Information guide

c)2.1 Seeking Prior Financial Authorisation

Prior Financial authorisation is required in the following circumstances:

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  Where there is a doubt about a patient’s eligibility for treatment;
  
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  Respite or convalescent care in a residential care facility;
  
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  Surgical/Medical procedures not listed on the MBS;
  
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  Prostheses not listed on the Department of Health Prostheses List;
  
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  Non-admitted sessional rehabilitation services for treatment in excess of four weeks, or where the treatment is not otherwise covered by a programme agreed between the parties;
  
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  Pharmaceuticals not listed on the Pharmaceutical Benefits Scheme or Repatriation Pharmaceutical Benefits Scheme; and
  
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  Specific treatments nominated in writing by DVA from time to time (e.g. cosmetic surgery).
  

Where prior financial authorisation is required, you should:

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  complete a hospital admission request or provide a written request from a doctor, and fax it to DVA on [phone]; or
  
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  contact DVA during business hours by telephoning 1300 550 457 (metro) or 1800 550 457 (non-metro).
  

2.2 Department of Defence Arrangements

All ADF Personnel admissions require prior financial authorisation from the Department of Defence local Joint Health Command. The contact details for the Joint Health Command are shown at Attachment 1. Claims for payment should be sent to the relevant Joint Health Command. Claims should not be sent to the Department of Human Services (DHS).

d)Hospital Services Agreement

The Hospital Services Agreement between DVA and your organisation defines how the arrangements will work. You should familiarise yourself with the aspects of the Agreement relevant to your position. Hospitals should note that DVA entered into a new Hospital Services Agreement in 2016. This Information Package reflects the updated arrangements, however it is to be noted that where questions arise, the Hospital Services Agreement takes precedence over these information notes.

Your DVA Contract Manager (see Clause 12.1 of your Hospital Services Agreement) is available to discuss any of the conditions of the Agreement, including:

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  Treatment of Entitled Persons;
  
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  Provision of Services;
  
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  Admission, Transfer and Discharge Procedures;
  
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  Charges, Fees and Billing
  
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  Guidelines for Programs; and
  
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  Quality and Performance Management.
  

The commencement of a new Hospital Services Agreement in 2016 included a shift to a new procurement model. DVA has responded to industry and government requests to reduce red tape by developing a simplified method of engagement. It involves a standard contract and an ability for providers to commence service delivery simply by accepting DVA’s terms and conditions, with the only negotiation being around prices.

A key aspect of the new model is that there is no necessary end date in the Hospital Services Agreement. This avoids a cumbersome tender process at set intervals, regardless of whether an approach to market adds value at that time. Commensurate with the concept of an ongoing agreement is the need for regular adjustment, to ensure that the arrangements reflect current legislation and government policy and broader industry trends. The Hospital Services Agreement therefore provides for the unilateral variation of the Agreement by DVA with three months’ written notice (clause 12.7 of the Agreement). The clause requires DVA to act in good faith, consistent with the requirement, as a Commonwealth agency, to act as a model contractor.

It is DVA’s intention that clause 12.7 will be used in the following circumstances:

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  Where DVA is obliged by the Government or other Commonwealth agencies to reference and incorporate new legislation or policy into the Agreement;
  
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  To correct typographical errors and to update references to other documents, and to websites and contact information; and
  
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  Where DVA wishes to change policy or standards for all contracted private hospital providers, and does so following an appropriate period of industry-wide consultation.
  

It is DVA’s intention that amendments would occur no more frequently than annually, bar exceptional circumstances. Separate to this, DVA will continue to enter into deeds of variation with hospital providers to reflect the changes to fees and charges that are agreed through the annual fee review process under clause 7.1 of the Agreement.

e)Admission, Transfer and Discharge

The Hospital Services Agreement (see Section 6) also outlines admission, transfer and discharge requirements that apply to Entitled Persons. Detailed information is available in your Agreement on:

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  Admission procedures and notification;
  

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  Prior Financial Authorisation requirements;
  
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  Pre-discharge assessments;
  
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  Transfer requirements;
  
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  Discharge Planning protocols;
  
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  Discharge documentation;
  
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  Medication Review;
  
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  Discharge medications;
  
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  Discharge advice to Local Medical Officers or General Practitioners;
  
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  Arranging post-discharge services; and
  
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  Supply of Hospital Episode Data.
  

To assist with admission and discharge, DVA has a range of resources available for hospitals to plan and undertake effective and sustainable discharge from hospital. Discharge Planning Checklist

4.1 Hospital Admission Voucher

A DVA Hospital Admission Voucher (form D652B) (or a hospital’s own admission form which includes all data elements required by the DVA Hospital Admission Voucher) must be completed for each veteran patient. This is a requirement of the Hospital Services Agreement. The admission voucher must be completed within two (2) business days of admission. These must be kept with the patient’s clinical record to confirm patient identity and eligibility when required for audit and investigation of claims, and to document the Entitled Person’s authorisation for disclosure of Clinical Information as shown by their signature.

Hospitals are reminded that they should not include the Hospital Admission Voucher with the claim sent to the Department of Human Services (DHS). The Hospital Admission Voucher (pdf version) can be located on the DVA website in the forms section at: http://www.dva.gov.au/sites/default/files/dvaforms/D0652B.pdf

4.2 Death Certification arrangements for a deceased veteran

Hospitals are reminded that they must use their best endeavours to educate attending doctors that, when an Entitled Person dies in the Hospital, the attending doctor should consult the Entitled Person’s Local Medical Officer to obtain a full and complete medical history to inform the wording of the cause of death noted in the Death Certificate. This is important to provide clarity in relation to the cause of death and to simplify subsequent claims by the Entitled Person’s dependents for benefits potentially available through DVA which can be affected by the recorded cause of death.

f)Contract Managers

Your organisation and DVA have both appointed Contract Managers (Clause 12.1 of the Agreement) to ensure that services provided are consistent with the spirit of the arrangements. The respective Contract Managers will work together to establish and maintain a productive working relationship.

The Contract manager’s role is to:

1. 
   Monitor the quality and review the outcomes of the Hospital Services provided at and from the Hospital to Entitled Persons;
   
2. 
   Investigate any complaints by or on behalf of Entitled Persons;
   
3. 
   Monitor the submission of invoices to DVA for the Hospital Services provided to the Entitled Persons and DVA’s payment for those Hospital Services;
   
4. 
   Initiate negotiations in accordance with clauses 7.1 and 7.2 of the Hospital Services Agreement;
   
5. 
   Provide such information as is reasonably agreed, to meetings at the State based Consultative Forum if requested by that body (see clause 3.2 of the Hospital Services Agreement);
   
6. 
   Promptly meet to attempt to resolve any disputes arising under the terms of this agreement;
   
7. 
   Facilitate the electronic transfer of invoices, statistical information or other data specified in this Agreement; and
   
8. 
   Ensure the timely exchange of information, as agreed.
   

5.1 Additional Information

General information is available on the DVA Hospitals Webpage at: www.dva.gov.au/providers/hospitals-day-procedure-centres-and-mental-health-private-hospitals. The Hospitals Webpage contains information to assist Contract Managers and hospital staff and includes:

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  The Group Accommodation and Theatre Banding (GATB) table;
  
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  Coronary Care Certificates;
  
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  Intensive Care Certificates; and
  
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  A list of contracted hospitals.
  

Other useful contact information is detailed in Attachment 2.
g)Quality Standards

Quality management under the arrangement between the hospital and DVA is aimed at continuously improving the effectiveness of veterans’ hospital care and health care in terms of accessibility, appropriateness, efficiency, continuity, and satisfaction.

As outlined in Section 5 of the Hospital Services Agreement, Hospitals must comply with the accreditation requirements specified in the Australian Health Services Safety and Quality Accreditation (AHSSQA) Scheme, including any Commonwealth or State laws or policies introduced as part of the implementation of the Scheme. The AHSSQA Scheme requires hospitals to be assessed to the National Safety and Quality Health Services (NSQHS) Standards (and where applicable, the National Standards for Mental Health Services 2010).