Radiation Oncology Health Program Grants Scheme

Guidelines

Page last updated: 03 December 2010

Downloadable version of Radiation Oncology Health Program Grants Scheme - Guidelines (PDF 131 KB). If you have any difficulty accessing any of the provided downloadable parts of this document, please contact the Radiation Oncology Section.

1. Definitions and Shortened Forms
2. Introduction
3. Policy Objectives
4. Background
5. Funding Arrangements
6. How to Apply
7. Assessment and Approval Process
8. Assessment Criteria
9. Transfer of Ownership/Control of an Existing Service
10. Procedural Fairness

Appendix
Appendix 1 - Rates to apply on and from 1 September 2010
Appendix 2 - List of eligible equipment
Appendix 3 – Conditions of Payment of Grant (public organisation)
Appendix 4 – Conditions of Payment of Grant (private organisation)
Appendix 5 – Requirement for Claims (Private Organisation)
Appendix 6 – Requirement for Claims (Public Organisation)

1. Definitions and shortened forms

Act The Health Insurance Act 1973

Approved health service The provision of radiation oncology services by an approved organisation authorised in accordance with subsection 41(3) of the Act at a specified address using identified equipment

Approved organisation An entity that has been approved by the Minister for Health and Ageing or their delegate as an organisation under subsection 40(3) of the Act

Area of need A geographical area where a need for radiation oncology services has been identified by the Commonwealth in consultation with state and territory health departments

Capital balance An amount determined for each type of radiation oncology equipment at the time an application for Radiation Oncology Health Program Grants (ROHPG) funding is approved

Minister Minister for Health and Ageing for the Commonwealth of Australia

Delegate An office holder delegated to exercise the powers conferred on the Minister under Part IV of the Act

DepartmentThe Department of Health and Ageing

Eligible equipment Radiation oncology equipment determined as being eligible for funding under the ROHPG Scheme

Legal instrument The document(s) approving radiation oncology health program grants and specifying conditions and the way claims should be made

Planned operational date The date on which the treatment of patients is likely to commence

Networked information system The combination of hardware and software components which enables the integration of all equipment in a radiotherapy facility

ROHPG Radiation Oncology Health Program Grant

Reimbursement rate An amount for each radiation oncology service attracting a Medicare benefit which is performed on each approved equipment type and is paid monthly and in arrears Top of Page

2. Introduction

The purpose of these Guidelines is to provide information about the Radiation Oncology Health Program Grants (ROHPG) Scheme, together with details about the application process and the criteria that will be used to assess applications received from those seeking funding under the Scheme. ROHPG funding is available to both public and private providers of radiation oncology services.

The Guidelines, together with the assessment criteria, have been developed to ensure that the application process for ROHPG funding is equitable and accountable and that the best use is made of Commonwealth funding.

3. Policy Objectives

ROHPGs are an element of the Commonwealth Government’s strategy to provide curative and palliative treatment to Australians with cancer through access to appropriate high quality radiation oncology services. It is estimated that around 52% of cancer patients would benefit from radiation oncology services.

Quality radiation oncology services are:
  • affordable for patients
  • delivered safely and accurately
  • performed using up-to-date equipment
  • coordinated with other cancer treatment services and planning processes.
Through ROHPGs, the Commonwealth Government aims to:
  • improve health outcomes for cancer patients
  • increase access to radiation oncology services
  • improve equity of access for cancer patients
  • ensure the highest quality and safety of radiation oncology services.Top of Page

4. Background

Health program grants are an alternative mechanism for the Commonwealth Government to fund health services outside of the Medicare arrangements. Health program grants are made under Part IV of the Health Insurance Act 1973 (the Act).

In 1988, the Commonwealth Government introduced ROHPGs as a contribution towards the capital costs incurred by radiation oncology providers for major radiation oncology equipment.

Funding under the ROHPG Scheme is separate from and complementary to Medicare benefits. Medicare pays benefits to patients for the professional and operating costs of radiation oncology services provided to them. Medicare benefits do not include funding for the cost of equipment used in providing these services.

The ROHPG arrangements provide ongoing funding for radiation oncology equipment through annual budget appropriations. There are also other budget measures which may provide funding for radiation oncology infrastructure. Radiation oncology equipment funded through other Commonwealth budget measures is generally not eligible for ROHPG funding.Top of Page

5. Funding Arrangements

5.1 Legislative Provisions

An organisation wishing to provide services must be approved as an ‘approved organisation’ by the Minister under section 40 of the Act. The approved organisation must have the health service to be provided by it approved by the Minister as an ‘approved health service’ under section 41 of the Act. A health service is approved for a specified location using particular equipment.

Section 42 of the Act allows the Minister to determine an organisation’s entitlement to be paid a proportion of the costs incurred in providing the approved health services.

Subsection 43(1) of the Act allows the Minister to specify any conditions attached to those payments.

Subsection 45(1) of the Act allows the Minister to direct an organisation to make claims for payment in a specified way.

The term ‘Minister’ includes a delegate.

5.2 Funding

A brief overview of the ROHPG Scheme is provided below:

ROHPG funding is available for a range of equipment including linear accelerators, CT interfacing planning computers, simulators and brachytherapy units. A list of equipment that is eligible for ROHPG funding is shown at Appendix 2.
  • The amount of ROHPG payable for the equipment is determined from time to time by the department in consultation with a stakeholder committee. Rates are calculated based on specifications for each type of equipment (including the cost of shielding), average costs supplied by manufacturers, the exchange rate for the Australian dollar and where applicable, an allowance for the cost of borrowing if funds have been borrowed to purchase the equipment. This allowance is based on the Commonwealth 10 year bond rate. The amount determined for a particular type of equipment is known as the capital balance.
For each equipment type, a reimbursement per service rate is determined for every radiation oncology service attracting a Medicare Benefit (see Table 1 of Appendix 1). This payment is calculated by dividing the capital balance by the notional number of services performed during the notional life of the machine (see Table 2 of Appendix 1).
  • Once an application has been approved, the eligible equipment is allocated a capital balance at the rate applicable at the time of approval. This capital balance applies for the life of the equipment, irrespective of rate changes in the meantime.
  • The capital balance allocated for the approved equipment is reduced by the reimbursement amount for each eligible service rendered using the equipment. Once the capital balance reaches zero, ROHPG is no longer paid. The discontinuation of ROHPG payments does not affect the Medicare Benefit payable for the service.
  • Both public and private organisations need to comply with a number of conditions for the payment of the ROHPG funding. These are shown at Appendices 3 and 4, respectively. For public sector organisations, it is also a condition that ROHPG payments be used solely for refurbishing or acquiring radiation oncology equipment at the location in respect of which the grant payment was made. For this reason, it is a condition that the public sector’s payments be held in a separate bank account and that these are reported on yearly. There is also an optional condition in relation to private organisations’ billing policies.
  • ROHPG payments are made to each service provider at the end of every month by Medicare Australia. Private organisations are required to provide claims for ROHPG payments in an electronic form acceptable to Medicare Australia. In the case of a public organisation, a claim for payment of Medicare benefits automatically generates a ROHPG claim for payment (see Appendices 5 and 6, respectively).
  • Applications for ROHPG approval must be made before equipment becomes operational. Retrospective funding will only be provided in exceptional circumstances, such as an unplanned replacement which is urgently required due to equipment breakdown.
Networked Information System (NIS) Payments
  • NIS payments are made to facilities for the cost of networking radiation oncology equipment and patient information management systems. Payments are based on the number of linear accelerators at each facility with the rate being determined according to ROHPG rates reviews.
  • NIS payments are calculated annually and paid twice yearly, in April and October each year (note: this was May and November. The new payment cycle commenced in October 2010). See Table 3 of Appendix 1 for the current NIS rates.Top of Page

6. How to Apply

Applications for ROHPG funding can be made at any time, but (unless there are exceptional circumstances) must be approved by the Delegate before the delivery of services to patients on the equipment has commenced. This applies to both public and private providers.

Applications should be made on the application form and provide the information as outlined under ‘Types of applications’ in section 6.1.

All ROHPG applications are to be mailed to:
Director,
Radiation Oncology Section
Department of Health and Ageing
MDP 853, GPO Box 9848
Canberra ACT 2601
Applications and enquiries can be emailed to the Radiation Oncology Section

6.1 Types of applications

There are five types of applications that can be submitted:
  1. New facility to be operated by a new organisation – where neither the organisation, nor the health service to be provided at a new facility, have been approved under Part IV of the Act.
  2. New facility to be operated by an organisation already providing radiation oncology services – where the organisation is receiving radiation oncology health program grants for another facility or other facilities, but the service to be provided at a new facility has not been approved. This includes the relocation of an existing facility.
  3. Expansion of capacity – to install additional equipment of the type already approved, e.g. the service has two linear accelerators and wants a third linear accelerator.
  4. Expansion of scope – for a type of equipment not already approved, e.g. when a facility without a High Dose Rate (HDR) brachytherapy unit wants such a machine.
  5. Replacement equipment – to replace an existing piece of approved ROHPG equipment with a piece of equipment of the same type, e.g. when a linear accelerator is replaced with another linear accelerator not already identified in the legal instruments.Top of Page
The following sections set out the information required to be submitted with an application for funding under the ROHPG Scheme.

6.1.1 New facility to be operated by a new organisation

A new facility to be operated by a new organisation first requires the organisation to be approved under section 40 of the Act. An application form for approval as an organisation is available for downloading at the following website - Radiation Oncology Health Program Grants Overview page
The approved organisation must then seek approval for the health service it will provide at a specific location (section 41 of the Act) and support the application with the following information:
  1. The expected opening date of the facility.
  2. The physical address of the facility.
  3. A project plan and timeframe for the establishment of the new service. The plan should identify the major steps from planning to service delivery.
  4. Details of the proposed service including:
      1. the type of equipment and number of machines to be located at the facility
      2. the expected number and type of radiation oncology treatment services to be provided, the number of patients to be treated at the facility and the impact this may have on other radiation oncology services in the area
      3. information that shows the service will be able to provide an integrated cancer care management system including:
        1. details of clinical oncologists and surgeons networked into services
        2. details of any arrangements that have been made for collaboration and/or multidisciplinary care and details of links to other centres, particularly for on-referral or discussion of complex cases (include any details of proposed links)
        3. access to other associated follow up care for patients.
  5. The extent of out-of-pocket costs for patients receiving treatment (for example, the number, or type of patients likely to be bulk billed, or charged the schedule fee only).
  6. A detailed explanation of how the required staffing will be achieved, the expected sources of staff and staff recruiting arrangements.
  7. The impact the proposed service will have on other facilities in the area.
  8. Major project risks and strategies for dealing with those risks.
The above provisions apply to both public and private providers.

Further to the information required above, private sector organisations would also need to provide a fully costed and independently audited business case that explains what will be achieved by the project over a 10 year period. This should cover:
  • An assessment of the catchment area (including size, region, number and age distribution of the catchment population, cancer incidence profile, existing cancer care services, unmet need and patient flows).
  • Project budget which identifies sources and amount of income to be generated and expected costs over 10 years.
An application form for seeking approval for a new health service is available for downloading at the following website - Radiation Oncology Health Program Grants overview page. This form should also be used for all other application types.
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6.1.2 New facility (or relocation of an existing facility) for organisations operating an existing facility (facilities)

For an approved organisation with approval to operate an existing facility (facilities), wishing to establish a new facility or relocate an existing facility, the organisation will need to seek approval for a new health service and support the application with the following information:
  1. The expected opening date of the facility.
  2. The physical address of the facility.
  3. A project plan and timeframe for the establishment of the new service. The plan should identify the major steps from planning to service delivery.
  4. If an existing service is moving premises, the date the existing service will cease operations at its current address and the reasons why the service is moving.
  5. Details of the proposed service including:
        1. the type of equipment and number of machines to be located at the facility
        2. the expected number and type of radiation oncology treatment services to be provided, the number of patients to be treated at the facility and the impact this may have on other radiation oncology services in the area
        3. Information that shows that the service will be able to provide an integrated cancer care management system including:
          1. details of clinical oncologists and surgeons networked into services
          2. details of any arrangements that have been made for collaboration and/or multidisciplinary care and details of links to other centres, particularly for on-referral or discussion of complex cases (include any details of proposed links)
          3. access to other associated follow up care for patients.
  6. The extent of out-of-pocket costs for patients receiving treatment (for example, the number, or type of patients likely to be bulk billed, or charged the schedule fee only and/or above the scheduled fee).
  7. A detailed explanation of how the required staffing will be achieved, the expected sources of staff and staff recruiting arrangements.
  8. The impact the proposed service will have on other facilities in the area.
  9. Major project risks and strategies for dealing with those risks.
The above provisions apply to both public and private providers.
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Further to the information required above, private sector organisations would also need to provide a fully costed and independently audited business case that explains what will be achieved by the project over a 10 year period. This should cover:
  • An assessment of the catchment area (including size, region, number and age distribution of the catchment population, cancer incidence profile, existing cancer care services, unmet need and patient flows).
  • Project budget which identifies sources and amount of income to be generated and expected costs over 10 years.

6.1.3 Expansion of capacity

For applications for expansion of capacity (additional equipment of a type already approved), the organisation must seek approval for a new health service and support the application with the following information:
  1. Planned operational date for the new equipment (the date the equipment will be ready to treat its first patient).
  2. Type of equipment and number of machines (make, model and details of accessories for each piece of equipment to be provided prior to becoming operational).
  3. Evidence that the equipment will meet identified patient demand (supported by information about the expected number and type of radiation oncology services to be provided and expected number of patients to be treated by the new equipment).
  4. Detailed explanation of how the required staffing will be achieved. This should include information on expected sources of staff, additional staff recruiting arrangements and any reorganisation of existing staff. If applicable, a statement that an increase in staff is not necessary and why, should also be included.

6.1.4 Expansion of scope

For applications for expansion of scope (equipment of a type not already approved), the organisation must seek approval for a new health service and support the application with the following information:
  1. Planned operational date for the new equipment (the date the equipment will be ready to treat its first patient).
  2. The type of equipment and number of machines (make, model and details of accessories for each piece of equipment to be provided prior to becoming operational).
  3. Evidence that the equipment will meet identified patient demand (supported by information about the expected number and type of radiation oncology services to be provided and expected number of patients to be treated by the new equipment).
  4. Detailed explanation of how the required staffing will be achieved. This should include information on expected sources of staff, additional staff recruiting arrangements and any reorganisation of existing staff. If applicable, a statement that an increase in staff is not necessary, and why, should also be included.Top of Page

6.1.5 Replacement equipment

For applications for replacement equipment, the organisation must seek approval for a new health service and support the application with the following information:
  1. Date of planned decommissioning of equipment to be replaced.
  2. Planned operational date of new equipment (the date the equipment will be ready to treat its first patient).
  3. Type of replacement equipment including make, model, accessories and specifications.
  4. ROHPG number of the equipment to be replaced.
  5. Brief statement of the reasons for the planned replacement of equipment (for example, age or frequent breakdowns).

7. Assessment and Approval Process

Once an application is received, the following assessment and approval process is undertaken:
  1. If the application is for a new facility, expansion in capacity or expansion in scope, it will be assessed against the criteria outlined in Section 8 of the Guidelines. During this process, clarification or additional information may be sought from the applicant.
  2. If the applicant is a private organisation, the application will be forwarded on a confidential basis to the relevant state or territory health department and state or territory cancer council for comment. A private organisation will need to acknowledge that they have consented to all the information in its application being provided to relevant state and territory health departments and cancer councils.
  3. If the application is for replacement equipment, it will normally be approved once the required information has been provided and the applicant has demonstrated that the equipment will meet identified patient demand.
  4. An assessment document will be prepared for the authorised delegate, together with a legal instrument if the application is recommended for approval.
  5. A decision will be made by the authorised delegate and the applicant will be notified of the outcome.
  6. Subject to consent by the approved organisation, the name and location of facilities approved for ROHPG funding will be posted on the department’s website.
Applicants should not assume that approval of an ROHPG application will be automatic. All applications will be subject to a rigorous assessment process and the department will be in regular contact with the applicant.Top of Page

8. Assessment Criteria

The Guidelines aim to provide relevant criteria for the Delegate to take into account when making decisions. However, the criteria do not constrain the Delegate from considering other factors or issues that may arise on a case-by-case basis, nor is the Delegate bound to take the criteria into consideration when making a decision.

Applications for a new facility, an expansion of capacity or an expansion of scope will usually be assessed against the following criteria.
Criterion 1: Eligible equipment Equipment must be eligible for ROHPG funding.
Appendix 2 provides a list of ROHPG eligible equipment
  • Equipment specified in applications must be eligible for funding under the ROHPG Scheme.

Criterion 2: Patient access

Services must be located in areas of need, regionally and nationally.
Areas of need are identified in consultation with the relevant state health departments.
  • Applications for approval of a new service must demonstrate that there is a need for radiotherapy services in the area where the facility is to be located.
  • Applications for an expansion of capacity or of scope must demonstrate that there is sufficient patient demand to justify funding of additional equipment.
  • In assessing an application against this criterion, the department will seek comment from the relevant state health department and the state cancer council if the applicant is a private organisation. Where significant cross-border flows of patients are expected, comment may also be sought from other states or territories.
  • If a public organisation is applying for funding, comment may be sought from potentially affected private providers, other affected parties and the community generally.
Services must be affordable.
The extent of out-of-pocket costs that result from the billing practices of services will have an important impact on equity of access and therefore will be a key consideration in the assessment of applications.
  • Applicants will need to demonstrate that the fees they charge for their radiotherapy services will not result in out-of-pocket costs that may affect patient access to those services.

Criterion 3: Viability

Services must be financially viable.
The extent of out-of-pocket costs that result from the billing practices of services will have an important impact on equity of access and therefore will be a key consideration in the assessment of applications.
Commonwealth funding decisions must ensure the most cost-effective use of public funds.
  • Private organisations will need to demonstrate that the service is financially viable in the short and long term.
  • Public organisations will satisfy this criterion if they can demonstrate that there is sufficient demand for the service to justify the expenditure.

Criterion 4: Multidisciplinary and patient-centred care

Radiation oncology services must be integrated with other cancer treatments and other medical services generally.

Radiation oncology services that are integrated with other medical services will help ensure the best possible treatment for patients.

Applicants will need to demonstrate that the service will form part of an integrated cancer management system including but not limited to, medical oncology; surgery; and allied health services, ie multidisciplinary care.
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Criterion 5: Staffing

Services must have adequate staffing.

Given the shortages in the radiation oncology workforce throughout Australia and overseas, it is important that services are able to demonstrate how this criterion will be met.
  • Applications for new health services will need to demonstrate that their facility can be adequately staffed; the risks associated with workforce shortages have been identified; they have strategies in place for dealing with workforce issues; staffing levels at other facilities will not be significantly affected.
  • Applications for expansion of scope or capacity will need to demonstrate that additional staffing requirements can be met and that staffing levels at other facilities will not be affected.

Criterion 6: Implementation

The project must be well developed, well resourced and be implemented within a reasonable timeframe.

ROHPG approvals effectively set aside the approved funds for up to 10 years. These funds cannot be used by other organisations, even if the implementation of the original project is seriously delayed.
  • Applicants will need to demonstrate that they have the resources and commitment to implement their project within a reasonable timeframe.
A realistic commencement date for treating patients will be an important consideration in assessing ROHPG applications. The maximum period the department would be expecting for a facility to become operational is three years from the approval date.

If an organisation is unable to commence delivery of patient services by the date specified in their application and cannot demonstrate that strategies have been put in place for commencement within a reasonable period, their approval may be revoked. An organisation may be asked to provide regular progress reports to the department.
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Another application with a different commencement date may be submitted if an approval is revoked.

9. Transfer of Ownership/Control of an Existing Service


Where there is to be a transfer of ownership or control of an existing approved health service, the organisation must seek approval for a new health service and provide the following information:
  1. Expected date of completion of the planned transfer of ownership.
  2. Details of all the equipment to be transferred.
  3. The ROHPG number of the equipment to be transferred.
If the organisation planning to take over the service is not an approved organisation, it must first complete an application form for approval as an organisation. This form is available for downloading at the following website - Radiation Oncology Health Program Grants Overview page.

It should not be assumed that approval of the transfer of ownership/control will be automatic. It is therefore recommended that an organisation planning to take over an existing ROHPG approved service apply for approval and await that approval, before entering into any contracts.

10. Procedural Fairness

10.1 If after taking into account all the information contained in an application (including advice provided by state and territory health departments and cancer councils in respect of private organisations) the Delegate is of a mind to not approve the application, the applicant will be provided with the opportunity to comment on the basis and reasons for the Delegate forming this view.
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10.2 Where the advice from the respective state and territory government and/or cancer council does not support the application of a private sector organisation and this a determining factor in the Delegate’s decision, the applicant will be provided with a copy of the state and territory government/cancer council advice.

10.3 If the Delegate does not approve the application after considering the comments provided by the application under paragraph 10.1, the applicant will be given the opportunity to seek a review of the decision by another delegate. A request for a review of the decision needs to:
    i. be in writing;
    ii. be made within 21 days of the decision; and
    iii. clearly set out the grounds on which the review is being sought.
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Appendices

Appendix One - Rates to apply on and from 1 September 2010

Downloadable version of Appendix One - Rates to apply on and from 1 September 2010 (PDF 20 KB)
Opening capital balance (with cost of borrowing)Reimbursement per service (with cost of borrowing)Opening Capital Balance (without cost of borrowing)Reimbursement per service (without cost of borrowing)
Single Photon Linear Accelerators SPLA* $4,106,001.49$2,626,352.98
MBS Items: 15215, 15218, 15221, 15224, 15227 $49.59 $31.72
Dual Modality Linear Accelerators DMLA*$4,634,626.23$2,964,481.24
MBS Items: 15245, 15248, 15251, 15254, 15257$55.97$35.80
Planning 3 or less workstations$591,410.14$461,428.99
Level 1 MBS Item: 15518$8.03$6.26
Level 2 MBS Item: 15521$35.45$27.66
Level 3 MBS Items: 15524, 15556, 15559, 15562$90.59$70.68
Planning 4 or more workstations$701,364.36$547,217.29
Level 1 MBS Item: 15518$9.52$7.43
Level 2 MBS Item: 15521$42.04$32.80
Level 3 MBS Items: 15524, 15556, 15559, 15562$107.44$83.82
Simulators$1,351,796.48$864,659.87
Level 1 MBS Item: 15500$40.82$26.11
Level 2 MBS Items: 15503, 15513$52.22$33.40
Level 3 MBS Items: 15506, 15550, 15553$101.94$65.20
HDR Brachytherapy - Treatment and Planning$1,183,462.70$756,987.25
MBS Items: 15304, 15308, 15312, 15316, 15320, 15324, 15328, 15332, 15336$499.58$319.55
MBS Items: 15536$195.05$124.76
LDR Brachytherapy $371,175.00$289,597.52
Treatment - MBS Item: 15338$1,145.41$893.67
Planning - MBS Item: 15539$768.01$599.22
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Appendix Two - List of Eligible Equipment

Downloadable version of Appendix Two - List of Eligible Equipment (PDF 11 KB)
  • CT Interfacing Planning Computer System with 3 or less workstations.
  • CT Interfacing Planning Computer System with 4 or more workstations.
  • Single Photon Linear Accelerator (SPLA) with Electronic Portal Imaging (EPI) and Multi Leaf Collimator (MLC).
  • Dual Modality Linear Accelerator (DMLA) with Electronic Portal Imaging (EPI) and Multi Leaf Collimator (MLC).
  • High Dose Rate (HDR) Brachytherapy.
  • Low Dose Rate (LDR) Brachytherapy (or seed brachytherapy).
  • Simulators – without CT, with CT capability and CT machines with simulation capability.
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Appendix 3 – Conditions of Payment of Grant (public organisation)

Downloadable version of Appendix 3 – Conditions of Payment of Grant (public organisation) (PDF 15 KB)

1. Interpretation
In this Schedule:
Approved health service means the health service approved in this Instrument under subsection 41(3) of the Act, that is provided, or to be provided, by the Organisation.
Department means the Department of Health and Ageing.
Grant means health program grant payable to the Organisation in respect of an approved health service.

2. Separate bank account for payments
(1) An approved organisation must have a bank account, under the sole control of the organisation and separate from its other bank accounts, into which all grant payments are to be paid on receipt.
(2) No other moneys may be paid into the account, except the following moneys, which must be paid into the account:
(a) interest earned on grant payments;
(b) input tax credits received in relation to a health service’s approved radiation oncology equipment;
(c) if equipment in respect of which a grant payment has been received is sold by the approved organisation, the proceeds of the sale.


3. Use of grant payments
It is a condition that grant payments, and amounts mentioned in subsection 2 (2), be used solely for refurbishing or acquiring radiation oncology equipment at the location in respect of which the grant payment was made.

4. Accounting for use of grant payments
(1) The organisation must keep proper accounts and records in relation to its use of grant payments, in such manner that those accounts and records are separate and distinct from the other accounts and records of the organisation.
(2) Before the end of 3 months after the end of a financial year, the organisation must give the department a written statement setting out:
(a) all grant payments received during the financial year; and
(b) amounts of grant payments carried over from any previous financial year; and
(c) amounts of grant payments spent on the acquisition, commissioning, replacement or renovation of approved equipment during the financial year; and
(d) amounts of grant payments carried over to the next financial year; and
(e) amounts, of a kind mentioned in subsection 2 (2), received in relation to the approved health service.


5. Misrepresentation of relationship with Commonwealth
(1) It is a condition that the Organisation not represent itself as:
(a) being, in any respect, any part of the Commonwealth Government; or
(b) having an association in the nature of an agency or partnership with the Commonwealth Government; or
(c) having authority to do anything in the name of, or otherwise on behalf of, the Commonwealth Government; or
(d) having authority to bind, in any respect, the Commonwealth Government.

(2) It is a condition that an employee of the Organisation not represent himself, or herself, as being an employee of, or as having any kind of authority to do anything on behalf of, the Commonwealth Government.

6. Indemnity
(1) It is a condition that:
(a) the Organisation indemnify the Commonwealth, its officers, employees and agents (those indemnified) from and against all actions, claims, demands, costs and expenses (including the costs of defending or settling any action, claim or demand) made, sustained, brought or prosecuted against those indemnified in any manner based on any loss or damage to any person or loss or damage to property which may arise in connection with any act or omission of the Organisation or subcontractor in the provision of the approved health service
(b) the Organisation agrees that the Commonwealth will be taken to be acting as agent or trustee for or on behalf of those indemnified from time to time.

(2) The Organisation’s liability to indemnify the Commonwealth under subsection (1) will be reduced proportionally to the extent that any unlawful or negligent act or omission of the Commonwealth or its employees or agents contributed to the loss or damage.

7. Patient Billing (this condition is optional on agreement with the organisation)
(1) It is a condition that the Organisation bulk bill Medicare for all patients who possess the following Commonwealth concession cards:
(a) Pensioner Concession Card;
(b) Commonwealth Seniors Health Card;
(c) Health Care Card; or
(d) DVA White or Gold Card.

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Appendix 4 – Conditions of Payment of Grant (private organisation)

Downloadable version of Appendix 4 – Conditions of Payment of Grant (private organisation) (PDF 16 KB)

1. Interpretation
In this Schedule:
Act means the Health Insurance Act 1973.
Organisation means xxxx at yyyy (address)
Approved health service means the health service approved under subsection 41(3) of the Act, that is provided, or to be provided, by the Organisation.
Department means the Department of Health and Ageing.
Grant means the health program grant payable to the Organisation in respect of the approved health service under Part IV of the Act.

2. Suspension of payments
It is a condition that payments to the Organisation may be suspended if any of the following occurs:
  1. the Organisation fails to comply with a condition;
  2. the department, by written notice, reasonably requests the Organisation to take an action to fully satisfy a condition, or to meet a time-frame for a purpose of a condition, and, within 28 days (or a longer period specified in the notice), the Organisation fails to effectively take the action;
  3. the Organisation gives the department notice that it elects to no longer accept health program grant payments;
  4. the Organisation:
    1. becomes bankrupt or otherwise insolvent; or
    2. makes an assignment of its estate to the benefit of creditors, enters into an arrangement or composition with its creditors or has a receiver, manager or administrator appointed on behalf of creditors or debenture holders; or
    3. goes into liquidation or passes a resolution to go into liquidation otherwise than for the purpose of reconstruction, becomes subject to a petition or proceedings in court for its compulsory winding-up or becomes subject to the supervision of a court (either voluntarily or otherwise).

3. Misrepresentation of relationship with Commonwealth
(1) It is a condition that the Organisation must not represent itself as:
(a) being, in any respect, any part of the Commonwealth Government; or
(b) having an association in the nature of an agency or partnership with the Commonwealth Government; or
(c) having authority to do anything in the name of, or otherwise on behalf of, the Commonwealth Government; or
(d) having authority to bind, in any respect, the Commonwealth Government.
(2) Also, an employee of the Organisation must not represent himself, or herself, as being an employee of, or as having any kind of authority to do anything on behalf of, the Commonwealth Government.

4. Protection of personal information
(1) The Organisation must give effect to the National Privacy Principles set out in Schedule 3 to the Privacy Act 1988 as if, in the provision of the
approved health service, the Organisation were an ‘organisation’ within the meaning of that Act.
(2) Giving effect to those Principles is taken to include the following additional actions:
(a) ensuring that persons who properly have access to information collected by the Organisation:
(i) are aware of the application of the Principles; and
(ii) give a written undertaking to the Organisation to observe the Principles in relation to information to which this section applies;
(b) cooperating with any reasonable inquiries and recommendations made by the Privacy Commissioner;
(c) complying, as far as practicable, with relevant guidelines published by the Privacy Commissioner.


5. Indemnity
(1) The Organisation indemnifies the Commonwealth, its officers, employees and agents (those indemnified) from and against all actions, claims, demands, costs and expenses (including the costs of defending or settling any action, claim or demand) made, sustained, brought or prosecuted against those indemnified in any manner based on any loss or damage to any person or loss or damage to property which may arise in connection with any act or omission of the Organisation or subcontractor in the provision of the approved health service.
(2) The Organisation agrees that the Commonwealth will be taken to be acting as agent or trustee for or on behalf of those indemnified from time to time.
(3) The Participant’s liability to indemnify the Commonwealth under subsection (1) will be reduced proportionally to the extent that any unlawful or negligent act or omission of the Commonwealth or its employees or agents contributed to the loss or damage.
(4) The indemnity referred to in subsection (1) will survive the revocation of this determination, the approval of the Organisation given under subsection 40(3) of the Act or the approval given under subsection 41(3) of the Act in respect of the approved health service.

6. Patient Billing (this condition is optional on agreement with the organisation)
(1) It is a condition that the Organisation bulk bill Medicare for all patients who posses the following Commonwealth concession cards:
(a) Pensioner Concession Card;
(b) Commonwealth Seniors health card;
(c) Health Care card; or
(d) DVA White or Gold Card.

And/or
(2) It is a condition that the Organisation:
(a) bulk bill Medicare for at least xx per cent of patients who receive the approved services;
(b) charge at least xx per cent of patients no more than the Medicare schedule fee for the approved services;
(c) charge at least xx per cent of patients no more than xx percent of the medicare schedule fee for the approved services.

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Appendix 5 – Requirement for Claims (private organisation)

Downloadable version of Appendix 5 – Requirement for Claims (private organisation) (PDF 8 KB)
1. Interpretation
In this Schedule:
Act means the Health Insurance Act 1973.
Approval means the approval given on …………………………, under s.41(3) of the Act, in respect of a health service provided, or to be provided, by the Organisation.
Approved equipment means equipment listed in the Schedule to the Approval.
Approved health service means the health service approved under the Approval.
Medicare benefit has the meaning given in subsection 3(1) of the Act.

2. Requirements for claims
(1) A claim for payment by the Organisation in respect of the approved health service:
(a) must be submitted:
(i) to Medicare Australia;
(ii) as electronic data in a form acceptable to Medicare Australia; and
(iii) in a manner that complies with subsection (2).

(2) A claim must be identifiable by reference to:
(a) the approved health service (identified by the applicable health program grant number - a 3 digit number allocated by Medicare Australia);
(b) the item of approved equipment to which it relates; and
(c) the particular service, or services, performed:
(i) using the approved equipment; and
(ii) in respect of which Medicare benefit has been claimed by a person, or persons, entitled to claim that benefit.

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Appendix 6 – Requirement for claims (public organisation)

Downloadable version of Appendix 6 – Requirement for claims (public organisation) (PDF 7 KB)
1. Interpretation
In this Schedule:
Act means the Health Insurance Act 1973.
Medicare benefit has the meaning given in subsection 3(1) of the Act.

2. Requirements for claims
(1) A claim for payment by the Organisation in respect of the approved health service is taken to have been made when a claim for Medicare benefit has been made in respect of the radiation oncology service provided.

(2) Accounts/receipts or Medicare bulk billing forms must clearly identify the equipment number for the equipment (as specified in Schedule 1) used to provide the radiation oncology service.
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