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 (CN) 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 CN Schedule of Fees.

Where urgent circumstances apply in regard to the commencement of care, the CN provider can contact DVA via secure email to outline these special circumstances and request urgent approval. At DVA’s discretion, one off approval can be granted for a short period of time to provide EC care without a comprehensive EC application. DVA will provide this approval in writing. Where this approval is granted, the CN provider is required to submit the completed EC application within two business days for assessment and processing by DVA.

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.

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

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.