Vietnam Veterans' Children Support Program

Information booklet

August 2006

INTRODUCTION
What is the Vietnam Veterans’ Children Support Program (VVCSP)
Who is Eligible for VVCSP Assistance
The Registration Process

ASSISTANCE AVAILABLE
General Requirements
Assistance with Non-Hospital Dental and Medical Treatment
Assistance with Public and Private Hospital Treatment
Aids and Appliances
Allied Health Care
Home Care
Home Modifications
Pharmaceuticals
Physical Rehabilitation
Respite Care and Emergency Short Term Carer Relief
Travel and Accommodation

PAYMENT OF CLAIMS
Steps required in making a VVCSP Claim
PRIVACY STATEMENT
GUIDELINES STATEMENT
FOR MORE INFORMATION

INTRODUCTION     

What is the VVCSP?

The Vietnam Veterans’ Children Support Program (VVCSP) assists Vietnam veterans’ children, who have certain medical conditions, with the cost of their:

• medical treatment
• medically necessary aids and appliances
• allied health services
• medically necessary travel and accommodation expenses
• home care assistance
• in-home and institutional respite care
• home modifications
• physical rehabilitation.

Assistance under the VVCSP is limited to out-of-pocket expenses after any Medicare, private health insurance or other benefits are payable. The VVCSP is not intended to be a substitute program for other programs, whether Commonwealth, State, Territory or Local Government or community based, which provide assistance, support or benefits for the medical conditions covered by the VVCSP.

The VVCSP is administered by the Department of Veterans’ Affairs (DVA).

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Who is Eligible for Assistance?

A person is eligible to participate in the VVCSP, if the person:

• is a resident Australian citizen; andis a birth child of an Australian Vietnam veteran
• was conceived after the commencement of the veteran parent’s first or only tour of service in Vietnam. [Generally, the veteran parent will have to have ‘Operational Service’ as defined in the Veterans’ Entitlements Act 1986 (VEA) and must be verified by DVA]
• has been diagnosed with one or more of the following medical conditions (“eligible conditions”) –
  • Acute Myeloid Leukaemia;
  • Adrenal Gland Cancer;
  • Spina Bifida Manifesta;
  • Cleft Lip; and/or
  • Cleft Palate.

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The Registration Process

Assistance under the VVCSP is limited to those people who are eligible, have registered and have provided documentary evidence of their eligibility.

To register, applicants must complete and return the registration form and supply the following documentation:

• a certificate from an appropriate medical practitioner stating that the applicant is suffering from an eligible condition and specifying the nature of that condition
• a certified copy or original of the applicant’s full (not an extract) birth certificate
• evidence that the veteran parent had “Operational Service” in Vietnam.

All original registration documents will be returned to the applicant.

Registration forms can be obtained by contacting the VVCSP Help Line on 1800 550 504.

A VVCSP claims kit will be mailed to the applicant after they have been approved and registered. The kit comprises:

• a VVCSP identification card
• VVCSP Claim and Reimbursement forms
• VVCSP Travel Claim forms
• a supply of reply paid envelopes addressed to the VVCSP.

Unsuccessful applicants will be advised in writing and may write to the VVCSP Monitoring Committee for reconsideration if they have not been successful.

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ASSISTANCE AVAILABLE

Assistance is available for services from the following dates –

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General Requirements when Claiming for Assistance

A registered person may be reimbursed for expenses incurred for services provided in Australia for the treatment of accepted VVCSP medical conditions.  The VVCSP is not a substitute for other programs, whether Commonwealth, State or Local Government or community based.  A registered person must claim any benefits the registered person continues to be eligible to receive from other programs before claiming from the VVCSP.  The VVCSP does not reimburse expenses where the registered person is entitled to claim compensation.

The type and amount of assistance provided under the VVCSP is set out in this booklet.  In some exceptional circumstances assistance beyond the amounts noted may be provided under the VVCSP.  An example of an exceptional circumstance is where the assistance provided by another program is not suitable for the registered person (e.g. the waiting list for assistance is unacceptably lengthy in a program, such as the Personal Assistance Device Program (PADP).  The VVCSP may assist in funding a specialised wheelchair).  All claims for assistance in exceptional circumstances must be made in writing. 

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Assistance with Non-Hospital Medical & Dental Treatment

Assistance may be provided for medical and dental services provided by a medical or dental practitioner for the treatment of a VVCSP medical condition.  

Registered persons are encouraged to seek prior approval from the VVCSP for non-hospital medical and dental treatment to be provided by a medical or dental practitioner.  All applications for prior approval must be made at least 14 days prior to receiving the treatment. 

All applications for prior approval and reimbursement must be supported by a statement from the treating medical or dental practitioner stating:

• the treatment is directly related to the registered person’s eligible condition; and
• the clinical need for the treatment; and
• where prior approval is sought, the approximate cost of the treatment.

The VVCSP may, where necessary, seek advice from its Medical and Dental Advisors and request clinical documents from the VVCSP registered person’s medical and/or dental practitioner.

The VVCSP will reimburse the difference between the total amount payable for the service and the Medicare Benefit or any other benefit from another source payable for that service including the National Cleft Lip and Cleft Palate Program.

Assistance is limited in relation to non-hospital dental treatment to a maximum of $2000 in a financial year. 

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Assistance with Medical and/or Dental Treatment provided in a  Public or Private Hospital

Public Hospital - Public Patient

VVCSP registered persons receiving medical treatment in a public hospital, as a public patient for the treatment of an eligible condition, will not be required to make a payment for the treatment or hospital stay.  Therefore, no claim needs to be made through the VVCSP.

Public or Private Hospital – Private Patient

Assistance for hospital accommodation, theatre fees or medical treatment for private patient admissions in either a public hospital or a private hospital will only be made where:

• the VVCSP registered person has private health insurance
• the admission to the private hospital must be directly related to the registered person’s eligible condition
• the private health insurance must insure the registered person for the service provided.

Registered persons are encouraged to seek prior approval from the VVCSP for medical and dental treatment to be provided in a hospital.  All applications for prior approval must be made at least 14 days prior to receiving the treatment. 

All applications for prior approval and reimbursement must be supported by a statement from the treating medical or dental practitioner stating:

• the treatment is directly related to the registered person’s eligible condition
• the clinical need for the treatment
• where prior approval is sought, the approximate cost of the treatment.

The VVCSP may, where necessary, seek advice from its Medical and Dental Advisors and request clinical documents from the VVCSP registered person’s medical and/or dental practitioner.

The VVCSP will reimburse a registered person for:

• medical treatment – the difference between the total amount payable and the Medicare benefit and relevant private health insurance rebate for the service
• hospital accommodation costs and theatre fees – the difference between the total amount payable and the relevant private health insurance rebate for the service
• any excess where the excess is payable by a registered person to obtain treatment for an eligible condition.

The VVCSP will not cover extras (e.g. television rental, telephone calls, newspapers etc). 

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Aids and Appliances Assistance

Assistance is provided for the purchase of aids and appliances prescribed to assist in the treatment of an eligible condition.

If the registered person is eligible through another program for the supply of aids and appliances, an initial assessment of the registered person's clinical need for aids and appliances must be undertaken according to the processes required by that program.  Evidence of this assessment must be provided to the VVCSP Project Officer by the registered person.

If the registered person is not eligible for aids and appliances under another program, an initial assessment of the registered person’s clinical need must be undertaken by the prescriber.  Before the purchase can proceed the prescriber must state in writing that:

• the aids and appliances are directly related to the registered person’s eligible conditions
• the clinical need for aids and appliances
• the approximate cost of the aids and appliances.

The consultation fee for the initial assessment where the registered person is not eligible under another program will be paid by the VVCSP.

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Allied Health Care Assistance

The VVCSP provides assistance with allied health care services if supported by a registered health care professional. The VVCSP registered person does not need to hold private health insurance. However if a VVCSP registered person does have private health insurance cover, the VVCSP will only pay the gap costs once the private insurance has been calculated. Assistance in this area is limited to a maximum of $4,000 per person in any financial year.

The VVCSP assistance covers services provided by health care professionals recognised as DVA approved service providers (ie physiotherapists, occupational therapists, speech pathologists, podiatrists etc.)

Where treatment is required from an allied health provider, the VVCSP registered person must seek prior financial authorisation from the VVCSP.

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Home Care Assistance

Home care assistance may be provided for domestic assistance, personal care, garden and home maintenance where a VVCSP registered person:

• is living independently
• does not have appropriate care arrangements in place with family, friends, or community organisations
• is clinically assessed by a doctor, occupational therapist, psychologist or alternative professional (approved by DVA) as being in need of such services. Generally the assessor would facilitate the service provider.

Domestic Assistance: Includes household cleaning, dishwashing, clothes washing and ironing, shopping, bill paying and meal preparation (if this is not being provided separately). If the registered person is ineligible for domestic assistance services from another program, the VVCSP will pay for domestic assistance by a privately hired home help provider, with the appropriate insurance cover, up to a maximum of $1,560 per person, per financial year, over and above assistance payable from all other sources or programs.

Personal Care: Includes assistance with daily self-care tasks such as eating, bathing, toileting, dressing, grooming, getting in and out of bed and moving about the house. If the registered person is ineligible for personal care from another program, the VVCSP will pay for personal care provided by a privately hired personal carer, with the appropriate insurance cover, up to a maximum of $6,500 per person, per financial year, over and above assistance payable from all other sources or programs.

Home Garden Maintenance: Includes assistance to ensure personal safety in and around the home such as changing light bulbs, minor carpentry and replacing tap washers. It does NOT include major home repairs or garden maintenance such as tree felling or tree removal, or routine garden services such as maintenance of flowerbeds, pruning of roses or mowing. Materials are not covered with this assistance. If the registered person is ineligible for home and garden maintenance from another program, the VVCSP will pay for home maintenance by a privately hired home help provider, with the appropriate insurance cover, to a maximum of $1,300 per person, per financial year, over and above assistance payable from all other sources or programs.

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Home Modification

Assistance may be available for home modifications to assist a VVCSP registered person to remain independent and safe in their home. Home modifications must be prescribed by professionals and/or organisations eligible to prescribe and complying with DVA's Rehabilitation Appliance Program (RAP).                                                              

If the registered person is eligible through another program, an initial assessment of the registered person's clinical need for home modifications must be undertaken according to the processes required by that program.  Evidence of this assessment must be provided to the VVCSP Project Officer.

If the person is not eligible for home modifications under another program an initial assessment of the registered person’s clinical need is undertaken by the prescriber. The prescriber must provide a statement outlining how the home modification is directly related to the registered person’s eligible condition, the clinical need for the home modification; and the approximate cost of the home modification.

Assistance includes internal and/or external handrails, stair lift, widening of doorways, access ramps and replacement of a bath with a hobless shower. Other recommended modifications by the prescriber that do not comply with RAP may be considered for assistance on a case by case basis.  The VVCSP will not pay for the installation of basic utilities to homes (eg. water, sewerage, lighting and heating) or non-essential items such as additional toilets and spa baths.

Home modification assistance is limited to and not to exceed the amount of, or amounts totalling, $5,000 per VVCSP registered person.  Costs incurred beyond this limit are the responsibility of the VVCSP registered person.

Assistance is not provided to registered persons living in Government owned homes.  The Government housing agency is responsible for any modification to its residences in accordance with its procedures.  VVCSP may assist in making modifications to privately rented accommodation, so long as all modifications comply with the requirements of RAP.

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Pharmaceutical Assistance

Assistance may be provided to cover costs for Pharmaceutical Benefits Schedule (PBS) items prescribed for the treatment of a VVCSP medical condition. The amount payable is the amount paid above the concessional beneficiary entitlement cost. As at 1 January 2006 the concessional beneficiary entitlement cost is $4.70 per script. This cost is indexed annually.

In exceptional circumstances the VVCSP may approve payment, less the equivalent concessional beneficiary entitlement cost (if applicable), for pharmaceutical items not listed on the PBS but directly related to the VVCSP registered person’s medical condition.

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Physical Rehabilitation

Assistance for physical rehabilitation is provided for a VVCSP registered person who can demonstrate a beneficial health outcome for their accepted VVCSP medical condition.

A VVCSP registered person must seek approval from the VVCSP prior to commencement of any proposed physical rehabilitation program and the request must be supported by a written recommendation from the VVCSP registered person’s medical practitioner.

The referral from the medical practitioner must demonstrate that the proposed physical rehabilitation will be both structured and supervised by a physiotherapist for a period of no longer than six months. A report from the medical practitioner will be required on completion of the physical rehabilitation outlining the health outcome and benefit to the VVCSP registered person.

Further physical rehabilitation will only be considered if supported by a written report from the VVCSP registered person’s medical practitioner outlining the health outcome and ongoing benefit to the VVCSP registered person.

Gym membership fees and recreational swimming fees cannot be claimed or considered as part of a recommended physical rehabilitation.

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Respite Care and Emergency Short Term Carer Relief

Respite care may be provided under the VVCSP to allow the VVCSP registered person’s usual carer to take a temporary or limited break.

If the registered person is eligible and is provided with respite care through another program, an initial assessment of the registered person's clinical need for respite must be undertaken, according to the processes required by that program.

If the registered person is not eligible for respite care services under another program, an initial assessment of the VVCSP registered person’s clinical need for respite care is required and must be undertaken by a doctor, occupational therapist, psychologist or alternative professional approved by DVA. The assessing professional must provide a statement that the respite care is directly related to the registered person’s eligible condition, the clinical need for the respite care and the approximate cost of the respite care.

Assistance for any combination of medically or professionally approved in-home or institutional respite care is provided to a maximum of $4,000 per person in any financial year. Costs incurred beyond this limit are the responsibility of the VVCSP registered person.

Approved in-home or institutional respite care may be organised by the professional recommending the service. The VVCSP will pay either the VVCSP registered person’s out-of-pocket costs where financial assistance has already been provided by another program e.g. Home and Community Care (HACC) or the basic daily care fee where other assistance has not been provided. 

Emergency short-term relief may be provided for a maximum of up to one week or $1,600 per person per financial year, (in addition to the $4,000 limit) where the only carer alternatives are:

• admission to hospital; or
• the VVCSP registered person being left without adequate care.

While in care, VVCSP registered persons are expected to pay all personal expenses such as clothing, personal toiletries, spending money and outing costs.

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Travel and Accommodation Assistance

As a guide, VVCSP registered persons who live in a rural and remote location with restricted public transport availability and who are required to travel more than 25 km (one way) will be considered for assistance with travel and accommodation to seek appropriate medical treatment. 

All requests for assistance with travel and accommodation must be approved in advance by the VVCSP.

However, travel and accommodation assistance may be provided without approval to a registered person with acute myeloid leukaemia and/or adrenal gland cancer and an authorised attendant provided the travel and accommodation is related directly to the treatment of the acute myeloid leukaemia and/or adrenal gland cancer.

Where a payment is being sought by an authorised attendant to accompany a VVCSP registered person then written certification is required from a treating practitioner that the person’s attendance is necessary.

Air Travel: Air travel must be approved in advance unless prevented by clinical circumstances.  The treating medical practitioner must provide a written statement explaining the clinical circumstances which prevented the registered person seeking prior approval.

Private Vehicle: If a private vehicle is used, the VVCSP may pay an allowance equivalent to the current rate per kilometre travelled for the most direct road route from home (accommodation at the time) to the treating practitioner as paid by the Repatriation Transport Program.

VVCSP will reimburse the cost of car parking that is directly related to the registered person’s time spent in consultation with the treating practitioner (parking tickets must be submitted).

Taxi Fares: Taxi fares may be paid pending approved medical practitioner certification that this form of transport is/was necessary, or where public or private transport is not available.  Without this certification, the VVCSP will only pay the private transport rate provided under the Repatriation Transport Program.

Public Transport: The VVCSP may also pay public transport fares in certain circumstances.

Where travel requires a combination of private motor vehicle, bus, train, tram or intra city only ferry, payment will be provided at the current rate of the DVA Repatriation Transport Program per kilometre travelled for the most direct road route from home (or accommodation at the time) to the treating practitioner. The VVCSP will pay either the actual fare paid or the kilometre allowance, whichever is the lowest. 

Receipts must be provided with all travel claims.

Travel by Ambulance:

If the registered person is transported by ambulance and is accompanied in the ambulance by an authorised attendant VVCSP will not pay travelling allowance for the registered person and the authorised attendant.

Accommodation :

Where a VVCSP registered person can provide evidence of the need for accommodation (ie written certification from the treating practitioner is received prior to the event), the VVCSP may assist with the cost of this accommodation. A combined accommodation and meal allowance at the rates applicable to the DVA Repatriation Transport Program is provided up to a maximum of $500 per episode of treatment.

This maximum payment covers both the registered VVCSP person and an authorised attendant.

Travel for accompanying persons after registered person admitted to hospital

If the registered person is admitted to hospital while accompanied by an authorised attendant, the  attendant is entitled to travel expenses to return home, at the time of admission and then travel expenses to return to the hospital at the time the registered person is discharged.

If the attendant does not choose to return home and chooses to stay in commercial accommodation, the lesser of:

• the amount of allowance that would have been payable had the attendant returned home when the registered person was admitted to hospital, and then back to hospital on the day they were discharged; or
• the amount of accommodation allowance payable for the period the registered person was hospitalised, with a maximum limit of $500;

will be paid.

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PAYMENT OF CLAIMS

Payments for claims of assistance may be in the form of a reimbursement to the VVCSP registered person (or the parent of a minor child, guardian or person authorised with an appropriate power of attorney). Alternatively, the VVCSP may make payments direct to the relevant practitioner or institution, which has provided the service. In special circumstances and with prior VVCSP approval an advance payment to the VVCSP registered person or a payment to a treating practitioner, institution or service supplier can be made.

VVCSP will not provide assistance where the VVCSP registered person is entitled to receive compensation payments.

Approval of a claim on one occasion does not mean that approval will be granted in relation to any subsequent claims. However, items of an unusual nature and/or significant cost will be considered.

All claims must be submitted with a completed and signed VVCSP Claim and Reimbursement  Form and accompanied with an appropriate tax invoice showing evidence of the remaining amount payable after a program provider, Medicare and/or any private health insurance payments (that the claimant may be entitled to) have been claimed . It is not mandatory that a VVCSP registered person must have private health insurance.

VVCSP may reimburse claims direct to the VVCSP registered person or direct to the relevant practitioner or institution, that has provided the service, via electronic funds transfer (EFT) or cheque.

ALL RECEIPTS OR TAX INVOICES PRESENTED TO THE VVCSP FOR PAYMENT MUST BE ATTACHED OR MATCHED TO AN AUTHORISED VVCSP CLAIM AND REIMBURSEMENT FORM BEFORE A PAYMENT CAN BE PROCESSED.

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STEPS REQUIRED IN MAKING A VVCSP CLAIM

Step 1

If required, prior approval is sought from the VVCSP for a service to be provided for a VVCSP registered person.

Step 2

The goods or service must be provided by a medical/health service professional, or a recognised registered business organisation or institution .

Step 3a

A service provider generates a tax invoice, which is paid for by the VVCSP registered person, parent of a minor child, guardian or authorised person with an appropriate power of attorney. The VVCSP registered person submits a completed and signed VVCSP Claim and Reimbursement Form together with the paid invoice for reimbursement to the VVCSP.

or

Step 3b

A service provider generates a tax invoice, which is sent to the VVCSP registered person to be forwarded to the VVCSP for direct payment to the service provider. The tax invoice must be accompanied by a completed and signed VVCSP Claim and Reimbursement Form.

or

Step 3c

A VVCSP service provider generates a tax invoice and sends this directly to VVCSP. It is then matched with the VVCSP Claim and Reimbursement Form for the service sent in by the VVCSP registered person.

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CLAIMS FOR TRAVELLING EXPENSES SHOULD BE SUMITTED USING THE VVCSP TRAVEL CLAIM FORM.

PRIVACY STATEMENT

DVA holds information belonging not only to veterans but also to veterans’ spouses and their children.  The Privacy Act 1988 (Privacy Act) provides for the regulation of the collection, storage, access, use and disclosure of personal information held by Commonwealth agencies.  The Privacy Act provides that a person is allowed access to personal information held about themselves.  Within DVA access to this information is generally provided for under the Freedom of Information.  Complaints that privacy has been breached may be directed to the department for investigation and/or may be made to the Privacy Commissioner.

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GUIDELINES STATEMENT

Guidelines to Prevail

The information provided in this booklet is for information only. For more details please refer to the VVCSP Guidelines and Procedures (“the guidelines”) for the granting of assistance to birth children of Vietnam veteran with specific medical conditions. Where there is a conflict between the information in this booklet and the guidelines, then the guidelines will prevail.

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FOR MORE INFORMATION

If you need more information or further clarification on eligible assistance for out-of-pocket expenses then please contact the VVCSP on:

1800 550 504

or write to:

Project Officer
Vietnam Veterans’ Children Support Program (VVCSP)
Department of Veterans’ Affairs
PO Box 21
WODEN  ACT  2606

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