Domiciliary Medical Oxygen Therapy

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RAP Schedule no.

AY02, AY16, AY26, AY27, AY32 and AY33 (refer to RAP Schedule Sub Category: Domiciliary Medical Oxygen Therapy)

AY03, AY05, AY07, AY08, AY12, AY15, AY18, AY20 and AY21, (refer to RAP Schedule Sub Category: Other Respiratory Aids and Appliances)

Definition

The Department of Veterans’ Affairs (DVA) defines Domiciliary Medical Oxygen Therapy (DMOT) as the use of prescribed medical oxygen for the management of medical conditions, such as:

  • Asthma
  • Chronic obstructive pulmonary disease
  • Pulmonary hypertension
  • Ischaemic heart disease
  • Interstitial Pulmonary Fibrosis
  • Sleep-Related Breathing Disorders
  • Malignancy
  • Cardiac failure
  • Ischaemic Heart Disease
  • Other conditions must be specified on the DMOT form.

Eligibility

The entitled person must have a clinical need for home oxygen and a:

  • Gold Card; or
  • White Card with an accepted condition relating to the clinical need for the equipment.

Prescribing

Assessing health provider

DMOT items must be prescribed by a suitably qualified assessing health provider as follows:

AY02: Oxygen – Concentrator;
AY26: Oxygen – Cylinder;
AY33: Oxygen or Other Respiratory Aids and Appliances – Non-Contracted Item (Exceptional Circumstances)

  • Respiratory Physicians (S);
  • Cardiologists (S);
  • Oncologists (S); or
  • Respiratory Clinic (RC).

AY16: Oxygen – Consumables and Accessories

  • Respiratory Physicians (S);
  • Cardiologists (S);
  • Oncologists (S);
  • Respiratory Clinic (RC);
  • General Practitioner (GP);
  • Registered Nurse (RN); or
  • Physiotherapist (Physio).

AY32: Oxygen – Education, Follow Up, Refresher Training

  • This item is for the contracted supplier to provide education and training to the entitled person, covering the correct set up and safe use of the prescribed DMOT and other respiratory aids and appliances, including consumables and accessories. This includes yearly refresher training for the entitled person. Carer/s and family members may also attend the entitled person’s training session/s.

Prior approval

Prior approval is not required for the supply of DMOT as long as all eligibility criteria and quantity limits are met and contracted DMOT items are prescribed.

Prior approval is required for the supply of non-contracted DMOT items under RAP Item AY33. DVA will only consider this in exceptional circumstances when an entitled person’s clinical need cannot be met by contracted DMOT items. The assessing health provider must explain the clinical reasons for the supply of non-contracted DMOT items in the D0804 - Application for Domiciliary Medical Oxygen Therapy and/or Other Respiratory Aids and Appliances form.

Deciding on the most appropriate treatment

An assessment needs to be conducted by a suitably qualified assessing health provider to determine the clinical need and the most suitable treatment.

Chronic Airways Disease, Pulmonary Fibrosis and other respiratory disease – Oxygen will be provided where the following criteria is met. The entitled person’s:

  • PaO2 is equal to or less than 55 mmHg in the absence of complicating factors.
  • PaO2 is equal to or less than 60 mmHg where significant complicating factors such as chronic anaemia, pulmonary hypertension, or polycythaemia exist.
  • Treatment of the respiratory condition should be optimised, and a stable state achieved where possible, before blood gases are obtained.

The oxygen flow that maintains a PaO2> 60 mmHg (SaO2> 90%) should be identified where possible.

Asthma – The entitled person has experienced repeated episodes of sudden life-threatening asthma despite compliance with appropriate maintenance therapy.

Palliative (cancer)– The entitled person has cancer, with lung involvement causing hypoxaemia, and a life expectancy of less than six months.

Nocturnal Hypoxaemia – The entitled person has isolated nocturnal hypoxaemia with nocturnal oxygen saturation equal to or less than 90 percent for more than 5% of the night, based on continuous overnight SaO2 monitoring during sleep, and secondary effects of chronic hypoxia such as daytime somnolence, polycythaemia or right heart failure are present. Where possible, an oxygen flow that maintains SaO2 greater than 90% should be identified.

Hypoxia with exercise (Exertional Hypoxaemia) –The entitled person experiences exercise induced oxygen desaturation on either a walk or step test to SaO2 < 90% while breathing room air, PLUS a demonstrable improvement in exercise performance on supplemental oxygen.

Please provide the results that demonstrate this as justification. An oxygen flow to achieve improvement should also be established.

The entitled person will be provided with equipment best suited to their needs to facilitate 2 hours use/day in the most cost efficient manner.  Should additional supplies be required, these should be requested by the assessing health provider.

Cardiac Disorders - The entitled person’s PaO2 at rest is less than 55 mmHg on room air in the absence of significant complicating factors, or 60 mmHg where significant complicating factors exist (see above).

In isolated cases of extreme cardiac disability, oxygen may be prescribed without blood gas measurements in the following circumstances:

  • Severe intractable angina on maximal drug therapy where further surgery is not clinically appropriate.
  • Recurrent episodic pulmonary oedema, severe pulmonary hypertension or severe chronic cardiac failure where no other drug therapy or interventional procedures are possible.

These indications are to be primarily thought of as palliative care.

Nebuliser Therapy - It is considered inappropriate for oxygen cylinders to be used for nebuliser therapy, as a nebuliser pump is adequate, and avoids any risk of hyperoxia.

Other - Assessing health providers may prescribe a variety of oxygen therapies including portable oxygen.

Special Circumstances - Requests for DMOT outside the Guidelines should be discussed with the DVA Rehabilitation Appliances Program on

1800 550 457 (option 1) or email rapgeneralenquiries [at] dva.gov.au.

Prescription and review arrangements

Prescription Period

From 1 June 2021, prescriptions for DMOT are valid for two years. If DMOT is required beyond the two year period, the assessing health provider must complete a new prescription before the two year period expires. 

Reviewing the entitled person’s prescription

The assessing health provider should regularly review the entitled person’s need for DMOT to ensure the prescription is still suitable for the client’s condition.

If a change of prescription is required, the assessing health provider can complete a new prescription within the two year period.

To assist with reviewing the prescription, the contracted supplier will provide to the assessing health provider data reports on the entitled person’s use of DMOT. This will happen when:

  • the entitled person is not showing compliance with DMOT over a 30 day period.
  • the prescription is nearing the end of the two year period.
  • the assessing health provider requests it.
  • Sustained unusually high oxygen use is detected.

Request for treatment

For a Gold Card holder

  1. An assessment must be conducted by a suitably qualified assessing health provider to determine the clinical need and the most suitable treatment.
  2. The assessing health provider should complete the D0804 - Application for Domiciliary Medical Oxygen Therapy and/or Other Respiratory Aids and Appliances form and forward it to one of the contracted suppliers detailed on the last page of the form.
  3. The contracted supplier will seek prior approval if required from DVA.

For a White Card holder

  1. An assessment must be conducted by a suitably qualified assessing health provider to determine the clinical need and the most suitable treatment.
  2. Ring DVA on 1800 550 457 or email rapgeneralenquiries [at] dva.gov.au to check eligibility under the entitled person’s accepted disability(ies).
  3. If the entitled person is eligible, the assessing health provider should complete the D0804 - Application for Domiciliary Medical Oxygen Therapy and/or Other Respiratory Aids and Appliances form and ensure the entitled person’s medical condition for which the therapy is required is on the form. Forward the form to one of the contracted suppliers detailed on the last page of the form.
  4. The contracted supplier will seek prior approval if required from DVA.

For Urgent or Palliative Requests

In exceptional circumstances, contracted suppliers can deliver DMOT items under urgent emergency arrangements. In these circumstances, the assessing health provider will need to tick ‘Yes’ to the question at the top of the form ‘Is this an urgent request for home oxygen?’ and send the D0804 - Application for Domiciliary Medical Oxygen Therapy and/or Other Respiratory Aids and Appliances form to the contracted supplier. The contracted supplier may contact the assessing health provider to discuss the delivery requirements.

For entitled persons who are residents of or on respite in a Residential Aged Care Facility (RACF)

It is the responsibility of the RACF to provide any oxygen therapy regardless of whether the entitled person is receiving a lower or higher level of care. DVA will not provide oxygen to a client in a RACF. Under the Aged Care Act 1997, the Commonwealth provides funding to RACFs for the provision of ongoing oxygen treatment to residents who require oxygen on an ongoing basis rather than for episodic or short-term illnesses, such as bronchitis.

If a client requires portable oxygen to enable them to continue treatment whilst on social outings and weekend visits, it is the responsibility of the RACF to provide this to the client.

DVA is not responsible for the supply of ongoing oxygen treatment for entitled persons receiving respite care in a Commonwealth funded RACF.

All RACFs can apply to the Department of Health for an oxygen supplement for residents in need of and receiving oxygen treatment on an ongoing basis. This includes residents receiving respite care and is irrespective of the classification level of the resident.

For entitled persons in rural or remote areas

A treating Specialist or Respiratory Clinic may request a GP to provide local clinical management of their client who lives in a rural and remote area. The GP can prescribe for these clients under the authority of the treating Specialist or Respiratory Clinic. The GP’s name and address are to be provided at ‘Other Assessing Health Provider Details’, together with details of the treating Specialist or Respiratory Clinic at ‘Specialist Physician/Respiratory Clinic Details’ on the D0804 - Application for Domiciliary Medical Oxygen Therapy and/or Other Respiratory Aids and Appliances form.

Ceasing DMOT

Where the removal of DMOT equipment is requested by an entitled person, the equipment should not be removed without discussion occurring with the assessing health provider.  It is the responsibility of assessing health provider to notify the contracted supplier if DMOT is no longer clinically indicated. The contracted supplier will arrange to collect the DVA funded equipment.

When an entitled person moves into a RACF for respite or on a permanent basis, it is the responsibility of the entitled person or their next of kin to notify the contracted supplier to suspend or cease the supply.

On the death of an entitled person, it is the responsibility of the entitled person’s next of kin to notify the contracted supplier to cease the supply.

Additional information

Consumables and Accessories

RAP Item AY16 can be prescribed by the assessing health provider at the time of prescribing DMOT using D0804 - Application for Domiciliary Medical Oxygen Therapy and/or Other Respiratory Aids and Appliances form.

After DMOT has been supplied by RAP, requests for consumables and accessories, including replacements, can be prescribed by the assessing health provider or initiated by the entitled person directly to the contracted supplier.

Consumables and accessories should be provided by the contracted supplier who supplied the DMOT where possible. Requests for consumables and accessories from a different contracted supplier will require a copy of the original prescription before supplying.

Consumables and accessories should be replaced when required.

Generators

RAP does not supply generators.

Other Respiratory Aids and Appliances

The following Other Respiratory Aids and Appliances can be prescribed by a suitably qualified assessing health provider using the D0804 - Application for Domiciliary Medical Oxygen Therapy and/or Other Respiratory Aids and Appliances form, as specified below:

AY03*: Other Respiratory Aids and Appliances – Humidifier;
AY05: Other Respiratory Aids and Appliances – Nebuliser;
AY07: Other Respiratory Aids and Appliances – Peak Flow Meter;
AY08*: Other Respiratory Aids and Appliances – Sleep Apnoea Positional Therapy Device;
AY15: Other Respiratory Aids and Appliances – Spacer; and
AY21: Other Respiratory Aids and Appliances – Consumables and Accessories

  • Respiratory Physicians (S);
  • Cardiologists (S);
  • Oncologists (S);
  • Respiratory Clinic (RC);
  • General Practitioner (GP);
  • Registered Nurse (RN); or
  • Physiotherapist (Physio).

AY12: Other Respiratory Aids and Appliances – Respiratory Suction Apparatus

  • Respiratory Physicians (S);
  • Cardiologists (S);
  • Oncologists (S);
  • Respiratory Clinic (RC);
  • General Practitioner (GP);
  • Registered Nurse (RN);
  • Physiotherapist (Physio); or
  • Speech Pathologist (SP).

AY18: Other Respiratory Aids and Appliances – Oscillating Positive Expiratory Pressure (PEP) Device

  • Respiratory Physicians (S);
  • Cardiologists (S);
  • Oncologists (S);
  • Respiratory Clinic (RC);
  • General Practitioner (GP); or
  • Physiotherapist (Physio).

AY20*: Other Respiratory Aids and Appliances – Inspiratory Muscle Trainer

  • Respiratory Physicians (S);
  • Cardiologists (S);
  • Oncologists (S);
  • Respiratory Clinic (RC);
  • General Practitioner (GP);
  • Physiotherapist (Physio); or
  • Speech Pathologist (SP).

*Some restrictions apply to asterisked items– see below

Restrictions on certain Other Respiratory Aids and Appliances

AY03: Other Respiratory Aids and Appliances – Humidifier

Humidifiers are limited to entitled persons receiving DMOT or with a tracheostomy or laryngectomy.

AY08: Other Respiratory Aids and Appliances – Sleep Apnoea Positional Therapy Device

Body position devices that discourage supine sleep. The simplest item to meet functional need will be supplied in the first instance.

AY20: Other Respiratory Aids and Appliances – Inspiratory Muscle Trainer

Inspiratory Muscle Trainers are limited to entitled persons with asthma, bronchitis or chronic obstructive pulmonary disease. DVA will not fund this item for fitness training.

Contracted suppliers

Contracted suppliers are listed on the D0804 - Application for Domiciliary Medical Oxygen Therapy and/or Other Respiratory Aids and Appliances form or visit the DVA website. Contracted suppliers provide all DMOT items covered by this Guideline.

Contracted DMOT items must not be sourced from a non-contracted supplier.

Contracted suppliers will:

  • provide the prescribed DMOT items;
  • provide education, follow-up and refresher training to the entitled person on the correct set up and safe use of DMOT and other respiratory aids and appliances, including consumables and accessories;
  • refer clinical and compliance concerns to the assessing health provider to complete a review of the entitled person’s prescription; and
  • provide data reports to the assessing health provider to assist with reviewing the entitled person’s prescription.

National Disability Insurance Scheme (NDIS)

DMOT can be provided by either DVA’s Rehabilitation Appliances Program or the NDIS through an individual care plan.

Essential Medical Equipment Payment (EMEP)

DVA entitled persons on DMOT may be eligible for the EMEP to assist with the costs of running this essential medical equipment. The assessing health provider may like to discuss this with the entitled person. To find out more and for the relevant claim forms, visit DVA EMEP website.

Australian Standards and legislative requirements

All DMOT devices provided by DVA under contracted arrangements are listed with the Therapeutic Goods Administration.

Health Provider Hotline

1800 550 457

Health Providers can contact DVA for any enquiries by calling the Provider Hotline: (Please press Option 1 when prompted for RAP).

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