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Section B Conditions of Funding: Acute Health

The standard conditions of funding, which are not program specific, are detailed in Schedule 1 of the Health Service Agreement 1999 - 2000. The conditions below apply specifically to the Acute Health Program.

1. Australian Health Care Agreement (AHCA) Framework

    The Australian Health Care Agreement (AHCA) is the successor to the Medicare Agreement which expired on 30 June 1998. The AHCA is an agreement between the Commonwealth of Australia and the State of Victoria, to provide and jointly fund health care for eligible persons who choose to use State funded health services for the five years from 1 July 1998 to 30 June 2003. It outlines the principles that are to guide the delivery of public hospital services.

    Public hospitals in Victoria must ensure that public hospital services are provided in accordance with the terms of the AHCA, and that eligible persons are able to access public hospital services as public patients.

    An electronic version of the AHCA between Victoria and the Commonwealth is available on the Internet at http://www.dhs.vic.gov.au/ahs/index.html

    Acute Health Circular 3/99 (as may be amended from time to time) provides further State Government advice on the AHCA.

    1.1 Hospitals to work within the Framework of the AHCA.

    The AHCA commits the Commonwealth and Victoria to the following Principles:

    1. 1.Eligible persons must be given the choice to receive public hospital services free of charge as public patients;
    2. 2.Access to public hospital services by public patients is to be on the basis of clinical need and within a clinically appropriate period; and
    3. 3.Eligible persons should have equitable access to public hospital services, regardless of their geographical location.

    The Commonwealth and Victoria agree that principles 2 and 3 are met if Victoria is using its best endeavors to achieve the outcomes sought in those principles to the greatest extent practicable.

    Under Principle (2), it is Victorian Government policy that both public and private patients should receive access to public hospital services on the basis of clinical need. The Victorian Government will allow preferential access for eligible veterans to public hospitals, but only so long as care of public patients is not impaired, consistent with Principle 2. Greater detail is given in the Department of Human Services Victoria Hospital Circular 17/1998.

    The AHCA provides that where an eligible person receives public hospital services as a public admitted patient, no charges will be raised for medical or hospital services. Under the AHCA, a nursing home type patient is excluded from being an eligible person in relation to public hospital services.

    Based on the AHCA, State Government policy for charging non-admitted patients is set out in the State’s Fees Manual, Fees and Charges for Acute Health Services in Victoria: A Handbook for Public Hospitals (as may be amended from time to time) To access this advice, please refer the Department Internet website:

    http://www.health.vic.gov.au/feesman/index.htm

    1.2 Admission of Patients.

    None of the following factors is to be a determinant of an eligible person's priority for receiving hospital services:

    1. whether or not an eligible person has health insurance;
    2. an eligible person's financial status or place of residence; or
    3. whether or not an eligible person intends to elect or elects to be treated as a public or private patient.

      1.2.1 The hospital will ensure that:

      1. an eligible person, at the time of admission, or as soon as practicable thereafter, elects or confirms whether he or she wishes to be treated as a public patient or a private patient and this election is recorded on the approved Patient Election form;
      2. in making the election referred to above, the eligible person is informed of the consequences of electing to be treated as a public patient and not as a private patient or vice versa;
      3. an eligible person's health insurance status or financial status or intention in respect of an election will not be a determinant in the priority for receiving hospital services; and
      4. any ineligible person is appropriately identified as such in the Victorian Admitted Episodes Dataset (VAED) formerly called the Victorian Inpatient Minimum Database (VIMD).

      1.2.2 The hospital will only admit patients in accordance with the Minimum Criteria for Admission as specified in the PRS/2 Manual Version 9.0 dated July 1999 and shall set in place administrative procedures for the certification of all patients admitted for Type C Professional Attention Procedures (exclusion list) or admitted overnight for designated Band 1 procedures of the Health Insurance Basic Table as defined by subsection 4(1) of the National Health Act 1953 (Commonwealth).

      1.2.3 The hospital will make every effort to verify the place of residence of interstate patients.

      1.2.4 The hospital will ensure that all patients admitted to hospital are asked whether they are of Aboriginal or Torres Strait Islander descent. The identification of Aboriginality is a mandatory data item to be reported by hospitals to the VAED. Aboriginal and Torres Straight Islander patients identified on the VAED will be funded at 10% higher than the nominated payment for WIES7.

    1.3 Claims for Medicare Benefits.

    The hospital will ensure that aftercare services for public patients and outpatients and accident and emergency services do not attract claims for Medicare benefits or claims for benefits under Veterans' Affairs Legislation.

    1.4 Pharmaceutical Benefits.

    The hospital will ensure that except in an emergency, it does not issue a prescription to an admitted patient on discharge, an outpatient or an accident and emergency patient, that would attract pharmaceutical benefits as defined in the National Health Act 1953 or Veterans' Affairs Legislation. (Note, this is shortly expected to change).

    1.5 Commonwealth-State Programs.

    Hospitals may receive specific purpose payments arising from Commonwealth-State Agreements. Funding received under such arrangements is subject to each program’s specific conditions.

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