These instruments provide the authority for deciding the type, frequency and cost of treatment provided to any eligible person who possesses a Repatriation Health Card under the MRCA.
When issued with a Repatriation Health Card under the MRCA, holders become entitled to treatment provided through the:
- MRCA Treatment Principles (contained in Instrument 2013 No. MRCC53);
- Repatriation Private Patient Principles (contained in Instrument 2015 No.R33); and the
- MRCA Pharmaceutical Benefits Scheme (contained in Instrument 2013 No. MRCC 44).
These instruments are available in the CLIK Legislation Library. The scope of these treatment arrangements broadly replicate the treatment arrangements under the VEA.
Subsection 287(2) of the MRCA makes provision for the approval of a particular class of treatment that is not dealt with in one of the three aforementioned instruments. It provides the authority for a Delegate to consider a written submission from a treating medical practitioner in a particular case and approve treatment that is outside the scope of the Treatment Principles, but is reasonably required by the person due to the nature of their medical condition.
Example 1. A person has an accepted claim for Major Depressive Disorder and the person has a White Repatriation Health Card. The person's treating Psychiatrist has provided a written recommendation that the person undertake a course of Yoga to assist with the management of their Psychiatric condition. As Yoga is not a class of treatment provided for in the Treatment Principles, the delegate may consider approval of the Yoga under subsection 287(2) of the MRCA.
Example 2. A person has an accepted claim for an L3/4 disc prolapse and the person has a White Repatriation Health Card. Their specialist has recommended that the person undertake massage therapy. Subsection 287(2) cannot be used to approve the massage therapy as massage therapy is provided for in the Treatment Principles, provided that is it performed as part of an authorised physiotherapy, chiropractic or osteopathy service as per Part 7.8.1 of the Treatment Principles. The request for massage therapy should be referred to the Medical and Allied Health section for their consideration.
Example 3. A Reserve Force member has an accepted claim for a right medial meniscus tear, and the member has been provided with a White Repatriation Health Card. An Orthopaedic Specialist has provided a written recommendation that the member requires arthroscopic surgery, however the treating Specialist does not accept DVA's payment arrangements under the Repatriation Health Card system. Subsection 287(2) of the MRCA cannot be used to meet the Specialist's costs as the surgery is a class of treatment provided for in the Treatment Principles and the Private Patient Principles. In this instance the Reserve Force member should discuss referral to an Orthopaedic Specialist who accepts DVA's payment arrangements with their referring General Practitioner. If this is not a suitable option then the case should be referred to the Medical and Allied Health section for their consideration. A needs assessment may be conducted and consideration given to transferring the member back to Treatment Pathway 1, but only as a last resort.
The provisions of subsection 287(2) should only be used by a delegate in the Medical and Allied Health section, in Primary Health Group, at the APS 5 level.