Document ID: chunk:federal_register_of_legislation:F2024C00800:front:0:p38
Version: federal_register_of_legislation:F2024C00800
Segment Type: other
Provision Reference: 
Character Range: 101537–104454

an entitled person as a private patient in a hospital where a private health insurer of the person agrees to pay the difference between the cost of shared accommodation for the person at the hospital and the cost of the private accommodation for the person — the MPPPs covers such treatment.

Note 1: "private patient" is defined in s.286(7) of the Act.

Note 2: this provision ensures paragraph 3.5.3(a) does not prohibit the Commission from accepting responsibility for part of the cost of private accommodation in a hospital where a private health insurer pays for the remainder of the cost.

The Commission's responsibility in this area is regulated by the MPPPs i.e. cost‑sharing between the Commission and the entitled person or a private health insurer is worked out under the MPPPs.

3.5.4 Where the Commission accepts financial responsibility under these MRCA Treatment Principles, it does so on behalf of the Commonwealth.

PART 4 — MEDICAL PRACTITIONER SERVICES

4.1 General Practitioners

4.1.2 Outline

    4.1.3 The aim of the medical services program is to ensure that as far as practicable entitled persons have access to free, safe and cost‑effective treatment.

    To achieve this objective the Commission or the Department deals with medical practitioners on two levels.

    At the first level the Commission or the Department deals with medical practitioners called general practitioners.  Services provided by these medical practitioners must be in accordance with these Principles and the Notes for General Practitioners if the Department is to pay for the services.

    It should be noted that while it is the Commission that accepts financial liability for treatment it is the Department (Commonwealth) that actually pays for the treatment.
    The second level of interaction between the Commission or the Department and medical practitioners is where the medical practitioner is a specialist.

    Unlike general practitioners, medical specialists (as at 1 April 2006) are not prepared to submit to the same level of regulation as general practitioners regarding services to entitled persons (at DVA expense) but if they are prepared to treat an entitled person at the rate set out in the Principles and charge DVA and not the entitled person, then the relationship between DVA and the specialist is covered by the Principles.

    4.1.4 Subject to paragraph 3.5.1, the Commission may accept financial liability for medical treatment provided to an entitled person by a general practitioner or a medical specialist.

    Note: paragraph 3.5.1 sets out the financial limits on Commission liability for treatment.

4.2 Providers of services
    4.2.1 Unless otherwise indicated in these Principles, an entitled person may be provided with only those services included in the Medicare Benefits Schedule.

4.2.2 The services referred to in paragraph 4.2.1 may be provided only by:

(a) a