On 1 October 2019, referrals from general practitioners (GPs) to allied health services changed for DVA clients.
Referrals are valid for up to 12 sessions of treatment or a year, whichever ends first. This new ‘treatment cycle’ aims to improve the quality of care for DVA clients. The client’s usual GP plays a key role as they are the care coordinator in the treatment cycle.
DVA clients can be referred by their usual GP to an allied health provider if they have a clinical need for allied health treatment. Referrals can also be initially made by a medical specialist or hospital discharge planner. Referral arrangements to medical specialists remain unchanged. Dental and optical services are not affected as they do not require a referral.
At the beginning of the treatment cycle, the allied health provider will prepare a Patient Care Plan and ask the client about their health goals. At the end of the treatment cycle the allied health provider will send a report to the client’s usual GP. The report will outline the treatment provided, the progress of the treatment and recommendations for further treatment if required.
The client’s GP will use this report to review the progress of their treatment and assess if further allied health treatment is clinically required, or whether other treatment options are needed. The GP will provide a new referral to the allied health provider if it is needed.
DVA clients will continue to have access to the care they need. Clients can have as many treatment cycles as their GP decides are clinically necessary.
DVA clients can have a separate treatment cycle for each allied health service they require. This includes having treatment cycles for different allied health services at the same time. For example, they may have services provided by a dietician, podiatrist and physiotherapist at the same time.
These changes do not apply to DVA clients with a Totally and Permanently Incapacitated (TPI) Gold Card for physiotherapy and exercise physiology services. When TPI clients use other allied health services, for example, occupational therapy, podiatry or psychology, the treatment cycle arrangements will change their referrals for these services.
DVA has produced leaflets that explain how the treatment cycle works:
Leaflets for your DVA clients are also available:
A letter has also been sent to GPs who have treated a DVA client during 2019:
Visit Notes for providers for up to date Notes for General Practitioners.
In exceptional circumstances, a small percentage of DVA clients may be adversely affected by the treatment cycle arrangements. The purpose of the At Risk Client Framework is to identify and support these clients with tailored referral and care arrangements that are specific to their needs. GPs can use the framework to determine whether a client needs a tailored allied health referral arrangement for up to 12 months to achieve better quality of care. DVA clients must be assessed by their usual GP who will determine whether tailored arrangements are required, in reference to the At Risk Clients Framework. The GP must complete and email the At Risk Client Assessment Form to DVA at treatment.cycle [at] dva.gov.au.
Why are we introducing the treatment cycle?
The treatment cycle aims to provider better care coordination and health outcomes for DVA clients accessing allied health treatment.
How will the GP’s role change?
The GP is key to this new process and will ensure the health care and allied health treatment is the most appropriate treatment for the DVA client’s needs. Oversight and review by the GP of allied health treatment is important to ensure treatment remains the most appropriate for a client’s needs, particularly when managing ongoing or chronic conditions.
The GP will need to use the end of cycle report from the allied health provider to review the client’s progress and assess if further allied health treatment is clinically required, or whether other treatment options are needed.
GPs can refer DVA clients for as many treatment cycles as they consider necessary, and to as many different providers as necessary.
Are any treatments excluded from the new referral arrangements?
The treatment cycle does not apply to:
- dental and optical services, as GP referrals are not currently required
- hearing services
- Open Arms – Veterans & Families Counselling, which provides free and confidential counselling to anyone who has served at least one day in the Australian Defence Force and the veteran community
- therapies that have other treatment limits. The Notes for Allied Health Providers and relevant fee schedule will advise which therapies are excluded from the treatment cycle.
Referrals from GPs to medical specialists (including surgeons and psychiatrists) are not subject to the treatment cycle.
Are any clients excluded from the new referral arrangements?
DVA clients who have a Totally and Permanently Incapacitated (TPI) Gold Card are exempt from the treatment cycle arrangements for exercise physiology and physiotherapy services.
Do treatment cycle referral arrangements apply for DVA clients with a DVA Rehabilitation Plan?
Yes. Allied health services for DVA clients with a DVA medical management rehabilitation plan to assist them to manage their accepted conditions, are funded through their Gold or White Card. The treatment cycle applies to these allied health services.
What are the transition arrangements after the introduction of the treatment cycle on 1 October?
If a DVA client is already receiving allied health treatment, they can continue to see their allied health provider up to 12 more times after 1 October under their existing referral.
If the client has an annual referral, they can receive:
- up to 12 sessions of allied health treatment after 1 October 2019, or
- treatment until their annual referral expires
whichever ends first.
If the client has an indefinite referral, they can receive:
- up to 12 sessions of allied health treatment after 1 October 2019, or
- treatment until 30 September 2020
whichever ends first.
All new referrals from 1 October onwards will be part of the new treatment cycle arrangements, excluding referrals to exercise physiology and physiotherapy for TPI Gold Card holders.
How do I provide feedback or raise concerns if I encounter problems with the treatment cycle?
If you have any questions or feedback about the treatment cycle you can email DVA GeneralEnquiries [at] dva.gov.au
What exemption applies for TPI clients?
The treatment cycle does not apply to exercise physiology or physiotherapy services for TPI Gold Card holders.
TPI clients receiving physiotherapy or exercise physiology:
- need an annual or indefinite referral for physiotherapy or exercise physiology;
- can have as many sessions as are clinically necessary in the period covered by the referral; and
- do not need the physiotherapist or exercise physiologist to report to the GP after 12 sessions.
Exercise physiology and physiotherapy services for TPI clients must be clinically necessary, evidence based and goals focused.
For allied health services other than physiotherapy or exercise physiology, TPI clients must use the treatment cycle.
How can providers identify a TPI client?
TPI clients hold a DVA Gold Card embossed with the letters ‘TPI’.
How long does a referral last?
A referral is valid for one year from the date of issue, or for 12 sessions of allied health treatment, whichever ends first.
Are DVA clients required to attend a face-to-face appointment with their GP to obtain a referral?
Yes. Clients should obtain a new referral from their GP at either an appointment made for this specific purpose or as part of any of their regular appointments.
Can medical specialists and hospital discharge planners refer clients to allied health services?
Yes, medical specialists and hospital discharge planners are able to refer to allied health services for an initial treatment cycle, but subsequent referrals must be made by the client’s usual GP. An initial referral may also be made by a health care professional (other than a hospital discharge planner) as part of a hospital discharge.
Can the referral be made to an allied health practice or does it have to be to an individual allied health professional?
The referral can be made to either an individual allied health provider or an allied health practice.
Is a separate referral required for each condition to be treated?
No. The referral from the GP must specify the condition or conditions to be treated, not the service to be provided. At any one time, an allied health provider should only have one treatment cycle per client, not one treatment cycle per condition per client. If a client has multiple conditions being treated by the same allied health provider, these should all be covered under a single treatment cycle.
Who is responsible for monitoring the number of sessions against each referral?
The treating allied health provider or administrative staff are required to monitor session numbers to ensure the client is receiving treatment under a valid referral.
Is a new referral required if there is a significant gap in treatment?
If there is an unplanned gap in treatment (e.g. if the client attends for three sessions, then stops for six months before returning), the allied health provider should use their clinical judgment to decide whether the client needs a new referral or whether they can continue their current treatment cycle.
Can a DVA client continue to receive treatment while waiting for access to a GP to review the report and provide a new referral?
It is preferred that all allied health treatment is provided against a valid referral. To support continuity of care when treatment frequency is high, the allied health provider can provide the report to the client’s usual GP after 8 sessions, but before the 12th session. This should be done with agreement of the client and their usual GP. For example, this might be necessary where the DVA client lives in a rural area where their GP only visits once a month.
Who can complete the At Risk Client Assessment Form?
DVA clients must be assessed by their usual GP who will determine whether tailored arrangements are required, in reference to the At Risk Clients Framework. The At Risk Client Assessment Form must be completed in full by the GP, including a clinical justification that explains why a tailored referral would better serve the client’s quality of care. This explanation does not need to be exhaustive, however it must be individualised and specific to the client’s circumstances.
Does DVA have to approve the At Risk Client Framework?
No. The client’s usual GP assesses the client against the Framework criteria and makes a clinical decision about whether tailored referral arrangements are required. The GP must lodge the completed assessment with DVA as a record of the arrangement, but DVA does not need to approve the GP’s decision.
How long can a client have a tailored arrangement?
A tailor arrangement can be in place for up to 12 months. Clients’ needs and circumstances change over time, and clients are not expected to maintain their tailored referral and review arrangements indefinitely. They should return to the treatment cycle requirements when appropriate.