Cross Border Provision of Prosthetic Services - Draft Policy for Discussion  Version 1.1 12th April 2000 Version 1 12th June 2000 Version 1.1

Preamble
Objective
Provision of Services across States/Territorries
Reimbursement of significant variances
Client Information Transfer
Proposed Parties
Date and Venue for signing

Preamble

The provision of prosthetic services to eligible amputees was administered by the Department of Veteran’s Affairs through a State and territory structure with funding from a centralised point and thus the funding of service for any eligible amputee in any location was easily encompassed. With the devolution of the responsibility for the administration of the Artificial Limb Scheme to the jurisdiction of the State and Territories, the available funding based upon the level of service provision at that time was provided to the States and Territories.

Although the level and type of service delivery of the various ALSs are subject to State or Territory policy, there needs to be an understanding as to what services will be provided to a visiting non-resident amputee. Transfer agreements stipulate that service provision cannot be denied on the basis of residence of the eligible amputee.

There is a concern that should the level and frequency of service being provided to amputees who are not residents of the State or territory administering the ALS change significantly, that there could be a sizeable cost to the State or Territory receiving the influx. There should be a mechanism to monitor and cost utilisation of services for non-residents and a means to enable adjustments should these become necessary. (This paragraph may be re-worded)

Provision of Services

Individuals who have historically been provided services in a State or Territory other than that of their residence at the time of the transfer of the Service to the State or Territory shall continue to be treated as if they were a resident of that State or Territory.

Services will be provided to a non-resident amputee under the following conditions:

The amputee is temporarily visiting (known timeframe) another State and requires some service.

Emergency services which could not have been foreseen shall be provided by the ALS up to their level of service. (Consumable items are not considered as emergency items)
Other services may be provided to the visiting amputee within the areas covered by the visiting State's policy for service provision AND available and funded in the State in which they are resident where:
The requested service arises from a prescribing clinic recognised by the ALS who is to fund the service.
The requested service is not a duplication of existing service provision
The requested service is approved by the administrators of both services
The amputee must complete the acquittal processes of the State providing the service
No net additional cost is incurred to the ALS as a whole

Each State or Territory shall determine its base cost of providing services to non-residents at the time of transfer as a percentage of its service costs (transfer level) for the fiscal year 99/00.

This base cost information shall be divulged to the State or Territory involved.

Each State or Territory shall monitor the amount of cross border servicing that is taking place on an annual basis and determine whether this has surpassed the levels inherent in the State based transfer (Transfer level) of Artificial Limb Services.

Where an administrator demonstrates that the level of service for non-residents has increased beyond the Transfer level, the administrator providing the service may request reimbursement from the State or territory which has exceeded the Transfer level.

The State or Territory ALS receiving the request for reimbursement shall make their best effort to honor this request.

Each variance calculation is a one-off event and is treated as such.

Client Information Transfer

Where emergency services are contemplated, the State or Territory providing the emergency service shall be provided the basic eligibility and prosthesis information upon request by the State or Territory of whom the client is a resident.

Where an amputee takes up permanent residence in another State, the ALS administrative information required will be transferred to the new State administrator. Clinical information required for the continued service will be forwarded to the appropriate treating clinic if so requested.

Proposed Parties

Every State and Territory ALS administrator

	Name	State/Terr.	Tel Number
	Ms Kate Moylan	NSW	02 9553 3048
	Mr Barry Leech	ACT	02 6244 2475
	Mr Ron Simard	QLD	07 3240 5973
	Mr John Middleton	SA	08 8275 1667
	Mr Amos Yee	VIC	03 9616 8007
	Mr Ian Burns	WA	08 9347 5264
	Mr John Alderdice	TAS	03 62227375
	Manager NT ALS	NT	08 89228900

 

Date and Venue for signing:

Wednesday 1 November, 2000- The face to face meeting prior to ISPO Adelaide (2-4 November 2000)