Patient Assisted Travel Scheme Policy...Patient assisted travel scheme Policy assistance for live organ donation is separate to Pats. information on the ive l organ donation scheme

Patient assisted travel scheme Policy

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Patient Assisted Travel Scheme Policy WA Country Health Service

This publication is available in alternative formats on request.


The Patient Assisted Travel Scheme (PATS)

- providing equitable access to specialist medical services

for people living in country Western australia.

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Artwork the artwork on the front cover and throughout the

document was reproduced with the kind permission of nyoongar artist, Phil narkle.

Patient assisted travel scheme Policy Patient assisted travel scheme Policy

contents

Pats overview ...................................................................................................... 3

Scheme summary ......................................................................................................................................... 3

intent of the scheme .............................................................................................. 4

eligibility ................................................................................................................. 5

Which people are not covered? .................................................................................................................. 5

What services are covered? ........................................................................................................................ 5

What services are not covered? ................................................................................................................. 6

Country Residency ...................................................................................................................................... 6

Distance ......................................................................................................................................................... 7

Nearest and most appropriate approved medical specialist .................................................................. 7

Escort ............................................................................................................................................................. 8

travel and accommodation assistance: guidelines ................................................ 9

What is not covered ..................................................................................................................................... 9

Travel assistance ......................................................................................................................................... 9

Accommodation assistance .......................................................................................................................11

Pats after inter hospital Patient transfer or Urgent medical transport .............. 12

deceased persons ............................................................................................... 12

service standards for Pats claims ...................................................................... 13

submitting a Pats application ............................................................................. 14

notes on completing your claim ........................................................................... 15

Patient Responsibilities ............................................................................................................................. 15

Authorisedofficer ....................................................................................................................................... 15

Time limit on claims ................................................................................................................................... 16

Missed travel and accommodation / No Show and Did Not Attend .................................................... 16

Unsuccessful or incomplete claims ......................................................................................................... 16

Lost paperwork ........................................................................................................................................... 16

Further information .................................................................................................................................... 16

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reviews and exceptional rulings ........................................................................ 17

What Exceptional Rulings are for .................................................................................................................. 17

Exceptional Rulings do not form precedent ................................................................................................. 17

Process for Exceptional Rulings.................................................................................................................... 17

complaints and compliments .............................................................................. 18

How to complain or compliment .................................................................................................................... 18

Going to the Ombudsman ............................................................................................................................... 18

What happens to the information collected about complaints and reviews? .......................................... 18

Privacy and Confidentiality ................................................................................... 19

auditing ................................................................................................................ 19

appendix one: list of approved specialist services ............................................ 20

appendix two: rural health regions ................................................................... 23

Appendix Three: Claim forms (Sample application and certification forms) ......... 24

Appendix Four: Glossary and Definitions ............................................................ 30

Appendix Five: PATS Office Contacts ................................................................. 32

appendix six: transplants and living donors ...................................................... 33

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Pats overviewScheme summary

The Patient Assisted Travel Scheme (PATS) aims to provide equitable access to specialist medical services for people living in country Western Australia through:

• a subsidy towards the cost of travel and accommodation for eligible permanent country residents and their approved escorts, who are required to travel more than 100 kilometres to access the nearest eligible specialist medical services, whether public or private, and includes consultations via telehealth; or

• limited travel assistance to country residents undergoing renal and cancer treatment who are required to travel more than 70 kilometres to their treatment centre.

Pats is also available to:

• assist eligible escorts that have been recommended by the referring or treating doctor as being medically necessary to accompany a Pats client during their travel;

• return country residents back to their home or transferring hospital after they have been discharged from hospital after an emergency transfer or inter hospital Patient transfer (IHPT) and they need to travel more than 100 kilometres; and

• assist with the cost of returning a country resident to their home town if they die while on Pats-eligible travel and need to be transported more than 100 kilometres. this includes escorts.

the subsidy rates help to reduce the out-of-pocket travel expenses experienced by country people when they need to access specialist medical services that are not available locally. subsidy payments may not cover all travel-related costs. the subsidy includes:

Subsidies available for travel greater than 100 kilometres

Surface transport

Private vehicle 16 cents per kilometre

community bus transporting two or more Pats clients

25 cents per kilometre

train or bus transport economy fare

Air transporteconomy air fare Pilbara or Kimberley residents

For distances where more than 16 hours surface travel would be required cancer patients travelling more than 350 kilometres one way for treatment, orYour doctor certifies air travel is essential for clinical reasons

Accommodationcommercial accommodation Up to $60 per night for a Pats

applicant, or $75 (combined) for a Pats applicant and an approved escort

accommodation subsidies are for a maximum period of six months continuous. extensions may be granted in special circumstances, but should be applied for in advancePrivate accommodation $20 per night each for a Pats

applicant and an approved escort

Subsidies available for travel 70 to 100 kilometres

Patients receiving cancer or renal treatment

$20 per return trip

note: renal treatment includes appointment with a nephrologist or vascular access consultant, surgery and follow up, home therapies training, pre-dialysis education and dialysis treatment

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assistance for live organ donation is separate to Pats. information on the live organ donation scheme can be found on page 33 (Appendix Six).

most medicare-eligible specialist medical services are covered by Pats, but there are some categories that are excluded, including elective, cosmetic, dental and lifestyle treatments. details on eligible services are listed on page 20 (Appendix One).

Payments of Pats subsidies or assistance in advance for eligible travel to the nearest available specialist medical service will only be made once all required information and certification from the treating or referring doctor is received.

these guidelines set out the eligibility criteria, subsidy rates and conditions for receiving the Pats subsidy.

claim forms are available from your local Pats office, hospital and many medical practices. Forms can be downloaded from the Wa country health website here.

if you have any questions, you should contact your local PATS office.

A list of offices and contacts is found at page 32 (Appendix Five).

intent of the schemePATSprovidesfinancialassistance(subsidies)toreducethecostofaccessingspecialistmedicalservices that are not provided locally. PATS assistance is provided in accordance with the following:

• Pats assistance is available to all permanent residents of a Wa country health service region or Peel who are eligible for medicare and who satisfy the eligibility criteria. see map on page 23 (Appendix Two).

• assistance is provided to the nearest available eligible specialist medical service or telehealth service that meets the clinical timeframe specified by the referring or treating doctor.

• assistance is provided to the closest private or public medical specialist services.

• assistance is for services within Western australia only. however, assistance for travel outside of the state may be provided if the referral is to the nearest specialist medical service and all the other criteria are met. this mainly affects the Kimberley and Goldfields regions where the closest specialist may be in darwin or alice springs. also refer to the Interstate Patient Transfer Scheme for treatments that are not available in Western australia.

• assistance is provided when the eligibility criteria is met and all required supporting information and medical certifications are submitted.

• individual circumstances will be taken into consideration and exceptional rulings may be made when an applicant doesn’t strictly meet the eligibility criteria but otherwise meets the intent of the scheme.

• exceptional rulings do not form precedents (a decision that has to be followed in other cases). They enable fair and equitable decisions to be made based on individual circumstances on a case-by-case basis.

• Pats does not cover medical expenses or other costs associated with accessing specialist medical services, such as parking, taxi payments, meals, medical appliances, or medical gap costs.

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eligibilityTo be eligible for the PATS subsidy, you have to:

• be an australian citizen, permanent resident or humanitarian visa holder (subclass 200-204)

• be a resident of a Wa country health service (WACHS) region or the Peel region (see country residency below)

• hold or be eligible for a current medicare card or a reciprocal health care agreement medicare card

• be receiving specialist medical treatment from a medical practitioner who is registered with medicare australia as a specialist in a particular specialty. these are listed in schedule 4 of the Health Insurance Regulations 1975 (Cth). an edited version of this list is reproduced at appendix one, and

• need to travel more than 100 kilometres one way to receive treatment.

limited assistance is available to people who are receiving cancer treatment or dialysis and need to travel between 70 to 100 kilometres one way.

Which people are not covered?

People who are not covered by PATS include those who are:

• not a resident of a Wachs region (see below for details on country residency)

• on a bridging visa

• travelling for treatment outside australia

• claiming damages or other payment for the injury or illness being treated

• injured in a motor vehicle accident and covered by insurance

• injured at work and you are covered by a work-related insurance scheme, such as workers’ compensation

• Fly In Fly Out (FIFO) workers

• school or university boarders in the Perth metropolitan area

• in custody (in jail)

• not eligible for medicare

• metropolitan residents travelling in country regions for work or holidays

• claiming travel or accommodation assistance from any other organisation, such as payments from veteran’s affairs or your health fund.

What services are covered?

• most medicare-eligible specialist medical services (see Appendix One)

• Fitting or replacement of an artificial limb or artificial eye (but not subsequent adjustments)

• next step: inpatient treatment for addiction (travel subsidy only)

• rehabilitation medicine

• complex wheelchair assessment and review

• oral maxillofacial surgery, including the management of facial trauma, such as a jaw fracture, serious dento-facial infections and oral malignancy (cancer) (but not for removing wisdom teeth)

• dental services for children eight years or under if they need hospital-based management of severe dental trauma or severe dento-facial infections, such as cellulitis, or if they have a significant medical co-morbidity or other serious conditions, or require general anaesthetic

• dental services for adults only if they need hospital-based dental services and have a significant medical co-morbidity, or if they have special needs and require general anaesthetic

• cleft lip and cleft palate treatment listed in the Medicare Benefits Schedule

• radiological services not available in your region (if Medicare-approved)

• repatriation of deceased persons where person was Pats-eligible (see criteria in policy).

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What services are not covered?

• treatment that is available in your region

• Treatment not covered by a Medicare Benefits Schedule (MBS) item number

• second opinions unless requested by the treating medical specialist

• radiological procedures if the procedure is available in your region

• non-specialist medical treatment, including treatment by a general practitioner

• research and clinical trials

• experimental treatment

• consultations required for legal purposes

• consultations required for educational support services

• General dental or orthodontic services, including but not limited to:

• the extraction of third molars (wisdom teeth), even if you need general anaesthetic or sedation

• orthodontic treatment (braces)

• non-surgical temporo-mandibular joint treatment (also known as the jaw joint)

• implant surgery or crown and bridge treatment

• endodontics (root canal therapy)

• periodontal (gum) surgery or treatment

• routine oral medicine services

• allied health and other health services including:

• cosmetic surgery

• complementary health treatments, such as acupuncture or herbal therapy

• physiotherapy

• occupational therapy

• speech pathology

• clinical psychology

• podiatry

• dietary and nutrition services

• respiratory therapy

• nursing services or residential care services

• diagnostic work-up visits, if available locally

• services related to surrogacy arrangements

• Procedures that are excluded under department of health policy, including liposuction, gender reassignment surgery, varicose vein procedures, and tattoo removal

• services provided by a general practitioner at a skin clinic

• medical advice, or a medical assessment

• Workplace medical assessments

• travel by ambulance

• treatment in an emergency department, unless you have been referred by your doctor and you see a specialist in the emergency department.

Country Residency

You must live in a WA Country Health Service region or the Peel region. See Appendix Two.

People who live in Peel may be eligible for Peel Pats, which is funded by the south metropolitan health service.

you need to provide proof of your residence in a country area.

your place of residence is usually your address on the electoral roll. other documents including your driver’s license, health care card, or a gas, water or electricity bill may be used as proof of residency if required.

if you have only been a country resident for a limited time, lease or mortgage documents may be used to prove your residency.

if you are a worker who travels around (an itinerant worker, such as a fruit picker or roustabout), your place of residence is where you were staying when the travel for approved medical specialist services began. Proof of your residence may include a letter from your employer or an employment contract, for example.

if you divide your time between two residences, your primary place of residence will be the address on your driver’s licence or the address registered for other official purposes (such as medicare, centrelink or the australian taxation Office).

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If you have no fixed address, you need to be able to show this to be eligible for assistance. Pats offices will accept a letter from your welfare or social worker, or a health professional referring you to specialist services.

there is no minimum length of time of country residency required to be eligible for Pats.

Christmas and Cocos Island residents

If you live on Christmas or Cocos (Keeling) Islands you are not covered by the Western australian Pats scheme, and the indian ocean territories Health Service (IOCTHS) is responsible for your patient assisted travel arrangements.

they can be contacted on:61 8 9162 7609 (Home Island clinic)61 8 9162 6655 (West Island clinic)

information on the health service can be found here.

Distance

You will be eligible for assistance if you have to travel more than 100 kilometres one way from your home to your closest eligible medical specialist.

limited assistance is available if you have to travel between 70 and 100 kilometres for renal or cancer treatment.

distance is worked out using the most direct or common route from the nearest town centre to your permanent residence and the commercial business district (CBD) of the treatment centre you are travelling to. For travel to the Perth metropolitan area, this is the Perth cBd, regardless of which suburb your appointment is in. if you live a long way from your nearest town centre, talk to your local Pats clerk, and they will add extra kilometres (the distance between your home and the town centre) to your claim.

Nearest and most appropriate approved medical specialist

PATS assistance is only available to the nearest appropriate medical specialist.

Pats does not differentiate between public or private specialists. Pats also does not differentiate between face-to-face consultations and telehealth consultations. this means that if the nearest appropriate medical specialist appointment is available by telehealth, you will be assisted to attend that appointment if the appointment is more than 100 kilometres away.

Your doctor should take into account your specific medical needs and urgency when they refer you to a specialist, and put this on your application form. if you are referred to a specialist that is not the closest, you should make sure your Pats application is assessed before you travel.

if there is no suitable or direct transport service available, then travel to the most accessible service may be approved. you need to discuss this with the local PATS office.

Exceptions to the nearest specialist service criteria

if you urgently need to see a specialist, or the waiting list for visiting specialist puts you at medical risk, you may be eligible for the Pats subsidy to see a specialist who is not the closest.

there may be other medical reasons why the closest specialist is not the most appropriate specialist. in this situation you may be asked to provide further information to support your request. your doctor should provide as much advice to the regional Pats team as possible about the reason why the nearest service is not the most appropriate (such as complexity, the requirement for a subspecialty, specific information about why the regional service is not suitable etc.) These cases will be dealt with under the exceptional rulings process.

Telehealth and follow up appointments

If you have a follow up appointment, the appointment should be done by telehealth where it isclinically(medically)appropriate.Yourspecialist,doctororlocalPATSofficewillbeabletogive you more information on telehealth availability.

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Escort

An escort is a person who travels with you to your appointment to assist you with your travel. An escort needs to be considered medically necessary by your doctor or treating specialist to be approved for the PATS subsidy.

an escort must be aged 18 years or over. an escort is responsible for your transport and accommodation needs during treatment. they must accompany you during your travel and when attending appointments, and must be able to take care of you (for example, to carry your bags if you can’t do it yourself, and get meals for you).

cultural, emotional or social comfort cannot be the main reason for an escort to accompany you.

Criteria for approval of an escort

escorts are automatically approved:

• for children under the age of 18

• if centrelink considers the escort a principal carer

• if you are a nominated support person for a home dialysis patient receiving training

• if you are receiving cancer treatment

• if an escort is legally required to make decisions on your behalf (see department of health consent to treatment Policy here ), and/or

• if your referring or treating doctor specifies in writing why an escort’s presence is essential. your doctor has to explain why you would be unable to manage your treatment alone.

examples of wording for doctors:

• Patient requires physical care assistance during travel/while in Perth

• Patient has early stage dementia and is easily disoriented

• Patient is at significant risk of seizure

• Patient is unable to drive within 24 hours of treatment (for clients who have driven to their appointments)

an escort will be approved if:

Impairment • you have cognitive impairment, such as acquired

brain injury or dementia, a visual or mobility impairment, or are frail aged.

Active role of carer • a carer is responsible for your medical treatment,

such dialysis, catheterising or administering treatment, or needs to tend to your personal care requirements if you have a physical disability.

Necessary assistance

• an escort is needed to assist you during long term specialist medical treatment, or in decision making, or where English is not your first language and no translator is available at the treatment centre.

escorts may not be approved if you are in hospital unless you have a life-threatening condition, except when required because of the reasons listed above. this is because you are considered to be in the care of medical and nursing staff while you are in hospital.

an escort may be approved if you need help to travel after you have been in hospital following an inter hospital Patient transfer or after an accident or incident needing emergency transfer by royal Flying doctor service or ambulance to hospital more than 100 kilometres from where you live.

if an escort does not stay with you when you are receiving treatment, but is required to transport you to or from home, they may be able to claim two return journeys when you are hospitalised. this will depend on whether it is more cost effective to do this rather than pay for continuing accommodation. your escort will need to speak to your local Pats office if this happens.

if a child is a boarder in the Perth metropolitan area but is hospitalised and is under 18, a parent living in the country will be approved as an escort, even though the child is not Pats-eligible.

Escorts for childbirth

Unless there is a medical requirement for an escort, escorts for childbirth are not eligible for the Pats subsidy.

Escort to a newborn infant

if a mother and newborn are hospitalised together, the mother is considered to be the newborn’s escort. if the mother has a medical condition and is unable to care for her newborn, the mother and the newborn may have separate escorts. the medical specialist must confirm that the mother is unable to provide the necessary care for her newborn.

Replacement escorts

if an escort needs to return home unexpectedly, or he or she becomes ill, a replacement escort may be approved. you will need to give your Pats office evidence about why the escort needs to return home. if you require an escort over a long period, multiple escorts will only be considered as part of an exceptional ruling.

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travel and accommodation assistance: guidelinesYou will need to keep tax receipts for your commercial accommodation or travel to have your PATS subsidy reimbursed.

What is not covered

The travel subsidy is only available to get you from your home town to the city or town where you are going for treatment.

Before you leave, you need to get yourself to the airport, bus or train station. When you arrive, you will need to make your own arrangements to get from the airport, bus or train station to your accommodation. taxi vouchers are not normally provided unless there is a medical requirement (see below). You will also need to make your own arrangements to get from your accommodation to your medical appointments.

the fuel subsidy payments may not cover all costs associated with your travel, such as wear and tear on your vehicle. you should also be aware that the Pats subsidy does not cover parking in hospital car parks or other expenses associated with your travel. if you hire a car, you are still eligible to claim the fuel subsidy only but not any hire charges.

Pats may not cover the full costs of your accommodation. you are responsible for any gap between the subsidy and the total cost of your accommodation. Pats does not cover the cost of food or drink while you are travelling, including any meals provided at your accommodation.

Pats accommodation assistance is not available while you are hospitalised.

If you are in financial hardship, you should contact the health service social worker to see whether you are eligible for assistance from other sources.

Transport once you are in Perth

PATS staff can help you to find information on how to use public transport and other transport alternatives in Perth. there are a number of bus services that operate from the domestic airports to Perth, including route 380 from t1 and t2, which has accessible buses that stop at Belmont Forum and victoria Park and route 40 from t3 and t4, which goes to elizabeth Quay via Great eastern highway.

Public transport options from the airport can be found here.

information on taxi availability and costs from the airport can be found here.

if you are aboriginal and staying in an aboriginal hostel, country health connection provides limited transport assistance in the Perth metropolitan area during business hours. Your PATS office will be able to assist you to book country health connection.

Travel assistance

Assistance in advance

if you are eligible for Pats assistance, you may receive assistance in advance for transport and accommodation on request. this is usually done by providing fuel cards or local Purchase orders for you to use at the service station, or by the Pats clerk booking your fares or accommodation on your behalf. no cash payments will be made in advance. you need to show that you have an appointment with a specialist to be able to access assistance in advance.

Check with your local PATS office to see if they can help you before you travel. you need to allow enough time for Pats staff to be able to assist you – generally, at least 48 hours’ notice is required.

sometimes you will not be able to claim assistance in advance for accommodation if the accommodation provider will not accept a local Purchase Order from your PATS office.

if assistance is paid in advance, you need to make sure you can pay the gap between the subsidy and the full cost of accommodation.

if you receive assistance in advance, you need to provide the PATS office with proof you attended your appointment. if you don’t do this, and PATS staff can’t find other evidence you went to your appointment, this may delay your future subsidies.

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Travel between 70 and 100 kilometres

if you travel between 70 and 100 kilometres one way while you are receiving cancer or renal dialysis treatment, you are eligible for a $20 travel subsidy for each return trip. treatment includes radiotherapy, chemotherapy, dialysis and surgery, for example. this is regardless of whether the trip is by private car or other paid transport. the subsidy can be used for travel or accommodation.

York and Northam residents

if you live in the town boundaries of northam or york, you are eligible for Pats subsidies.

Travel home during extended periods of treatment

if you have to stay away from home for an extended period for treatment, Pats will not usually provide assistance to return home during this time.

however, Pats may subsidise your return home if there are special reasons.this may be approved through the exceptional ruling process. return trips during periods of treatment must be supported by the treating doctor.

Travelling country resident

if you are a permanent resident of a Wachs region and you are temporarily away from home in another Wachs region, and you need to access specialist medical services, you may be eligible to receive the Pats subsidy. this applies only if the need for treatment was not known or not foreseeable when you left your usual place of residence. the Pats subsidy is limited to returning you either home or to where you were when you needed medical assistance, whichever is less. your home region is responsible for Pats costs, but the PATS office in the region travelled to may be able to assist with travel arrangements if necessary.

if you are travelling to the metropolitan area for unrelated reasons (such as to visit family or for holidays) and you become sick or need to attend a medical specialist’s appointment, you are not eligible for Pats to return home.

see assistance following inter hospital Patient transfer.

Taxi travel

taxi vouchers are only supplied if you have a medical or physical condition that requires them. Decisions are made by your local PATS office on

a case-by-case basis. you may be eligible for taxi vouchers if you:

• are permanently unable to walk, or use complex walking aids

• are blind or have a severe visual impairment

• have a disability or condition that make it impractical for you to use other transport, such as an intellectual impairment

• are very ill and unable to use other transport, such as after a major surgical procedure.

taxi vouchers will only be provided for use in Perth, not for travel to your local airport or bus station.

Air travel

In the Goldfields, Great Southern and Midwest

If you live in the Goldfields, Great Southern or Midwest, flights need to be approved by the regional Pats coordinator and each request is assessed on a case-by-case basis. Flights will not be approved unless there is sufficient documentation supporting the need to fly. There needs to be a clear medical reason for you to fly.

it is important that your doctor writes the medical reasons why you need to travel by air as there needs to be a reason more than convenience or preference. if your doctor does not provide enough detail, the PATS office may request that your doctor or specialist provides more information on the clinical (medical) risk if you don’t travel by air.

Fitness to fly

if you have been hospitalised and undergone a surgical procedure under general anaesthetic, the airline may need a Fitness to Fly or travel clearance form. The flying exclusion from the date of the surgery may vary depending on the airline and the surgical procedure performed. you can check this with the airline.

The Fitness to Fly form needs to be filled out by the treating medical officer or doctor before you fly. Your treating hospital will ensure the Fitness to Fly form is completed and send a copy to your PATS office. You should carry your Fitness to Fly form with you.

you may also need extra accommodation days to fit with the medical requirements of the airline, so your doctor will need to note this in your Pats claim form or Specialist Certification form.

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if you need assistance, contact your local Pats office. Please note that PATS staff are not qualified to make decisions on whether you need a Fitness to Fly form.

Relocated Dialysis Patients and Transport Assistance

if you were required to relocate so you could access dialysis treatment, and a dialysis satellite unit then becomes available close to your original home, Pats assistance will be provided for the return journey.

Accommodation assistance

You are eligible for accommodation assistance only if you live more than 100 kilometres from the treatment centre and:

• the medical specialist certifies that you need to stay overnight for follow-up

• the forward and return journeys cannot reasonably be completed in one day because of factors such as:

• time required travelling

• type of travel

• transport schedules and availability

• appointment or treatment time, or

• your medical condition.

if you are required to attend another associated health-related appointment after your specialist appointment, you may be able to extend your stay by one or two days.

Please be aware that Pats clerks normally do not book accommodation except for some hostels, such as milroy lodge, ronald mcdonald house or aboriginal hostels. your Pats clerk can provide you with a list of accommodation that may be

located close to your treatment centre or offer lower cost options for Pats clients. this is also available on the Pats website here. these providers are not endorsed by the Wa country health service, and the list is provided for your information only.

if your appointments run behind schedule and you can’t return home, please ask your specialist to write this in your certification form. Let your local PATS office know as soon as you are able to, and you may be eligible for a subsidy for your extra accommodation or travel expenses.

Accommodation subsidy ends under certain circumstances

if you have been staying in the treatment centre for more than six months, you will need to have your claim for the Pats subsidy re-assessed.

if there are special circumstances, a further extension of accommodation assistance may be granted under an exceptional ruling.

Pats accommodation assistance will not be paid indefinitely and if you require continuous ongoing treatment you will need to consider relocating to be near the treatment centre. you may be eligible for assistance under the national rental affordability scheme through the department of communities, or able to receive rental assistance through centrelink.

Accommodation for allied health appointments

if you need to access allied or dental services, and you are attending the treatment centre for specialist medical treatment, in some cases you can extend your trip by one or two days to accommodate these appointments.

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Pats after inter hospital Patient transfer or Urgent medical transportIf you are transferred from one hospital to another, or you are transferred to hospital by Royal Flying Doctor Service or ambulance, you may be eligible for the PATS subsidy to return home after you have been discharged.

if you were hospitalised while travelling in a Wachs region, and you choose to return to that Wachs region, you will only receive the equivalent subsidy you would have got if you returned home. For example, if you live in albany and you were travelling in Broome at the time you were hospitalised and were flown to Perth, you will only receive funding equivalent to returning from Perth to albany. if there is a difference between the two amounts because you choose not to return home, you will receive the lesser amount.

if you travel between hospitals as an inpatient, this is known as inter hospital Patient transfer, and the cost for this is the responsibility of the hospital that refers you. For example, if Kalgoorlie hospital transfers you to Fiona stanley hospital, Kalgoorlie hospital will pay all the costs associated with transporting you to Fiona stanley. if you are transferred to hospital in the home, you are also considered an inpatient, and your costs are not covered by Pats.

you are only eligible for Pats assistance to return home after you have been discharged from hospital. the hospital discharging you needs to contact your local PATS office to arrange your return home before your discharge. your home PATS office is responsible for costs.

you will be eligible for a Pats accommodation subsidy after you have been discharged if:

• you have to stay at the treatment centre for outpatient specialist medical care, or for a short period for a follow-up appointment

• you cannot fly because of airline requirements (that is, you are not yet fit to fly)

• you cannot get immediate transport home after discharge because there is no transport available. For example, there are no buses or flights on that day, or

• you have to wait overnight while you are in transit. For example, you are waiting for transport back to a remote community.

deceased personsPATS meets the base cost of repatriating the deceased to their former place of residence for a person who:

• died within Western Australia (WA) while on inter-hospital transfer or during Patient Assisted Travel Scheme (PATS)-approved or Pats-eligible travel, or

• was an escort assisting a person travelling with approved Pats assistance.

if a child dies after birth, the parent is provided with financial assistance for the transportation of the child’s body.

metropolitan hospital staff (usually a social worker or Aboriginal Health Liaison Officer) will arrange for the deceased person to be transported to the local health service or funeral director in consultation with families.

country health connection is able to assist aboriginal families with these arrangements. the health service in the region the person lived is responsible for costs, and Pats staff assist with the paperwork.

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service standards for Pats claims • All information provided will be verified or

clarified before claims are approved or not approved.

• Where a claim is not approved you will be provided with an explanation why your claim has not been supported, as well as details on how you may seek a review of your claim or submit additional information to support your claim.

• reviews will be conducted through a fair, impartial and transparent process.

• complaints and requests for review will be dealt with promptly and you will be advised of the outcome in writing, as well as orally if this is needed.

• you can check the status of your claim at any time with your local PATS office.

• Privacy and confidentiality is respected and

maintained.

• you should submit your Pats application Form

before travel so you know whether you are

eligible for the Pats subsidy. your costs may

not be reimbursed if you don’t do this.

• claims will be assessed within 10 working days

of all information being submitted.

• claims requiring urgent approval due to the

urgent clinical nature of your referral will be

handled as a priority and every effort will be

made to meet your travel requirements and

bookings.

• Payment of approved claims will be made within

30 working days (six weeks) of all receipts and

specialist certifications being received.

1312


submitting a Pats applicationThis is the process for most PATS applications. There may be some regions trialling different forms,soaskyourPATSofficeifyouareunsure.Ifyouneedanyhelpwithyourapplication,contactyourPATSoffice.

1. Get a PATS Application Form from your local PATS office or referring doctor, or online here.

2. your doctor needs to complete and sign section a of this form. your doctor needs to give enough detail so the PATS office can assess your claim, especially if you need to fly or to have an escort.

3. you need to complete and sign section B of this form.

1. send the completed, signed PATS Application Form to your local PATS office (by mail, email, or in person) as soon as you can. It may take up to ten days to process your claim. if you haven’t had much notice of your appointment and need your claim processed urgently, please advise the Pats clerk when you lodge your claim.

2. if your Pats application is approved, you will receive a PATSSpecialistCertificationForm.

1. take the PATSSpecialistCertificationForm to your appointment with the specialist.

2. your specialist or another staff member at the clinic needs to complete Section A of this form at this appointment and return it to you. if your application needs clinical detail (for example, to explain why you need extended accommodation in Perth), you need to make sure a doctor fills it out.

1. you need to complete and sign Section B of the PATSSpecialistCertificationForm. you need to attach original receipts or tax invoices to your claim form.

2. return the completed PATSSpecialistCertificationForm to your local PATS office.

if you live in the south West, you need to:

1. Ask your doctor to phone or fax the SW PATS office to register your claim.

2. Contact the South West PATS office on 1800 823 131 to complete your registration prior to your appointment.

3. if approved, you will receive a PATSSpecialistCertificationForm to take to the specialist.

4. The specialist or specialist’s staff will sign this form to confirm your attendance and any further necessary appointments.

5. Post, fax, or email the PATSSpecialistCertificationForm to your south West Pats office within twelve months of your appointment and ensure all necessary receipts are attached.

6. Payment of any assistance you are entitled to will then be posted (cheque) or paid by EFT.

Before you travel to your specialist’s appointment

At your appointment

After your appointment

In the South West

South West PATS can be contacted on:

T: 1800 823 131 (Monday to Friday 8:30am to 4:30pm), F: 08 9427 9011, E: [email protected]

Postal: South West PATS Office, PO Box 712, Osborne Park BC WA 6916

Before your specialist appointment

14


mailto:[email protected]


notes on completing your claimPatient Responsibilities

you need to make sure that you have all of the information you need before you submit a claim. if you do not, it may take longer to process. For example, when you are claiming reimbursement, you need to include original tax invoices or receipts.

you need a Pats application Form for each specialist you see. each application is valid for 12 months. if you need to see your specialist after 12 months you will need a new form to be completed.

Separate PATS Specialist Certification forms need to be lodged for each type of specialist you see at each location where approved medical specialist services are accessed.

the approved medical specialist or authorised officer needs to complete all parts of the form and sign on or after the last listed date you received specialist services. however, if you want to receive a reimbursement after each appointment, you will need to have your PATS Specialist Certification form signed at each visit. other acceptable evidence includes your referral letter with the surgery date stamp from your appointment, your discharge letter, or an invoice from your specialist.

Authorisedofficer

An authorised officer is a person who works with your medical specialist and can confirm

your details and the approved medical specialist services received. An authorised officer can be a registrar, resident medical officer, intern, nursing unit manager, social worker, ward clerk or administration staff such as a receptionist. your referring local doctor is an authorised officer if they have received evidence of your attendance at a specialist appointment, such as a discharge summary or assessment letter from the specialist following your appointment.

The authorised officer can sign a PATS form on behalf of the medical specialist as long as the medical specialist’s name and provider number is also given. The authorised officer needs to make sure all parts of the PATS Specialist Certification form are complete, including approval of an escort and approval of your accommodation if needed.

If an authorised officer is not available, PATS staff who have access to patient records in public hospitals may use these to verify that a person was an inpatient or outpatient at a particular time. these records will be accessed as a last resort and in accordance with Wa health policies on patient confidentiality. You may also print a statement from medicare through myGov to show you used medicare-eligible services.

if your application needs clinical information, you need to make sure a doctor puts this information on your form.

1514


Time limit on claims

if you can, it is better to apply for the Pats subsidy before you travel, so you will know exactly what you are eligible for. you should not assume you are eligible, or how much you are eligible for, until your claim has been assessed. this is particularly important if you are paying for air travel, because there are strict eligibility requirements.

if you haven’t applied for Pats before your specialist visit, you need to apply for Pats within 12 months. you will still need to meet all the criteria for the Pats subsidy to be eligible for assistance.

Missed travel and accommodation / No Show and Did Not Attend

if you have been provided with assistance in advance and you miss your appointment or do not make your booked travel, you need to be able to give good reasons why you were unable to attend or you may not be eligible for replacement travel costs. Good reasons include genuine hardship, misunderstanding and other unavoidable circumstances.

if you do not explain to Pats staff why you missed your appointment or travel, it may affect your future patient travel subsidies or future access to assistance in advance.

the Pats staff reviewing your claim will look at all the information surrounding your missed appointment and give you an opportunity to respond before making a decision.

Unsuccessful or incomplete claims

You will be notified in writing explaining why your Pats claim was unsuccessful. if your Pats claim is partly eligible, you will be notified of any unsuccessful aspects. The PATS office may speak to you about why your claim was not successful. if your claim is unsuccessful due to missing information, you will be advised on what is needed to complete the claim.

you can appeal a decision if you are unhappy with the outcome. see pages 17–18.

Lost paperwork

if you don’t have enough documentation to support your claim, and it is impracticable to find replacements, you can fill in a statutory declaration.

information on statutory declarations and forms can be found at here.

Further information

Contact your local PATS office. The contact details are available on page 32 (appendix Five).

16

http://www.dotag.wa.gov.au/_apps/search/results.aspx?query=statutory+declaration


reviews and exceptional rulingsIfyouwantareviewofaPATSdecision,youneedtocontactyourlocalPATSoffice,explainingwhyyouthink the decision was incorrect, and providing any additional information that may support your claim.

The PATS office will review your claim, and a Pats regional coordinator or regional medical coordinator may also call you to discuss your complaint or request. the time it will take to review the decision depends on how complicated your claim is. The PATS office may need to get advice from medical specialists or others to make sure they are giving you the right information, so the time it will take to respond to your complaint or request may vary. however, you will have a written response within four weeks.

if you believe that your claim has been unfairly declined you may ask for it to be considered as an exceptional ruling by the regional director.

What Exceptional Rulings are for

exceptional rulings consider the individual circumstance of the application and are granted if it is demonstrated the intent of the Pats scheme is met, even though some of the strict parameters of the Pats policy may not have been.

Exceptional Rulings do not form precedent

exceptional rulings do not form precedents (a decision that has to be followed in other cases). this means that if you have a Pats claim made under an exceptional ruling, a similar claim made by you or somebody else in the future may not be approved. this is because exceptional rulings are made based on individual circumstances on a case-by-case basis.

Process for Exceptional Rulings

Request an Exceptional Ruling

1. your Pats claim is declined, or a Pats clerk escalates a claim where the case appears justified but the claim does not fall into the strict parameters of the policy.

2. you or your advocate requests reconsideration of a declined Pats application.

Evidence to support claim

3. you provide extra supporting information if required, such as a letter from a doctor or treating specialist.

Decision process

4. the regional coordinator considers whether your claim should be considered as an exceptional ruling.

5. the regional coordinator seeks additional information if required from the regional medical director, dental specialist, other doctors or PATS Central Office.

6. the regional coordinator forwards your claim and supporting documentation to the regional director.

7. the regional director assesses your claim.

8. the regional director may request further information.

9. the regional director approves or declines claim.

Decision communicated

10. the regional coordinator informs you and provides you with appeal information if the exceptional ruling is declined.

11. the Pats team is advised of the outcome and the level of assistance to be provided if approved.

Application / supporting information

it is important that your exceptional ruling claim has as much information and evidence as possible to support it. For example, you may need a letter from your doctor or specialist explaining the details of your situation, including information that may not have been included in your original application.

1716


complaints and compliments If a PATS claim or an Exceptional Ruling request is declined, you will be informed of the right to request a review, or how to submit a complaint.

health services have to ensure information and processes followed conform to the Wa health complaint management Policy 2015. this is available here.

How to complain or compliment

Contact your local health service or PATS office: they will provide you with information on how to give positive or negative feedback directly to the health service. the health service values your feedback, and has to record and respond to all feedback that is received. We encourage you to lodge any complaint through this process as a first step.

a list of compliments and complaints pages for Western australian hospitals can be found here.

alternatively, the health and disability services Complaints Office can help you resolve any complaints you may have. their website is here or free call 1800 081 583.

if you would like support with the complaint process you can contact the health consumers’ council on 1800 620 780 or through their website here.

the health consumers’ council is an independent community-based organisation that represents health consumers.

Need assistance?

if you need help to make your review request or to provide feedback, please telephone the PATS Central Office team on 08 6383 1800 or 08 6383 1801.

if you need help in a language other than english please call the national telephone interpreter service on 131 450 if you need immediate help.

if you want to book an interpreter, you can either call 131 450 or else use the booking form here.

People who speak aboriginal languages can contact the Kimberley interpreting service on 08 9169 3161 or at their website here.

Going to the Ombudsmanif you are still not happy with the result of your complaint after you have got a response from the health service, the Ombudsman’s office may be able to assist you.

information on how to get help from the ombudsman can be found on the website here.

What happens to the information collected about complaints and reviews?information collected in complaints and reviews are used in annual reports, without identifying the person who complained. this information is used to improve the way PATS offices deliver services.

18

http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=13196

http://healthywa.wa.gov.au/Articles/A_E/Compliments-and-complaints

https://www.hadsco.wa.gov.au/home/

http://www.hconc.org.au/

https://www.tisnational.gov.au/en/Agencies/Forms-for-agencies/New-Job-booking-form.aspx

http://www.kimberleyinterpreting.org.au/contact.html

http://www.ombudsman.wa.gov.au/Complaints/Making_complaints.htm


Privacy and confidentialityall health staff in public hospitals and health services have to follow the Patient Confidentiality policy. this includes all Wachs staff. the policy can be found here. Private providers have to observe the Privacy Act 1988 (Cth).

you have a right to access your personal information through the Freedom of Information Act 1992 (WA).

auditingThe Office of the Auditor General audits PATS claims. this means that Pats staff have to make sure they make decisions that are in line with policy. they also need to provide clear and detailed reasons for any decisions made under exceptional. health services need to do this so they can demonstrate that public money is spent fairly and according to policy.

Pats staff also have to make sure they have tax invoices, receipts and other documentation when reimbursing you for commercial travel or accommodation.

1918

http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=13317


appendix one: list of approved specialist servicesAn approved medical specialist is a medical practitioner registered with Medicare Australia as a specialist in a particular specialty under the Health Insurance Act 1973 (Cth) as per Schedule 4 of the Health Insurance Regulations 1975.

specialist services include:

Paediatrics General specialties Radiology

clinical genetics

clinical haematology

clinical immunology and allergy

endocrinology

Gastroenterology and hepatology

General paediatrics

infectious disease

nephrology (renal medicine)

neurology

Psychiatry

rehabilitation medicine

rheumatology

thoracic

sleep medicine

anaestheticscardiologycardiothoracic surgeryclinical genetics dermatology*dialysisendocrinologyGastroenterology and hepatologyGeneral medicineGeneral surgeryGeriatric medicineGynaecologyhaematologyhand surgeryimmunology and allergyinfectious diseaseintensive care medicineinternal medicineIn Vitro Fertilisation (IVF) (for treatment, not consultations)maternal–Foetal medicineNephrology (renal medicine)neonatology and perinatalneurologyneurosurgerynuclear medicineobstetrics and gynaecologyOccupational medicine (not workers’ compensation related)oncologyophthalmologyorthopaedic surgeryOtolaryngology (head and neck surgery)Otorhinolaryngology/ENT (ear, nose and throat)Pain medicinePalliative medicinePlastic and reconstructive surgery (if not an excluded procedure)PsychiatryPublic health medicineradiation oncologyrefractive surgical proceduresrenal medicinereproductive endocrinologyrespiratory and sleep medicinerheumatologythoracic and sleep medicinesports medicineUrogynaecologyUrologyvascular surgery

Bone densitometry (when films are read by a specialist)

diagnostic radiology (ct, mri, nuclear medicine, Ultrasound and X-ray)

diagnostic ultrasound

diagnostic nuclear medicine

magnetic resonance Imaging (MRI)

mammography (Breastscreen) if referred by doctor or a specialist

obstetric and gynaecological Ultrasound

20

http://www.health.wa.gov.au/circularsnew/pdfs/13358.pdf


Approved treatments: guidelines

Dialysis

if you undergo dialysis, you are eligible for Pats assistance even if you do not see the nephrologist. the nursing staff are able to sign your PATS Specialist Certification form.

you can also receive Pats assistance if you are attending a home therapies unit for review, assessment or treatment, or training to perform dialysis.

Medical imaging

if you are referred to a radiologist for a procedure approved under medicare, you are eligible for Pats assistance if you are attending the closest service.

services include x-ray, interventional radiological procedures, ultrasound, computed tomography (CT), nuclear medicine (NM) and magnetic resonance imaging (MRI).

if you don’t see a radiologist, a radiologist needs to be involved in reading and reporting on the images for you to be eligible for Pats assistance. the medical imaging technologist is able to sign the PATS Specialist Certification form.

Mammography

you will be eligible for Pats assistance if:

• you have been referred by a medical practitioner and a screening service is not available within an acceptable time frame,

• the assessment is covered by the medicare Benefits Schedule, or

• you are referred for diagnostic imaging evaluation of a palpable breast lump or other breast abnormality.

Assisted reproductive treatment (IVF)

you are eligible for Pats assistance for referral to specialist treatment covered by an item in the Medicare Benefits Schedule.

if you are a partner, you will be eligible for Pats assistance if you are referred to a specialist for an initial consultation and one visit per cycle of treatment as a patient.

Pats assistance is not available for education, pathology or counselling. you should try to access services such as counselling through videoconferencing.

Pats assistance is not available for parties involved in surrogacy.

Refractive surgical proceduresyou are eligible for Pats if you are referred by an ophthalmologist for excimer laser keratotomy (PRK) or LASIK eye surgery.

Wheelchair applicantsyou will be eligible for Pats assistance if you are referred for complex wheelchair assessment and review.

you can be referred by a medical practitioner, physiotherapist or occupational therapist.

Next Step: inpatient treatment for addictionyou will be eligible for Pats assistance if you are referred to next step specialist medical services or a next step approved specialist service provider for an initial consultation for admission into a treatment or therapy program. you will not receive accommodation assistance during your treatment.

other rehabilitation services are generally not covered.

Child birthif you need to travel to your nearest birthing centre to deliver your baby, you are eligible for the Pats accommodation subsidy before the birth based on a risk assessment undertaken by your GP obstetrician or specialist obstetrician. this risk assessment should be based on established screening criteria. Generally, this should be at about 37 weeks’ gestation. clinicians should refer to Wachs’ maternity and newborn services policy, in particular appendix 4. this can be found here.

similarly, Pats assistance following birth will be available based on a risk assessment undertaken by your GP obstetrician or specialist obstetrician. Generally, this will be available for up to five days following an uncomplicated birth. extra nights may be approved if you are prevented from flying after the birth.

Pats assistance is not available for an escort unless there are complications that put the mother or baby’s life at risk or in cases when the mother and newborn may need an escort to return home, such as after a multiple birth. normal escort eligibility applies in other cases.

2120

https://www.health.wa.gov.au/publications/documents/WACHS_Maternity_and_Newborn_Services_Policy.pdf


Oral conditions

Pats assistance is only available for serious oral conditions.

Oral Maxillofacial Surgery

you will be eligible for Pats assistance if you are receiving treatment listed in the oral and Maxillofacial Medicare Benefits Schedule. This includes the management of facial trauma, such as a jaw fracture, serious dento-facial infections and oral malignancy (cancer).

you will not be eligible for Pats assistance if you are attending an oral maxillofacial specialist for the purposes of removing wisdom teeth.

Dental services for children

children eight years or under will be eligible for Pats assistance if they need hospital-based management of severe dental trauma or severe dento-facial infections, such as cellulitis.

children will also be eligible for hospital-based dental services if they have a significant medical co-morbidity or other serious conditions.

they will also be eligible if they are having dental treatment that requires a general anaesthetic. this includes removal of a tongue tie for a newborn baby by a specialist paediatric dentist in cases where the child is not thriving.

Dental services for adults

adults will be eligible for Pats assistance if they need hospital-based dental services and have a significant medical co-morbidity.

adults will also be eligible for Pats assistance for dental services if they have special needs and require general anaesthesia.

adults are not eligible for Pats for standard extractions including wisdom teeth, even if a general anaesthetic is required.

For all adult dental claims, please ensure your doctor provides enough medical information for the Pats staff to make an assessment.

Dental treatment for cleft lip and palate

children will be eligible for Pats assistance if they need cleft lip and cleft palate treatment listed in the Medicare Benefits Schedule.

22


appendix two: rural health regions

Kimberley

Pilbara

Mid West

Wheatbelt

Great Southern

South West

Metro

Peel

Goldfields

2322


appendix three: claim formsPlease note: they may vary from region to region

sample application form - page 1 of 4

24

THIS IS AVAILABLE IN ALTERNATIVE FORMAT ON REQUEST FROM A PERSON WITH A DISABILITY December 2014

Office Use only: PATS REFERENCE NUMBER SECTION A - MEDICAL PRACTITIONER TO COMPLETE REFERRAL 1. PATIENT DETAILS Title

Surname Given Names

DOB _____ /_____ / ______ Male Female

2. REFERRAL DETAILS Referral must be to the nearest eligible specialist (including visiting specialists)

Name of Specialist

Does the patient need to be seen urgently (<30 days) Yes OR No

Is this referral for cancer treatment? Yes OR No

Is this referral for renal dialysis? Yes OR No

3. AIR TRAVEL RECOMMENDATION Does the patient require air travel due to their clinical condition? Yes No

Please note: If the patient’s clinical condition changes after their first appointment the mode of travel recommended may change. 4. ESCORT RECOMMENDATION (Escorts are automatic for patients Under 18) Does the patient require an escort? Yes No Please select reason: Disability Frailty Medical condition Other(specify below) 5. CLINICAL DETAILS to support referral to other than the nearest specialist; recommendation for air travel and /or an escort must be proved by a Medical Practitioner.

6. REFERRING MEDICAL PRACTITIONER STAMP / DETAIL AND SIGNATURE Name I certify that the information given is correct.

Address

Telephone Signature Date

Provider Number

PATS APPLICATION FORM

SAMPLE


appendix three: claim forms (cont.)Please note: they may vary from region to region


24


SECTION B – PATIENT TO COMPLETE DETAILS Please submit this PATS form to your PATS Office (fax, mail, email or in person) as soon as possible and prior to any travel being undertaken. Completed applications should be lodged within 8 weeks of your appointment. PATS applications will be assessed for eligibility and may take up to 10 working days to process. Enquires for appeal or a ruling on your specific circumstances should be made at your local PATS Office. 7. PERSONAL DETAILS Title Surname First Name Residential Address Postal Address (if different)

Home Phone Mobile Work Phone Preferred Contact Home Mobile Work Email (Provide email address) Are you a Permanent Country

Resident? Yes No Male Female Aboriginal / TSI

Yes No

Is this travel related to treatment covered by any of the following? Workers Compensation Motor Vehicle Insurance Employer funded travel

Do you have any of the following cards? If yes, please provide the number.

Medicare Card Number

Concession Card Type Number

Veterans Affairs White Silver Gold

8. APPOINTMENT DETAILS Specialist name and phone number Appointment date, time and location

9. RECOMMENDED ESCORT DETAILS (must be over 18 years of age)

Title

Surname

Given Names

10. RELEVANT TRAVEL NOTES

Please note below any information relevant to your circumstances that needs to be made known to the PATS office undertaking your booking. ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………


SAMPLE

25



SECTION B – PATIENT TO SIGN If you require further information about PATS contact your local PATS Office or www.wacountry.health.wa.gov.au Your forms can be submitted at the below listed hospitals/ health services

11. CONDITIONS OF TRAVEL/ PATIENT/ GUARDIAN DECLARATION Confirmation of attendance at your appointment You must return your PATS Specialist Certification form to the local PATS Office even if you have had your subsidy paid in advance. Failure to do this may result in you becoming ineligible for PATS assistance in the future. Changes to Travel and/ or Accommodation Arrangements: If for medical reasons you are unable to catch the flight/bus/train as booked or if you need additional accommodation, you must contact your local PATS Office as soon as possible. Reimbursement of Costs The PATS Specialist Certification form and receipts for commercial accommodation &/or transport will need to be returned to your local or regional PATS office within 8 weeks of your appointment. I give permission to my Medical Practitioner to provide medical information to the PATS Office to support my application for PATS if required. Yes No I understand and accept these conditions and certify that the information above is correct at the time given. I agree that I will repay any cost incurred should I fail to use the pre-booked travel or fail to attend appointments. Patient / Guardian Signature_______________________ Date ____/____/____

Goldfields § Kalgoorlie (08) 9080 5681 § Esperance (08) 9071 0801

Great Southern 1800 728 747 § Albany § Denmark § Gnowangerup § Katanning § Kojonup § Mt Barker

Kimberley 1800 914 100 PATS forms can be lodged at all Hospitals within the Kimberley

Midwest (08) 9956 2216 § Exmouth § Carnarvon § Dongara § Geraldton

Pilbara 1300 653 231 PATS forms can be lodged at all Hospitals within the Pilbara

South West 1800 823 131 Fax: (08) 9427 9011 Postal: SW PATS P.O Box 712 Osborne Park BC WA 6916

12. DATE APPLICATION RECEIVED BY PATS OFFICE Wheatbelt 1800 728 792 PATS forms can be lodged at all Hospitals within the Wheatbelt

Date ____/____/____




SAMPLE

26

.



SECTION C - PATS OFFICE 13. REGIONAL APPROVAL

Referral is to other than the nearest eligible medical specialist

& / or

Air travel is recommended & trip is less than 16 hours by road or more than 350kms for people having cancer treatment

Other exceptional circumstance.

Comments / Notes …………………………………………………………………………………………………………………... …………………………………………………………………………………………………....……………... …………………………………………………………………………………………………....……………... …………………………………………………………………………………………………………………... …………………………………………………………………………………………………………………... …………………………………………………………………………………………………………………... Approved / Recommended YES NO Comments Patient

Escort

Mode of Travel

Signature of Incurring Officer / Delegated Financial Authority

Date

14. PATIENT NOTIFIED OF OUTCOME PATS OFFICE TO COMPLETE Notified by Phone: Mobile Work Home Message left Spoke to Client Email Letter Fax Other Other Notes Date Time Name and signature of PATS Clerk




SAMPLE

2726


THIS FORM IS AVAILABLE IN ALTERNATIVE FORMAT UPON REQUEST – December 2014

PATS SPECIALIST CERTIFICATION FORM

SECTION A

PATS Reference Number

ATTENTION: Health professional/ clinic employee. To facilitate reimbursement of the patient’s expenses and/or confirm travel details please complete fully the details below.

PATS

OFF

ICE

1. PATIENT DETAILS Name

Address

DOB

2. SPECIALIST CERTIFICATION The above named patient received specialist treatment on or between: and

Was the patient required to stay overnight? Yes No

Was the patient hospitalised? Yes No

The patient was hospitalised on or between: and

Does the patient require travel home to be upgraded to air travel? Yes No Has the patient’s condition changed so they require an escort? Yes No

If ‘Yes’ to above medical specialist to provide clinical reasons that make air travel and /or escort essential. __________________________________________________________________________

Does the patient require further / follow up treatment? Yes No

If ‘Yes’ to above, can the follow up service be provided by a regionally based / visiting specialist or Telehealth if available? Yes No

If these alternatives are not suitable, please provide the clinical reason to support a return trip. __________________________________________________________________________ Date of Next Appointment

Does the patient have a Treatment Plan1 ? Yes No

3. MUST BE SIGNED BY A HEALTH PROFESSIONAL / CLINIC EMPLOYEE WHO CAN VERIFY THE PATIENT’S ATTENDANCE. Name and signature of health professional / clinic employee Date ____________________________________________________________________________

Address Telephone Number

All applications to travel for further treatment are subject to Health Service approval.

1 A patient with a clearly identified treatment program of out patient visits can obtain one approval to cover a treatment program. The specialist must provide a schedule of appointments.


Sample certification form - page 1 of 2

SAMPLE

28



Sample certification form - page 2 of 2

2928



SECTION B

PA

TIEN

T TO

CO

MPL

ETE

4. PATIENT OR PARENT / GUARDIAN VERIFICATION TO BE COMPLETED AFTER SPECIALIST VISIT Dates for private and/ or commercial accommodation assistance required:

Patient on/ between Private Commercial

on/ between Private Commercial on/ between Private Commercial

Escort on/ between Private Commercial

on/ between Private Commercial


5. INSTRUCTIONS TO PATIENT

To be eligible for PATS assistance 1 A health professional / clinic employee who can verify your attendance must complete

Section A.

2 Patient must complete Section B and attach receipts for commercial accommodation &/or transport to the form.

3. Return the completed PATS Specialist Certification form to your local PATS Office within 8 weeks of appointment.

4. Reimbursement for the use of Taxi travel must be approved by your local PATS Office PRIOR to departure.

If you require less or more time at the treatment centre to complete your course of treatment please contact your local PATS Office for assistance as soon as possible. If you need more information about PATS, contact your Regional PATS Office: Goldfields: Kalgoorlie 9080 5681: Esperance 9071 0801

Great Southern: 1800 728 747 Pilbara: 1800 138 653

South West: 1800 823 131 Kimberley: 1800 914 100

Wheatbelt: 1800 728 792 Midwest: 9956 2216

IMPORTANT Please ensure you return this form within 8 weeks of appointment. I declare that the expenditure shown on the attached receipts was incurred by me, and that

the benefits have not been claimed from any other source.

Patient/ Parent/ Guardian Signature

Date

.



SECTION B

PA

TIEN

T TO

CO

MPL

ETE

4. PATIENT OR PARENT / GUARDIAN VERIFICATION TO BE COMPLETED AFTER SPECIALIST VISIT Dates for private and/ or commercial accommodation assistance required:

Patient on/ between Private Commercial

on/ between Private Commercial on/ between Private Commercial

Escort on/ between Private Commercial



5. INSTRUCTIONS TO PATIENT

To be eligible for PATS assistance 1 A health professional / clinic employee who can verify your attendance must complete

Section A.

2 Patient must complete Section B and attach receipts for commercial accommodation &/or transport to the form.

3. Return the completed PATS Specialist Certification form to your local PATS Office within 8 weeks of appointment.

4. Reimbursement for the use of Taxi travel must be approved by your local PATS Office PRIOR to departure.

If you require less or more time at the treatment centre to complete your course of treatment please contact your local PATS Office for assistance as soon as possible. If you need more information about PATS, contact your Regional PATS Office: Goldfields: Kalgoorlie 9080 5681: Esperance 9071 0801

Great Southern: 1800 728 747 Pilbara: 1800 138 653

South West: 1800 823 131 Kimberley: 1800 914 100

Wheatbelt: 1800 728 792 Midwest: 9956 2216

IMPORTANT Please ensure you return this form within 8 weeks of appointment. I declare that the expenditure shown on the attached receipts was incurred by me, and that

the benefits have not been claimed from any other source.

Patient/ Parent/ Guardian Signature

Date

SAMPLE


Appendix Four: Glossary and Definitions Approved escort

an approved escort is responsible for a Pats client’s transport and accommodation needs during treatment and has been deemed necessary by a doctor.

an approved escort may also be a carer.

Carer

A carer is a person who provides ongoing care or assistance to a person with a disability as defined in the Disability Services Act 1993 section 3; or for a person who has a chronic illness, including a mental illness as defined in the Mental Health Act 2014 section 4; or a person who, because they are frail, requires assistance with carrying out everyday tasks. the Carers Recognition Act 2004 (WA) provides more detail.

Clinical Escort

a clinical escort is a clinically trained person who is required to accompany a patient for medical reasons as certified by the referring practitioner. The person must be a registered nurse, enrolled nurse, or have appropriate clinical skills. the regional director approves the clinical escort through the Pats database, and the cost is paid by the local health service (not by PATS).

What is the difference between a carer and an escort?

A carer is defined in section 5 of the Carer Recognition Act 2004 (WA). This section refers to a carer as someone who provides ongoing care for a person who has a disability, a chronic illness, including mental illness, or who requires care because they are frail.

an escort refers to a person who is assisting a Pats consumer to attend their specialist medical appointment. an escort may be a carer as well, but an escort might only be helping a person with travel and other needs in the short term.

if you need medical specialist treatment and you are a carer for another person, you can talk to your health service about having the person you care for accompany you to the treatment centre if you cannot make other care arrangements. For example, you are caring for someone with a disability and need to travel for specialist treatment, and there is no one available to take care of that person. this will be considered under the exceptional rulings process.

Extra escort – payment

second escorts are provided with a $60 per night accommodation subsidy.

Dependent child

a dependent child is a child under the age of 18 who normally resides with a parent and who is not in full time employment. this can include a child who is in a boarding institution during school term time.

Cancer patient

After you have had a confirmed diagnosis of cancer and have been referred to a medical specialist for appropriate cancer treatment, you are considered a cancer patient for Pats purposes.

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Cancer treatment means medical specialist treatment which involves surgery, radiotherapy, chemotherapy, immunotherapy and/ or palliative intervention.

Inter Hospital Patient Transfer (IHPT)

inter hospital Patient transfer occurs when an admitted patient is required to be transferred from one health service or hospital to another for a higher level of treatment or care.

Primary Evacuation (PE)

Primary evacuation is when a person has a medical emergency, such as a car accident or heart attack, and needs to be evacuated by ambulance, emergency vehicle or royal Flying doctor service to hospital.

renal treatment means an appointment with a nephrologist or vascular access consultant, surgery and follow up, home therapies training, pre-dialysis education and dialysis treatment.

Telehealth

telehealth is the use of information and communication technology to provide healthcare over a distance. this includes the transmission of images, voice, data and videoconferencing between two or more sites.

telehealth connects regional patients to safe, high quality and cost-effective clinical services closer to home. telehealth provides regional patients with improved access to timely specialist and emergency care, which can lead to improved health outcomes.

see here for more information on telehealth.

For Pats purposes, the closest medical specialist includes those services provided by telehealth.

Treatment centre

the city or town in which the patient visits an eligible medical specialist, or accesses an eligible specialist service.

Trip

For the purposes of Pats a trip is considered a two way journey. a one-way return journey following inter hospital Patient transfer is also a trip.

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http://www.wacountry.health.wa.gov.au/telehealth


Appendix Five: PATS Office Contacts Wheatbelt Regionnortham regional hospital robinson street northam Wa 6401 Phone: 1800 728 792 Fax: 9690 1317 email: [email protected]

GoldfieldsRegion

Kalgoorlie: Piccadilly street, Kalgoorlie, Wa, 6430 locked Bag 7, Kalgoorlie, Wa, 6433 Phone: 9080 5681 Fax: 9080 5750 email: [email protected]

esperance: hicks street, esperance, Wa, 6450 Po Box 339, esperance, Wa, 6450 Phone: 9079 8101 Fax: 9079 8066 email: [email protected]

South West Region

sW Pats P.o. Box 712 osborne Park Bc Wa 6916 Phone: 1800 823 131 (toll free) Fax: 9427 9011 email: [email protected]

Kimberley Region

Po Box 62 Broome Wa 6725 Phone: 9194 2236 Fax: 9194 2234 email: [email protected]

Pilbara Region

hedland health campus PmB 12 south hedland Wa 6722 Phone: 1800 138 653 Fax: 9174 1099 email: [email protected]

Midwest Region

Po Box 22 Geraldton Wa 6531 Phone: 9956 2216 Fax: 9956 2409 email: [email protected]

Great Southern Region

Po Box 252 albany Wa 6331 Phone: 1800 728 747 Fax: 9892 2570 email: [email protected]

Peel RegionPlease note that Peel is not part of the Wa country health service. rockingham General hospitalelanora drivecooloongup Wa 6218Postal address:Po Box 2033rockingham Wa 6168Phone: 9599 4485Fax: 9599 4620email: [email protected]

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appendix six: transplants and living donors The Live Organ Donor scheme is separate to PATS. The scheme applies where your primary purpose of travel is for live organ donation assessment and/or retrieval in Western Australia and you are a permanent resident of a WACHS region and are eligible for treatment under Medicare.

you may be requested to provide evidence of your usual residence.

the hospital that will be undertaking the transplant is responsible for applying for the scheme on your behalf to the regional director in the region where you live.

the referral is to be written (this can include email) and must include:

• the donor’s full name

• your date of birth

• your residential address

• the dates and type of treatment required outside of your usual residential location.

Where practicable, Wachs is to book all travel and accommodation to achieve the most economical rates.

Following the completion of surgery, you need to submit a claim to the local health service for any outstanding travel and accommodation costs, attaching tax receipts and other documentation necessary for reimbursement.

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Documents

Patient Assisted Travel Scheme Policy...Patient assisted travel scheme Policy assistance for live organ donation is separate to Pats. information on the ive l organ donation scheme