Patient transport charging guidelines for Victoria

Transcription

1 Patient transport charging guidelines for Victoria Effective 1 July 2014 These guidelines cover patient transport provided by Ambulance Victoria and licenced non-emergency patient transport providers Department of Health

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3 Patient transport charging guidelines for Victoria Effective 1 July 2014 These guidelines cover patient transport provided by Ambulance Victoria and licenced non-emergency patient transport providers

4 If you would like to receive this publication in an accessible format, please phone using the National Relay Service if required, or This document is available as a PDF on the internet at: Copyright, State of Victoria, Department of Health, This publication is copyright, no part may be reproduced by any process except in accordance with the provisions of the Copyright Act Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne July 2014.

5 Contents Overview 1 Table 1: Admitted 2 Table 2A: Non-admitted (emergency department) 3 Table 2B: Non-admitted (rural public health service) 4 Table 3: Community 5 Table 4: Private in private healthcare facilities 7 Glossary 8 Frequently asked questions 11 Does Medicare cover ambulance transport costs? 11 Who are Community Service Obligation (CSO)? 11 Who pays for transport of Community Service Obligation (CSO)? 11 Who pays for transport of overseas visitors? 12 Who pays for transport of asylum seekers? 12 Who pays for transport of veterans? 13 Who pays for transport of prisoners or people in police custody? 13 Who pays for transport of people involved in a transport- or work-related accident? 13 Who pays for transport of a person with mental illness? 14 Who pays for transport to a specialist clinic or a health independence program? 15 Who pays for transport of private to and from private healthcare facilities? 15 Who pays for transport to privately practising clinicians located on hospital premises? 16 Who pays for inter-hospital transfers for admitted? 16 Who pays if a patient initiates an inter-hospital transport? 16 Who pays for transport of a person with ambulance membership? 17 Who pays for transport of a person with private health insurance? 17 Who is authorised to approve clinically necessary patient transport? 17 When is Ambulance Victoria responsible for payment? 18 Who has payment responsibility for non-admitted at a public hospital with an emergency department (ED) or at a rural public health service without an ED? 18

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7 Overview The Patient transport charging guidelines for Victoria (the guidelines) outline who has responsibility for the payment of clinically necessary patient transport 1. The new guidelines replace the 2008 guidelines and begin from 1 July They include: tables that outline payment responsibilities for clinically necessary patient transport a glossary frequently asked questions (FAQs). The tables outline the payment responsibilities for clinically necessary transports for: 1. Admitted 2. Non-admitted 3. Community 4. Private in private healthcare facilities. It is important to pay close attention to the information in the new guidelines as payment responsibilities do vary. Payment responsibilities relate to clinically necessary patient transport provided by Ambulance Victoria and licensed non-emergency patient transport providers. For a transport to be considered clinically necessary, it must be medically authorised by an appropriate health professional. An appropriate health professional for the purposes of these guidelines is one of the following: a registered medical practitioner a registered division 1 nurse an Ambulance Victoria paramedic and/or authorised staff of the Emergency Services Telecommunication Authority a registered mental health practitioner. For further information on what is considered clinically necessary refer to the Non-emergency patient transport: clinical practice protocols at < Please check the website for the latest update of the guidelines at < noting that the guidelines will be updated periodically. These guidelines do not cover payment responsibilities for transport provided to with an Ambulance Victoria membership. Charges that apply to members are subject to the conditions of the Ambulance Victoria Membership Subscription Scheme. Further information can be found at < 1 In these guidelines, transport may include situations where Ambulance Victoria provides treatment to the patient but does not transport them. Page 1

8 Patient Transport Charging Guidelines for Victoria Effective 1 July 2014 Table 1: Admitted Transports from a public hospital or public mental health inpatient facility Responsible for payment Patient category Sending hospital TAC or VWA DVA Patient Ambulance Victoria To: Public hospital or public mental health inpatient facility General (including community mental health ) 3 Community Service Obligation (CSO) 3 DVA TAC or VWA 1 Patients subject to an Inpatient Assessment Order, Inpatient Temporary Treatment Order or Inpatient Treatment Order under the Mental Health Act 2014 or apprehended by Police under s. 351 of the Mental Health Act 2014 To/from: Diagnostic or public day procedure service General Community Service Obligation (CSO) DVA TAC or VWA 1 To: Private healthcare facilities General 2 3 Community Service Obligation (CSO) 2 3 DVA 4 5 TAC or VWA 1 To: Community General Community Service Obligation (CSO) Hospital in the Home Community mental health 6 DVA TAC or VWA 1 If the patient is a NSW resident, NSW Mental Health is responsible for payment. Community includes GP clinics, private consulting rooms, the patient s home and/or residential aged care services. 1 TAC or VWA are responsible for payment for those who are eligible under these schemes. 2 The sending hospital is responsible for payment where the transport is clinically necessary for ongoing care or where the sending hospital cannot provide the care required (for example, an Adult Retrieval Victoria transfer). 3 The patient is responsible for payment if the transport is due to patient choice (that is, the transport is not clinically necessary); for example, they wish to receive treatment from a preferred physician or in a preferred facility. The transferring hospital is required to inform the patient that they are responsible for payment. Hospitals should be aware that concession entitlements only cover transports that are authorised as clinically necessary and they should ensure that are aware of this. Patients with Ambulance Victoria membership should confirm their entitlement to transport. Patients should also check with their private health insurer as to whether this transport is covered. Where hospitals book these transports with Ambulance Victoria, Ambulance Victoria will send the invoice to the hospital. Hospitals should complete the Patient-initiated transfer form for transport booked with Ambulance Victoria, available at < to document the patient s decision. Ambulance Victoria will then bill the patient directly. 4 The sending hospital is responsible for payment where the transport is clinically required. 5 DVA is responsible for payment if the transport is due to patient choice. DVA must provide approval prior to transport. 6 The hospital that admitted the patient is responsible for payment. Page 2

9 Table 2A: Non-admitted (emergency department) Transports from a public hospital with an emergency department Responsible for payment Patient category Sending hospital TAC or VWA DVA Patient Ambulance Victoria To: Public hospital or public mental health inpatient facility All emergency 3 DVA TAC or VWA 1 To: Private healthcare facilities All emergency 2 3 DVA 4 5 TAC or VWA 1 To: Community General Community Service Obligation (CSO) DVA TAC or VWA 1 In this context, transport includes who are in an emergency department, which includes CSO ; subject to an Inpatient Assessment Order, Inpatient Temporary Treatment Order or Inpatient Treatment Order of the Mental Health Act 2014; and apprehended by police under s. 351 of the Mental Health Act It does not relate to the type of transport the patient may need emergency or non-emergency. Community includes GP clinics, private consulting rooms, the patient s home, and/or residential aged care services. 1 TAC or VWA are responsible for payment for those who are eligible under these schemes. 2 The sending hospital is responsible for payment where the transport is clinically necessary for ongoing care or where the sending hospital cannot provide the care required (for example, an Adult Retrieval Victoria transfer). 3 The patient is responsible for payment if the transport is due to patient choice (that is, the transport is not clinically necessary); for example, they wish to receive treatment from a preferred physician or in a preferred facility. The transferring hospital is required to inform the patient that they are responsible for payment. Hospitals should be aware that concession entitlements only cover transports that are authorised as clinically necessary and they should ensure that are aware of this. Patients with Ambulance Victoria membership should confirm their entitlement to transport. Patients should also check with their private health insurer as to whether this transport is covered. Where hospitals book these transports with Ambulance Victoria, Ambulance Victoria will send the invoice to the hospital. Hospitals should complete the Patient-initiated transfer form for transport booked with Ambulance Victoria, available at < to document the patient s decision. Ambulance Victoria will then bill the patient directly. 4 The sending hospital is responsible for payment where the transport is clinically required. 5 DVA is responsible for payment if the transport is due to patient choice. DVA must provide approval prior to transport. Page 3

10 Patient Transport Charging Guidelines for Victoria Effective 1 July 2014 Table 2B: Non-admitted (rural public health services) Transports from a rural public health service without an emergency department Responsible for payment Patient category Public hospital TAC or VWA DVA Patient Ambulance Victoria To: Public hospital or public mental health inpatient facility Emergency (including community mental health ) Community Service Obligation (CSO) 2 DVA TAC or VWA 1 Patients subject to an Inpatient Assessment Order, Inpatient Temporary Treatment Order or Inpatient Treatment Order under the Mental Health Act 2014 or apprehended by Police under s. 351 of the Mental Health Act 2014 Patients absent without leave from a designated mental health service under s. 352 of the Mental Health Act 2014 (including where the setting for a treatment order has changed from community to inpatient) To: Private healthcare facilities Emergency Community Service Obligation (CSO) 2 DVA TAC or VWA 1 To: Community General Community Service Obligation (CSO) DVA TAC or VWA 1 In cases where fees are the responsibility of the public hospital seeking the patient s return, the transferring hospital should ensure that the hospital seeking the patient s return is correctly identified in communication with the patient transport provider. Failure to do so will result in charges remaining the responsibility of the hospital initiating the transfer. Community includes GP clinics, private consulting rooms, the patient s home, and/or residential aged care services. 1 TAC or VWA are responsible for payment for those who are eligible under these schemes. 2 The patient is responsible for payment if the transport is due to patient choice (that is, the transport is not clinically necessary); for example, they wish to receive treatment from a preferred physician or in a preferred facility. The transferring hospital is required to inform the patient that they are responsible for payment. Hospitals should be aware that concession entitlements only cover transports that are authorised as clinically necessary and they should ensure that are aware of this. Patients with Ambulance Victoria membership should confirm their entitlement to transport. Patients should also check with their private health insurer as to whether this transport is covered. Where hospitals book these transports with Ambulance Victoria, Ambulance Victoria will send the invoice to the hospital. Hospitals should complete the Patient-initiated transfer form for transport booked with Ambulance Victoria, available at < to document the patient s decision. Ambulance Victoria will then bill the patient directly. Page 4

11 Table 3: Community Transports from the community Responsible for payment Patient category Public hospital Hospital admitting patient TAC or VWA DVA Patient Ambulance Victoria To: Public hospital or public mental health inpatient facility General Community Service Obligation (CSO) DVA TAC or VWA 1 Hospital in the Home Community mental health Patients subject to an Inpatient Assessment Order, Inpatient Temporary Treatment Order or Inpatient Treatment Order under the Mental Health Act 2014 Patients absent without leave from a designated mental health service under s. 352 of the Mental Health Act 2014 (including where the setting for a treatment order has changed from community to inpatient). To: Specialist clinic and health independence program General Community Service Obligation (CSO) DVA TAC or VWA 1 Hospital in the Home Community mental health Table continues next page Page 5

12 Patient Transport Charging Guidelines for Victoria Effective 1 July 2014 Table 3: Community (continued) Transports from the community Responsible for payment Patient category Public hospital Hospital admitting patient TAC or VWA DVA Patient Ambulance Victoria To/from: Diagnostic or public day procedure service General Community Service Obligation (CSO) DVA TAC or VWA 1 Hospital in the Home Community mental health To: Private healthcare facilities General Community Service Obligation (CSO) DVA TAC or VWA 1 Hospital in the Home Community mental health To: Community General Community Service Obligation (CSO) DVA TAC or VWA 1 Hospital in the Home Community mental health In the event of an evacuation or closure of a residential aged care service, payment is the responsibility of the residential aged care service. Community includes GP clinics, private consulting rooms, the patient s home and/or residential aged care services. A patient may also be transported from a public space. 1 TAC or VWA are responsible for payment for those who are eligible under these schemes. Page 6

13 Table 4: Private in private healthcare facilities Transports from private healthcare facilities Responsible for payment Patient category Sending private healthcare facility TAC or VWA DVA Patient Ambulance Victoria To: Public hospital or public mental health inpatient facility General Community Service Obligation (CSO) DVA TAC or VWA 1 To: Diagnostic or public day procedure service General Community Service Obligation (CSO) DVA 2 3 TAC or VWA 1 To: Private healthcare facilities General Community Service Obligation (CSO) DVA TAC or VWA 1 To: Community General Community Service Obligation (CSO) DVA TAC or VWA 1 Community includes GP clinics, private consulting rooms, the patient s home, and/or residential aged care services. 1 TAC or VWA are responsible for payment for those who are eligible under these schemes. 2 The transferring private healthcare facility is responsible for payment if the patient is admitted. 3 DVA is responsible for payment if the patient is non-admitted. Page 7

14 Patient Transport Charging Guidelines for Victoria Effective 1 July 2014 Glossary Term Admitted patient Adult Retrieval Victoria (ARV) Ambulance Victoria (AV) Community Definition A patient who has undergone a hospital s admission process to receive treatment and/or care. This treatment and/or care can occur in a traditional hospital setting and/or in the person s home (under programs such as Hospital in the Home and Geriatric Evaluation and Management). Adult Retrieval Victoria (ARV) is part of Ambulance Victoria and coordinates the transfer of requiring critical care where services are not available in the originating hospital. Patients may be transferred from a public hospital which does not have critical care facilities, or from a public hospital which has critical care facilities but is unable to accept the patient for other reasons. For sending public hospitals without critical care services, Ambulance Victoria is financially responsible for the patient. These will be separated from the sending hospital and transferred to the private hospital (if they were admitted before transfer). For public hospitals with critical care services, the sending public hospital will be financially responsible for the patient. Ambulance Victoria provides emergency and non-emergency patient transport by road and air. Further detail on Ambulance Victoria is available at < Community includes GP clinics, private consulting rooms, the patient s home and residential aged care services. A patient may also be transported from a public space. Community mental health patient A person receiving mental health services within the community from a mental health service provider on a voluntary basis. Community Service Obligation (CSO) patient Compulsory mental health patient Designated mental health service Diagnostic or public day procedure service DVA Emergency department (ED) Under the State Concession Scheme, Community Service Obligation (CSO) are eligible for certain concessions. In these guidelines, CSO patient refers to a person holding a type of concession card that in general makes them eligible for free clinically necessary ambulance transport. More information about CSO and the relevant types of concession cards can be found in the frequently asked questions. A person who is receiving compulsory mental health assessment or treatment under the Mental Health Act This includes compulsory, security and forensic. The mental health service that initiated the treatment order which may be a public hospital, public health service, denominational hospital, privately operated hospital or a private hospital within the meaning of s. 3(1) of the Health Services Act 1999 that has been prescribed in the Mental Health Regulations 2014 and the Victorian Institute of Forensic Mental Health. Designated mental health services are listed in the Mental Health Regulations 2014 at < Diagnostic services provide medical imaging such as CT scans, MRI, x-rays etc and may be provided at a public or private facility. Public day procedure services provide treatments where the patient could reasonably expect to be admitted and discharged on the same date. This includes hyperbaric treatment. Department of Veterans Affairs. A dedicated area in a hospital that is organised and administered to provide emergency care (including reception, triage, initial assessment and management) to people who perceive the need for, or are in need of, acute or urgent care. Some publicly funded hospitals have designated EDs, most of which operate 24 hours a day. Page 8

15 Emergency patient General patient Health Independence Program (HIP) Hospital Hospital in the Home (HITH) Inter-hospital transfer Medi-hotel Mental Health Act 2014 A patient that presents to the emergency department of a public hospital or a rural health service. A person receiving treatment and/or care in a hospital. For the purpose of these guidelines, this does not include patient types such as CSO, DVA, TAC or VWA. Note that patient has a legal meaning under the Mental Health Act 2014 and refers to a compulsory, security or forensic patient. The Health Independence Program (HIP) provides hospital substitution and diversion services by supporting people in the community, in ambulatory settings and in people s homes. These services focus on improving and optimising people s function and participation in activities of daily living to allow them to maximise their independence and return to, or remain in, their usual place of residence. HIP is a consolidation of the following programs: post-acute care (PAC); subacute ambulatory care services (SACS); the Hospital Admission Risk Program (HARP); and residential in-reach. A hospital is a health care facility established under Commonwealth, State or Territory legislation as a hospital or a free-standing day procedure unit, and authorised to provide treatment and/or care to. Hospitals may be: public hospitals, denominational hospitals, public health services, and privately operated (public) hospitals as defined in the Health Services Act 1988, as amended private hospitals and day procedure centres registered under the Victorian Health Services Act 1988, as amended. Private hospitals are required to maintain separate registrations for each site. A hospital may be located at one physical site or have several campuses. For the purposes of these definitions, hospital includes satellite units managed and staffed by the hospital and private homes used for service provision under the Hospital in the Home program. Hospital in the Home (HITH) provides hospital care in a person s own home, which can be a private residence or a residential aged care facility. HITH provides acute care that would otherwise need to be delivered within a hospital. Patients who receive HITH are classified as admitted. Transport of an admitted patient from a public or private hospital to another hospital. Medi-hotels provide a non-ward residential service maintained and/or paid for by the hospital to accommodate as a substitute for a traditional hospital ward. Not that Hospital in the Home (HITH) is not classed as a medi-hotel service. The Mental Health Act 2014 of Victoria, available at < Mental health practitioner Mental health practitioner are defined in the Mental Health Act 2014 as any of the following who are employed or engaged by a designated mental health service: Registered psychologists Registered nurses Social workers Registered occupational therapists. Non-admitted patient Private healthcare facilities Private patient Public hospital A patient who has not undergone a hospital s formal admission process. In these guidelines, these are in a public hospital with an emergency department or a patient at a rural health service. Private healthcare facilities include private hospitals and day procedure centres. This excludes bush nursing hospitals. Refer to hospital for more information. A patient in a public or private hospital using their private health insurance. Refer to hospital for more information. Page 9

16 Patient Transport Charging Guidelines for Victoria Effective 1 July 2014 Residential aged care service Rural health service without an emergency department Specialist clinic TAC VWA A service providing Commonwealth-funded residential aged care under the Aged Care Act A public rural health service without an emergency department provides varying levels of emergency care supported by general practitioners (GPs) on an on-call basis in an urgent care setting. These services have capacity to provide initial resuscitation and limited stabilisation to high-acuity prior to early transfer, and definitive care to with non-critical conditions according to patient need and available local resources. Specialist clinics provide planned non-admitted services with access to: medical, nursing, midwifery and allied health professionals for assessment, diagnosis and treatment ongoing specialist management of chronic and complex conditions in collaboration with community providers pre- and post-hospital care maternity care related diagnostic services, such as pathology and imaging. Patients are referred to specialist clinics by GPs, specialists and other communitybased healthcare providers, as well as clinicians in emergency departments, inpatient units and other areas of the hospital. Patients may also self-refer for some clinics, such as some allied health and maternity services. Transport Accident Commission Victorian WorkCover Authority Page 10

17 Frequently asked questions Does Medicare cover ambulance transport costs? No, Medicare does not cover ambulance transport costs. Who are Community Service Obligation (CSO)? Under the State Concession Scheme, Community Service Obligation (CSO) are eligible for certain concessions. In these guidelines, CSO patient refers to a person holding a type of concession card that in general makes them eligible for free clinically necessary ambulance transport. A CSO patient includes: a person holding a current Pensioner Concession Card (including dependent children as listed on the card but excluding spouses) a person holding a current Health Care Card (excluding holders of a Health Care Card for Carer Allowance and Foster Care issued in the name of the child) and their dependents, including spouses as listed on the card (in circumstances where the dependant is the patient) a child holding a current Child Disability Health Care Card (payment type CD) or Foster Care Health Care Card (payment type FO), but not their guardians/families as listed on the Card a child under a Custody to Secretary Order a child under a Guardianship to Secretary Order. Who pays for transport of Community Service Obligation (CSO)? Eligibility for concessions Under the State Concession Scheme, Victorians eligible for concessions receive free clinically necessary ambulance coverage throughout Australia. This coverage will provide free emergency and medically authorised non-emergency ambulance transport to the nearest and most appropriate hospital. A person eligible for free clinically necessary ambulance transport will be one of those noted in the frequently asked question above, Who are community service obligation (CSO)? For an eligible person listed under that question, free transport does not apply where: the individual is being transported from a private healthcare facility the individual initiates a transport from one hospital to another hospital of their own choice, for example to receive care from a preferred physician or at a preferred location this includes both public-to-public and public-to-private transports. Asylum seekers may also be eligible for free transport. For more information, refer to the frequently asked question Who pays for transport of asylum seekers?. Concession benefits do not apply to: a patient who only holds a Commonwealth Seniors Health Card (that is, they do not have one of concession cards listed above) a patient that requests to be repatriated or relocated to or from Victoria for non-clinical reasons (for example for their own or their family s convenience or for social reasons). Repatriation back to Victoria must be authorised as clinically necessary and there must be a demonstrated clinical requirement for ambulance transport where another party is responsible for the account, for example: the Department of Veterans Affairs (DVA) where a person holds a Gold Card or a White Card (subject to the conditions of the card) Page 11

18 Patient Transport Charging Guidelines for Victoria Effective 1 July 2014 the Transport Accident Commission (TAC) (subject to the conditions under the scheme) the Victorian WorkCover Authority (VWA) (subject to the conditions under the scheme) where a patient is being transferred to a private hospital for ongoing care and/or as part of a preexisting arrangement between the transferring hospital and the private hospital and/or the transfer has been organised by Adult Retrieval Victoria (ARV). ARV transfers to private hospitals are predominately related to ICU / Coronary Care beds. Evidence of concession entitlements In order to access entitlements a valid Pensioner Concession Card or Health Care Card number must be provided at the time of transport and be valid at the time of transport or when an invoice is received from Ambulance Victoria. Failure to provide a valid card will result in the account remaining the responsibility of the relevant individual, hospital or other party such as TAC, VWA or DVA as detailed in the guidelines. Who pays for transport of overseas visitors? Inter-hospital transports For all inter-hospital transfers of overseas visitors that are clinically necessary, the transferring hospital is responsible for payment and will be billed by the patient transport provider. All other transports For all clinically necessary transports of overseas visitors that are not an inter-hospital transfer (for example from the community to a public hospital), the overseas patient is responsible for payment and will be billed by the patient transport provider. Who pays for transport of asylum seekers? Asylum seekers in the Asylum Seeker Assistance Scheme (ASAS) and Community Assistance Scheme (CAS) Ambulance transport charges for asylum seekers in ASAS and CAS will be directed to the appropriate service provider by Ambulance Victoria for full payment. Payment of a bill for emergency patient transport of a client in ASAS or CAS is assessed by the service provider on a case-by-case basis. Current providers are: Adult Migrant English Service (AMES) Australian Red Cross Diversitat Geelong Mallee Family Care (Swan Hill) New Hope Foundation Spectrum MRC Springvale Community Aid and Advice Bureau Sunraysia Mallee Ethnic Communities Council (Mildura) Uniting Care Cutting Edge (Shepparton). Those agencies whose clients also include non-asas/cas asylum seekers who have no capacity to pay can request a waiver of emergency ambulance fees for these particular clients only. Asylum seekers in the community with no capacity to pay Asylum seekers living in Victoria who have no capacity to pay have free access to ambulance services for emergency transport only. Cases need to be approved and/or verified by one of the following nominated agencies; Ambulance Victoria then provides a waiver for the emergency ambulance transport for that client. Asylum Seeker Resource Centre Page 12

19 Australian Red Cross Baptcare Sanctuary Brigidine Asylum Seeker Project Hotham Mission Asylum Seeker Project Victorian Foundation for Survivors of Torture (Foundation House) Asylum seekers in community detention and detention centres Charges for asylum seekers in the Community Detention Program or for people in a detention centre will be directed to the International Health and Medical Service (IHMS) funded by the Department of Immigration and Border Protection (DIBP) for full fee reimbursement. Further information can be found at the Diversity in Health section of the Department of Health website < Other resources can be found at the Victorian Refugee Health Network < Who pays for transport of veterans? Veterans may be entitled to free transport. An eligible Department of Veterans Affairs (DVA) patient includes: Persons holding a Repatriation Health Card For All Conditions (Gold Card). Some holders of a Repatriation Health Card For Specific Conditions (White Card). Eligibility for free transport is subject to the conditions of the card. Who pays for transport of prisoners or people in police custody? Prisoners Prisoners are not charged for patient transport. Fees for prisoners are charged to the responsible primary healthcare provider at each prison. People in police custody Ambulance Victoria will bill Victoria Police for ambulance attendance or transport to hospital for persons in police custody when: the injury was a consequence of the person s arrest the injury was sustained in police custody. Ambulance Victoria will not bill Victoria Police for ambulance attendance: in relation to a suspect s/prisoner s general health issue such as asthma, heart problems or drug withdrawal in relation to any pre-existing medical condition, including drug withdrawal, or any concerns raised while in custody that require ambulance attendance or transport to hospital if the person is subject to an Inpatient Assessment Order, Inpatient Temporary Treatment Order or Inpatient Treatment Order under the Mental Health Act 2014 and also needs concurrent medical attention. Who pays for transport of people involved in a transport- or workrelated accident? For who are eligible under the Transport Accident Commission (TAC) or the Victorian WorkCover Authority (VWA), transport costs may be covered under these schemes. Page 13

20 Patient Transport Charging Guidelines for Victoria Effective 1 July 2014 Who pays for transport of a person with mental illness? In some circumstances, patient transport fees will be covered by the Transport Accident Commission (TAC), the Victorian WorkCover Authority (VWA), the Department of Veterans Affairs (DVA) or the transferring hospital. A person with mental illness is not required to pay for emergency or non-emergency patient transport if they are: a compulsory patient (that is, a patient subject to an Inpatient Assessment Order, Inpatient Temporary Treatment Order or Inpatient Treatment Order under the Mental Health Act 2014) being transported under s. 351 a patient absent without leave from a designated mental health service under s. 352 of the Mental Health Act 2014 (including where the setting for a treatment order has changed from community to inpatient) being transferred between a major hospital and a residential mental health facility. In general, if a mental health service in a hospital or in the community makes a clear decision as a part of treatment to arrange patient transport, payment is the responsibility of the transferring and/or admitting hospital as outlined in the tables. Community mental health services conducting assessments on hospital premises At times, after a triage assessment (via telephone or in person) a community mental health clinician may arrange to see a community mental health patient at an emergency department (ED) as a safe venue for conducting a mental health assessment. In these situations, the person is transported as a community mental health patient from the community to the ED (see Table 3: Community From community to public hospital Community mental health patient) and payment responsibility is with the hospital that auspices the community mental health clinician. Note that the community mental health clinician should liaise with the hospital ED prior to arranging the appointment to determine whether the mental health assessment can be undertaken at that venue. If the person to be transported is placed on an Assessment Order in the community or subsequently placed on an Inpatient Assessment Order (IAO), Inpatient Temporary Treatment Order (ITTO) or Inpatient Treatment Order (ITO) upon assessment in the ED and requires transport to a designated mental health service, payment responsibility lies with Ambulance Victoria (see Table 3: Community From community to public hospital Patients subject to an IAO, ITTO, ITO of the Mental Health Act 2014). In cases where a community mental health patient has decided to present at a hospital ED or rural health service without prior consultation or arrangement with a mental health clinician, the patient is generally responsible for payment, noting concessions or other coverage from TAC, VWA or DVA may be applicable (see Table 2A and Table 2B). If, during or after the assessment, the patient is treated by the hospital ED and requires subsequent transport for admission to another hospital, this is an inter-hospital transport and payment responsibility is with the sending hospital (even if the patient is under an order for compulsory assessment and/or treatment). Transport under section 351 of the Mental Health Act 2014 Under s. 351 of the Act, police may apprehend a person who appears to have a mental illness and as a result needs to be apprehended to prevent serious and imminent harm to the person or others. Police may request transport of the person for a mental health assessment. In this circumstance, Ambulance Victoria has payment responsibility. Page 14

21 If the mental health assessment results in the patient being placed on an Assessment Order, Temporary Treatment Order or Treatment Order, the subsequent transport of that patient to a designated mental health service is also the responsibility of Ambulance Victoria. Cross-border arrangements for mental health Victoria has agreements with the Australian Capital Territory (ACT), New South Wales (NSW) and South Australia (SA) covering the interstate treatment, transfer and apprehension of compulsory. Victoria also has agreements with the ACT, NSW and Queensland covering the apprehension and return of forensic and security. Further information about these arrangements can be found at <health.vic.gov.au/mentalhealth/crossborder>. Who pays for transport to a specialist clinic or a health independence program? Non-admitted patient clinics (which also used to be called outpatient and sub-acute clinics) are now called specialist clinics or a health independence program. The health service that auspices the specialist clinic or the Health Independence Program (HIP) is responsible for authorising that the transport of a patient attending an appointment is clinically necessary. Patients are responsible for payment, except in the following circumstances: TAC, VWA and DVA may be covered by their respective schemes. The auspicing health service is responsible for payment for all appointments of Community Service Obligation (CSO). Patients being transported to Medicare Benefits Schedule (MBS) billed clinics will be treated in the same way as those being transported to a state-funded specialist clinic or HIP. If Ambulance Victoria is used to book transport for to attend a specialist clinic or HIP, this booking will only be accepted from the auspicing health service. Requests from general practitioners, residential aged care services or other non-health service personnel will not be accepted. Please note that when a patient is receiving renal dialysis treatment they are classified as an admitted patient and therefore their transport falls under the following tables: for a dialysis patient travelling to their treatment from their home (including a residential aged care facility): Table 3: Community Transport from community to public hospital for a dialysis patient travelling from their treatment back to their home (including a nursing home): Table 1: Admitted Transport from a public hospital to community. When a renal patient sees their specialist for example, for a review of their treatment this is classified as transport to and from a specialist clinic, and payment responsibility is in accordance with Table 3: Community. Who pays for transport of private to and from private healthcare facilities? Private healthcare facilities have payment responsibility for all CSO transported from their premises to another setting. For the purposes of these guidelines, the term private healthcare facilities includes private hospitals and private day procedure centres and excludes bush nursing hospitals (given their broader role in Victoria s rural healthcare system). Mildura Base Hospital is also excluded as it is a publicly funded hospital. Page 15

22 Patient Transport Charging Guidelines for Victoria Effective 1 July 2014 Where the private healthcare facility is treating the CSO patient via prior arrangement with a health service, the private healthcare facility remains responsible for the cost of transport but should discuss this with the health service directly. Where a patient is the responsibility of another party such as TAC, VWA or DVA, payment responsibility varies and is in accordance with Table 4: Private. Who pays for transport to privately practising clinicians located on hospital premises? Sometimes privately practising clinicians have private consulting rooms located on hospital premises. When patient transport is authorised by a privately practising clinician located on hospital premises, responsibility for payment is in accordance with Table 3: Transports from the community. Who pays for inter-hospital transfers for admitted? If an admitted patient is transferred from a public hospital to another hospital (public or private) for clinical reasons, the transferring hospital is responsible for the cost of the transport. Transfers of this type may be required because: a higher level of care is needed the required care cannot be provided at the transferring hospital there is a pre-existing arrangement between the transferring hospital and the receiving hospital the transfer has been organised by one of Ambulance Victoria s retrieval services, that is Adult Retrieval Victoria (ARV), Paediatric Infant Perinatal Emergency Retrieval (PIPER) or Medical Emergency Adult Retrieval Service (MEARS). Patient transport to and from a medi-hotel is considered an inter-hospital transfer and the transferring hospital is responsible for payment. If health services that offer critical care services use private critical care as flexible capacity, the referring health service is responsible for the cost of the patient's care, including the cost of transport. DVA clients are subject to separate arrangements. For further information, refer to the frequently asked question Who pays for transport of veterans?. Where a health service does not offer critical care services and Ambulance Victoria s retrieval services are unable to source a public sector bed, Ambulance Victoria can transfer the patient into a private critical care bed. Ambulance Victoria is then responsible for the cost of care (including the cost of transport) while the patient is in the private bed and will arrange a transfer into an available public bed as soon as possible when it is deemed clinically suitable. TAC and VWA may cover transport for clients eligible under their respective schemes. Who pays if a patient initiates an inter-hospital transport? A patient may initiate an inter-hospital transport to another public or private hospital due to their own choice. In this situation, the transport is not clinically necessary. For example, the patient is liable for the cost of that transport if: the patient chooses to move to another hospital to be closer to their home and/or family members (this includes returning back to Victoria from another state or territory where they might have been receiving treatment) the patient chooses to move to another hospital in order to be treated by a preferred physician or in a preferred hospital. Concession cards (such as a Pension or Health Care Card) held by the patient (or patient s agent) do not cover patient-initiated transport. Health services should make aware of this when discussing the transport. Page 16

23 Patients with an Ambulance Victoria membership should contact Ambulance Victoria to confirm their transport entitlements. Patients should also check with their private health insurer as to whether this transport is covered under their policy. If a health service decides to book this transport through Ambulance Victoria, health services should complete, together with the patient, the patient-initiated transfer form available from Ambulance Victoria s website from 1 July This will ensure that Ambulance Victoria has all the details it requires to bill the patient. If health services do not complete this form, the health service will be liable for this transfer, as Ambulance Victoria will not have the details they need to bill the patient. After a patient-initiated transfer, Ambulance Victoria will bill the health service. The health service will provide the completed patient initiated transfer form to Ambulance Victoria and Ambulance Victoria will then promptly cancel this charge and bill the patient directly. Who pays for transport of a person with ambulance membership? Insurance for patient transport provided by Ambulance Victoria can be arranged by joining Ambulance Victoria s Membership Subscription Scheme. Further information on Ambulance Victoria membership can be found at < If a patient receives a transport invoice which they believe should be covered by their membership, the patient should complete the relevant section on the reverse of the invoice and return it to: Ambulance Victoria Accounts Receivable Department PO Box 2000 Doncaster VIC 3108 Who pays for transport of a person with private health insurance? Insurance for patient transport can be purchased from private health insurers. Private health insurance policies differ in their coverage of patient transport, the types of transport offered (for example air transport) and the number of transports per year. Policies also differ in the definitions of an emergency and a non-emergency patient transport. General information on private health insurance coverage for Victorians can be found at < It is important that a person with private health insurance check with their insurer about the level of cover under their policy for patient transport. Who is authorised to approve clinically necessary patient transport? For a transport to be considered clinically necessary, it must be medically authorised by an appropriate health professional. An appropriate health professional for the purposes of these guidelines is one of the following: a registered medical practitioner a registered division 1 nurse an Ambulance Victoria paramedic and/or authorised staff of the Emergency Services Telecommunication Authority a registered mental health practitioner. Payment responsibilities relate to clinically necessary patient transport provided by Ambulance Victoria and licenced non-emergency patient transport providers. For further information about what is considered clinically necessary, refer to the Non-emergency patient transport: Clinical practice protocols at < Page 17

24 Patient Transport Charging Guidelines for Victoria Effective 1 July 2014 When is Ambulance Victoria responsible for payment? Ambulance Victoria payment responsibility is outlined in the tables. Where Ambulance Victoria is identified as responsible for payment in the tables, the patient transport must be booked through Ambulance Victoria. Ambulance Victoria is not responsible for payment, even when it is indicated in the tables, if the transport is booked with a provider other than Ambulance Victoria. Who has payment responsibility for non-admitted at a public hospital with an emergency department (ED) or at a rural public health service without an ED? Public hospitals with a designated ED are responsible for the payment of patient transport of nonadmitted. Rural public health services without an ED provide varying levels of emergency care supported by general practitioners on an on-call basis in an urgent care setting. These services have capacity to provide initial resuscitation and limited stabilisation to high-acuity prior to early transfer, and definitive care to with non-critical conditions according to patient need and available local resources. In this setting, where patient transport is required, the patient has payment responsibility unless they are covered by a concession or by another provider such as TAC, VWA or DVA. The rural public health service should make the patient aware of this before transport is organised. Page 18