Exceptional Cases

Some DVA clients have nursing and/or personal care needs that are not covered in the Schedule of Fees. DVA considers these as Exceptional Cases (EC) to make sure the clients receive the community nursing services they require.

Exceptional Case applications

Exceptional Case (EC) applications can only be completed (and services provided) by DVA approved Community Nursing providers.

Prior approval must be sought from DVA through the EC process, and EC approval must be given before services commence that are outside the Community Nursing Schedule of Fees.

Application submission is via DVA secure email. Please contact exceptional.cases@dva.gov.au to set up secure email facilities and refer to the DVA sensitive emails webpage for further information.

Community Nursing Providers must refer to Notes for Community Nursing Providers Attachment A – Exceptional Case process for further information.

Urgent Exceptional Case requests

Where urgent circumstances apply in regard to the commencement of care outside the Schedule of Fees, such as end-of-life palliative care, DVA Community Nursing providers can seek urgent Exceptional Case approval by email to exceptional.cases@dva.gov.au. Community Nursing providers must receive approval in writing from DVA to enable services to be claimed.

At DVA’s discretion, interim approval can be granted for a short period of time to ensure the appropriate care is in place for the client whilst the Community Nursing provider prepares and submits the EC application with supporting documentation. DVA will provide interim approval in writing via secure email to the Community Nursing provider.

A one-off interim approval can be granted on the basis of the information provided in an email request that must include:

• Client name and DVA file number
• Overview of urgent circumstances
• For end-of-life care requests, the most recent assessment from palliative care specialist or team indicating the phase of palliation (including specialist team contact details)

Where urgent interim approval is granted, the provider is required to submit a complete Exceptional Case application within 5 business days to enable processing within the interim period.

Exceptional Case process

Step 1

Complete D1004 -Application for Exceptional Case Status form.

Step 2

Attach all required documents as detailed in the Application for Exceptional Case Status form.

Step 3

Complete the relevant attachment/s if required:

• D1004A - Attachment 1 — Dementia / Short Term Memory Loss/ Confusion
• D1004B - Attachment 2 — Mental Health (Depression/ Anxiety/ Posttraumatic Stress Disorder/ Alcohol and Substance Misuse)
• D1004C - Attachment 3 — Palliative Care (End of Life/ Metastatic Cancer/ Non-Malignant Palliative Care)
• D1004D - Attachment 4 — Wound Care

The attachment/s may require additional information and/or documents to be provided. Attach the required documents as detailed in the relevant form/s.

Step 4

Please submit the EC application and any attachments electronically.

If this form is completed manually, email a scanned copy of the original signed EC application form and EC attachments as photocopies.

Applications are to be submitted via secure email toexceptional.cases@dva.gov.au.

Variations or Interruptions to Care

You must let DVA know when there is a variation or interruption to care that has been approved under an EC application.

To do this, use the relevant D1307 Exceptional Case – Variation or D9384Exceptional Case – Interruption to Care form.

Refer to the Notes for Community Nursing Providers for further information.

Request for reimbursement of nursing consumables over $1,000

You may apply for reimbursement of nursing consumables that cost more than $1,000 (up to a maximum of $1500) by completing the D9297 Exceptional Case — Request for Reimbursement of Nursing Consumables over $1,000 form. We have more information about this in the Notes for Community Nursing Providers.