Notes for consultant pharmacists

Table of contents

Foreword

1 Background

2 DVA contact list

3 Notes for consultant pharmacists

4 Your responsibilities

5 Consultant pharmacist services

Appendix A — Accounts procedures
1 The DVA Accounts Payment System

Appendix B — DVA schedule of fees

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Foreword

Pharmacists play a key role in providing treatment for veterans, their widows/widowers and dependants. With the ageing of many veterans, the role of pharmacists is increasing in importance. Adding to this trend are the progressive enhancements to the range of Repatriation health services.

The Repatriation Commission and its administrative arm, the Department of Veterans’ Affairs (DVA) looks forward to continuing to work closely with pharmacists in the support of veterans. These Notes explain the procedures to be followed when pharmacists provide consultant pharmacist services for the 350,000 eligible DVA beneficiaries.

The Notes provide information set out in the following Sections:

Section 1 Background information on relevant DVA health programs

Section 2 Useful DVA contact addresses and phone numbers

Section 3 Explanation about the status of these Notes

Section 4 Your responsibilities as a consultant pharmacist

Section 5 Consultant pharmacist services

Appendix A How to claim payment

Appendix B Schedule of services and fees

DVA very much appreciates the special role played by pharmacists in providing high quality health care to Australia’s veterans. Should pharmacists have suggestions that would further improve our consultant pharmacist arrangements, or have any queries about the arrangements, they should contact their DVA State Office pharmacy areas. The addresses and telephone numbers are listed in Section 2.

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1. Background

1.1 The role of the Department of Veterans’ Affairs

The Repatriation Commission (‘the Commission’) is responsible for the general administration of the Veterans’ Entitlements Act 1986 (‘the Act’).

Under the Act, the Commission is authorised to prepare Treatment Principles, a document legally binding on the Commission, setting out the circumstances under which financial responsibility is accepted for the health care of entitled persons.

An ‘entitled person’ means a person eligible for benefits or treatment from the Commonwealth or the Commission in accordance with the Veterans’ Entitlements Act 1986 or other legislation in the Veterans’ Affairs portfolio.

The Department of Veterans’ Affairs (DVA) assists the Commission in providing the benefits and treatment to the entitled persons under the Act.

For the purposes of these Notes:

• DVA and the Commission shall be collectively referred to as ‘DVA’ throughout the document; and

• Veterans, war widows/widowers and dependents shall be referred to as ‘entitled persons’.

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1.2 The DVA health care program

The DVA health care program provides access for entitled persons to services, for example medical, physiotherapy, chiropractic and pharmacist services, which will assist in coping with disabilities and improving health and well being.

You may be particularly interested in the following services.

1.2.1 The Local Medical Officer Scheme

A Local Medical Officer (LMO) is a medical practitioner in general practice who is contracted under the Repatriation Comprehensive Care Scheme (RCCS) to provide medical services to entitled beneficiaries. The LMO acts as the coordinator of an entitled person’s health care and, as such, only the LMO (or another general practitioner acting on behalf of the LMO) can arrange a client’s referral to you.

1.2.2 The Repatriation Pharmaceutical Benefits Scheme

Pharmaceutical services are delivered to entitled persons through the Repatriation Pharmaceutical Benefits Scheme (RPBS).

There are approximately 350,000 people eligible to receive pharmaceutical benefits through the RPBS. The average age is now 74 years, with 15 per cent under the age of 60 years and 66 per cent aged 75 years or over.

The RPBS is administered by the DVA and is designed to meet the specific needs of veterans and war widows/widowers. Within the RPBS are contained all the drugs included in the Pharmaceutical Benefits Scheme (PBS) Schedule plus a range of pharmaceutical items specifically to cover veteran needs.

The Repatriation Pharmaceutical Reference Committee (RPRC) advises the Commission about the items which should comprise the RPBS Schedule, their conditions of supply and other matters relating to the RPBS. The RPRC is comprised of experts nominated by medical and pharmaceutical organisations, DVA and the RSL. Within RPRC guidelines, departmental pharmacists may authorise access to drugs outside the PBS and RPBS Schedules, as well as approve the ‘authority required’ drugs on the Schedule.

To ensure equitable access to medication, the pharmaceutical allowance reimburses medication expenditure up to a defined limit and a safety net provides protection for people who require chronic medication.

In addition, the pharmaceutical service associated with the RPBS includes the following activities:

• remuneration of pharmacists for dispensing RPBS prescriptions;

• regular review and assessment of the RPBS Schedule;

• supervision of RPBS Authority required processing and ‘prior approval’ arrangements for supply of drugs outside the Schedule; and

• promotion of the quality use of medicines.

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1.2.3 The Quality Use of Medicines program

DVA’s Quality Use of Medicines program is designed to encourage best practice in the prescribing, dispensing and use of veterans’ medications. DVA promotes and conducts education and intervention programs to assist veterans and health service providers to better manage specific health problems and reduce unnecessary risks in medication use.

Regular medication reviews should be made of the elderly patient’s total medications, including non-prescription medications. Apart from ensuring such reviews occur and assisting compliance, medication management involves pharmacists taking a more direct responsibility for achieving definite, agreed outcomes from medication therapy and using their drug therapy knowledge to benefit patients. A number of strategies assist this.

Community-based medication management service

At the request of the doctor and with the entitled person’s consent, an accredited pharmacist reviews the use of medications to identify potential problems and sources of confusion. The consultant pharmacist will recommend appropriate changes to therapy and then monitors the veteran’s ongoing medication use.

Dose Administration Aid (DAA) Trial

DVA, in association with the Department of Medicine at the University of Queensland, is running a trial to determine whether entitled persons living at home are likely to benefit from using dose administration aids (DAAs). The trial is being run in Queensland, New South Wales, Victoria and Tasmania, and will involve approximately 1200 veterans.

Hospital medication management program

In certain private hospitals under contractual arrangements made with the DVA there is now in place a hospital medication management program. The program includes making clinical pharmacist advice available on ward rounds, conducting inpatient medication reviews and advising on the formation of drug committees and hospital formularies. In order to ensure effective communication links between the hospital and community environments, discharge medication planning and follow-up programs are conducted.

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Prescriber Intervention and Feedback Program

This is a rational prescribing initiative introduced after consultation with medical and pharmaceutical organisations, ex-service organisations and the Commonwealth Privacy Commission.

Repatriation Pharmaceutical Benefits Scheme (RPBS) prescription data is extracted and analysed to identify patients who, because of the drug or drug combinations they are taking, may be at risk of a medication misadventure. The doctors involved are contacted and provided with feedback and information about their prescribing for individual patients.

Clinical programs conducted to date have been:

• Polypharmacy

• Drug Interactions

• Drugs in the elderly

• Acid suppressive drugs

• Polypharmacy 2

• Benzodiazepines

• Warfarin

• Therapeutic Duplication

The 2001 program included Polypharmacy as well as, NSAIDs including Cox 2, congestive heart failure and tricyclics.

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MediWise

This program provides resources to assist pharmacists to talk to groups of entitled persons about quality medication use by the elderly. These presentations encourage a more active and responsible role when using medications.

The 1997 kit was revised in 2000 and included a new video featuring Peter Cundall. If you are interested in conducting a MediWise presentation, please contact the DVA Pharmacy Adviser in your State.

MediList

DVA provides this patient-held record card to entitled persons’ doctors and pharmacists. Prescription and over-the-counter medications are noted on the MediList card with the aim of reducing confusion about current medications and assisting in the identification of potential drug interactions.

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1.2.4 Health promotion

DVA health promotion helps entitled persons maintain independence, prevent illness and improve health and quality of life.

Health promotion officers in each DVA State Office develop, coordinate and implement programs about moderate physical activity, living with chronic illness, personal safety and mental health.

Implementation of many of the strategies for health promotion involves partnerships with other organisations, such as other Government departments, community and ex-service organisations and private enterprise.

DVA has a range of educational resources such as books, videos and training programs, which can be obtained from State Offices or local Veterans Affairs Network offices. Topics cover dementia, back care, prostate, posttraumatic stress disorder, incontinence and wound care.

1.2.5 The VVCS - Veterans and Veterans Families Counselling Service (VVCS)

The VVCS provides free and confidential counselling and support for entitled persons of all conflicts and peacekeeping forces, ex-serving members of the Australian Defence Force and their families.

Shopfront centres are located in every State capital and in Canberra, Darwin and Townsville. Regional centres operate in Albury/Wodonga, Lismore, Launceston Southport, Maroochydore and Newcastle.

The VVCS provides assessment, referral and follow up for entitled persons participating in posttraumatic stress disorder programs.

The counselling services are designed to help with a range of difficulties including marital problems, personal and family relationships, stress and anxiety, and employment and social difficulties. Some groups are run for partners and children of entitled persons.

Toll-free telephone access during business hours

During business hours all VVCS Centres offer toll-free telephone access to counselling from anywhere in each State or Territory. The phone numbers are listed in Section 2 of these Notes.

Veterans’ Line

VVCS operates a national freecall after hours crisis counselling telephone service. The phone numbers are listed in Section 2 of these Notes.

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1.3 Veterans’ Affairs Network (VAN)

The VAN is an information, advice and advocacy service. VAN promotes independence and quality of life of entitled persons in their local community. For contact addresses and telephone numbers, see Section 2.

VAN answers questions and provides information on any concerns members of the veteran community may have about pensions, allowances, or health care entitlements; provides up-to-date information and advice on any health, welfare and home support services available in the local community or through the Department; and works with local communities to develop local programs to better meet the needs of the veteran community.

1.4 Veterans’ Affairs Pharmaceutical Approvals Centre (VAPAC)

The VAPAC located in DVA’s Queensland State Office now handles all processing of RPBS approvals. Not only does VAPAC give prescribers access to qualified and experienced pharmacists 24 hours a day to approve prior approval applications, but VAPAC pharmacists are able to consult with doctors on the regime for each patient, to ensure that they are receiving the most appropriate medication for their condition.

1.5 Veterans’ Home Care Program (VHC)

VHC through the provision of a wide range of home care services, will enable entitled persons to maintain and improve their health and well-being and remain living in their own homes longer.

VHC will give eligible Gold and White Card holders, who are assessed as needing home care services, access to domestic assistance, personal care, home and garden maintenance and respite care. These services complement the existing services provided to entitled persons by DVA, which include community nursing, in-home and residential respite care, allied health services, home modifications and transport for health treatment.

Entitled persons can be referred for assessment for VHC services by their doctor, hospital discharge planner, or they can self-refer. Contracted Veterans’ Home Care Assessment/Coordination Agencies and service providers will provide the services.

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2. DVA Contact List

NATIONAL OFFICE

Address	13 Keltie Street Woden ACT 2606
Pharmaceutical Adviser	Health Services Branch Telephone: (02) 6289 6448 Fax: (02) 6289 4727 PO Box 21 Woden ACT 2606

Role of the State Office Pharmacy Section
In each of DVA’s State Offices, the pharmacy section will assist with the administration of pharmaceutical services to our clients. If you require clarification of the Department’s administrative procedures, client’s entitlements, or have a clinical query, then contact the pharmacy section in your DVA State Office.

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NEW SOUTH WALES STATE OFFICE ( also services the ACT)

SYDNEY	STD Area Code 02
Address	Tower B, Centennial Plaza 280 Elizabeth St Surry Hills 2010
Postal Address	GPO Box 9998 Sydney 2001
Accounts address	Health Insurance Commission GPO Box 9998 in your capital city
Pharmacy Adviser/MediWise	9213 7998 9213 7734 9213 7510, or Outside Sydney 1800 113304
General enquiries
Metropolitan callers	9213 7777
Country callers	1300 13 1945 (for interstate callers)
Border towns	1800 555 254 (free call outside metropolitan area)
Health Professionals
Medical	9213 7017
Chiropractic/Osteopathy	9213 7017
Community nursing	9213 7038
Dental / Optical	9213 7020
Oxygen	1800 777 634 (Brisbane)
Physiotherapy	9213 7017
Podiatry	9213 7454
Card holder entitlement queries	9213 7077
	9213 7019
M.E.P.I.	9213 7746
Day Clubs Coordinator	92137225
Rehabilitation Appliances Program	9213 7975
Health promotion	9213 7183 9213 7785 Back to Top
Veterans’ Affairs Network (VAN)
Sydney	Tower B, Centennial Park 280 Elizabeth Street Surry Hills 2010 9213 7900 1300 55 1918 (from anywhere in Australia)
Canberra	10 Moore Street GPO Box 9998 Canberra City 2601 (02) 6267 1411 1300 55 1918
Gosford	Suite 1, 250 Mann Street Gosford 2250 (02) 4323 4945
Lismore	Office 6, Level 1 Conway Court (opp. Memorial Baths) Molesworth Street Lismore 2480 (02) 6622 4481
Newcastle	Ground Floor 6 Auckland Street Newcastle 2300 4926 2733
Parramatta	Shop 3, The Octagon Centre 99 Phillip Street Parramatta 2150 9893 9892
Wollongong	Commonwealth Offices Level 1 43 Burelli Street Wollongong 2500 4226 0190 Back to Top
VVCS - Veterans and Veterans Families Counselling Service
Veterans line	1800 011 046
Sydney	88 Phillip Street Parramatta 2150 9 635 9733 1800 043 503 (free call) 1800 043 503 (veterans’ line)
Canberra	Ground Floor, GO3 Gas Industry House 7-9 Moore Street Canberra City 2601 (02) 6247 2988
Albury/Wodonga	81 Hume Street Wodonga 3690 (02) 6056 1341 1800 043 503 (free call NSW) 1800 011 046 (free call VIC)
Lismore	Office 6, Level 1 Conway Court Molesworth Street Lismore 2480 (02) 6622 4479 1800 043 503 (veterans’ line)

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VICTORIA STATE OFFICE

MELBOURNE	STD Area Code 03
Address	300 Latrobe Street Melbourne 3000
Postal address	GPO Box 9998 Melbourne 3001
Accounts address	Health Insurance Commission GPO Box 9998 in your capital city
Pharmacy Adviser	9284 6442
General enquiries	133 254 1800 555 254 (free call outside metropolitan area) 9284 6440 (facsimile-Pharmacy Section)
Health professionals
Medical	9284 6615
Chiropractic/Osteopathy	9284 6628
Community nursing	9284 6444
Dental	9284 6339
Occupational therapy	9284 6331
Physiotherapy	9284 6335
Podiatry	9284 6391
Anzac Day Centre	78 North Road Brighton 3186 9596 4258
Card holder entitlement queries	9284 6613
Day Clubs Coordinator	9284 6571
Health promotion	9284 6416 Back to Top
Veterans’ Affairs Network (VAN)
Melbourne	300 Latrobe Street Melbourne 3000 9284 6000 1300 55 1918 (from anywhere in Australia)
Ballarat	12 Dawson Street South Ballarat 3350 (03) 5331 3844 1300 55 1918 (from anywhere in Australia)
Frankston	Suite 2, Level 1 54-58 Wells Street Frankston 3199 9783 7312 1300 55 1918 (from anywhere in Australia)
Geelong	200 Malop Street Geelong 3220 (03) 5221 8963 1300 55 1918 (from anywhere in Australia)
Morwell	11 Hazelwood Road Morwell 3840 (03) 5133 0177 1300 55 1918 (from anywhere in Australia)
Wodonga	81 Hume Street Wodonga 3690 (03) 6056 4321 1300 55 1918 (from anywhere in Australia)
VVCS - Veterans and Veterans Families Counselling Service (VVCS)
Veterans’ Line	1800 011 046
Melbourne	290 Burwood Road Hawthorn 3122 9818 0388 1800 011 046 (free call)
Albury/Wodonga	81 Hume Street Wodonga 3690 (02) 6056 1341 1800 011 046 (free call VIC) 1800 043 503 (free call NSW 1800 011046 (veterans’ line)

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QUEENSLAND STATE OFFICE

BRISBANE	STD Area Code 07
Address	5th Floor AMP Place 10 Eagle Street Brisbane 4001
Postal address	GPO Box 9998 Brisbane 4001
Accounts address	Health Insurance Commission GPO Box 9998 in your capital city
Pharmacy Adviser	3223 8652 or 1800 552 580
General enquiries
Metropolitan clients	3223 8333
Country Queensland clients	1800 555 254 (free call outside metropolitan area)
Northern NSW clients of Brisbane Office	1300 13 1945 or 3229 9654 (facsimile)
Health professionals
Medical	3223 8680
Chiropractic/Osteopathy	3223 8307
Community nursing	3223 8800
Other allied health professionals	3223 8333
Occupational therapy	3223 8679
Oxygen	3223 8631
Physiotherapy	3223 8683
Podiatry	3223 8682
Card holder entitlement queries
Surnames: A-Gib	3223 8606
Surnames:Gic-Nic	3223 8355
Surnames:Nic-Z	3223 8667
Day Clubs Coordinator	3223 8654
Carer support	3223 8743
Health promotion	3223 8333 Back to Top
Veterans’ Affairs Network (VAN)
Brisbane	AMP Place 10 Eagle Street Brisbane 4000 (07) 3223 8475 1300 55 1918 (from anywhere in Australia)
Cairns	Level 2 Orchid Plaza 78-87 Abbot Street Cairns 4870 (07) 4052 1126
Gold Coast	12 Short Street Southport 4215 (07) 5630 0203
Maroochydore	5 Carnaby Street Maroochydore QLD 4558 PO Box 1708 Maroochydore QLD 4558 (07) 5479 5112
Townsville	7 Tomlins Street South Townsville 4810 (07) 4722 3344 1300 55 1918 (from anywhere in Australia) Back to Top
VVCS - Veterans and Veterans Families Counselling Service
Veterans’ Line	1800 011 046
Brisbane	Wimpole Place 15 Astor Terrace Spring Hill 4004 3831 6100
Maroochydore	6 Ocean Street Maroochydore 4558 (07) 5479 3992
Southport	National Mutual Plaza 12 Short Street Southport 4215 (07) 5591 6332
Townsville	Shop 4-6, Kirwan Plaza 42 Thuringowa Drive Kirwan 4817 (07) 4723 9155 1800 019 332 (free call)

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SOUTH AUSTRALIA STATE OFFICE (also services NT and Broken Hill NSW)

ADELAIDE	STD Area Code 08
Address	Blackburn House 199 Grenfell Street Adelaide 5000
Postal address	GPO Box 9998 Adelaide 5001
Accounts address	Health Insurance Commission GPO Box 9998 in your capital City
Pharmacy Adviser	8290 0513 or 1800 113304 ext 513
General enquiries
Metropolitan callers	133 254
Country callers	1800 555 254 (free call outside metropolitan area) 8290 0232 (facsimile)
Health professionals
Medical Adviser	(Mon, Wed, Fri PM) 8290 0471
Community nursing	(Mon & Fri AM) 8290 0471
Dental	(Wed) 8290 0481
Occupational therapy	(Mon & Thurs AM) 8290 0247
Podiatry	(Fri AM) 8290 0471
Physiotherapy	(Tue & Thurs PM) 8290 0481
Psychology	(Thurs AM) 8290 0481
Card holder entitlement queries	8290 0381
Rehabilitation Appliances Program	8290 0320
Community Development Adviser	8290 0478
Health promotion	8290 0579 Back to Top
Veterans’ Affairs Network (VAN)
Adelaide	Blackburn House 199 Grenfell Street Adelaide 5000 8290 0555 1300 55 1918 (from anywhere in Australia)
Darwin	Civic Centre 2 Chung Wah Terrace Palmerston NT 0830 (08) 8935 1444 1300 55 1918 (from anywhere in Australia)
VVCS - Veterans and Veterans Families Counselling Service (VVCS)
Veterans’ Line	1800 011 046
Adelaide	99 Frome Street Adelaide 5000 (08) 8290 0300
Darwin	Civic Centre 2 Chung Wah Terrace Palmerston NT 0830 (08) 8935 1444 1300 55 1918 (from anywhere in Australia)

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WESTERN AUSTRALIA STATE OFFICE

PERTH	STD Area Code 08
Address	AMP Building Address 140 St Georges Terrace Perth 6000
Postal address	GPO Box 9998 Perth 6001
Accounts address	Health Insurance Commission GPO Box 9998 in your capital city
Pharmacy Adviser	9366 8337 or 9366 8324
General enquiries
Metropolitan callers	133 254
Country callers	1800 555 254 (free call outside metropolitan area) 9366 8420 (facsimile)
Health professionals
Medical	9366 8539
Chiropractic/Osteopathic	9366 8373
Community nursing	9366 8329
Oxygen	9366 8290
Physiotherapy	9366 8440
Podiatry	9366 8369
Card holder entitlement queries	9366 8373
Day Clubs Coordinator	9366 8355
Health promotion	9366 8365 Back to Top
Veterans’ Affairs Network (VAN)
Perth	12th Floor, AMP Building 140 St Georges Terrace Perth 6000 9366 8444 1300 55 1918 (from anywhere in Australia) Back to Top
VVCS - Veterans and Veterans Families Counselling Service (VVCS)
Veterans’ Line	1800 011 046
Perth	31 Ventnor Avenue West Perth 6005 9481 1955 9481 8252 (facsimile)

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TASMANIA STATE OFFICE

HOBART	STD Area Code 03
Address	254-286 Liverpool St Hobart  TAS  7000 Postal address GPO Box  9998 Hobart 7001
Accounts address	Health Insurance Commission GPO Box 9998 in your capital city
Pharmacy Adviser	6221 6631 (part time)
General enquiries	133 254 1800 555 254 (free call outside metropolitan area) 62216610 (facsimile)
Health professionals
Medical	62216634 (pm only)
Chiropractic/Osteopathic	6221 6685
Community nursing	62216743
Dental	6221 6741
General	6221 6738
Physiotherapy	6221 6729
Podiatry	6221 6741
Occupational therapy	6221 6679
Card holder entitlement queries	6221 6738
Carer Support Coordinator	6221 6629
Day Clubs Coordinator	6221 6629
Health promotion	6221 6697 Back to Top
Veterans’ Affairs Network (VAN)
Hobart	21 Kirksway Place Battery Point 7004 62216628 1300 55 1918 (from anywhere in Australia)
VVCS - Veterans and Veterans Families Counselling Service
Veterans’ Line	1800 011 046
Hobart	254-286 Liverpool St Hobart  TAS  7000 1300 55 1918 (from anywhere in Australia)
Launceston	29 Elphin Road Launceston 7250 6331 7500

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3. Notes for Consultant Pharmacists

This information is based on the provisions of the Veterans’ Entitlements Act 1986 (the Act) and the Treatment Principles, and is aimed at helping you to provide services to entitled persons. Please contact the Pharmacy Adviser in your DVA State Office should you have any queries (See Section 2).

These Notes form part of the Services Agreement (the Agreement) with the Commission. The information contained herein is binding; any breaches may lead to formal legal proceedings or termination of DVA provider status.

For information relating to pharmacist activities with respect to dispensing and supply of pharmaceutical items for entitled persons, please continue to refer to the Schedule of Pharmaceutical Benefits for Approved Pharmacists and Medical Practitioners (the ‘yellow book’).

3.1 Relationship between DVA and health care providers

A decision made by the Commission in 1996 requires DVA to seek written agreements with its health care providers in order that there is a clear definition of the rights and obligations of all parties. Written agreements between health professionals and DVA assist in forging an alliance in which the provision of high quality care for entitled persons is the joint objective.

3.2 Who can provide consultant pharmacist services?

The legislation administered by DVA requires that, where a state or territory has enacted requirements for registration of certain occupations, the provider of the service must be registered, and be contracted with DVA at the time of providing the service.

To gain approval to provide services to entitled persons, you must:

• be registered by the relevant board in the state or territory where the service is provided; and

• be accredited by the Australian Association of Consultant Pharmacy or The Society of Hospital Pharmacists of Australia.

Please remember that your accreditation and state registration must be maintained. DVA may seek to recover payments for services made during times when registration or accreditation was not current.

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3.3 Registration with DVA

All consultant pharmacists must be individually registered with DVA.

1. Registration of appropriately qualified pharmacists with DVA involves the signing of an Agreement (two copies). These and other registration documents can be obtained from the Pharmacy Adviser in your state.

2. If you agree to the terms and conditions set out in the Agreement and these Notes, please complete two (2) copies of the Services Agreement’s Signature page and return them, with evidence of registration and accreditation, to the Pharmacy Adviser in your DVA State Office.

• When completing the Agreement, please be sure to include your business or street address along with your name (do not use PO Box numbers please). This address will be the nominated address for notices forwarded from DVA and should be the same as that provided by the body that has accredited you as a consultant pharmacist.

3. If DVA accepts your application, the second completed copy of the Agreement’s Signature page will be returned for your records. You will be issued with a provider number by DVA and subsequently a provider card by the Health Insurance Commission (HIC) on behalf of DVA.

• The provider number as indicated on the card is to be used when claiming payment and uniquely identifies you in DVA’s account payment system.

The Commission cannot accept financial responsibility for services provided by health care providers who have not signed an Agreement.

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3.4 No obligation on DVA

In agreeing to contract with DVA, you acknowledge that there is no obligation on DVA to provide you with any quantity of business. Contracting with DVA does not mean that DVA will necessarily utilise your services.

3.5 Withdrawal from DVA register

If you decide to move from your area or cease practice, please notify the client and LMO to assist transfer to another consultant pharmacist. Please also notify the Pharmacy Adviser in your DVA State Office of this in writing and return your card.

3.6 DVA’s responsibilities

DVA will accept financial responsibility for the provision of consultant pharmacist services to meet clinically assessed needs of entitled persons if the arrangements are in accordance with the Agreement and these Notes.

Appendix B lists the schedule of fees.

DVA DOES NOT PAY for pharmacy services if the veteran or war widow/widower is NOT ENTITLED to treatment at DVA’s expense.

More information on eligibility and restrictions to services are contained in Section 5.

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4. Your Responsibilities

4.1 Accounts

The Health Insurance Commission (HIC) undertakes the processing of DVA claims. Full details of account paying procedures and HIC contact numbers and addresses are in Appendix A. DVA continues to be responsible for authorising services and queries relating to treatment policy.

If you change your address you must notify the Pharmacy Adviser in your DVA State Office. You may need to be issued with a new provider card and/or number so that your accounts can be paid.

4.1.1 Fees

Payment for services is based on DVA’s schedule of Fees for consultant pharmacist services, which is provided at Appendix B.

DVA’s financial responsibility for the consultant pharmacist services you provide to entitled persons, on behalf of DVA, is limited to the amounts set out in the schedule of fees at Appendix B.

You may not make a separate charge on an entitled person for this service.

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4.2 Standards of care

In addition to meeting state or territory registration requirements (refer to Section 3.2), consultant pharmacists must meet any professional and ethical standards set by the profession.

It is your responsibility to obtain a copy of these standards.

4.3 Noncompliance

DVA conducts a quality assurance program on the care provided to ensure that the care:

• complies with professional standards accepted by DVA; and

• is suitable and appropriate for the client’s needs.

While consultant pharmacist services to clients are generally appropriate and of a high standard, please be aware that if they do not comply with DVA requirements:

• payments of accounts could be withheld; and/or

• your Agreement could be terminated, resulting in your removal from the DVA register.

DVA may initiate action to recover monies if it is found that there has been inappropriate servicing, and may initiate a civil or criminal prosecution if there is evidence of fraud.

DVA may also disclose relevant information, including information about inappropriate servicing, or other unprofessional conduct, to your state registration board or other relevant body. (refer Part I(b) in Services Agreement for further information).

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5. Consultant Pharmacist Services

5.1 Community-based medication management service

Except in certain circumstances, such as a radical change in conditions or medication regimen, and with referral from the patients doctor, the medication management service is for a 12-month period. Fees paid encompass all follow-up required during this period.

The services should be conducted according to standards and procedures set out by the pharmacy profession and must provide the following elements:

1. Assessment of medications

• Generation of a medication history to identify the current range of prescription and non-prescription medications and related therapies.

• Conduct of a medication review, with access to all the entitled person’s medication containers, to identify problems such as:

  • interactions with other drugs, medical conditions, allergies or food;

  • potential adverse effects;

  • medication duplication or unnecessary polypharmacy;

  • drug-caused therapy or conditions;

  • confusion or problems with dose, purpose or use; or

  • outdated medications.

2. Agreement of action with the entitled person

• Confirmation and reinforcement of the entitled person’s understanding of their medication regimen, including expected outcomes and actions to be taken should specified adverse effects occur.

• Assistance with compliance.

• Integration of self-care elements where appropriate.

3. Follow up

• With referring doctor:
  Written report of findings and recommendations is provided. The report is for information and action of the LMO and no changes to medication are made by the consultant pharmacist without LMO approval.

• With entitled person:
  Compliance and medicine-related problems are monitored, and the regimen agreed with the LMO is reinforced, over the next 12 months. This can be by visit, telephone call or as the entitled person collects prescription refills.

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5.2 Referral

A LMO referral, Form D904, must be provided by the entitled person’s doctor to order the medication management service.

In line with quality use of medicines principles adopted by DVA, the target group for community-based medication management review may have the following risk factors:

• currently taking 5 or more regular medications;

• taking more than 12 doses of medication per day;

• significant changes made to medication treatment regimen in the last 3 months;

• medication with a narrow therapeutic index or requiring therapeutic monitoring;

• symptoms suggestive of an adverse drug reaction;

• sub-therapeutic response to treatment with medicines;

• suspected noncompliance or inability to manage medication related therapeutic devices;

• consumers having difficulty managing their own medicines because of literacy or language difficulties, dexterity problems or impaired sight, confusion/dementia or other cognitive difficulties;

• consumers attending a number of different doctors, both general practitioners and specialists; and

• recent discharge from a facility/hospital (in the last 4 weeks).

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5.3 Eligibility

Gold Card holders are eligible for a medication review, and White Card holders are eligible when the medication review relates to an accepted disability, malignant neoplasia, pulmonary tuberculosis or posttraumatic stress disorder if DVA has accepted a claim for treatment of these conditions. Allied veterans, who are holders of an Orange Card, White Card or both, are not eligible for a medication review.

5.4 Restrictions

Specific conditions apply for medication management services provided in nursing homes, hospitals, and for travelling expenses. These conditions are set out below.

Aged residential care facilities (hostels and nursing homes)
DVA will not accept financial responsibility for medication review services provided to residents of aged residential care facilities. These services receive separate government funding.

Hospitals
DVA will not accept separate financial responsibility for the medication management services provided to veterans in hospital.

Travelling Expenses (known as Kilometre Allowance)
The purpose of Kilometre Allowance (KA) is to recompense allied health professionals who are required to treat an entitled person at their home, away from the provider’s normal place of business, for their vehicle and driving costs.

The current policy restricts payment of the KA to travel undertaken beyond a provider’s local area, as reasonable travel is included as a component in the ordinary fee for a home or institutional visit. The allowance only becomes payable where more than 10km are claimed per visit. The KA rate is regularly reviewed.

To claim the KA the provider uses the normal claim for payment form. The provider should enter the total amount of kilometres travelled per journey per client. The Treatment Accounts System (TAS) will automatically deduct the first 10km from each claim.

Appendix B lists the schedule of fees.

5.5 Your responsibility

DVA is reliant on you to ensure the safety, suitability and appropriateness of your recommendations to the entitled persons and their doctors.

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Appendix A — Accounts Procedures

1 THE DVA ACCOUNTS PAYMENT SYSTEM

The Health Insurance Commission (HIC) undertakes the processing of DVA claims.

Incomplete, inaccurate or illegible information causes delays. Please use DVA stationery, provided free by the HIC and designed so that sufficient information is supplied to process the account promptly. See HIC contact numbers for ordering stationery.

Imprinting the entitlement card on DVA stationery minimises errors when processing accounts.

1.1 Provider registration

Providers are issued with plastic identification cards that contain information used in our payment system. These can be used in supplied imprinters, which can be requested from the HIC. Cards contain the provider name, practice address and a number used in our payment system identifying the provider at that place.

When you change your address, a new provider number must be obtained for each new address. If submitting an account with a new address using a provider number relating to another practice, the cheque will go to the previous address.

All changes to details must be submitted in writing to DVA.

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2 BILLING PROCEDURES

Claims for payment for consultant pharmacist services are made by submitting a completed Claim for Treatment Services voucher (D1217) and Health Practitioner Service Voucher (D1221) to the HIC.

This billing procedure is to be used only for consultant pharmacist services as outlined in these Notes. It is not to be used, for example, to claim payment for the supply of pharmaceuticals.

The same consultant pharmacist must have rendered all services in an account. The claim may contain service vouchers of various clients so long as the total number is less than 100.

2.1 Claim for Treatment Services (D1217)

Please use claim Form D1217 when billing. It is supplied in carbonised format and will copy in an imprinter. After completion, attach the relevant Health Practitioner Service Vouchers to your account and send with the "Departmental" copy to HIC. Keep the "Claimant" copy for your records.

This form has mandatory requirements, failure to complete or omissions mean the entire account is returned unpaid.

Claims for payment are submitted to:

Health Insurance Commission
GPO Box 9998 in your capital city.

The Claim for Treatment Services (D1217) is completed this way:

Section A Provider Details: accredited consultant pharmacist who actually provided the service. For cards imprinted, the details will copy; if writing, insert provider details here.

Section B Number of Vouchers: write in total number attached.

Section C Total Amount Claimed: for all attached service vouchers.

Section D Payee Provider Details: only complete this section if the accredited consultant pharmacist who gave the services (as shown in Section A) is not to receive the payment for them.

Refer to the front cover of the form for further directions.

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2.2 The Health Practitioner Service Voucher (D1221)

The Health Practitioner Service Voucher (D1221) details services provided to DVA clients. This voucher can be used in an imprinter. Submit the "Departmental" copy to HIC with a Claim for Treatment Services voucher, (D1217), keep the "Claimant" copy for your records and give the entitled person the "Patient" copy.

The Health Practitioner Service Voucher has mandatory information requirements:

• the practitioner’s name, that of the client and the consultation date;

• the service item number and fee claimed (see Appendix B).

Please get the service voucher signed by the client for each service, give the entitled person the "Patient" copy of the completed service voucher and keep the "Claimant" copy for your records, to help if querying. The "Departmental" copy is sent to the HIC.

The Health Practitioner Service Voucher (D1221) is completed this way:

Section A Patient Details: full name and DVA file number. Imprinter use assists.

If file number unavailable, please write the client’s full name birth date and address.

Section B Condition Treated: can be left blank.

Section C Name of Provider: accredited consultant pharmacist who gave the service.

Section D Referring Practitioner’s Name: doctor providing the D904.

Section E Referring Practitioner’s Provider Number: if unavailable, please supply an address.

Section F Referral Date: as stated.

Section G Doctor’s Referral Form: the D904 must be attached.

Section H Date of Service: the date on which the Report was provided to the doctor and the Patient Care Plan initiated.

Section I Item Number: lists of item numbers and fees (see Appendix B). These will constitute full payment from DVA. No entitled client may be otherwise levied.

Section J: the Amount Claimed for the service provided is written in.

Section K Kilometres Travelled: Enter the total amount of kilometres travelled per journey per client. The Kilometre Allowance will only apply to home visit (Item Number CP41).

Section L Client Declaration: the service recipient signs here unless the provider certifies that the client is unable to.

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3 RECEIVING PAYMENT

When HIC pays a claim for payment, a cheque goes to the provider detailing all services that have been paid. The statement also shows:

• a code and explanation if HIC, on behalf of DVA, has declined to pay;

• whether the amount paid differs from that claimed;

• the veteran’s DVA file number if altered; or, where not supplied; and

• the phone number for any queries.

3.1 Nonpayment of claims

Sometimes a claim will not be paid by HIC. Reasons for this include:

• the claim form is unsigned by the provider,

• the servicing or payee provider is not identified;

• the service voucher is unsigned by the client:

• information needed to pay the claim has been omitted on the service voucher (e.g. date of service, patient name or DVA file number);

• the information is incorrect (e.g. item numbers, veteran’s details).

• no item number or description of the service is provided.

Where appropriate, the entire claim or a number of service vouchers are returned to the provider with an explanation of non-acceptance. The claim or voucher may be resubmitted to the HIC when altered.

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3.2 Resubmitted claims

If an entire claim is returned to you for reasons listed in Section 3.1, please resubmit it to HIC as a whole. If a single voucher or number of vouchers is declined and returned, the information needs amending. The voucher(s) can be resubmitted with the next claim.

3.3 Adjustments

An adjustment may be required if an incorrect payment has been made. Requests for adjustments should be made in writing to the HIC and the following information must be supplied:

• the reason for the adjustment;

• the provider number;

• the claim number (pre-numbered by HIC); and

• details of the client involved.

Please don’t submit your copy of a service voucher or claim form to the HIC for an adjustment. In unusual circumstances, (such as when an entire account is lost in transit), it may be necessary to send your copies to us. If this happens, attaching a letter telling why the account is being resubmitted will be appreciated.

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4 FOR FASTER PROCESSING

• use the client’s entitlement card and our imprinter;

• use our stationery;

• please include the provider name and number;

• complete the mandatory information requirements as listed in Section 2;

• ensure legibility and correctness.

5 INQUIRIES

For inquiries about payment matters, please have the following information ready when contacting HIC:

• provider number and account number (on form D1217); and

• service voucher details: service date; patient’s name; file number.

This assists the process, ensuring our response is both accurate and complete.

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6 CONTACT NUMBERS AND ADDRESSES FOR HIC

For queries on payment issues please contact the HIC on 1300 550 017.

Requests for DVA stationery should be directed to:

HIC Stationery
Locked Bag 4444
Tuggeranong ACT 2901
Fax: (02) 6230 0477
Phone: 1800 067 307

Written queries and completed claims should be sent to:

Health Insurance Commission
GPO Box 9998 in your capital city

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Appendix B — DVA SCHEDULE OF FEES

DVA Schedule of fees

Consultant pharmacist service	Item Number	Fee
Medication Review (in rooms)	CP40	$93.70
Medication Review (home visit)	CP41	$123.05
Kilometre Allowance		76c/km

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