DVA Funded Physiology Services

Clarification on the Department of Veterans' Affairs (DVA) funded Exercise Physiology Services

DVA has received a number of enquiries regarding a perceived reduction in access to services. There has been no change to DVA policy for the provision of exercise physiology services and no direction to reduce access to clinically necessary treatment.

Why was the policy reviewed?

The policy was reviewed because the fee schedule was not aligned with similar discipline fee schedules and there was concern that claiming patterns by exercise physiologists did not match expected patterns based on the policy.

What were the policy changes?

The review resulted in a number of alterations and additions to the fee schedule to provide clarity for existing services and to broaden the range of services. This includes the introduction of aquatic exercise physiology.

What was funded before the review?

Since 2007, DVA has been funding exercise physiology services to treat a specific condition, upon referral from a General Practitioner. Exercise physiology treatment can assist with rehabilitation from a major injury or illness, or to help manage a chronic disease like arthritis or diabetes.

What is funded now?

DVA continues to fund exercise physiology to treat a specific condition. In addition, exercise physiologists can now also provide aquatic exercise physiology treatment.

What was NOT funded before the review?

DVA has a long standing policy that it does not pay for ongoing, generalised exercise programs and classes or gym membership. DVA has never funded services for general fitness or exercise classes.

What is NOT funded now?

DVA continues to not fund participation in ongoing, generalised exercise programs or ongoing group exercise classes supervised by an exercise physiologist. An expected outcome from a course of exercise physiology treatment is a program that can be undertaken independently without the need for costly gym equipment. If veterans wish to continue with an exercise program following their treatment, it becomes a private arrangement between the veteran and the gym or exercise physiologist.

What information is available?

DVA has provided a range of material to help inform both veterans and their health care providers about the operation of the exercise physiology arrangements:

  • Article on page 9 in Vetaffairs Spring 2013 edition
  • Flyer - Are you providing exercise physiology services?

This material and additional information is available on the DVA website: Veterans: CLICK HERE

Providers: CLICK HERE

Or contact DVA on 133 254 (metro) or free call 1800 555 254 (regional callers).

Are you providing exercise physiology services to DVA clients?

This flyer is designed to help Exercise Physiologists (EPs) understand exercise physiology treatment funded by the Department of Veterans’ Affairs (DVA) for eligible members of the veteran and defence force community (entitled persons).

What is the aim of DVA funded exercise physiology?

The aim of DVA funded exercise physiology is to:

  • assess the entitled person and design an exercise intervention that addresses their referred condition; and
  • provide the entitled person with the skills to manage the exercise component of their treatment on their own, through exercise.

Who can provide treatment?

Exercise physiology services must be provided by an EP who is accredited by Exercise & Sports Science Australia and is registered with the Department of Human Services. See Notes for Allied Health Providers Section One: General, clause 58.

Who can I treat?

An EP can treat a DVA entitled person who has a Gold Card, or who has a White Card where the referral for treatment is for a condition accepted by DVA.

If there is any doubt about an entitled person’s eligibility to receive exercise physiology services, we advise you to contact DVA Office on 1300 550 457 (metropolitan callers) or 1800 550 457 (non-metropolitan callers).

For more information refer to the Notes for Allied Health Providers - Section One: General, clause 10-16.

Does the entitled person need a referral?

Yes, the entitled person requires a valid referral from their medical practitioner, medical specialist or hospital discharge planner. A written referral using the letterhead of the referring health care provider can be accepted as long as it contains the same information as the D904 form.

It is a requirement that the referring practitioner includes a diagnosis on the referral form to inform the EP of the patient’s condition which requires clinically necessary treatment. If you receive a referral where the condition to be treated has not been specified you will need to contact the referring practitioner. An EP with a current referral can also transfer the veterans’ referral to another EP. For more information refer to the Notes for Allied Health Providers - Section One: General, clause 23-33.

Do I need to prepare a patient care plan?

Yes, you must prepare a patient care plan (PCP) for each entitled person following the first consultation. The PCP should be reviewed as clinically necessary. By preparing a care plan with achievable and time specific goals, the entitled person is more likely to make progress with their treatment.

For more information refer to the Notes for Allied Health Providers -Section One: General, clause 34-36.

Can entitled persons receive exercise physiology treatment for as long as they want? No, the program is not meant to be an ongoing form of treatment. The length of treatment is determined by clinical necessity. The aim is to assess and then teach entitled persons the skills they need to manage their exercise program independently as part of the treatment provided.

So, how long will DVA pay for entitled persons to see an exercise physiologist? DVA will pay for entitled persons to see an EP until they are able to undertake their exercise program on their own.

EPs are required to prescribe an exercise program that addresses the entitled persons referred and assessed needs. Once the program has been determined, an EP may work with the patient to establish self-management of their exercise program. This may include checking on them from time to time to assess their progress and adjust their program accordingly. Whilst a referral is valid for 12 months, this does not mean the entitled person will require treatment for 12 months. DVA does not fund ongoing, weekly treatment to promote exercise adherence and for exercise participation purposes.

Does DVA pay for general exercise programs, fitness centre or gym memberships? No, DVA does not pay for general exercise programs or fitness centre memberships. If the entitled person wants to join a generalised exercise class, fitness or gym program, this needs to be a private arrangement between them and the exercise physiologist or the fitness centre/gym.

What other options are there for entitled persons?

DVA’s Heart Health program is available to veterans and peacekeepers interested in increasing their physical health and wellbeing. For more information, call VVCS - Veterans and Veterans Families Counselling Service on 1800 011 046.

What fees does DVA pay?

EP service fees are detailed in the DVA Exercise Physiology Schedule of Fees at: CLICK HERE

Can I claim online?

Yes, electronic claiming is available. As an initial step contact your software vendor. If you do not have a software vendor then go to: CLICK HERE

For more information about online claiming contact: onlineclaiming@dva.gov.au or contact DVA on 1300 550 457 (metropolitan callers) or 1800 550 457 (non-metropolitan callers). DVA will not reimburse you for any costs associated with on-line claiming.

Do I need to use a Recipient Created Tax Invoice (RCTI) for claiming? Yes, you will need to complete an RCTI agreement if you are registered for GST purposes. For more information see: CLICK HERE

When can I claim an initial consultation?

An initial consultation can only be claimed for a new episode of care or a new and unrelated condition. A referral is required for each new condition claimed as an initial consultation. For more information refer to the Notes for Allied Health Providers - Section 2(f) Exercise Physiologists, clause 8.

When do I claim a group consultation?

If you are treating more than one participant at the same time, regardless of their referral or payment type, it is classified as a group consultation (e.g. a mixed group of Medicare, private patients and DVA funded clients). All group consultations must be limited to no more than 12 participants.

Do I need to be present during the entire group consultation?

Yes, the EP must be present for the entire treatment session. All participants must receive constant overall supervision with intermittent individual care throughout the consultation. You cannot claim a group consultation for generalised exercise, fitness or gym programs. For more information refer to the Notes for Allied Health Providers - Section 2(f) Exercise Physiologists, clause 10-16.

If I receive payment for a group session from a Residential Aged Care Facility can I also claim for payment from DVA?

No, you cannot claim for services that have been paid or will be paid for by a third-party (e.g. the Residential Aged Care Facility). For more information refer to the Notes for Allied Health Providers - Section One: General clause 125.

Can my aide or student provide treatment on my behalf?

No, an aide or a student cannot provide treatment on your behalf. The EP must be present at all times during DVA funded consultations.

For more information refer to the Notes for Allied Health Providers - Section One: General, clause 74.

The fee I charge is more than the DVA fee. Can I charge the difference to the entitled person?

No, if you accept an entitled person’s Gold or White Card, you must charge your service according to the DVA Exercise Physiology Schedule of Fees. You cannot charge a copayment or separate charge to an entitled person for the treatment provided.

For more information refer to the Notes for Allied Health Providers - Section One: General, clause 93.

Can I charge DVA if the entitled person does not show up for an appointment?

No, DVA will not pay for missed appointments. If it is your standard practice to charge a fee for missed appointments then the entitled person will be responsible for this payment provided they have been advised beforehand.

For more information refer to the Notes for Allied Health Providers - Section One: General, clause 94.

Can I charge the entitled person for entry into the pool/gym?

No, you cannot charge an entitled person entry fees for gyms or pools. All consultation fees include the client’s entry cost into a gym or pool.

For more information refer to the Notes for Allied Health Providers - Section 2(f) Exercise Physiologists, clause 11.

When can I claim a kilometre allowance?

You are able to claim an allowance for home visits per kilometre where:

  • the distance is greater than 10kms;
  • where the entitled person is physically unable to travel to your clinic; and
  • there is no suitable provider located closer to the entitled person.

You are not able to claim kilometre allowance from DVA for travel between one office to another or from a head office to the gym or the pool.

For more information refer to the Notes for Allied Health Providers - Section One: General, clause 46-50.

My client needs an exercise band. How can I claim for this? Therapeutic exercise bands can be obtained through the Rehabilitation Appliances Program (RAP) program (item AV10), if they are clinically necessary. You will need to complete a D0992-Direct Order Form which is available from CLICK HERE. For more information refer to the RAP schedule (item range AV10 to AV16) at: CLICK HERE

Can I provide consultations via Skype?

No, DVA does not fund consultations via Skype or other Voice Over Internet Protocol (VoIP) services. It is expected that the EP will be physically present during all consultations.

Can I provide massage therapy as part of my exercise physiology treatment?

No, DVA only funds massage therapy if it is delivered during a consultation by a physiotherapist, chiropractor or osteopath.

What are the rules around advertising for exercise physiology services? You must seek permission in writing from DVA to include any reference to DVA or their clients (e.g. terms such as ‘ex-service personnel’ or ‘veterans’ in your advertisements, websites or promotional material). Phrasing such as 'Treatment is bulk billed', 'Treatment is free' or 'Gym membership included' should not be used in your advertising. A simple statement such as "Entitled Department of Veterans' Affairs clients may be referred for clinically necessary exercise physiology treatment on a valid D904 referral form" would be an acceptable advertisement. Changes to material that has been previously approved must be re-approved by DVA.

Requests can be sent to:

Assistant Director - Provider Engagement
Department of Veterans’ Affairs
GPO Box 9998 MELBOURNE VIC 3001
Or Email - providerpartnering@dva.gov.au 

For more information refer to the Notes for Allied Health Providers - Section One: General clause 70-72.

Where can I get further information?

The following documents are recommended readings prior to providing treatment to eligible members of the veteran and defence force community:

  • Notes for Allied Health Providers - Section One: General ; and
  • Notes for Allied Health Providers - Section 2(f) Exercise Physiologists.

The documents are available on the DVA website at: CLICK HERE

How do I contact DVA?

To contact DVA please call: 1300 550 457 (metropolitan callers) 1800 550 457 (non-metropolitan callers)

 Agent Orange Linked To 'Unusually Aggressive' Skin Cancer

A new study backed up past evidence suggesting Vietnam War veterans who had been exposed to the herbicide Agent Orange had a higher risk of developing melanotic invasive skin cancer (NMISC). Agent Orange was used during the Vietnam War as an 'herbicide and jungle defoliant.'

Exposure to the toxic dioxin contaminant (TCDD) in the substance has been linked to a number of diseases and cancers, a Wolters Kluwer Health: Lippincott Williams & Wilkins news release reported.

TCDD is among the most carcinogenic compounds ever to undergo widespread use in the environment," the authors wrote, the news release reported.

Veterans Affairs recognises certain health problems (including specific cancers) related to dioxin exposure, but skin cancer is currently not included on that list.

The researchers looked at 100 men who were enrolled in the Agent Orange registry who had lighter skin types.

'Exposure to TCDD consisted of living or working in contaminated areas for 56 percent of veterans, actively spraying Agent Orange in 30 percent, and travelling in contaminated areas for 14 percent,' the news release reported.

The team saw cases of NMISC in 51 percent of the study participants; which is twice as high as the general population of men in the same age group. In the men who had actively sprayed Agent Orange the cases rose to 73 percent. The men with the lightest skin and eye colour were found to have the highest risk of developing NMISC.

Forty-three percent of the study subjects suffered from chloracne, which is a skin condition directly linked to dioxins; 80 percent of these men developed NMISC.

A number of cases of 'unusually aggressive' NMISC were observed in the study population, many of which required multiple surgeries.

The link between dioxin exposure and basal cell carcinoma and squamous cell carcinoma (the two most common forms of skin cancer) has not yet been proven.

Further studies are warranted to determine the relative risk within this patient population and to determine appropriate management strategies so that veterans may receive the care they earned in service," ASPS Member Surgeon Doctor Mark W. Clemens of The University of Texas MD Anderson Cancer Centre said in the news release.

Rebekah Marcarelli 29 January 2014

 PTSD Information – Video ‘Dents in the Soul’

This video is the result of a need identified by Army and supported by the Directorate of Mental Health for information about Post Traumatic Stress Disorder (PTSD) to be made readily available for Defence members and their families. It is equally appropriate for all ex-service personnel and their families, to assist gain a better understanding of PTSD – its causes, its symptoms, and what can/should be done to help. If you are viewing by yourself it is suggested that you view it several times – watch it all the way through, think about the content, then viewing it again pausing or replaying segments as required to take on board the various views expressed. If you then have further questions or seek additional information, our Pension or Welfare officers can direct you to appropriate assistance. Duration of the video is 31 Minutes.


Dents in the Soul

Video courtesy RUSI of NSW website

 Hearing Services for Eligible Veterans - FREEDOM of Choice

If you are an entitled person, you are able to receive, free of charge, a range of hearing rehabilitation services appropriate to your needs via the Australian Government Hearing Services Program which is administered by the Office of Hearing Services (OHS).

Hearing loss is sometimes referred to as the invisible disability. Rarely can it be cured and no type of hearing aid can restore your hearing, the good news is that your hearing loss can be managed by an individual hearing rehabilitation program to achieve realistic communication improvement.

The rehabilitation team, that is you and your hearing services provider, devise an individual program based upon your needs.

The program consists of assessment, information sharing and strategies to make the most of your communication abilities and better manage your hearing loss.

If your provider thinks that, as part of your hearing rehabilitation program, you will require hearing aids they will in the first instance talk about the free range of quality high technology devices appropriate for your rehabilitation needs. They will also explain about the range of top-up hearing aids that are available. These hearing aids offer additional features which are not clinically necessary for your rehabilitation program. As well they are also generally not free.

DVA does not cover the cost of top-up hearing aids, as veterans and war widows have access to the large range of well featured, quality, free-to-client hearing aids that will meet their rehabilitation needs. DVA and the OHS expect that if you require hearing aids as part of your rehabilitation program there will almost always be an appropriate free option for you.

If there are exceptional circumstances, your practitioner should consult the entire panel of free-to-client hearing devices. Should they still believe there are no appropriate free-to-client hearing devices available to you on the free-to-client list; your provider can submit evidence to the Office of Hearing Services for consideration of a non-standard device.

For more information go to the DVA website and refer to factsheet HSV22 Hearing Services for Veterans. You can also discuss your case with the Veterans’ Affairs Audiologist by calling 1800 637 816.

Hearing Services - it’s your FREEDOM of choice.

 Heart attack info ASPIRIN

Keep aspirin by your bedside. It can save your life.


About Heart Attacks

There are other symptoms of an heart attack besides the pain on the left arm.
One must also be aware of an intense pain on the chin, as well as nausea and lots of sweating,
However these symptoms may also occur less frequently.
Note: There may be NO pain in the chest during a heart attack.
The majority of people (about 60%) who had a heart attack during their sleep, did not wake up.
However, if it occurs, the chest pain may wake you up from your deep sleep.

If that happens, immediately dissolve two aspirins in your mouth and swallow them with some water.

Afterwards: CALL 000

  • say "heart attack!"
  • say that you have taken 2 aspirins.
  • phone a neighbour or a family member who lives very close by
  • take a seat on a chair or sofa near the front door, and wait for their arrival and...
  • DO NOT lie down

Bayer is making crystal aspirin to dissolve under the tongue. They work much faster than the tablets.

Do remember this it may save your life!

Bayer is making crystal aspirin to dissolve under the tongue. They work much faster than the tablets.

 New Online Health Assistance For Ex-Service Personnel

Two new websites are being piloted to provide the ex-service community with access to vital health resources, the Minister for Veterans’ Affairs and Minister for Defence Science and Personnel, Warren Snowdon, announced today.

CLICK HERE to download a .pdf with more detail on "the Wellbeing Toolbox".

CLICK HERE to download a .pdf with more detail on "Touchbase".

Mr Snowdon said the sites, the Wellbeing Toolbox and touchbase, have been developed specifically for ex-service and transitioning personnel, their families and friends to help them face challenges that moving from military to civilian life may present.

"It is important that our service personnel and their families have access to helpful and informative resources to assist them in their day-to-day life.

These websites provide information links and where necessary, facilitate early intervention options for those who may be experiencing mental health issues.

The Wellbeing Toolbox provides interactive educational material in key areas such as problem solving, building support, helpful thinking, getting active, keeping calm and sleeping better and has been developed in conjunction with leading experts at the Australian Centre for Posttraumatic Mental Health."

"The site provides practical step-by-step tips and tools for improving mental and physical wellbeing and relieving stress," Mr Snowdon said.

The touchbase website, developed jointly by Defence and the Department of Veterans’ Affairs provides information on lifestyle issues such as employment and finances, and is a one-stop-shop for useful links on topics ranging from compensation and finances to health, housing and parenting support.

The touchbase website also provides users with the opportunity to keep in touch or reconnect with other former serving personnel, family and friends using its online community Find Your Mates.

"These websites are being piloted and I would encourage any current transitioning or recently discharged service personnel using the sites to provide feedback on how we can continue to improve the information and support provided during such a crucial time in a serving member’s life," Mr Snowdon said.

The Wellbeing Toolbox can be accessed at www.wellbeingtoolbox.net.au and touchbase at www.touchbase.gov.au.

Media inquiries: Minister Snowdon: Alice Plate 0400 045 999, Department of Veterans’ Affairs Media: 02 6289 6203 or 0413 994 704

 DVA's Mental Health Initiatives

CLICK HERE to download a .pdf evaluation of the Department of Veterans' Affairs Mental Health initiatives.

The report identifies the key issues as Communication and Provider Practice.  It is worthy of review in detail.

 Over 50?

A man over 50? CLICK HERE to check your health NOW.

Honour the Dead
But Fight Like Hell for the Living

 
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