On 1 October 2019, referrals from 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.
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. Dental and optical services are not affected as they do not require a referral.
At the beginning of the treatment cycle, you will prepare a Patient Care Plan and ask your client about their health goals. At the end of the treatment cycle you will send a report to your 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:
Letters have also been sent to allied health providers who have treated a DVA client during 2019:
Visit Allied Health Professionals for up to date Notes for Allied Health Providers. Fee schedules are available at the Dental and Allied Health fee schedules page.
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 allied health provider role change?
Allied health providers will need to develop a Patient Care Plan for the client at the beginning of the treatment cycle. This should include an assessment using validated outcome measures and SMART goals: Specific, Measurable, Achievable, Relevant and Timed.
At the end of the treatment cycle allied health providers will need to prepare a report on the client’s progress using the mandatory end of cycle report template. The report must include assessment of the client’s progress using validated outcome measures and will include recommendations for further treatment if required. The allied health provider will send the report to the client’s usual GP.
In circumstances where continuity of care is required, the allied health provider should collaborate with the GP to support timely access to GP consultations and allied health treatment for the DVA client.
A collaborative approach ensures that care for DVA clients is well coordinated and remains relevant to their clinical needs.
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 relevant provider notes and fee schedule will advise which therapies are excluded from 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.
Will DVA clients be able to access allied health services outside of the treatment cycle arrangements?
In addition to TPI veterans who are exempt for exercise physiology and physiotherapy services, as part of the treatment cycle arrangements, DVA has developed the At Risk Client Framework. This framework will be used for assessing DVA clients who may need tailored arrangements outside of the treatment cycle in exceptional circumstances. The Framework aims to provide tailored referral and care arrangements for the minority of clients for whom the treatment cycle would detrimentally impact upon their health, wellbeing or treatment; and/or place on them an unreasonable burden or imposition.
The Framework will be used by GPs to determine whether a client needs tailored allied health referral arrangements and provide criteria to assist GPs in making this decision. The Framework arrangements are consistent with the role of the GP as care coordinator in Australian health care, responsible for determining the needs of the patient and referring them to clinically necessary health services. DVA anticipates that only a small number of DVA clients will need tailored arrangements.
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’.
Can exercise physiologists and physiotherapists claim end of treatment cycle reports for TPI veterans?
No. Exercise physiologists and physiotherapists cannot claim the end of treatment cycle report for TPI clients as they are exempt from the treatment cycle arrangements.
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. If the referral is made to a practice the client should aim to see one practitioner from the practice for the full treatment cycle, where possible.
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.
What if the client does not require 12 treatments?
If a client achieves all the outcome measures in their patient care plan in less than 12 treatments, their allied health provider can complete an end of cycle report after a minimum of two sessions (initial plus one other consultation).
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.
Can the treating provider’s clinical notes act as a Patient Care Plan?
Yes, if it contains all the required information.
Is a separate Patient Care Plan required for each condition being treated?
No, only one Patient Care Plan per client is required. However, the Patient Care Plan should be shared with the client’s usual GP at the start of the treatment cycle. This will assist the GP to coordinate the health care for the client. In some circumstances the allied health provider may identify conditions or concerns that were not included in the referral. Sharing a copy of the patient care plan with the client’s usual GP is particularly important in these circumstances.
Will providers be remunerated for completing a Patient Care Plan?
No, Patient Care Plans are best clinical practice and should form part of an initial consultation. These are not a new DVA requirement.
Is a new Patient Care Plan required for a patient who presents with a new condition or a change in an existing condition?
No, an update of the existing Patient Care Plan is sufficient. However, new conditions must be reported to the client’s usual GP.
Is there a minimum number of treatments in a treatment cycle before a report fee can be claimed?
Yes, a minimum of two sessions (initial plus one other consultation) is required.
Will a short length of treatment (e.g. three or four sessions) require a report?
Yes, providers should complete a report at the end of a treatment cycle even if it isn’t 12 sessions. However, to claim a report at least two sessions should have occurred, an initial and another consultation. Completion of the report attracts a payment which can be claimed through usual claiming practices.
Is an end of cycle report required for each condition?
No, the treatment cycle report should include all conditions being treated by the allied health provider.
If the client is referred by a specialist or hospital discharge planner, who is the report sent to?
The allied health provider preparing the report must send a copy to the referring provider and the DVA client’s usual GP.
Is a fee payable for the end of cycle report?
Yes. Allied health providers can claim a fee of $30 (excl. GST) on completion of the report at the end of each treatment cycle. This End of Cycle Report item will be available for reports made from 1 October 2019. Please check the fee schedule for your profession for the relevant item number to claim.