Document ID: chunk:federal_register_of_legislation:F2024C00744:front:0:p45
Version: federal_register_of_legislation:F2024C00744
Segment Type: other
Provision Reference: 
Character Range: 119979–122994

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 general practitioner; or

(b) a medical specialist.

       4.2.3 (1) An entitled person may be provided with services that are not made available under the Medicare Benefits Schedule ("unlisted services").

       (2) Unlisted services are not to be provided to an entitled person if the Commission is satisfied that they are:

             (a) a mere improvement on existing Medicare Benefits Schedule listed services; or
             (b) experimental and have not been demonstrated to be effective or safe by extensive clinical trials.

    4.2.4  Subject to paragraph 4.2.3(2), unlisted services are to be provided to an entitled person under paragraph 4.2.3(1) if the Commission is satisfied that the services will provide a substantial benefit to the health of the entitled person.

    Note 1: the prior approval of the Commission is required before unlisted services may be provided (Paragraph 3.2.1 (b)).

    Note 2: the availability of funds and the need to reasonably control expenditure are factors