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Stoma Appliance Scheme Operational Guidelines
The purpose of this document is to provide a practical reference guide for stoma associations on the practice and procedures that must be followed when providing stoma related products to their members under the Australian Government’s subsidised Stoma Appliance Scheme (SAS).
These guidelines identify the role and functions that the Department of Health, Department of Human Services (DHS) and the Australian Council of Stoma Associations (ACSA), provide in relation to the administration and management of the SAS.
This document also provides stoma associations with guidance regarding membership requirements, requirements for supply of stoma related products, reporting and financial requirements and the location and condition standards of premises which stoma associations operate from. A detailed reference guide to the range of forms used under the SAS is also listed.
|ACSA||Australian Council of Stoma Associations|
|Stoma Association||Stoma Association|
|Department||Australian Government - Department of Health|
|DHS||Australian Government - Department of Human Services|
|Member/Ostomate||Eligible person who receives products under the SAS|
|SAS ||Stoma Appliance Scheme|
|SPAP ||Stoma Product Assessment Panel|
|STN||Stomal Therapy Nurse|
|GST||Goods and Services Tax|
2. Roles of the Department of Health, Department of Human Services (DHS), Australian Council of Stoma Associations (ACSA) & Stoma Associations
The Australian Government makes all policy decisions related to the SAS and the Department implements all decisions by Government. The Department also has responsibility for the Stoma Product Assessment Panel (SPAP) and approving new stoma associations. The Department also has compliance responsibility for the SAS program and liaises with DHS and ACSA.
2.2 DHS - Medicare
DHS has responsibility for managing the processing and payments of claims lodged for products supplied through the SAS, as well as reporting to the Department and the provision of statements lodged for payment by the stoma associations. DHS liaises with Department and ACSA to ensure payment integrity is maintained on behalf of the Australian Government.
The ACSA represents, at a national level, the interests of all stoma associations across Australia. ACSA has primary responsibility for the operational management of the distribution to people with a stoma of products listed on the SAS, by its member stoma associations. ACSA is responsible for monitoring the continuing compliance by stoma associations with the requirements of the Operational Guidelines and any other requirements of the Department and DHS as communicated from time to time. ACSA also provides liaison with the Department and suppliers, and coordinates support services for people with a stoma throughout Australia.
2.4 Stoma Associations
Stoma associations are organisations which distribute stoma related products through the SAS under the guidance and direction of ACSA. Stoma associations also provide information, encouragement and emotional support to their members concerning most aspects of living with a stoma and assist members with completing the appropriate forms required by DHS and the Department. Stoma associations are required to provide representatives of ACSA, the Department and/or DHS with open and transparent access to any and all documentation and records related to the distribution to their members of stoma products listed on the SAS Schedule when requested. Such a request will be in writing and will be for the purpose of monitoring the stoma association’s compliance with the requirements of the Operational Guidelines and any other requirements of the Department and DHS as communicated from time to time. Open and transparent access may involve viewing documentation and records within the operating premises of the stoma association.
3.1 Premises and Supply of Products
The premises of a stoma association may be located within a hospital complex or a private building.
3.1.1 Premises located in a hospitalWhere a stoma association operates within a hospital complex there should not be any other link with the hospital other than that of a professional relationship with the hospital medical staff. Where a stoma association operates within a hospital complex they are required to conform to the local council requirements.
Stoma Associations must provide supplies only to persons with a stoma after discharge from ostomy surgery, and not to in-patients of the hospital.
Under no circumstances should hospital administrative or clerical staff be employed to carry out the day to day operations of the stoma association. There should not be any financial link between the two organisations in particular the purchasing of stoma related products or pharmaceuticals through the hospital system. All stoma related products and pharmaceuticals should be purchased from the suppliers, or their agents, approved by the Department, except in exceptional circumstances (contact the Department for authority).
A satisfactory working relationship should be arranged with the local hospital. If there is a STN available in the hospital, arrangements for members to have access to this service should be made.
3.1.2 Facility requirementsThe premises, where possible, should have adequate space for an office, a shop front for members contact and storage room for stoma related products. There should also be adequate space for a work area for the preparation of member's orders and for the dispatch of orders by mail/courier etc.
3.2 Approval of new associations
The Department endeavours to have stoma associations established in geographic areas which complement one another. Stoma associations are generally not approved in areas where an existing stoma association is situated.
Applications for approval should be accompanied by supporting documentation from the other stoma associations within the region demonstrating the need for an additional stoma association to be established. All enquiries on the establishment of a new stoma association should be directed to the Department through ACSA.
3.2.1 Requirements of new Stoma Associations New stoma associations should:
- be able to demonstrate that they will be able to develop a reasonable membership base. It is considered that, in the absence of special circumstances, a minimum of 1000 members (actual or projected) in capital cities and 500 in regional areas would be necessary for a new stoma association to be viable;
- be able to provide adequate office space, storage space and a shop front for member contact;
- demonstrate a knowledge of and the ability to administer the SAS;
- provide similar ostomy support programs as are provided by existing stoma associations;
- be prepared to supply product to any member of the SAS requesting product including members of other stoma associations;
- be able to demonstrate financial viability in respect of operating revenue, the provision of premises, acquisition of a computer based claims program, funding of inventory and meeting staffing requirements and/or have volunteer assistance;
- address the restriction on geographical co-location as set out in Clause 3.2 of the Guidelines;
- be able to establish eligibility for membership of ACSA;
- where the new stoma association is being sponsored by an existing organisation, that organisation should be prepared to establish a separate division for ostomy support which would have separate financial accountability and would encompass the operation of the SAS;
- be able to submit electronic claims to DHS via usb only. Prior approval for CTS claims is required by DHS; and
- meet all payment integrity requirements under the SAS.
4. Membership to the SAS
4.1 Eligibility Requirements
4.1.1 General Requirements To access stoma related products under the (SAS), a person:
- must have a temporary or permanent artificial body opening (created surgically or otherwise) which facilitates the removal of urine and/or products of the gastrointestinal tract where the person does not have normal gastrointestinal tract or bladder functions; and
- be an eligible person within the meaning of the Health Insurance Act 1973. An eligible person means an Australian resident or an eligible overseas resident.
A person must reside in Australia in order to receive stoma related products under the SAS. Products will not be supplied under the Scheme if a period of more than six months is spent overseas – see 6.5.5.
To confirm eligibility, a person must have one of the following recorded on the Stoma Appliance Scheme Application Form (DHS Form PB049), and may be asked to present as proof of eligibility:
The application form must contain identifying details of an STN or referring health practitioner including their name, signature and registration number.
- a valid Medicare or Department of Veterans’ Affairs entitlement number;
- a valid Australian Reciprocal Medicare Card number (if the person is a resident of a country that has signed a Reciprocal Health Care Agreement with Australia); or
- a valid passport number if the person is a resident of New Zealand or the Republic of Ireland.
4.1.2 Access to the SAS under Reciprocal Healthcare Agreements Visitors who are eligible to receive benefits under a Reciprocal Health Care Agreement (RHCA) can access stoma related products under the SAS for the period of their stay in Australia by virtue of subsection 7(2) of the Health Insurance Act 1973.
In terms of visitors to Australia who are eligible to receive benefits under a RHCA, there is no legislative basis for these persons to be excluded from receiving products through Programs subsidised under Section 9A of the National Health Act (unless the Guidelines for the program specifically state the exclusion). Therefore, access to benefits under the RHCAs should be honoured by the SAS.
The RHCAs are also intended to be applied beneficently, that is, where there is ambiguity, the ostomate gets the benefit of the doubt. The RHCAs do not exclude pre existing conditions from eligibility; the only exclusion is ‘medical tourism’, where someone enters the country for the express purpose of receiving treatment.
It is at the discretion of the stoma association as to whether the visitor is required to become a temporary association member.
4.1.3 Migrant Eligibility A holder of permanent resident status (migrant) must reside in Australia at their primary place of residence to be eligible for DHS benefits.
A migrant may reside overseas and hold a current: Medicare card, however, if they have been absent from Australia for more than twelve months (return trips to Australia for a holiday is not taken into account) they must provide documentation on their return to Australia which proves they have returned to reside. Documents may be from Australia or documents showing they have severed ties from the country they have left are acceptable.
Further information regarding migrant eligibility can be found on the DHS website.
4.1.4 Stoma Association Requirements Each stoma association will provide to DHS a list of persons accepted as members of the SAS, complete with:
- Entitlement card number;
- Medicare number;
- Evidence that the person meets the eligibility requirements for membership of the SAS by completing DHS form PB049 Stoma Appliance Scheme Application; and
- Any other statistical data as requested by the Department or DHS.
These details are maintained on the ostomy data base. Changes in membership details are advised monthly to DHS when forwarding claims for payment. Evidence of a stoma should consist of a certificate from a registered health practitioner or STN in an approved form.
Stoma associations are authorised to issue stoma related products to all approved members of the SAS on production of an entitlement card. Eligible people are required to reside in Australia in order to receive stoma related products under the SAS.
4.2 SAS Service Fee
Subject to Clause 4.3, a Service Fee shall be payable by members of the SAS in respect of the costs of operating the SAS that are not met by the 2.75% handling fee (Clause 7.4). The Service Fee shall be a national uniform annual amount as determined from time to time by the Department, in consultation with ACSA, and shall be payable to the association where the member usually obtains their stoma related products. The fee shall be compulsory but associations shall make provision for the fee to be paid by instalments in the case of financial hardship.
4.3 Stoma Association Membership Fee
Stoma associations may charge an Association Membership Fee in respect of the services they provide to their members. Financial members of stoma associations shall not be required to pay the SAS Service Fee provided the stoma association of which they are a member charges a uniform national membership fee and uses part of its membership fees to meet the costs of operating the SAS that are not met by the 2.75% handling fee (Clause 7.4).
Stoma associations may also charge an additional Membership Fee in respect of the services they provide other than to the supply of stoma related products under the SAS. A member who is not able to pay the additional Membership Fee because of financial hardship may apply to the association in writing to have the additional Fee waived. If the additional Membership Fee is waived, the stoma association shall also make provision for remainder of the Membership Fee to be paid by instalments.
4.4 Membership to ACSA
All stoma associations must be a member of ACSA. Associations that have operational problems in relation to the SAS must first refer the matter to ACSA for advice or assistance. If ACSA cannot resolve the matter they will seek assistance from either the Department or DHS. However, problems relating to the processing and payment of claims should be referred directly to DHS unless they are of a general nature in which case they should first be discussed with ACSA.
5. Reporting requirements for Stoma Associations
Stoma associations are required to provide ACSA with:
- Monthly new membership numbers and statistical details;
- Annual membership numbers and statistical details;
- Details of members accessing the SAS;
- Yearly financial statements; and
- Any other information related to the stoma associations SAS activities as requested.
It is important that any change which may affect the day to day operation of the payment and processing procedures, in particular any changes to association name, banking details, authorised persons, mailing address and location of premises, be reported as soon as possible in writing and in some cases via email to DHS. This will prevent any unnecessary delays or rejection of payments to stoma associations.
Stoma associations should provide to DHS details relating to changes in membership i.e. new members joining, transfer of existing members to other stoma associations, change of address for members and details of those members who have had a reversal, and no longer require aids and appliances, or are deceased. Stoma associations should also provide to DHS any other information related to their SAS related activities as requested.
Any information or data which the Department requests from ACSA or stoma associations will need to be provided in a timely manner.
6. Supply of products
6.1 The SAS Schedule
The Schedule is a list of stoma related products that are able to be accessed under the SAS. The Schedule contains information on each product, such as a description, SAS and company product codes, pack size, maximum issue and manufacturer code, and lists the maximum price that suppliers can charge for a product on the SAS. If a stoma association pays less than the maximum price for an item, DHS should be informed of this when claiming.
6.2 Updates to the SAS Schedule
Stoma associations and key stakeholder groups receive from the Department the SAS schedule updates which contains the latest version of the schedule and information relating to those stoma related products that have been deleted, added, varied or an advance notice for the deletion of products from the schedule.
6.3 Dual or multiple stomas
The following procedures have been implemented for people who have more than one stoma and require additional stoma related products and pharmaceutical benefits:
- Issue the first number from the membership numbers allocated to the stoma association by DHS for members with a single stoma;
- A second group of entitlement cards available to each stoma association for use by members who have dual or multiple stomas (numeration to be as provided by DHS). These cards are to be issued by the stoma association to members for their second and subsequent stomas in a similar manner to the initial card issue;
- A copy of the dual stoma application form must be sent to DHS endorsed "dual stoma" and indicate the membership number allocated by the stoma association;
- The member, when obtaining supplies, must use one number for normal requirements and the second for additional supplies; and
- Where the second stoma occurs sometime after the first, a second application form must be submitted to DHS showing details of the original application and the number allocated and marked "dual stoma".
6.4 Two month ordering cycle
Stoma associations wishing to adopt a two month ordering cycle will be required to abide by the following restriction and process:
6.4.1 RestrictionThe two-month ordering cycle will be available to members who have had their stoma for six months or greater. The two-month ordering cycle may be suspended for members during any period when the stoma related products they order are subject to change or review.
6.4.2 ProcessFor claiming purposes the stoma association will need to place a “T” in the “Medical certificate obtained and sent to Medicare” box found at the top of the ‘Supply of stoma appliance’ form (PB046) which is sent to DHS with every claim. This will enable DHS to recognise that the claim is a two-month order.
6.5 Procedures for the supply of products to members
6.5.1 Maximum quantityIt is the responsibility of each stoma association to ensure no more than the maximum quantity of any of the stoma related products is provided to members on a monthly or annual basis unless there has been a certificate of authorisation issued for an increase in quantities forwarded to the Department requesting additional supplies. This certificate must be signed by the members' health practitioner or STN.
6.5.2 Ordering supplies within one sub-group listed on the scheduleWhen supplies are requested from within one sub-group listed on the schedule, and the products are intended for the same purpose, the supplied amount is restricted to the maximum limit for that type of product.
6.5.3 Ordering supplies from more than one group listed on the scheduleWhen supplies are requested from two or more different sub-groups listed on the schedule, but for which the products serve the same purpose, the maximum amount supplied from each group must be reduced accordingly (e.g. if the products are supplied equally from two sub-groups then the maximum quantity for each sub-group should be reduced by 50%.
6.5.4 Monthly SuppliesIf a member has not ordered or has not been supplied under a one or two month ordering cycle they are not entitled to add that supply of stoma related products to any subsequent claim.
6.5.5 Holiday IssueMembers are entitled to have up to six months supply if travelling overseas. Members requiring more than two months supply of products will need to supply associations with proof of travel, such as documents.
6.5.6 Stock ControlIndividual stoma associations should have a system in place so that they are fully aware of the stock they need to replace and methods to predict when stock is required. It is important that all stoma associations are aware of the different supplier's ordering system and how long it will take to get new stock after ordering.
6.5.7 Unavailability of ProductsIn the event of unavailability of a product, an alternative product should not be supplied unless an order has been placed by the member for the alternative product. Members should be advised to seek advice from an STN or their medical practitioner should this occur.
6.5.8 Norfolk Island OstomatesFrom 1 July 2016 mainland Australian taxation, social security, immigration, biosecurity, customs and health arrangements, including Medicare and the Pharmaceutical Benefits Scheme, were extended to Norfolk Island. In order to receive supplies, ostomates of Norfolk Island are required to be a member of a stoma association. Norfolk Island ostomates are covered by special arrangements allowing them to receive six months supply of stoma products at one time.
6.5.9 Members working and living in remote locationsMembers working and living in remote locations are eligible for approval for additional stoma supplies. The member must be under the continuing care of a medical professional (either a registered medical practitioner or a STN) and have regular and ongoing reviews. The original DHS form PB050 must be returned to the stoma association and will be considered incomplete if not signed and dated by a recognised medical professional or STN. The Department will consider each application case-by-case.
6.5.10 Members incarceratedAll enquiries relating to incarcerated persons access to SAS products should be referred to the Department.
7.1 Requirements of a Stoma Association manager
A manager of a stoma association should have the ability to:
- operate a small business organisation with particular reference to financial skills in the area of accounting; and
- operate an accounting system including receipt of membership fees and preparation of claims submitted to DHS for processing and payment. Managers are required to set procedures to ensure that accounts are processed quickly to obtain any financial advantage that may be offered by the suppliers e.g. discounts for accounts paid within a specified time.
7.2 Payment of accounts
Stoma associations should endeavour to make the full payments of their accounts by the due date. Payment of invoices in a prompt and timely manner to the manufacturers is recommended upon receipt of invoice.
7.3 Pricing arrangements
Prices for the supply of approved stoma related products are negotiated directly by the Department with the relevant supplier. GST is not payable on any item listed on the SAS Schedule. GST is only payable on the 2.75% handling fee.
Stoma associations are responsible for the purchase of stoma related products to distribute to their members. They are reimbursed on the listing price in the SAS Schedule, plus a 2.75% handling fee.
8. DHS claims processing and payments
8.1 Preparation of a claim for payment
Due care should be exercised by each stoma association when preparing a claim for submission to DHS for processing and payment. If a claim does not meet the appropriate standard the processing of the claim may be delayed or returned to the stoma association to be corrected. If a claim contains items that are not listed, these items will be rejected and payment will not be made. For stoma related products that have been supplied to a member who does not have a certificate authorising a supply in excess of the allowable maximum quantity, only the maximum quantity will be allowed and paid for.
Stoma associations should also ensure each form lodged in a claim is completed correctly. Details on this form include the name of the organisation, approval number, member's name, member's entitlement card number, member's address, indication if a medical certificate has been obtained for excess quantities, item supplied, quantity ordered and supplied, code and brand supplied, serial number of the item in the claim.
All medical certificates provided for additional supplies should include the member’s name and address and the member’s entitlement number. These certificates are only valid if they are issued by a health practitioner or an STN. Each certificate is valid for a period of up to six months from the date nominated and the quantity of additional stoma related appliances and benefits, including the reason for additional supplies, must be specified by the health practitioner or the STN requesting the increased quantity.
8.2 Submission of an ostomy claim
Claims for reimbursement by DHS should be lodged by each stoma association on a monthly basis.
The original claim is then forwarded to DHS with the Claim for Payment form (PB043) and the duplicate should be retained by the stoma association. Each form must be physically signed by the member or agent receiving the items. If the order has been forwarded by other means this should be indicated on the form, e.g. "certified despatched" and carry an original signature from a responsible officer. This would then indicate the items have been forwarded by mail/courier etc.
Other details which must be completed on the Claim for Payment form include the name of the stoma association, address, claimant's approval number and serial number range of the items submitted in the claim. If changes to the claim are required such as serial numbers omitted from the claim as the items were not supplied, an explanation must be added to the claim form.
8.3 Payment of an ostomy claim
There is a provision, for those items that may delay payment or where an incorrect price has been paid, to be adjusted by using a bulk adjustment note. This allows the variation of a payment either positive or negative to be amended in subsequent claims. If the adjustment is positive the payment can be released immediately. If the adjustment is negative the amount owing will be deducted from future claims.
Payments for all claims processed by DHS are paid via electronic funds transfer to the financial institution nominated by the stoma association. A statement of account is forwarded to the address provided by each stoma association following payment to their nominated financial institution. Claims are processed and completed for payment within 17 days of the submission of a correctly completed and submitted claim. If the claim is rejected and resubmitted the claim will be processed within 17 days of the resubmission date.
The statement of account is supplied in one of two formats, i.e. summary or detailed. The summary report lists all items of the same code together with a total number and cost for the item. A detailed statement lists each item in serial number order individually costed. To choose the type of report that is required the stoma association should advise the processing centre of their needs. The statement contains all details of items rejected for payment, any adjustments that may be made to a claim including the payment of the 2.75% administration fee. The statement may contain details of more than one claim.
8.4 Receipt of products
It is a requirement that members upon receiving their products from their stoma association sign for receipt of their products. Stoma associations must ensure that for those members who receive their appliances via post should, ensure that the appliances form forwarded to DHS is clearly marked “certified dispatched”. The officer from the stoma association must countersign each claim marked in such manner.
SAS products are subsidised by the Australian Government. As such, the Department and DHS may choose to undertake a review of stoma associations claims for payment integrity purposes. A follow-up check may be made later if considered necessary, and orders and invoices checked as to the items supplied to members over that period of time.
Stoma associations are required to retain any orders or copies thereof, submitted by members, or their agents, requesting supplies of stoma related products, for a minimum of two years as per the Act. Stoma associations should also retain copies of the invoices provided by the suppliers of the stoma related products for at least the same period of time. The original must be sent to DHS for payment. Reviews may be undertaken by the Department or DHS during this period.
After each annual general meeting where required by state laws, each incorporated stoma association may be required to complete the periodical return to the Office of Consumer and Business Affairs in the state they are registered.
A list of the current DHS forms used under the SAS is detailed below. These forms are subject to change.
9.1 Stoma Appliance Scheme Application form DHS form PB049
This interactive online form combines and replaces the previously used Stoma Appliance Scheme Authority and Certificate of Eligibility forms. This form should be completed prior to the issuing of a membership entitlement card. Part 1 is completed by the applicant giving details of their name, address, date of birth, Medicare or Department of Veterans’ Affairs entitlement number, Stoma Appliance Scheme entitlement number to be issued (see 9.5 Appliance Scheme Entitlement Card – PB044), type of stoma and stoma association name and address.
The applicant must also sign an authorisation giving DHS the authority to make enquiries about or examine any aids and appliances supplied to the applicant under the Scheme. Part 2 is completed and signed by the applicant’s stomal therapy nurse (STN) or referring health practitioner. The original of the form is to be forwarded to DHS and a copy is to be provided to the applicant. A duplicate form must be completed for each additional stoma requiring stoma-related products.
9.2 Stoma Appliance Scheme entitlement card DHS form PB044
This card is issued to members of stoma associations to indicate entitlement to receive supplies through a stoma association. Each card is serially numbered by DHS before being issued to an association. This enables DHS or the association to identify a member by the number. Details which are included on the card are the member's name, address and signature.
9.3 Supply of stoma appliances and pharmaceutical preparations DHS form PB046
This computer form is used by stoma associations as a supply form stoma related products where claims are submitted in electronic format (on computer disk). Details on this form include the name of the stoma association, approval number, members name, members entitlement card number, members address, indication if a medical certificate has been obtained for excess quantities, item supplied, quantity ordered and supplied, code number, brand supplied and the serial number of the item in the claim. The original of this form is forwarded to DHS with a Claim for Payment Form; the duplicate is retained by the stoma association. This form must be signed by the member or their agent when collecting the appliances and benefits. If the items have been dispatched by other means this should be indicated on the form.
9.4 Stoma Appliance Scheme Claim for payment DHS form PB043
This form is used by the stoma association as a claim for payment for items supplied. The original of this form is forwarded to DHS together with the relevant supply forms to constitute a claim. The certification on the claim for payment form must be signed by the approved or authorised person of the stoma association confirming that supplies have been made. Other details which must be completed on the Claim for Payment form are the name of the stoma association, address, claimant's approval number, claimant's reference, serial numbers of items submitted in the claim. The duplicate of this form is retained by the Association.
9.5 Application for additional stoma supplies DHS form PB050
To be eligible for approval for additional stoma supplies, the member must be under the continuing care of a medical professional (either a registered health practitioner or a STN), with regular and ongoing reviews. The original DHS form PB050 must be returned to the stoma association and will be considered incomplete if not signed and dated by a recognised health professional.
This form is to be used to obtain additional supplies above the maximum allowance and must include the members name, address and entitlement number. These certificates are valid for a period of up to six months from the date nominated on the form must be signed by either a registered medical practitioner or STN. A full description of the product and the amount of additional quantity authorised must be specified by the registered health practitioner or STN as well as the reason for the additional supplies.
Certificates authorising additional supplies which result in a total supply to the member of more than twice the normal allocation of any one product must be accompanied by a clinical justification of the additional supply quantity. More than twice but less than four times the normal allocation of any one product must have clinical justification submitted with the authority certificate signed by an STN or health practitioner. More than four times the normal allocation of any one product must also have clinical justification and authority certificate and must receive approval from the Department.
The particular requirements below must be addressed when completing an Application for Additional Stoma Supplies form PB050.
9.5.1 Review DatesThe Application for Additional Stoma Suppliers Form (PB050) is valid for a period of up to six months only. A review date must be supplied on the form which is up to but not exceeding six months from the date which the form was issued to the member. Forms that do not include a valid review date will be returned to the health practitioner or STN for correction. This may delay the member from receiving the benefits due to them under this Scheme.
9.5.2 Replacing AuthoritiesReplacement authorities can only be issued following a review by a medical practitioner or STN and the subsequent completion of a new Application for Additional Stoma Suppliers Form (PB050). The review must take place prior to the review date nominated on the original form (up to but not exceeding six months – see 9.8.1 Review Dates). Requests for replacement authorities cannot be submitted over the phone, even if the authority has expired.
9.5.3 Clinical JustificationIn certain circumstances a member’s requirements may exceed the two month standard supply. If this occurs, the reviewing health practitioner or STN is required to provide separate clinical justification which demonstrates this requirement. Separate clinical justification should provide details of the basis for which additional products are required, including detailed medical reasoning as to why additional supplies are necessary and the implications for the member if those supplies are not approved. Inadequate clinical justification may result in a delay in processing the request and may delay the member receiving products necessary for their medical welfare.
9.5.4 Reason for Increased Supply – Use of ‘other’ as a Reason CodeA health practitioner or STN should only tick ‘other’ in the category of Reason for Increased Supply where the reason is not already listed on the form. This should be only in exceptional circumstances where the member’s situation is highly unusual and additional information which clarifies the circumstances must be provided on the form. It should also be noted that the use of the category ‘other’ will assist DHS and the Department in ensuring members who fall into these unusual circumstances are appropriately monitored and information regarding stomas is kept complete and up-to-date.
9.6 Authorisation forms for irrigation kits, tieman tip catheters, ace stoppers, and silicone adhesive spray (Australian Association of Stomal Therapy Nurses form)
9.6.1 Irrigation kits, tieman tip catheters and ace stoppersThe use of irrigation kits, tieman tip catheters and ace stoppers by persons with a stoma requires special authorisation by a registered health practitioner or STN. These products should not be dispensed to a member prior to the sighting of the duly completed and signed authorisation form.
9.6.2 Silicon adhesive sprayThis product requires a registered health practitioner or STN authorisation prior to ordering. A separate clinical justification is to be provided giving details of the investigation of the condition and the basis on which the product is required.
It is the responsibility of each stoma association to ensure that no more than the maximum quantity of any of the stoma related products is provided to members on a monthly or annual basis unless there has been a certificate of authorisation issued for an increase in quantities forwarded to DHS requesting additional supplies. This certificate must be signed by either a registered health practitioner or an STN. Products should not be ordered prior to the sighting of the signed authorisation form.
9.7 Stoma Appliance Scheme Dual entitlement card DHS form PB045
For those members who have more than one stoma and require additional stoma related product, this card must be completed as per the Stoma Appliance Scheme Entitlement card (PB044). These cards are to be issued by the stoma association to members for their second and subsequent stomas in the same manner to the initial card issue. Each card is serially numbered by DHS before being issued to an association by the contracted supplier for DHS stationery.