Document ID: chunk:federal_register_of_legislation:F2024C00800:front:0:p30
Version: federal_register_of_legislation:F2024C00800
Segment Type: other
Provision Reference: 
Character Range: 78734–81830

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 10.4A.

    (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 for 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 7.6A.2;

         (o) community nursing services specified as requiring prior approval in Treatment Principle 7.3;

(p) physiotherapy that exceeds the limits specified in paragraph 7.5.1;

(q) podiatry that is not specified in paragraph 7.6.1;

         (r) provision of rehabilitation appliances specified as requiring prior approval in or under Part 11;

(s) provision of a visual aid to an entitled person by an optometrist or an optical dispenser that is either:

           (i) not available to the entitled person under the DVA document entitled "Pricing Schedule for Visual Aids", referred to in Schedule 1; or

           (ii) available to the entitled person under the DVA document entitled "Pricing Schedule for Visual Aids", referred to in Schedule 1, but with the stipulation that prior approval is required.

         (t) repair of a rehabilitation appliance specified as requiring prior approval in or under Part 11;

(w) ambulance transport, except for that provided by certain ambulance services specified in paragraph 12.1.1;

         (x) cosmetic surgery;

         (y) medical devices not included on the Department's schedule of 'Benefits Payable in Respect of Surgically Implanted Prostheses, Human Tissue Items and Other Medical Devices;

         (z) psychiatric inpatient care or psychiatric day patient program care;

         (za) treatment specified in any Notes for Providers (however described) and in any Fee Schedule as requiring prior approval.

3.2.2 In considering whether prior approval will or will not be given and what conditions, if any, will apply, the following will be taken into account:

(a) any specific requirements contained in these Principles or the Act;

(c) the extent of funds that are available;

(d) reasonable