Effective date

This pricing schedule is effective from 1 July 2006.

Military Rehabilitation and Compensation Commission

This schedule has been amended to reflect the inclusion of the Military Rehabilitation and Compensation Commission (MRCC) in the optical program arrangements.  The MRCC is responsible, under the Military Rehabilitation and Compensation Act 2004, for the granting of compensation and other benefits for current and former members of the Australian Defence Force (ADF) who suffer an injury or disease due to service after 1 July 2004, and for the dependants of members whose deaths were the result of an injury or disease due to service after 1 July 2004.

The same Gold and White Repatriation Health Cards currently issued are also issued by the MRCC. There will be no discernible difference from the processes currently in place. Arrangements for referrals, claims and payments remain the same.

Spectacle frame arrangements

The introduction of new arrangements for the supply of spectacle frames have been incorporated into this schedule. Schedule 2-Approved Frames, has been removed, and items relating to spectacle frames in Schedule 1-Spectacles have been amended.

Removal of lens pairs

All items for spectacle and contact lens pairs have been removed. For pairs of lenses, simply claim for two individual lenses.

Removed items

The following items have been removed: OP02, OP04, OP06, OP14, OP16, OP18, OP22, OP24, OP26, OP28, OP30, OP31, OP33, OP35, OP42, OP43, OP47, OP48, OP81, OP83, OP85, OP87 and OP89.

Amended items

The following items have been amended: OP32 and OP44.

New items

The following items have been introduced: OP64 and OP65.

Introduction

The following notes are provided for your information and assistance when providing optometric services and visual aids to Australia's eligible veterans, war widow/widowers and their eligible dependants (referred to in this schedule as veterans).

Role of the Repatriation Commission

The Repatriation Commission is responsible, under the Veterans' Entitlements Act 1986, for the granting of pensions, allowances and other benefits, and providing health care services to eligible veterans.

Role of the Military Rehabilitation and Compensation Commission

The Military Rehabilitation and Compensation Commission (MRCC) is responsible, under the Military Rehabilitation and Compensation Act 2004, for the granting of compensation and other benefits for current and former members of the Australian Defence Force (ADF) who suffer an injury or disease due to service after 1 July 2004, and for the dependants of members whose deaths were the result of an injury or disease due to service after 1 July 2004.

Role of the Department of Veterans' Affairs

The Department of Veterans' Affairs provides administrative support to the Repatriation Commission and the MRCC in discharging its responsibilities. Optometric services and visual aids may be provided to eligible veterans at the expense of the relevant Commission.

Veterans' Affairs Health Program

The objective of the Veterans' Affairs Health Program is to provide access to quality, cost-effective health care services to eligible veterans, through arrangements with DVA-registered health care professionals and public and private hospitals.

Optometrists and optical dispensers play a key role in providing optometric services and visual aids under the Health Program.

Who is eligible for optometric services and visual aids?

Veterans with a Gold Repatriation Health Card are automatically eligible for services under DVA's health care arrangements.

Veterans with a White Repatriation Health Card have limited treatment entitlement. They are only eligible for optometric services for specific conditions, known as their 'accepted disabilities' that affect their vision. Please refer to page 3.

A Repatriation Health Card must be current, as indicated by the expiry date, for the cardholder to be eligible for treatment.

Spouses and dependants of living veterans are generally not eligible for treatment under DVA arrangements. However, some may be eligible because of their own war or defence service, and will have their own Repatriation Health Card.

Other cards that contain a DVA logo, such as Pensioner Concession Cards, do not provide access to health care services under DVA arrangements. If you are unsure of a veteran's eligibility for optometric services or visual aids, please contact the DVA office in your State/Territory. Contact details are provided on page 11.

Repatriation Health Cards

Health care services are provided according to card type and on the basis of clinical need. The colour of the card indicates the level of entitlement to treatment. Alternatively, the department may give written authorisation for treatment.

A veteran should present his/her card or written authorisation to you before you provide treatment. This will allow you to confirm treatment eligibility and check the card expiry date. Please verify that the cardholder's signature on the back of the card matches the signature on the treatment service voucher.

Only the veteran named on the Repatriation Health Card is eligible for treatment at Commission expense. Entitlement does not extend to the cardholder's spouse or other family members.

Repatriation ORANGE Card

The Orange Card is for PHARMACEUTICALS ONLY and cannot be used for any medical or other health care treatment. The holder of an Orange Card has access to the extended range of pharmaceuticals available under the Repatriation Pharmaceutical Benefits Scheme at the concessional rate, and also receives the pharmaceutical allowance.

This card is issued to British, Commonwealth and Allied veterans and mariners with qualifying service from World War I or World War II, who have been resident in Australia for more than 10 years.

The Orange Card gives NO entitlement to health care services. You must not accept this card for optometric services or optical appliances.

Allied veterans resident in Australia

DVA acts as an agent for certain other countries whose eligible veterans reside in Australia.  These veterans hold a White Card with limited eligibility for treatment. Subject to decisions by relevant government departments of these countries, allied veterans may be treated for conditions accepted by their country as related to their war service.

Who is responsible for checking eligibility?

Optometric services

Optometric servicse are provided to veterans in accordance with Medicare arrangements and the Schedule of Services in the Medicare benefits for services by optometrists book. It is the optometrist's responsibility to verify that the cardholder is entitled to optometric assessments during the two-year entitlement period.

You can check a veteran's entitlement to optometric assessments on the Medicare Australia Hotline from anywhere in Australia. You will be asked to quote the veteran's DVA file number that is printed on their Repatriation Health Card.

The Medicare Australia Hotline number is: 1300 652 752

Alternatively, you can check entitlement by phoning the DVA office in your State or Territory. DVA will not meet the cost of optometric assessments to which a veteran is not entitled.

Optometrists may either direct bill through Medicare using the veteran's Medicare card, or claim payment through Medicare Australia using the veteran's Gold or White Card and DVA stationery.

If a veteran insists on proceeding with an initial consultation to which they are not entitled, the optometrist must explain to the veteran that they must accept full responsibility for payment of the account. The optometrist should also explain that the Medicare rebate would be at the rate of a subsequent consultation.

Visual aids

It is the dispensing provider's responsibility to verify that the veteran is entitled to the visual aids prescribed and supplied. If you have any doubt about eligibility or entitlement, you should contact DVA for clarification. The Repatriation Commission and the MRCC will not accept financial responsibility for visual aids provided to ineligible persons.

Dispensing of visual aids

Visual aids for eligible veterans must be dispensed in accordance with the contractual arrangements between the Repatriation Commission and MRCC, and optical dispensers.

Eligible veterans may choose to have their visual aids dispensed by the prescribing optometrist, or to take their prescription to the DVA-contracted optical dispenser of their choice.

What visual aids are veterans entitled to?

In any two-year period, eligible veterans are entitled to:

one pair of reading and one pair of distance spectacles; or

one pair of spectacles with either bifocal, trifocal or progressive power lenses.

Significant change in visual function within two years

Eligible veterans may have their lenses replaced within the two-year period if they have undergone a significant change in visual function (eg. a change in refraction) or a change in their clinical condition. Where possible, the new lenses should be fitted to the veteran's existing spectacle frames.

Where there is a significant change in visual function within a two-year period, the ophthalmologist or optometrist must tick the 'change in refraction' box on the Spectacles Prescription form (D931). The dispensing provider must attach a copy of the prescription to their service voucher and submit it with their claim for payment.

Additional pairs of spectacles

Veterans who live in isolated areas and would be severely handicapped by loss or breakage of spectacles, may receive duplicate pairs of spectacles, subject to the department giving prior financial authorisation.

Replacement of spectacles due to accidental loss or breakage

Where a veteran accidentally loses or breaks their spectacles within the two-year period, the relevant Commission will pay for replacement spectacles. However, the replacement spectacles must contain the same type of lenses that are being replaced, unless the veteran has undergone a significant change in visual function or has developed new signs or symptoms.

You must attach a written declaration stating the reason for replacement to your claim for payment, and the veteran must sign the declaration. You do not need prior financial authorisation for replacement spectacles when you follow this process.

Lens standard for veterans

All prescription lenses for veterans should be supplied in scratch resistant acrylic material, except in circumstances where standard glass lenses would better meet the needs of the veteran.

All lens prices in this schedule include the cost of scratch resistant coating.

Non-DVA frames

Co-payment frames

After viewing the in-store range, a veteran may pay a co-payment of up to $30.00, plus GST ($33.00), to obtain a frame that is not available under DVA arrangements. In these cases, the dispenser must fulfil the order by supplying and fitting lenses in strict accordance with the prescription. These should be the only circumstances in which a veteran is asked to pay a co-payment for a frame.

Clinical necessity

In instances where the prescribed lenses cannot be accommodated by a frame supplied under DVA arrangements (eg Hi Drop [aphakic] lenses), DVA will pay the full cost of a suitable frame, if DVA has given financial authorisation prior to supply.

Ultra light-weight metal frames

Ultra light-weight metal frames are not available to veterans at Commission expense for reasons of veteran preference, unless provided under item OP44.  However, other ultra light-weight metal frames may be supplied where a DVA frame would not accommodate the type of lenses required for the veteran's specific clinical need.

You must obtain the department's financial authorisation before supplying non-DVA ultra light-weight metal frames. The department will ask you for written certification of the clinical reasons for supply.

Non-DVA schedule lenses, including acrylic photo-sensitive lenses

The Repatriation Commission and the MRCC do not meet the full cost of non-DVA schedule lenses provided to veterans on the basis of veteran preference.

However, if the veteran requires non-DVA schedule lenses for a specific clinical condition, the relevant Commission will meet the full cost of the lenses, if the department has given prior financial authorisation. It is the optical dispenser's responsibility to obtain prior financial authorisation from the department for non-DVA schedule items. The department will ask you for written details of the veteran's relevant clinical condition to justify the need for non-DVA schedule lenses, including the lens brand and price of lens.

If a veteran prefers plastic photosensitive lenses the relevant Commission will pay a contribution towards the cost (i.e. a single distance or multi vision lens item plus OP 52), and the veteran pays the difference between the DVA schedule fee and the retail price.

Warranty and repairs

DVA expects optometrists and optical dispensers to honour the full warranty period allowed for spectacle frames and other visual aids, when repairing spectacles for veterans. All spectacle frames must be provided with a minimum 12 month repair and replacement warranty.

Please note that repair item OP60 includes a component for postage. Therefore, you must not claim additional postage (OP69) when claiming payment for OP60.

Contact lenses & consumables

When clinically required, contact lenses are to be supplied to eligible veterans in accordance with the arrangements and optical conditions specified in the Medicare benefits for services by optometrists book. Contact lenses must not be supplied in any other circumstances without the department's prior financial authorisation. Contact lenses must not be provided at Commission expense for reasons of veteran preference.

Eligible veterans are entitled to non-disposable contact lenses once every twelve months OR disposable contact lenses once every three months. Please refer to Schedule 2 for further information.

Low vision aids

Eligible veterans may access the range of low vision aids listed in Schedule 3. Non-optical low vision appliances are generally provided through the department's Rehabilitation Appliances Program. You should contact the department if a veteran requires a non-optical low vision appliance, and the department will make the necessary arrangements. Please refer to Schedule 3 for further information.

Prior financial authorisation from DVA

Where a spectacle prescription contains:

items from the Prior Financial Authorisation Items section of Schedule 1;

contact lenses in Schedule 2 that have not been prescribed for optical conditions as described in the Medicare benefits for consultations by optometrists book;

items in Schedule 3 that exceed the maximum price;

optical appliances that are not listed in the Pricing Schedule for Visual Aids; or

additional pairs of spectacles for eligible veterans living in isolated areas,

you must obtain the department's financial authorisation, before dispensing the visual aid. To obtain prior financial authorisation, please telephone the DVA office for your state or territory (refer page 11 for contact details). You may be asked to confirm your request by faxing a written request itemising the cost of each item, and the clinical reasons for each item, to the department. Please use your own letterhead for these requests.

Domiciliary visits and kilometre allowance

Optometrists may undertake a consultation in an eligible veteran's home when there is a genuine need to do so. A genuine need includes when the veteran is bedridden or non-ambulatory and does not have access to transport.

A kilometre allowance may be claimed for each kilometre travelled after the first 10 kilometres, outside metropolitan areas for domiciliary visits to the veteran's home. A kilometre allowance may also be claimed if you travel to a veteran who is an in-patient at either a private or public hospital, or receives high level care in a residential care facility (formerly nursing home level of care). You must be the nearest suitable provider to the veteran's home to claim kilometre allowance. You should enter the total number of kilometres travelled (from your practice location to the veteran's home and return) on the Optometric/Optical Service Voucher (Form D1223). Medicare Australia will automatically deduct the first 10 kilometres and calculate the amount payable at the Australian Government private motor vehicle per kilometre rate.

For full details and instructions on claiming this allowance, please refer to Section 3 of the Notes, and to DVA Fact Sheet HIP 81 "Information for Allied Health Providers - Kilometre Allowance", which can be found on DVA's web site at www.dva.gov.au/factsheets

Optometrists are also able to claim a DVA domiciliary allowance for an optometric consultation in the veteran's home. The loading is equal to an extra 1/3 of 100% of the usual MBS consultation fee under the terms of the DVA Optometrical agreement. The Medicare payment system automatically calculates the domiciliary fee.

GST

The prices contained in Schedules 1, 2 and 3 do not include GST. The Medicare Australia payment system automatically adds the GST payable for taxable items, and issues you with a Recipient Created Tax Invoice (RCTI) to meet invoicing requirements under GST law. RCTIs are only issued for Direct taxable items claimed.

When a veteran chooses a co-payment frame, DVA pays the GST payable on its share of the cost (i.e. the relevant OP item), and the veteran pays the GST payable on their share of the cost.

DVA stationery

Please use DVA stationery when claiming payment. This will ensure that Medicare Australia receives sufficient information to process your account promptly.

The DVA stationery you need to claim payment from Medicare Australia are:

D931 Spectacles Prescription form

D1223 Optometric/Optical Service Voucher (complete one voucher for each service rendered by one practitioner to one veteran)

D1217 Claim for Treatment Services (attach your individual D1223s to this claim form when claiming payment)

DVA claim stationery is available from:

www.dva.gov.au/health/quick/providerforms.htm

DVA Distribution

PO Box 251

Woden ACT 2606

Phone: 1800 155 355

Fax: 1800 671 670

Claiming payment

Medicare Australia processes the department's treatment claims for payment. Please send your claims for payment to:

Medicare Australia

GPO Box 964

ADELAIDE  SA 5001

Please direct your payment enquiries to Medicare Australia on: 1300 550 051

Payment problems

Non-payment of claims

Sometimes Medicare Australia will not pay a claim, for one of the following reasons:

the provider has not signed the service voucher;

the servicing or payee provider is not identified;

the spectacles prescription is missing or is incomplete (i.e. when applicable, there is no indication of a significant change in refraction or that the veteran has lost or broken their spectacles);

prior financial authorisation was required, but not sought;

the veteran has not signed the service voucher;

information is omitted from the service voucher or there is incorrect information;

for a White Card holder, the condition treated is omitted; or

the claim is older than six months.

If there is a problem with a claim, Medicare Australia will return either the entire claim (i.e. D1217 with the attached D1223s) or a number of individual service vouchers to the provider with an explanation for non-payment.

Resubmitting claims

If an entire claim is returned to you for any of the above reasons, please make the necessary amendments and resubmit it to Medicare Australia intact as one complete claim, but with a D1217 form.

If single vouchers are returned to you, please make the necessary amendments and resubmit them to Medicare Australia as part of your next claim.

Retrospective adjustments

If you require an adjustment to a payment you have already received, you should send a written request to Medicare Australia, and include the following information;

the reason for the adjustment;

your provider number, name and address;

the identification number of the claim requiring adjustment; and

the name and DVA file number of the veteran for whom you provided the services.

DVA contact numbers

If you have any questions concerning any aspect of the department's Optical Supplies Program, please telephone the DVA office in your State or Territory on the numbers listed below. You may also request prior financial authorisation on these telephone numbers.

FOR ALL STATES AND TERRITORIES:

TOLL FREE NUMBER FOR ALL NON-METROPOLITAN AREAS:

Item

Description

GST-Exclusive Price

GST Status

OP01

Near Stock Lens (each)

Note: This item is restricted against OP52, OP54, OP56  and OP57.

EXEMPT

OP03

Near Grind Lens (each)

Note: This item is restricted against OP52, OP54, OP56 and OP57.

EXEMPT

OP05

Near Aspheric Lens (each)

Note: This item is restricted against OP52, OP54, OP56  and OP57.

EXEMPT

OP13

Distance Stock Lens (each)

EXEMPT

OP15

Distance Grind Lens (each)

EXEMPT

OP17

Distance Aspheric Lens (each)

EXEMPT

OP21

Bifocal Lens (each)

EXEMPT

OP23

Bifocal Aspheric Lens (each)

EXEMPT

OP25

Trifocal D28 Lens (each)

EXEMPT

OP27

Progressive Lens (each)

EXEMPT

OP34

Grind Prisms (greater than 2.00 dioptres) (each)

(Prisms of 2.00 dioptres or less are included in the cost of grind lens.)

EXEMPT

Item

Description

GST-Exclusive Price

GST Status

OP52

Photosensitive Tint (each)

EXEMPT

OP54

Tint applied as part of initial dispensing (each)

EXEMPT

OP57

Tint applied after spectacles dispensed or to veterans' own spectacles (each)

TAXABLE

OP56

UV coating (each)

Note: This item is restricted against single vision near lenses and photosensitive tint (OP52).

EXEMPT

OP32

Plastic frames

TAXABLE

OP44

Metal frames

TAXABLE

OP64

Plastic co-payment frames

TAXABLE

OP65

Metal co-payment frames

TAXABLE

Item

Description

GST-Exclusive Price

GST Status

OP38

Fit new lens to veteran's existing/own PLASTIC frame (each)

Note:  This item is restricted. It can only be claimed in conjunction with an item for new lenses.

TAXABLE

OP39

Fit new lens to veteran's existing/own METAL frame (each)

Note:  This item is restricted. It can only be claimed in conjunction with an item for new lenses.

TAXABLE

OP41

Spectacles Case

TAXABLE

OP37

Sunglasses (to fit over existing spectacles)

Please claim the list price, without exceeding the maximum price.

Note:  This item is restricted against itself and OP items 51, 52, 54, 57, and 71, i.e. a veteran may receive only one of these items in a two-year period (37 or 51 or 52 or 54 or 57 or 71).

Maximum

TAXABLE

OP51

Sunglasses clip on (flip-up or standard)

Note:  restrictions apply - refer to the note at OP37.

TAXABLE

OP69

Postage (claim the actual cost of postage, up to maximum), exclusive of GST

Maximum

TAXABLE

OP60

Repair or replace temple/joint (incl. Postage)

TAXABLE

OP62

Nose pads (each)

TAXABLE

Item

Description

GST-Exclusive Price

GST Status

OP45

Miscellaneous, GST-exempt item

FBN

EXEMPT

OP46

Miscellaneous, GST-taxable item

FBN

TAXABLE

OP71

Plano Sunglasses

Restrictions apply - refer to the note at OP37.

FBN

TAXABLE

OP72

Non-Schedule Lens

FBN

EXEMPT

OP73

Non-Schedule Frame

FBN

TAXABLE

OP76

Non-Schedule Prisms, including Fresnel

FBN

EXEMPT

Item

Description

GST-Exclusive Price

GST Status

OP75

Contact Lens related consumables

List price

TAXABLE

OP79

Tint for contact lenses

EXEMPT

OP80

Soft Spherical (each)

EXEMPT

OP77

Soft Spherical Disposable (each) (3 month supply)

EXEMPT

OP82

Soft Toric (each)

EXEMPT

OP78

Soft Toric Disposable (each) (3 month supply)

EXEMPT

OP84

Rigid Gas Permeable/Hard Spherical (each)

EXEMPT

OP86

Rigid Gas Permeable/Hard Toric (each)

EXEMPT

OP88

Rigid Gas Permeable/Hard Bitoric (each)

EXEMPT

Item

Description

MAXIMUM PRICE (without prior financial authorisation)

GST Status

OP63

Frames for pin hole spectacles

TAXABLE

OP61

Lenses for pin hole spectacles and prescribed by an optometrist or ophthalmologist

EXEMPT

OP90

Stand magnifier/type etc.

TAXABLE

OP91

Hand magnifiers/Pendant

TAXABLE

OP92

Torch/Flashlight magnifiers

TAXABLE

OP93

Head Band mounted magnifiers  )

Chest magnifiers  )

Embroidery magnifiers  )

TAXABLE

OP94

Clip On lens system

TAXABLE

OP59

Spectacle mounted telescopic aids eg. mounted into the lens and forming part of the lens and prescribed by an optometrist or ophthalmologist

EXEMPT

OP95

Other telescopic aids

TAXABLE

OP96

Spectacle mounted magnifiers

TAXABLE

OP58

Reading magnification devices [specifically designed (and intended) for the purpose of reading]

EXEMPT

OP97

Lamps with magnification

TAXABLE

OP98

Glare aids

TAXABLE

OP99

Accessories for use with low vision aids, eg lap desks, single rail line guides, reading stands etc.

TAXABLE