Document ID: chunk:federal_register_of_legislation:F2024C00744:front:0:p36
Version: federal_register_of_legislation:F2024C00744
Segment Type: other
Provision Reference: 
Character Range: 94632–97670

Subsection 85(8) provides, in effect, that where a service pension is suspended, the Commission may determine that, for the purposes of treatment eligibility, the person is deemed to be continuing to receive that pension during the period, or part of the period, of suspension.

2.8.2 Where a person's pension is reduced or cancelled because the person supplied false or misleading information, and that reduction or cancellation results in a reduction or loss of eligibility for treatment, treatment benefits will be reduced or will terminate from the date of reduction or cancellation of the pension.

PART 3 — COMMISSION APPROVAL FOR TREATMENT

3.1 Approval for treatment
3.1.1 The Commission's prior approval may be required for treatment.

      Note: Paragraph 1.5.1 provides that any approval given for treatment under the Treatment Principles revoked upon the commencement of these Treatment Principles is deemed to have been given for the purposes of, and under, these Principles.

3.2 Circumstances in which prior approval is required

3.2.1 Treatment requiring prior approval includes:

         (b) provision of services that are not made available under the Medicare Benefits Schedule except where otherwise stated.

         Note: see paragraph 4.2.3.

(d) outpatient treatment at a private hospital where the requirement for prior approval for such treatment is specified in a contract.

(e) treatment at a hospital according to the requirements contained in section 4 of the RPPPs.

          Note: where the patient is a holder of a White Card and eligibility for the treatment required is uncertain, the Commission will not accept financial responsibility for the cost of care unless the Department has verified eligibility.

         (f) admission to a hospital or the provision of hospital treatment not otherwise specified;

          Note: see paragraph 9.1.9.

(h) convalescent care in an institution — except where the institution is a private hospital or public hospital;

Note: for convalescent care in an institution that is a hospital see paragraph 9.5.2

         (ha) respite care in an institution — except where the institution is a private hospital or public hospital;

Note: for respite care in an institution where the institution is a hospital see paragraph 10.7A.

    (j) in‑home respite care;

          (ja) emergency short term home relief (ESTHR) to be provided within 24 hours after a previous               service of ESTHR;

         Note: the intention is that 3 days (the max ESTHR per emergency) should be sufficient
         time or alternative respite care to be arranged and prior approval is required before a further immediately subsequent service of ESTHR may be provided.

         (k) provision of residential care in Australia or overseas;

         Note: see paragraph 2.2.4 and Part 10

         (n) dental treatment specified as requiring prior approval in Part 5 or in a DVA document incorporated into the Principles;

 (na) diabetes educator services specified in paragraph