19 June 2020: The MRCA Treatment Pathway 1 and Treatment Pathway 2 information below has been retained for historical purposes only. A Single Treatment Pathway has been in effect since 12 December 2019. See section 8.1 Overview [2] for current information.
Last amended: 20 September 2012
Unless a person is entitled to a Gold Repatriation Health Card, MRCA delegates are required to decide which Treatment P — athway is most appropriate following an assessment of a person's needs pursuant to section 325 [3] of the MRCA.
Upon acceptance of liability or when a person claims compensation, a delegate must carry out a needs assessment under section 325 [3] of the MRCA, and then determine, under section 327 [4], whether the claimant should have their treatment costs reimbursed and be issued with a Treatment Authority letter setting out a specified authority for treatment of the accepted conditions (Treatment Pathway 1) or whether they should be issued with a White Repatriation Health Card (Treatment Pathway 2).
In accordance with section 345 [5] of the MRCA a decision under section 327 [4], about which treatment path applies, is not an original determination and therefore not a reviewable decision for the purposes of Chapter 8 [6] of the MRCA. However the decision on the appropriate treatment pathway may be changed following a subsequent needs assessment as per paragraph 8.2.1 [7] below.
This section contains the following topics:
19 June 2020: any MRCA Treatment Pathway 1 and Treatment Pathway 2 information below has been retained for historical purposes only. A Single Treatment Pathway has been in effect since 12 December 2019. See section 8.1 Overview [2] for current information.
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. F — requently, full time serving members relocate at the time of their discharge from the ADF and t — his 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 wi — ll be needed immediately post-discharge. T — his information should be used during the Needs Assessment and help inform any decision on treatment path.
Where the client has a W — hite Repatriation Health C — ard, it is open to t — he MRCA delegate to change the T — reatment Pathway back to Treatment Pathway 1. In order to do this, the delegate must conduct a needs assessment in accordance with section 325 [3] of the MRCA, and make a determination under section 327 [4] that the claimant is entitled to reasonable medical treatment under section 271 [9] and is issued with a Treatment Authority letter, as distinct from a White Repatriation Health Card provided via section 280 [10]. 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 whe — ther 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 C — ard 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 whe — ther or not the item can be provided via prior approval from the Medical and Allied He — alth section. Some examples of the type of treatment that may receive prior approval include prescription medication — s and co — ntinence 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 T — reatment P — rinciple — s 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. T — reating 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 P — athway 1 or a White Repatriation Health Card under T — reatment 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.
19 June 2020: any MRCA Treatment Pathway 1 and Treatment Pathway 2 information below has been retained for historical purposes only. A Single Treatment Pathway has been in effect since 12 December 2019. See section 8.1 Overview [2] for current information.
A determination under section 327 [4] is not required if a person is automatically eligible for a Gold Repatriation Health Card, or apart from the exceptions explained in 8.5 [12], where a person is a current serving member.
Example: A member is injured while serving in February 2005 and his injuries result in paraplegia. Liability is accepted under the MRCA in July 2005. However, because the member is still serving he receives treatment from the ADF under section 58 — F [14] of the Defence Force Regulations 1952 (the Defence Regulations), including the provision of appliances and pharmaceuticals. His condition stabilizes and the member's claim for permanent impairment is accepted. He is assessed at 70 impairment points. He is discharged in April 2006. Section 281 [13] automatically applies and the member is issued with a Gold Repatriation Health Card for any treatment after discharge.
Once a person reaches 60 impairment points there is no discretion as to which treatment path applies, they must be given a Gold Repatriation Health Card. A Gold Card issued via section 281 entitles the person to treatment for all conditions, in exactly the same way as under the VEA. By definition a Gold Card cannot be issued until such time as the person has been assessed for permanent impairment. [13]
It should be noted that a person may become eligible for a Gold Card by virtue of a combination of their MRCA, SRCA and VEA impairments.
Section 199 [15] of the MRCA states that to be eligible for SRDP the person needs to meet each of the following criteria:
The latter criteri — on requires that the client has undergone a formal assessment of their capacity for rehabilitation in accordance with section 44 [16].
A Gold Repatriation Health Card will be embossed with 'TPI' if a person is assessed as being SRDP eligible. The client does not have to be in receipt of SRDP to be issued with a Gold Card, they merely need to be eligible. This enables those persons to obtain the same concessions that are available to TPI pensioners and War Widow/ers under the VEA.
4.A current full time serving member of the ADF (including a reservist on CFTS) is usually provided with medical treatment by the Department of Defence under the Defence Regulations. Accordingly a decision about which Treatment Pathway is appropriate is not required unless the Service Chief requests that the MRCC accept responsibility for the cost of that member's treatment. Further commentary on treatment for serving members is at 8.5 [12].
Links
[1] https://clik.dva.gov.au/user/login?destination=comment/reply/19266%23comment-form
[2] http://auth-clik.dvastaff.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-8-treatment-injuries-and-diseases/81-overview
[3] clik://LEGIS/MRC-ACTS/MRCA/S325
[4] clik://LEGIS/MRC-ACTS/MRCA/S327
[5] clik://LEGIS/MRC-ACTS/MRCA/S345
[6] clik://LEGIS/MRC-ACTS/MRCA/Ch 8
[7] https://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-8-treatment-injuries-and-diseases/82-treatment-pathways-sections-325-327/821-moving-person-between-treatment-pathways
[8] https://clik.dva.gov.au/user/login?destination=comment/reply/19288%23comment-form
[9] clik://LEGIS/MRC-ACTS/MRCA/S271
[10] clik://LEGIS/MRC-ACTS/MRCA/S280
[11] https://clik.dva.gov.au/user/login?destination=comment/reply/19277%23comment-form
[12] https://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-8-treatment-injuries-and-diseases/85-transferring-cost-treatment-adf-dva
[13] clik://LEGIS/MRC-ACTS/MRCA/S281
[14] clik://LEGIS/MRC-ACTS/MRCA/S58
[15] clik://LEGIS/MRC-ACTS/MRCA/S199
[16] clik://LEGIS/MRC-ACTS/MRCA/S44
[17] clik://LEGIS/VEA/Section 85(4B)
[18] clik://LEGIS/VEA/Section 85(7A)
[19] https://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-8-treatment-injuries-and-diseases/86-treatment-and-service-provision-severely-injured-adf-clients-and-transitioning-adf-clients/861-adf-process