Country Health South Australia Local Health Network. Patient. Assistance. Transport. Scheme (PATS) Information Booklet

Transcription

1 Country Health South Australia Local Health Network Patient Assistance Transport Scheme (PATS) Information Booklet

2 Statement of Principles In administering the Patient Assistance Transport Scheme (PATS), Country Health SA Local Health Network will have regard to the following broad principles: > The scheme is intended to subsidise the unavoidable financial costs for those residents of South Australia that have no option but to travel a long distance to receive essential medical specialist services from an approved medical specialist. > The scheme is not intended to support choice of specialists. Patients should be treated as close to home as possible without compromising the safety and quality of the care provided. The scheme will not support the additional costs of travel if a patient makes a choice to travel beyond their closest specialist services. > Assistance should be targeted towards those considered to be most disadvantaged with regard to access to specialist health services. > Country Health SA Local Health Network acknowledges the National Policy Principles in regard to the eligibility, principles and administration of the South Australian Patient Assistance Transport Scheme.

3 Table of Contents 1. PATS Overview Eligibility Criteria What specialist medical services are covered? What travel subsidies are available? What accommodation subsidies are available? How are escorts subsidised? Financial Hardship Assistance How to Apply Patient Responsibilities Administrative Processes and Appeals Contact Information How does the PATS process work?...21 PATS Information Booklet page 1

4 1. PATS Overview What is PATS? The Patient Assistance Transport Scheme (PATS) is a subsidy program funded by the Government of South Australia to assist people travelling more than 100km each way to receive approved medical services. The PATS provides a subsidy to eligible patients for the cost of long distance travel to specialist diagnostic or treatment services. What are the eligibility criteria? You are eligible for PATS if: > > You are a permanent Australian citizen or permanent resident residing in South Australia > > You live more than 100km away from the nearest treating specialist > > You have a referral from a local doctor to the nearest treating specialist for specialist treatment > > You receive treatment claimable under Medicare from a recognised medical specialist; and > > You have claimed any available benefits from your private health fund first, if applicable. What specialist medical services are covered? Most specialist medical services covered by Medicare are eligible under PATS. However, referrals to other health professionals, for example allied health (speech pathology, physiotherapy, podiatry, clinical psychology, occupational therapy, audiology, and pathology), dentists and nursing professionals, are not covered by PATS. Your local hospital or local doctor can provide details of specialist medical services covered under PATS. What kind of assistance is available? If you meet the eligibility requirements, assistance is available to travel on the most economical form of transport appropriate to your medical condition as recommended by your local doctor. The PATS offers a fuel subsidy of 16 cents per kilometre for car travel, a payment toward the cost of public transport where this is approved, or a payment toward the cost of air travel if this is deemed essential by your local doctor. Two conditions apply for air travel to be subsidised by PATS: > > There must be a valid medical reason for air travel for both the forward and/or return journeys, and the referring local doctor or treating specialist must specify the medical reason for air travel in their sections of the form; and > > The referring local doctor or the treating specialist must obtain prior approval from PATS to authorise air travel. Accommodation subsidies of up to $40 (plus GST) are also available for commercial accommodation in a hotel, motel, caravan park, or serviced apartment for patients who live 100kms away and are required to stay overnight for medical reasons, distance or transport schedules. page 2

5 Escorts may be approved for people with certain medical conditions. An escort is a family member or adult responsible for the patient s needs for the period of transport and accommodation during treatment. An approved escort must be: > > 18 years of age or older (and be able to cope with the special medical needs of the patient) > > Accompanying the patient whilst travelling; and > > Deemed necessary by either the referring GP or the approved specialist. How do I apply? Application forms are available from referring local doctors, your local PATS office or online at In order to be eligible for PATS, you need authorisation from your local doctor in the first instance. (See How does the PATS process work on page 21, for an easy guide on how to apply for PATS.) After you ve attended the medical appointment, completed forms should be sent to your nearest PATS office for payment via fax, mail, or . Original receipts for eligible travel and accommodation need to be submitted with your application form. If the patient is a concession card holder and experiencing financial hardship, PATS administrators are able to assist with the payment of public transport or fuel costs in advance of travel. How long does the PATS payment process take? PATS payments may take up to six weeks to be processed from the date of lodgement. The lodgement date is the date the PATS office receives the completed application form. Payments will be made via an Electronic Funds Transfer (EFT). Patients should contact their nearest PATS office to discuss an alternative payment method if they don t have a bank account. Responsibilities of PATS Applicants PATS applicants must ensure that the information provided is true and correct. False declarations may be liable to penalties of perjury under the Oaths Act SA Health provides a range of subsidies to assist different patient needs in regard to travel. Patients are only entitled to claim from one scheme. If they meet all the PATS criteria, they will be directed to apply to PATS. PATS Information Booklet page 3

6 2. Eligibility Criteria What are the eligibility criteria? You are eligible for PATS if: > > You are a permanent Australian citizen or permanent resident residing in South Australia > > You live more than 100km away from the nearest treating specialist > > You have a referral from a local doctor to the nearest treating specialist for specialist treatment > > You receive treatment claimable under Medicare from a recognised medical specialist; and > > You have claimed any available benefits from your private health fund first, if applicable. To be eligible for PATS assistance, a patient must fulfil all of the above eligibility criteria. Patients can also talk to their local doctor or local PATS office to find out if they are eligible. Ineligibility You are ineligible for PATS if: > > You participate in clinical trials or experimental treatments > > You reside in states or territories other than South Australia > > You are on holidays or visiting friends or family both intra and/or interstate > > You are undertaking a journey to or from outside Australia > > You are undertaking a journey between hospital admissions when the hospital is responsible for the transport > > You are accessing allied health (for example physiotherapy, osteopathy, podiatry, psychology) or general practitioner services > > You are eligible to claim assistance under another State, Territory or Commonwealth Scheme or from a registered benefits organisation including the Department of Veterans Affairs > > You have received or claimed by way of compensation, damages or other payment in respect to the illness or injury being treated > > You were injured in a motor vehicle accident and are covered by the Motor Accident Commission of South Australia; or > > You were injured at work and are covered by WorkCover. Concession Cards For the purposes of PATS subsidy determinations, a current Commonwealth concession card is either : > > a Pensioner Concession Card (PCC); or > > a Health Care Card (HCC). In some circumstances a Department of Veterans Affairs white or gold card holder may be eligible, for example if the patient is not eligible for Department of Veterans Affairs transport or accommodation support. page 4

7 Location To be eligible for PATS, patients must live more than 100 kilometres (by the shortest surface route) from the nearest medical specialist. Residents of Kangaroo Island travelling to the mainland for specialist services are also eligible for PATS. Interstate Patient Travel Patients who live near a South Australian border, where the nearest medical specialist is in an adjoining state or territory are eligible for PATS. Patients residing in a metropolitan or rural region who are required to travel interstate to seek specialist services from an approved medical specialist, when treatment is not available within South Australia, may also be eligible for accommodation assistance paid through PATS. The referring medical service must confirm in writing that the required service cannot be provided in South Australia. Accommodation subsidies may be available for treatments that can only be given in specific state hospitals. The subsidy levels may vary from the PATS subsidies. Contact the hospital social worker or the Adelaide PATS office for further information. South Australian Residency To be eligible for PATS assistance, patients must be Australian citizens or permanent residents and be residing in South Australia at the time of referral, and receiving approved medical specialist services. The place of residence is defined as the place where a person lives permanently and is determined by the address at which the patient is registered on the electoral roll. Other documents to confirm residence include copies of a patient s drivers licence, health care card or utility bills. In the case of border or combined towns, assistance under PATS will only be available to patients residing within the South Australian border. Residents from Victoria or Northern Territory should apply to the scheme operating in their respective state. Patients who can demonstrate that they are a genuine itinerant worker will have the place of residence determined from the place where the patient is staying at the time of the commencement of the relevant medical need. To be eligible for assistance the itinerant worker must return to that place. Patients able to demonstrate that they do not have any fixed abode are eligible for assistance. The place of residence is determined as the place where they are staying at the time of commencement of the relevant journey. To be eligible for assistance the patient must return to that place. Arrangements for Aboriginal or Torres Strait Islander People Travel and accommodation assistance for people on the Anangu Pitjantjatjara Yankunytjatjara Lands requiring medical specialist services is the responsibility of the Nganampa Health Council. The Nganampa Health Council manages the transport and accommodation funds to meet the unique needs of the communities; benefits are not provided by PATS to this community on an individual basis. There are no special arrangements of this kind for other Aboriginal Community Controlled Health Services. PATS Information Booklet page 5

8 Online Distance Calculator Tool An Online Calculator accurately determines the distance you travel from your home to medical specialist services. The distance you travel determines whether you are eligible for PATS, and if you are, the amount that you will be subsidised under the scheme. You can measure distances yourself using the Online Calculator or ask your local PATS officer or local doctor to use the Online Calculator to measure the distances for you. The Online Calculator uses current GPS mapping software to accurately measure the shortest distance from the departure point to the travel destination. The web-based technology is both up-to-date and regularly changes in line with improvements to roads. The tool consistently and accurately calculates the distance travelled via the most direct and simplest surface route between: > > The township or postcode of the patient s residence; and > > The central point (usually the GPO) where the medical service is provided. There is often more than one option available for travelling to your destination, however, the shortest practical distance is calculated by the Online Calculator for the purpose of all PATS applications. This uses electronic mapping technology to determine whether the minimum distance criteria are met for both travel and accommodation subsidies. If the place of residence is outside the town s recognised boundaries, an additional kilometre allowance may be added. The treatment location is a specific list of locations where medical specialists consult any treatment centre in the Adelaide postcode area is regarded as Adelaide on the treatment list for the purposes of the calculation and is measured to the GPO. Patients driving from Kangaroo Island and using the ferry need to enter the start location on the tool as Cape Jervis, the treatment centre as Adelaide, then check the extra distance box to add in kilometres travelled across the island to the ferry. The Online Calculator tool can be accessed via the following link: page 6

9 3. What specialist medical services are covered? Most specialist medical services covered by Medicare are eligible under PATS. Your PATS office or local doctor can provide details of specialist medical services covered under PATS. Services ineligible for a PATS subsidy The following services are ineligible for assistance under the scheme: > > Surgery provided for cosmetic reasons only. > > General dental and orthodontic services (except for oral surgery). > > Allied health professional services such as psychologists, physiotherapists and speech pathologists. > > Services that do not satisfy the nearest specialist service definition. > > Patients participating in clinical trials. > > Services provided by sport and exercise medicine specialists. Making referrals to a medical specialist The referral to a specialist medical service must be made by: > > A rural GP to a South Australian medical specialist or oral/maxillofacial surgeon. > > A dental practitioner to the nearest specialist oral surgeon for an approved medical service. > > An approved nurse practitioner in a rural/remote location to the nearest recognised specialist. Why does the PATS require authorisation from local doctors? To verify that: > > The nearest specialist criteria relating to the patient s treatment is satisfied. > > There is a need for an escort for the patient when travelling to the medical specialist. > > Travel by air is medically necessary rather than by private vehicle or other modes of transport. (See Clinical criteria for approval of air travel on page 11 for further information.) When air travel is recommended, an approval number must be obtained from the PATS office prior to travel (see process for Obtaining prior approval for air travel on page 10). Approved medical specialists To be eligible for PATS, patients must be referred to a medical specialist who is recognised as a specialist surgeon or consultant physician in a particular speciality under the Health Insurance Act 1973, and is: > > Registered as a specialist under state or territory law. > > Registered with Medicare Australia with a specialty code. > > A registered local doctor providing specialist services in a hospital under the supervision of an approved specialist. > > A dental practitioner registered by the Health Insurance Commission as an oral surgeon, or who has been approved to render prescribed medical services of an oral surgery nature in the operating theatre of a hospital. > > An obstetric general practitioner in certain defined situations. > > An anaesthetist general practitioner in certain defined situations. PATS Information Booklet page 7

10 Peer recognition is not sufficient to confer specialist status. Only local doctors (including registrars) employed as specialists will be accepted for PATS purposes. Locations of specialist services Providing you have a referral from a local doctor, you can choose to attend any specialist service. However, PATS travel assistance is only provided for the nearest eligible service. The local hospital will have a list of specialists within the region (including visiting or video conferencing). Initiatives utilising new technologies such as digital images on X-rays are designed to reduce the need for travel and should be utilised at every opportunity. The authorising health practitioner must provide valid medical reasons to support a referral to a specialist other than the nearest provider. Special interests in a particular area of speciality or by-passing waiting lists for non-urgent treatment are not considered legitimate reasons to bypass a nearer specialist. Reference to family support, free accommodation at a preferred place of treatment, or reasons of personal convenience are not acceptable reasons for waiving the criteria to use the nearest medical specialist (including visiting medical specialists). Referrals outside of the region will only be considered for PATS if the regional service is unable to see the patient within a clinically acceptable timeframe. If a patient has been visiting a particular specialist and a similar service has since been established closer to their home, they will no longer be eligible under PATS to continue seeing their usual specialist, unless there are clinical reasons why they need to do so. Approved treatments The specialist medical services for which assistance is provided are defined as: > > Services covered by an item in the Commonwealth Medicare Benefits Schedule (MBS). > > Routine dental treatment only in circumstances where a patient s medical condition necessitates specialist medical back up at the time of dental treatment (e.g. coagulation disorders, epilepsy, or severe disability). > > Hare Lip/cleft palate patients who are registered with the Commonwealth Health authority. Transplant recipients and donors Rural South Australians required to travel to participate in a transplant (for example receiving or donating an organ) are eligible for PATS assistance under certain circumstances. A donor may apply for a PATS subsidy if they are a matched donor travelling to the SA Transplant Centre and the donor travelling is a requirement for the transplant to proceed. Under these circumstances a donor is regarded as a PATS patient and PATS eligibility criteria and subsidy provisions apply. In this case, the recipient does not need to be a PATS eligible patient. Donors travelling from outside of the state may be eligible for PATS assistance in exceptional circumstances this would be negotiated with the PATS office on a case-by-case basis. Subsidies for travel to follow-up services In some circumstances patients will need to travel for their initial treatment, but follow-up services such as checking their progress or checking the condition of a surgical wound may be provided locally. In such cases, PATS would only be available for the initial treatment and not the associated follow-up services that can instead be provided locally. page 8

11 4. What travel subsidies are available? The most direct means of surface transport is used, which may be by car, coach, rail, passenger ferry or a combination of these, but must be via the most direct route. Assistance for travel is based on the following principles: > > The patient is required to travel from and return directly to the permanent residence at the conclusion of treatment. > > Patients who use more than one mode of surface transport to reach their specialist treatment are eligible to apply for a subsidy for each mode. Supporting documentation for each type of transport used is required. > > Travel by air requires prior approval, with medical evidence stating that other modes of transport are inappropriate. When air travel is recommended, a claim number must be obtained from the PATS office prior to travel. (See Obtaining prior approval for air travel on page 10 for further information.) > > Patients who are eligible for PATS but select air travel due to concerns about lost time for work or other family reasons will be reimbursed at a public transport rate, e.g. the equivalent bus fare. Surface travel (coach or rail) Costs are reimbursed according to the relevant economy or discounted fare. Car travel The PATS offers a fuel subsidy of 16 cents per kilometre for car travel, a payment toward the cost of public transport where this is approved, or a payment toward the cost of air travel if this is deemed essential by your local doctor. Where patients use their own car for travel, car travel distance is measured by the most direct surface route between the patient s place of residence and the general post office in the treatment location. Where patients are able to share a car to travel to an appointment, only one PATS application is to be lodged for a fuel subsidy. This also applies to vehicles provided through Community Passenger Networks or non-government agencies assisting patients with travel. In these circumstances the PATS subsidy is paid to the agency managing the transport service or the owner of the car. Distances are calculated using the Online Distance Calculator Tool. (See the Online Distance Calculator Tool on page 6 for further information.) The cost of a hire car is not eligible for subsidy, but the normal vehicle allowance may be paid to assist with the fuel costs. Air travel Two conditions apply for air travel to be subsidised by PATS: > > For air travel to be approved under PATS, there must be a valid medical reason for air travel for both the forward and/or return journeys and the authorising local doctor or treating specialist must articulate the medical reason for air travel in their sections of the form. > > The referring local doctor or the treating specialist must obtain prior approval to authorise air travel from the PATS office. PATS Information Booklet page 9

12 Approval for air travel is always conditional on patients meeting the primary eligibility criteria for PATS. (See Clinical criteria for approval of air travel on page 11 for further information.) Where a patient chooses to travel by air and medical approval is not granted, or the reasons provided by the referring local doctor or treating specialist are insufficient, or the approval is not obtained prior to travel, the reimbursement will be the equivalent of the most economical public transport fare (where available) or fuel subsidy. Obtaining prior approval for air travel The referring doctor or specialist, or their authorised representative, must contact the PATS office for a PATS air advance claim number and enter this number on the application form. If the medical reason for travel is related to the patient s existing medical condition, the authorising doctor can obtain prior approval for both the forward and return journeys simultaneously. If there is a medical reason for the return journey to be made by air, the treating specialist will need to obtain prior approval for this trip also. The continuing need for air travel on subsequent visits must be considered, authorised and approved on each occasion. The PATS office will need the following information for prior approval: > > Patient details > > Medical reason for air travel > > Specialist details > > Journey details, including the expected forward and return dates; and > > Whether an escort is medically required. It is the responsibility of the patient to book and pay for all tickets. Advance purchase of the air ticket through a local travel agent may be considered and arranged through the PATS office when the patient is a concession card holder. Missed flights PATS will only pay for one journey to a medical appointment. If a patient is unable to travel on a pre-paid journey, they must provide 24 hours notice of cancellation. The patient will be required to refund any costs incurred by PATS for prepaid travel if they fail to provide adequate advance notice and do not undertake the travel. Cancellation or postponement of treatment by the hospital or health service The PATS scheme will provide the level of financial assistance allowable towards the cost of travel pre-paid by PATS in the event that: > > A hospital admission for an elective procedure has been postponed; or > > A specialist appointment is cancelled or postponed; or > > The patient is not notified until after commencing the journey. page 10

13 Clinical criteria for approval of air travel Applications for air travel require approval prior to travel, stating the clinical criteria relevant for each patient journey. A guide for local doctors and/or treating specialists in considering and certifying the need for air travel is below, and should be noted on the PATS form. Criteria Active clinical management Pain Management Urgency Restricted mobility Life threatening conditions Musculo-skeletal instability Explanation Patients with conditions that would be difficult to manage during prolonged road travel or if away longer than one day, including those requiring ambulatory oxygen, regular catheterisation by self/carer, frequent nebuliser therapy (less than four hourly), dialysis patients. Patients with severe pain that is likely to be worsened by prolonged sitting, for example; those experiencing post-operative pain (within two weeks of an operation) bone metastases, acute disc prolapse of neck/back. Some patients with chronic back pain will be best transported by road where they can stop at regular intervals. Patients clinically determined as being in need of urgent treatment or referral, for example patients called for organ transplant or those commencing radiotherapy/chemotherapy/dialysis. This includes patients requiring significant assistance with ambulation, which precludes other forms of transport. Potentially life threatening conditions where a long journey may compromise patient health. This does not include emergency situations, where a patient is airlifted to a major hospital. This includes patients for whom prolonged jolting/jarring may compromise their treatment outcome. Additional transport assistance If the patient has no other means of transport, PATS may be able to make special arrangements with the cost of a taxi from their place of residence to an airport/bus station/ferry terminal. Where a patient is able to access a community transport or community managed bus service, specific arrangements may exist between the management of the service and PATS in regard to the provision of a subsidy. Local PATS offices or the Community Passenger Network Co-ordinator will advise on these situations. Use of a taxi or a shuttle bus around the local area at the treatment destination is not covered by PATS. PATS is only provided for the travel to and from the patient s residence to the medical specialist location. No travel undertaken during a treatment episode will be eligible for PATS assistance. If a patient has been taken to a medical service for emergency treatment, they may be entitled to assistance to return home. Where a patient elects to bypass the nearest specialist without a valid reason, a payment for the equivalent travel via public transport to the nearest specialist may be made, when the nearest specialist still necessitates a trip of a distance greater than 100km. In the situation where a patient is required to stay for a specified treatment period, PATS will assist with the trips undertaken at the commencement and cessation of treatment. Trips home during this period are not eligible. PATS Information Booklet page 11

14 5. What accommodation subsidies are available? Accommodation subsidies of up to $40 (plus GST) are available for commercial accommodation in a hotel, motel, caravan park, or serviced apartment for patients who live 100kms away and are required to stay overnight for medical reasons, distance or transport schedules. Commercial accommodation is accommodation that is registered as a business and has an Australian Business Number (ABN) and may be a hotel, motel, caravan park, apartment, flat or accommodation facility associated with health organisations. Services providing clinical support to patients in the way of rehabilitation (e.g. slow-stream rehabilitation involving physio or other therapies) or primary care services (e.g. step down units) are not commercial accommodation services for PATS purposes. PATS does not provide subsidy payments to these services funded through SA Health. Approval of accommodation nights For the patient to be eligible for accommodation assistance, the medical specialist must state on the PATS application form that it is necessary for the patient (and escort if relevant) to be accommodated at or close to the location they are receiving the approved medical specialist services. The medical specialist must state on the form the number of nights of accommodation required in connection with the treatment. Patients and escorts who are non-concession card holders are required to pay the first night of their accommodation. Where a patient is hospitalised, the treating specialist must endorse the escort to be medically necessary to remain before they are eligible for extended accommodation assistance. An approved travel escort is automatically entitled to assessment for assistance for the night before admission and the night of discharge. Accommodation subsidy rate A maximum of $40 per night for commercial accommodation (plus GST) or the cost of the accommodation if less than $40 for eligible patients and an approved escort. There is a maximum benefit of $80 per night (plus GST) where two escorts are endorsed. Bulk billing arrangements Direct payments for accommodation are only paid to PATS approved commercial accommodation providers and accommodation facilities associated with specific health services. In these situations, the accommodation is approved by the PATS administrators and an authority issued. Only the number of approved nights will automatically be paid. It is the responsibility of the accommodation provider to follow up unpaid accounts with patients for any nights which are not eligible for PATS. page 12

15 Required accommodation details All original receipts or invoices for commercial accommodation (highlighting the eligible items), must be attached to a PATS application form before the application can be processed. Commercial accommodation receipts and invoices must be provided on letterhead and contain the following details: > > The name and address of the commercial accommodation provider. > > The Australian Business Number (ABN) of the accommodation provider. > > Name of the patient (and escort). > > Date(s) each person was accommodated. > > Cost of each person s accommodation per night. > > Total cost of the accommodation. Limits to the time for provision of an accommodation subsidy Ongoing accommodation subsidies for accommodation will not be provided for longer than a three month period within a 12 month timeframe from the initial appointment for the relevant medical speciality. The patient, and an authorised travel escort, has an entitlement for the night before and the night of the first appointment or hospital admission/discharge. Any other accommodation must be medically endorsed and approval for accommodation for a patient and escort during the course of treatment must be given by a treating specialist or the local doctor completing the application on the specialist s behalf. Accommodation costs for lengthy treatment periods Direct payments for accommodation are paid to PATS approved commercial accommodation providers. Inquire with the referring health service, hospital or the local PATS office for advice on appropriate service providers. Patients may direct their accommodation entitlements to be paid directly to the accommodation provider. Under these circumstances it is the responsibility of the organisation to ensure they are listed on the PATS form to receive reimbursement. Where the treatment is recommended as a block, and accommodation is negotiated for a block period, PATS will pay the subsidy for all the nights required for the length of stay. Under this arrangement it is expected that the patient remains at the location for this period. PATS Information Booklet page 13

16 6. How are escorts subsidised? For PATS purposes, an escort is defined as a person who is required to be with a patient for specific medical reasons. Patients aged 17 years or under are automatically entitled to an escort. Special approval for two escorts for a child only may be approved where there are extenuating or life threatening circumstances. In all other circumstances only one escort per patient is eligible for PATS assistance. An approved patient escort may also be eligible to seek assistance for travel and accommodation costs. An escort is responsible for the patient s transport and accommodation needs during treatment. An escort s entitlement to a travel allowance is conditional on a patient being eligible for PATS assistance. Escorts have no entitlement in their own right. An approved escort is only eligible for travel assistance for the relevant journey from and returning directly to the patient s residence accompanying the patient. Escorts approved for PATS assistance An approved escort must be: > > 18 years of age or older > > Accompanying the patient whilst travelling; and > > Deemed necessary by either the authorising practitioner or the treating specialist. An escort should be an adult and be able to cope with the special medical needs of the patient. Escorts not assisted by PATS An escort is not assisted by PATS with their costs when: > > The requirement for an escort has not been noted by the authorising practitioner or the approved medical specialist. > > The authorising practitioner or medical specialist lists emotional support as grounds for an escort. (See Clinical criteria for approval of an escort on page 15 for further information.) > > The escort does not travel with the patient; this includes situations where the patient travels by road or air ambulance. Failure to cite the medical reason for an escort may result in non-reimbursement of escort costs to the patient. Escort travel by public transport Patients and an approved escort (if applicable) are eligible for reimbursement of travel by economy rail, coach and passenger ferry (excluding vehicles) for each component of the program. One patient contribution is deducted from the amount payable. page 14

17 Clinical criteria for approval of an escort Where an escort is required, PATS requires that a referring local doctor and/or treating specialist approve the escort. An escort is a relative, friend or carer, who is an adult and is able to cope with the special medical needs of the patient to accompany an eligible patient during travel and/or remain with the patient during treatment. A guide for local doctors and/or treating specialists in approving the need for an escort is below, and should be noted on the PATS form. If the doctor or specialist considers that there is a valid medical reason for an escort, which is not covered by the clinical criteria listed below, then specific details must be provided. Emotional support is not sufficient grounds for endorsement of an escort. Criteria Impairment Active role of carer Involvement in medical treatment Children Support person As an alternative to air travel Explanation Patient with cognitive impairment, including acquired brain injury, dementia and confusion. Visual impairment where mobility is impaired. Where the carer is responsible for the patient s medical treatment (renal dialysis, catheterising, and administering of treatment) or personal care needs, for example, in the case of patients with physical disability. Where a partner is required for part of the procedure, including fertility treatments, organ/donor transplants. Patients under 17 years of age are automatically entitled to one escort. Two escorts may be considered if the child s condition is considered life threatening. Where an escort is required to support the patient during long-term specialist medical treatment (e.g. intervention for mental illness), and/or in decisionmaking about cancer treatments or major procedures, and/or for cultural reasons such as in the case of Aboriginal and Torres Strait Islander and persons from Culturally and Linguistically Diverse (CALD) backgrounds. Where an escort may facilitate another means of travel as an alternative to air travel - for example, where the patient has a visual or hearing impairment or a mental illness, such as schizophrenia, psychosis or severe depressive disorder. PATS Information Booklet page 15

18 7. Financial Hardship Assistance If a patient is a concession card holder experiencing financial hardship and can t afford to pay their travel costs up-front, PATS administrators are able to assist with the payment of public transport or fuel costs in advance of travel. In these circumstances, the patient will need to verify with the PATS office first that they are eligible for an advance payment; then book the transport with the appropriate booking agent and provide the PATS office with documentation to verify the cost of the trip. The PATS office will then arrange payment of the travel on the patient s behalf, or provide a fuel card for fuel purchase. When an advance payment has been provided, the signed PATS application form MUST be returned promptly to the PATS office following the specialist visit. Further advances will not be provided if forms are outstanding. Failure to make a journey after an advance was paid by PATS Should the patient and/or escort receive an advance payment for a journey and fail to make the journey for any reason they must: > > Notify the appropriate PATS office of this within two weeks of receipt of funds; and > > Provide a reimbursement for the full amount/return the fuel card to the PATS office. Patients are liable for the full cost of any pre-paid public transport bookings if the booking agent or PATS office is not notified in sufficient time to cancel the booking. page 16

19 8. How to Apply Application forms are available from referring local doctors, your local PATS office or online at In order to be eligible for PATS, you need authorisation from your local doctor in the first instance. (See How does the PATS process work, on page 21 for a guide on how to apply for PATS.) After you ve attended the medical appointment, completed forms should be sent by the patient to their nearest PATS office for payment via fax, mail, or the patient s nearest PATS office. Documents to be provided with an application The following are required to be attached to completed application forms: > > Original invoices and receipts must support all applications for travel and accommodation. > > Original public transport tickets, proof of payment for e-tickets or the traveller s copy of the air tickets where air travel has been undertaken are also required. > > Accommodation invoices and receipts need to be limited to, or clearly identify, each of the nights and the individuals eligible for that application. Photocopied receipts are not accepted and, under audit regulations, receipts cannot be returned to the applicant after a payment is made. Petrol receipts are not required. Documents required for advance payments and accommodation applications A photocopy of the patient s current concession card must be included with any application for either an advance payment or for accommodation assistance to receive consideration for payment of the first night s accommodation costs. When an advance payment has been provided, the signed PATS application form MUST be returned promptly to the PATS office following the specialist visit; further advances will not be provided if forms are outstanding. Electronic Funds Transfer (EFT) section of the application form The EFT payment section of the application form must be completed. All PATS payments will be made by EFT. Please ensure that your payment details are correct check with your bank if unsure. If the details are not correct or the bank details are not included, your form will be returned to you to be resubmitted with the correct details. Lodgement of application forms Patients should ensure that all sections of the application form are correctly completed and the required receipts are attached. The form should then be lodged at the nearest PATS office within three months of the first specialist appointment date on the application. Time limits on lodging applications Completed PATS forms must be submitted no later than three months after the date of the first medical specialist appointment noted on the form. PATS will not back date any payments beyond this period. PATS Information Booklet page 17

20 9. Patient Responsibilities It is the responsibility of the applicant to ensure that each required section of the application form is complete and all the supporting documentation is provided. Once a patient or applicant (or a delegated authority, if patient is under age or unable to sign), has signed the application for assistance, they are declaring that all the information on the form is true and correct. Any forms which are incomplete or incorrect will be returned to the patient for completion. If travel or accommodation bookings have been made on your behalf, and you are unable to complete your trip, it is your responsibility to notify the booking office or the PATS office as soon as possible. page 18

21 10. Administrative Processes and Appeals Lost paperwork Statutory declarations may be provided where original receipts are considered insufficient to support an application or where the original receipts are lost. Death of a patient during a PATS subsidised trip If a patient or escort dies during a journey or at the place of treatment, the travel allowance payable is deemed to be cost of the return journey via the original means of transport. Accommodation costs are not payable for the deceased escort/patient beyond the time the person dies. A deceased estate is not entitled to claim for transportation costs associated with the return of a deceased person. Where a payment is made to a deceased person it should be made to the estate of the deceased claimant. PATS audits Country Health SA Local Health Network reserves the right to conduct an audit on PATS applications and payment processes, which includes all scheme participants. This includes but is not limited to patients, escorts, referring local doctors and specialists. Rejection of applications If the application does not meet all the required criteria, or the documentation is incomplete, the PATS officers may reject the application. In this case, the patient will receive notification, in writing, of the reason that the claim was unsuccessful. Appeals A patient has three months from the date of notification of an unsuccessful application (in part or full) to lodge an appeal. An appeal should be submitted in writing, which may be by letter, fax or . Consumer feedback If a patient, carer or family member would like to forward a compliment, suggestion, or concern to help us improve our service, they may do so via their local or regional PATS office or via at CHSAPATS@health.sa.gov.au or direct to: The Consumer Feedback Manager Country Health South Australia Local Health Network PO Box 287 Rundle Mall Adelaide SA 5000 PATS Information Booklet page 19

22 11. Contact Information For more information on PATS visit or contact your local PATS office: Adelaide Central Office PO Box 3017 Rundle Mall Adelaide SA 5000 Telephone: (08) Fax: (08) Mount Gambier & Districts Health Service Wehl Street North PO Box 267 Mount Gambier SA 5290 Telephone: (08) Fax: (08) Port Lincoln Health and Hospital Services PO Box 630 Port Lincoln SA 5606 Telephone: (08) Fax: (08) Pt Augusta Hospital & Regional Health Services Hospital Road Port Augusta SA 5700 Telephone: (08) Fax: (08) Riverland Regional Health Service Maddern Street Berri SA 5343 Telephone: (08) Fax: (08) Whyalla Hospital & Health Services Wood Terrace PO Box 267 Whyalla SA 5600 Telephone: (08) Fax: (08) page 20

23 12. How does the PATS process work? STEPS 1 Go to the local doctor* Verify that the specialist service is not available locally and seek authorisation for PATS assistance (transport, accommodation or escorts). Local doctor completes section 1 of application form on first claim of this issue Go to the specialist* Confirm attendance and need for further appointments and PATS assistance (transport, accommodation or escorts). Specialist completes section 2 of application form. After your medical appointments Patient/service provider completes section 3 of application form. Send completed forms and receipts to PATS office. Payment Payment of any assistance you re entitled to within six weeks of lodgement. * In those limited instances where local doctors or specialists claim air travel is clinically essential, approval from PATS is required before you travel. If this is not obtained, the reimbursement will be the equivalent of the most economical transport. PATS Information Booklet page 21

24 For more information or contact your local PATS office. Department for Health and Ageing, Government of South Australia. All rights reserved. FIS: December 2014.