Document ID: chunk:federal_register_of_legislation:F2024C00744:front:0:p37
Version: federal_register_of_legislation:F2024C00744
Segment Type: other
Provision Reference: 
Character Range: 97389–100493

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 control over expenditure;

(e) the clinical need for the proposed treatment; and

(f) the suitability and quality of the proposed treatment.

    3.3 Circumstances in which prior approval is not required
3.3.2 Treatment not requiring prior approval includes:

(a) treatment by a general practitioner except where otherwise indicated in Part 4;

         (b) medical specialist consultations in country and Territory areas, except where otherwise indicated in principle 4.7;

              Note: Prior approval is not required for medical specialist consultations in States or Territories where the RPPPs apply — see paragraph 1.2.2.

(c) dental treatment specified as not requiring prior approval in Part 5 or in a DVA document incorporated into the Principles;
(d) dental prosthetic treatment specified as not requiring prior approval in Part 5 or in a DVA document incorporated into the Principles;

         (da) diabetes educator services, except where otherwise indicated in Principle 7.6A;

(e) the prescription and supply of pharmaceutical items as set out in