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.
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.
Prior to any aid or appliance being issued under the rehabilitation provisions, the Rehabilitation Coordinator should request a RAPTOR report to ensure that they have a good understanding of what aids and appliances have been previously provided to the client. A RAPTOR report can be requested by contacting the Manager, RAP Operations. If requested, RAPTOR reports should be printed and placed on the client’s file and in the client’s UIN container in TRIM.
In order to ensure an audit trail, where aids and appliances cannot be provided through RAP, they must be provided through a rehabilitation plan, even if this is an "in house" plan and aids and appliances are the only supports that are being provided through the plan.
This approach also helps to ensure that the Rehabilitation Coordinator has a good understanding of the client’s needs, including their psychosocial needs, and what supports and services could be utilised to assist a person to adjust to their accepted conditions, and to become as independent as possible in self managing their condition.
For example, if a functional, home or product assessment to investigate for aids and appliances highlights that the client is experiencing high levels of pain, and that they are having difficulties managing their conditions, then a psychosocial rehabilitation plan could be opened and a pain management course could be approved as part of this plan. A medical management rehabilitation plan could also be considered so that the person can get assistance in managing their appointments and ensuring that all treatment options are being explored.
All approvals for aids and appliances provided through the rehabilitation provisions must be recorded in the case notes in R&C ISH together with a list of the aids and appliances that were provided. These details should also be included on the client’s rehabilitation plan. A copy or print out of the RAPTOR report should also be included on the client’s file. If requested, RAPTOR reports should be printed and placed on the client’s file and in the client’s UIN container in TRIM.
Where a client is on a vocational rehabilitation plan, it is more likely that any aids or appliances that they require to assist them with retraining, study or work will need to be provided through the rehabilitation provisions. This is because items listed on the RAP Schedule could be classified as medical aids and appliances designed to address clinical needs rather than vocational needs.
If the client is receiving aids and appliances through the National Disability Insurance Scheme (NDIS)
Both the NDIS and DVA provide aids and appliances to help clients to manage their activities of daily living. DVA can provide aids and appliances through RAP or through a rehabilitation plan. The NDIS can provide aids and appliances, through an individual care plan.
. An important principle is that the same aid or appliance must not be provided by both NDIS and DVA. Therefore, it is important for Rehabilitation Coordinators to advise Occupational Therapists or other allied health professionals undertaking assessments for aids and appliances, that they should:
ask the client whether they are receiving any services or equipment from the NDIS;provide details of any services or equipment being provided through the NDIS; explain to the client that they cannot receive the same aids and appliances through both the NDIS and DVA; anddocument that they have made the client aware that they cannot receive the same items through both the NDIS and DVA.
If a person or their family member is provided with a Gold or White Repatriation Health Card for their treatment, then they are eligible to receive MRCA Supplement at the low rate in lieu of the former pharmaceutical allowance.
Persons with a Repatriation Health Card have to make a co-contribution when purchasing pharmaceuticals. The Safety Net Scheme ensures that a person does not pay for more than 60 prescription items (currently) at the concessional rate in a calendar year. After this prescriptions are free. The MRCA Supplement is designed to compensate a person for the co-contribution they make for each prescription item.
If a person travels overseas they will not be eligible for the MRCA Supplement if they are absent for more than 26 weeks. If a person leaves Australia permanently, they will not be eligible for the MRCA Supplement after the day on which they left Australia.
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.
Some former members of the ADF with serious injures may require extensive care to live independently in the community. Appropriate care may be provided through Attendant Care services provided for in Chapter 4 [6] of the MRCA, and discussed in detail in Chapter 9 [7] of this manual. However some persons will require community nursing services in their own home in order to live independently.
Part 7.3 of the MRCA Treatment Principles provides Community Nursing for Repatriation Health Card holders on Treatment Pathway 2. The Community Nursing program provides access to community nursing services to eligible former members of the ADF to meet all of their clinical needs. These clinical needs are assessed by the contracted community nursing provider that delivers the community nursing services. It is expected that a majority of former ADF members requiring community nursing services on Treatment Pathway 2 will have a high complexity and level of care needs.
The Community Nursing program has an 'Exceptional Case Unit' of contracted specialist nurses that assesses the individual care needs of complex and high level clients to determine the fee to be paid for this care.
A serving member may need access to nursing services prior to discharge and being placed on Treatment Pathway 2. In these circumstances where it is expected that a serving member will be placed on Treatment Pathway 2, a DVA-contracted community nursing provider should be used unless there is good reason why such a provider cannot be accessed. This should occur even if the cost of these services may initially be met by Defence or via Treatment Pathway 1, to ensure continuity of care. Therefore, it is important to liaise with the ADF Rehabilitation Coordinator and the Community Nursing manager in the relevant DVA Location office. A list of DVA's contracted Community Nursing providers by geographic region can be found on DVA's internet site at http://www.dva.gov.au/service_providers/community_nursing/contracted_providers/Pages/index.aspx [8]
Persons requiring nursing care should be placed on Treatment Pathway 2 as soon as possible following discharge from the ADF.
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.
Last amended: 5 September 2013
The definition of treatment in section 13 [10] includes the provision of aids and appliances in paragraph 13(2)(b). However, aids and appliances may also be provided under Chapter 3 [11] of the MRCA, either in conjunction with a rehabilitation program or to those who have been assessed under section 44 [12] as not having the capacity for rehabilitation.
Section 5 [13] states that a medical aid of a person means an artificial limb or other artificial substitute, or a medical, surgical or other similar aid or appliance, that is used by the person.
The requirement for an aid or appliance pursuant to Chapter 3 is considered according to the criteria specified in section 58(2) [14]. Included at paragraph 58(2)(b) is consideration of any difficulties faced by the person in gaining access to, or enjoying reasonable freedom of movement in, his or her place of residence, education, work or service.
In general terms an aid or appliance pursuant to the provisions of Chapter 3 is designed to assist a person to enjoy freedom of movement in the community. Items that might assist in the home could include backrests, grab rails, shower chairs, pick-up sticks, specially designed chairs, tap turners and other adaptive equipment. Items that might assist in the workplace could include document holders, writing boards, specially designed chairs, footrests and wrist-rests. A medical aid or appliance provided as treatment under Chapter 6 should have a curative or palliative effect. Typically these items are likely to include prostheses, orthopaedic footwear, wheelchairs and tens machines. In practice, many aids or appliances could come under either provision.
Section 274(1) [15] of the MRCA provides that aids and appliances that can be provided via Chapter 3 [11] of the MRCA may not be provided under Treatment Pathway 1. However it needs to be recognised that the provision of alterations, aids and appliances under Chapter 3 [11] of the MRCA is dependent upon the person at least having been assessed for rehabilitation in accordance with section 44 [12].
If a person has been provided with an aid or appliance under Treatment Pathway 1 and later undertakes a rehabilitation assessment, any future aids and appliances including the repair or replacement of aids and appliances previously provided, should be dealt with under Chapter 3.
Part 11 [16] of t — he MRCA Treatment Principles also provides aids and appliances via the Rehabilitation Aids and Appliances Program and HomeFront (RAP) for those MRCA persons on Treatment Pathway 2. However, the MRCA Treatment Principles also state that compensation should be provided under Ch — a — pt — e — r — s 3 [17] or 4 [18] of the MRCA, and that RAP should only be utilised when those Ch — a — pt — e — rs are not applicabl — e. The reference to Chapter 4 in Part 11 of the MRCA Treatment Principles is a reference to the Motor Vehicle Compensation Scheme, which is discussed in detail in Chapter 9 [7] of this manual.
Wholly dependent partners and eligible young persons who are dependants of a deceased MRCA person do not have access to the provisions of Chapter 3 [11] or Chapter 4 [6] of the MRCA, and therefore only have access to alterations, aids and appliances provided for in Part 11 [16] of t — he MRCA Treatment Principles. Accordingly, Part 11 of the MRCA Treatment Principles generally only applies to wholly dependent partners and eligible young persons, or to those MRCA persons who have not undertaken a rehabilitation assessment in accordance with section 44 [12].
There is only limited scope for alterations to a person's home in Part 11.9 [19] of the MRCA Treatment Principles. There is no provision for alterations in the Treatment Pathway 1 provisions contained in Part 2 of Chapter 6 [20] of the MRCA. Accordingly, alterations to a person's place of residence, education, work or service should be provided via the provisions contained in Chapter 3 [11] of the MRCA. Details about assistance with home alterations can also be found in chapter 10 [21] of the Rehabilitation Guide.
Last amended: 5 September 2013
Information about guide, hearing and assistance (service and companion) dogs as aids, including the specific assistance that each of the different types of dogs are trained to provide, can be found in chapter 10.6.4 [22] of the Rehabilitation Guide.
Guide dogs and hearing dogs are regarded as a medical aid or appliance. A guide or hearing dog would therefore normally be considered in the context of the person's medical treatment.
Assistance dogs (service and companion dogs) are regarded as a rehabilitation aid. The rehabilitation policy guidelines regarding the provision of companion or service assistance dogs and the payment for costs associated with keeping these dogs are still being finalised and all requests for assistance are being considered by the MRCC.
Please refer to chapter 10.6.4 [22] of the Rehabilitation Guide for details about the information that must be forwarded to rehabilitation@dva.gov.au [23] before a request for a service or companion dog can be considered.
Last updated 2 May 2011
Residential care such as might be provided in a nursing home or hostel is provided for in Part 10 of the MRCA Treatment Principles. Where a person is a MRCA Treatment cardholder and is in high-level residential care solely because of their accepted MRCA injury or condition, (i.e. not because of a requirement for aged care) the Department pays the residential care subsidy instead of the Department of Health and Ageing and may also, in exceptional circumstances cover the 'residential care amount'.
The MRCA TPs definition of the 'residential care amount' equates to the 'maximum daily amount of resident fees' as defined in Section 58-2 of the Aged Care Act 1997. This includes:
Exceptional circumstances exist where the person:
The financially disadvantaged test will always be met if the person has dependants and is required to maintain a home for their dependants at the same time as paying the 'residential care amount'.
Where exceptional circumstances exist, the Delegate is to:
This will assist in providing updated information regarding the management and assistance for these severely injured persons and their families to senior management.
Following approval the Delegate is to:
Section 284 [25] of the MRCA provides for a Gold Repatriation Health Card to wholly dependent partners (of a deceased MRCA person),and eligible young persons who are wholly or mainly dependant immediately before the person's death.
Wholly dependent partners and eligible young persons with a Gold Repatriation Health Card are entitled to the same treatment as former members with a Gold Repatriation Health Card. Wholly Dependent Partners will have 'War Widow/er' embossed on their Gold Repatriation Health Card.
Further information on Death and Dependant benefits is included in Chapter 7 [27] of this manual.
Last amended: 24 January 2011
From 1 August 2010 Gold Card holders travelling overseas are entitled to have costs associated with receiving overseas travel vaccinations, when the vaccinations are provided within Australia. While many vaccinations are not compulsory, vaccination is considered to be the most effective method of preventing infectious diseases, while travelling overseas.
Approved medical practitioners administering overseas travel vaccinations prescribe the clinically required vaccines on an Authority Prescription following contact with the Veterans' Affairs Pharmaceutical Advisory Centre (VAPAC) where prior approval can be obtained on the24 hour free call number 1800 552 580.
Claims for Medical Expenses Privately Incurred (MEPI) for overseas travel vaccinations are processed through VAPAC as per current arrangements for all pharmaceutical MEPI claims.
It is important for all Gold and White Card holders to be reminded that cards do not cover the cost of treatment for non-service related conditions that arise while travelling overseas and that they should advise DVA of intentions to travel overseas. However, card holders are able to claim for the reasonable treatment cost for service related conditions while travelling overseas. (See 8.7.7 [29]).
Links
[1] https://clik.dva.gov.au/user/login?destination=comment/reply/19282%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] https://clik.dva.gov.au/user/login?destination=comment/reply/19261%23comment-form
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/19270%23comment-form
[5] https://clik.dva.gov.au/user/login?destination=comment/reply/19269%23comment-form
[6] clik://LEGIS/MRC-ACTS/MRCA/Ch 4
[7] https://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-9-other-benefits-under-military-rehabilitation-and-compensation-act-2004
[8] http://www.dva.gov.au/service_providers/community_nursing/contracted_providers/Pages/index.aspx
[9] https://clik.dva.gov.au/user/login?destination=comment/reply/19276%23comment-form
[10] clik://LEGIS/MRC-ACTS/MRCA/S13
[11] clik://LEGIS/MRC-ACTS/MRCA/Ch 3
[12] clik://LEGIS/MRC-ACTS/MRCA/S44
[13] clik://LEGIS/MRC-ACTS/MRCA/S5
[14] clik://LEGIS/MRC-ACTS/MRCA/S58
[15] clik://LEGIS/MRC-ACTS/MRCA/S274
[16] clik://LEGIS/MRC-INST/2004/21/P11
[17] clik://LEGIS/MRC-ACTS/MRCA/S3
[18] clik://LEGIS/MRC-ACTS/MRCA/S4
[19] clik://LEGIS/MRC-INST/2004/21/11.9
[20] clik://LEGIS/MRC-ACTS/MRCA/Ch 6/Pt 2
[21] https://clik.dva.gov.au/rehabilitation-policy-library/10-alterations-modifications-aids-appliances-and-motor-vehicle-assistance
[22] https://clik.dva.gov.au/rehabilitation-policy-library/10-alterations-modifications-aids-appliances-and-motor-vehicle-assistance/107-consideration-specific-aids-and-appliances/1075-provision-personal-response-systems
[23] mailto:rehabilitation@dva.gov.au
[24] https://clik.dva.gov.au/user/login?destination=comment/reply/19272%23comment-form
[25] https://clik.dva.gov.au/service-eligibility-assistant-updates/all-determinations-order-date-signed-oldest-most-recent/determinations-under-mrca
[26] https://clik.dva.gov.au/user/login?destination=comment/reply/19280%23comment-form
[27] https://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-7-compensation-death
[28] https://clik.dva.gov.au/user/login?destination=comment/reply/19283%23comment-form
[29] https://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-8-treatment-injuries-and-diseases/87-other-provisions/877-access-treatment-overseas