Department of Veterans’ Affairs

From 1 October 2019, the Department of Veterans’ Affairs Treatment Cycle Initiative (TCI) replaces a 12-month referral system for allied health care for veterans and war widows with a 12-session or up to 12-month referral (whichever comes sooner).

The TCI is a GP-centric model, requiring the patient to return to the GP at the end of each treatment cycle for review and further referral if required.

The APA has expressed strong concerns to the Department about the TCI potentially resulting in:

  • Gaps in service
  • Additional out pockets expenses for DVA clients
  • Burden of additional GP visits on DVA clients, especially those with high and complex needs.

We have strongly and successfully advocated for:

  • a delay in the implementation of the TCI from 1 July to 1 October
  • a report writing fee in the fee schedule for allied health providers in recognition of the additional work involved in administering the initiative.
  • Exemptions from the TCI for complex cases

We have also provided forthright feedback on the DVA clinical provider notes, fee schedule and definitions used. The Department has made some adjustments in response to our feedback and committed to considering other comments as part of a broader review it is planning.

The APA has worked intensively with the Department to represent physiotherapists and act in the best interests of veterans.

The delay in implementation has allowed time for greater consultation with clinical experts and the APA has provided forthright feedback, particularly about exempting clients with complex needs and clarification of the provider notes and fee schedule.

DVA has agreed to a $30 fee and to create a simple report template for allied health providers to use when reporting on their patients’ conditions to GPs. We believe this report will require 10-15 minutes’ effort.

We will continue to advocate strongly as the Department has committed to undertake a broader review of programs.

Background

The Treatment Cycle Initiative was first proposed by the Department in 2016 as part of a review of provider arrangements. The proposal was released in 2018 and the APA strongly expressed concern about it and the lack of clinical input into the recommendation. The initiative was unexpectedly announced as a Budget measure in the 2019-20 Federal Budget.

It was due to be implemented on 1 July 2019 but the APA’s strong advocacy efforts resulted in the initiative being delayed until 1 October 2019 to allow for greater consultation and communication.

The APA met with the Minister for Veterans Affairs the Honourable Darren Chester and senior Departmental officials on 3 May 2019 where agreement was reached that high needs, complex cases would be exempted from the initiative.

What you need to know

The Department of Veterans’ Affairs Treatment Cycle will go ahead on 1 October and the APA has been working with the department on a number of components.​

When current referrals expire, clients will be required to return to their GPs who will assess whether a further referral is required.

The GP can refer clients for a further 12 sessions or 12 months (whichever comes sooner) or, if high needs, complex cases they have the discretion to provide uncapped referrals for periods up to 12 months.

Toward the end of each treatment cycle, physiotherapists will be required to provide the client’s GP with a report on their condition. We believe this report will require 10-15 minutes’ effort.

TPIs (totally and permanently incapacitated) are exempt from the requirements of the treatment cycle for physiotherapy and exercise physiology only.

The Department has introduced an At Risk Framework that allows GPs to provide referrals for uncapped sessions for periods of three, six or 12 months.

Every veteran with a current valid referral under the current arrangements will be grandfathered over to a new Treatment Cycle regardless of whether that referral is for two months or 10 months old.

The new referral date for these clients will therefore become 1 October 2019.

Physiotherapists will then have 12 treatments or 12 months (whatever comes first) to provide treatment and be compliant with the new arrangements.

Next steps

We will actively monitor the implementation and impact of the TCI and At Risk Framework over the next 12 months. We will continue to work with the Department to ensure issues and concerns are addressed and will keep the Minister and Shadow Minister informed of our views.

We invite members to keep us informed at policy@australian.physio.

Frequently Asked Questions

Every veteran with a current valid referral under the current arrangements will be grandfathered over to a new Treatment Cycle regardless of whether that referral is for two months or 10 months old.

The new referral date for these clients will, therefore, become 1 October 2019.

Physiotherapists will then have 12 treatments or 12 months (whatever comes first) to provide treatment and be compliant with the new arrangements.

Those with complex cases may be assessed by their usual GPs using the At-Risk Framework that allows for uncapped referrals of up to 12 months to be provided.

While each TCI referral provides up to 12 sessions or`12 months (whichever comes sooner), there is no limit to the number of treatment cycles that a veteran can receive. They can continue to go back to their usual GP as many times as needed for re-referral to a new treatment cycle when they have used their sessions. However, it is at the usual GPs discretion.  A subsequent referral will be provided pending review of the report provided by the allied health provider.

No. TPIs (totally and permanently incapacitated) are exempt from the requirements of the treatment cycle for physiotherapy and exercise physiology only. TPI classification is noted on a client's gold card. This means the current referral arrangement remains in place for TPI clients - the referral is valid for 12 months. TPIs can also be granted an indefinite referral for physiotherapy and exercise physiology only at the discretion of the GP. This can be requested in liaison with the GP.

As per current arrangements, specialists and hospitals can still refer for physiotherapy services under the TCI. However, there are some restrictions:

  • Specialists and hospitals can only refer for the first (one) treatment cycle. A subsequent referral is at the discretion of the GP.

Compared to previous arrangements the terms of business have been updated for Hospital referrers to allow for any member of the managing inpatient team (allied health provider, nurse, medical) to make this referral. Previously this was technically limited to a “discharge planner”.

The Department states that a client’s usual GP is a GP who:

  • has provided the majority of care to the patient over the previous 12 months; or
  • will be providing the majority of care to the patient over the next 12months; or
  • is located at a medical practice that provided the majority of services to the patient in the past 12 months or is likely to provide the majority of services in the next 12months.

If the client does not have a usual GP, then it is recommended that they discuss the arrangement with health professionals they are in contact with or with DVA.  It is important that all clients in general and under this framework have a usual GP, so they can receive high quality primary care.

The At Risk Framework acknowledges that the TCI is not suitable for DVA clients with the most complex needs. It is a framework to enable GPs to assess complex and high needs cases and provide them with uncapped three, six or 12 month referrals outside of the TCI.

The criteria for inclusion:

a) Is the client experiencing:

  1. complex psycho-social factors? OR
  2. severe health conditions or needs that result in the treatment cycle having an adverse impact on their health, treatment and wellbeing? OR
  3. severe function impairments that result in the treatment cycle having an adverse impact on their health, treatment and wellbeing? OR
  4. a combination of severe health, functional impairments or complex psycho social factors that result in the treatment cycle having an adverse impact on their health, treatment and wellbeing?

AND

b) Would the client’s quality of care be improved by tailored referral and oversight arrangements?

It is not considered that any one of these factors by itself would qualify the client for inclusion in this framework.  The key question is quality of care, and better health outcomes being achieved through a more tailored arrangement.  The GP is expected to indicate how the quality of care will be ensured.

While physiotherapists can still only undertake one consultation per day, as per the fee schedule which states: “Two consultations cannot be claimed on the same day”, the end of cycle report fee is not considered to be a ‘consultation’ item. The end of cycle report to ensure it is not part of this requirement, nor does the client need to be present for the completion of the report. As an example, if a physiotherapist claims a PH20 fee item, they would also be able to claim for the PH90 on the same day for that client – assuming that this is either the end of the treatment cycle (ie the 12th session) or from the 8th session if continuity of care is required.

Clients with an existing referral can continue to receive services against that referral for either another 12 sessions from 1 October 2019 or 12 months from the referral date, whichever is sooner. 

For example, if a current referral was issued in July 2019, then from 1 October 2019 the client can have another 12 sessions against this referral.  If the 12 sessions have not been reached by July 2020 then the client will require a new referral.

Specifically:

- for current annual referrals – up to 12 sessions after 1 October 2019 or until the annual referral expires, whichever ends first.
- for current indefinite referrals – up to 12 sessions after 1 October 2019 or until 30 September 2020.

The PH code for the End of Cycle Report is PH90.

Yes this would be compliant – the treatment does not change what would currently happen under similar circumstances.

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.

If the client presents with a new condition, or their condition changes, it is important that the allied health provider communicates this to the client’s usual GP. If the client is a White Card holder, the allied health provider will need to check if DVA arrangements cover treatment of a new condition. Allied health providers should use their clinical judgement to determine whether the client should visit their GP to discuss the new or changed condition, or whether treatment should continue under the current treatment cycle. The Patient Care Plan must be updated to reflect the new or changed condition, and shared with the client’s usual GP.

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, these should all be covered under a single treatment cycle.

Yes, the provider is still able to claim, it just means that they forgo, the $3 GST component of the report – that is they would receive $30 rather than $33 if they were registered for GST.