Home Medical Oxygen Therapy

Last updated: 
1 October 2020

RAP Schedule no.

AY02 and AY16 [refer to RAP Schedule]

Definition

DVA defines Home Medical Oxygen Therapy (HMOT) as the use of prescribed medical oxygen for the management of medical conditions, such as:

  • Asthma
  • Chronic obstructive pulmonary disease
  • Pulmonary hypertension
  • Ischaemic heart disease
  • Interstitial Pulmonary Fibrosis
  • Sleep-Related Breathing Disorders
  • Malignancy
  • Cardiac failure
  • Ischaemic Heart Disease
  • Other conditions must be specified on the HMOT form.

Eligibility

The DVA client must have a clinical need for home oxygen and a:

  • Gold Card; or
  • White Card with an accepted condition relating to the clinical need for the equipment.

Prescribing

Suitably qualified health provider

HMOT must be prescribed by a suitably qualified health provider, these include:

  • Respiratory Physicians (S);
  • Cardiologists (S);
  • Oncologists (S);
  • Respiratory Clinic (RC);
  • General Practitioner (GP)/Local Medical Officer (LMO) in a rural or remote area where there is no Specialist available;
  • Registered Nurse (RN) (only AY16); and
  • Physiotherapist (Physio) (only AY16).

 

Prior approval

Prior approval is not required for the supply of HMOT as long as all eligibility criteria is met.

Deciding on the most appropriate treatment

An assessment needs to be conducted by a suitably qualified assessing health provider to determine the clinical need and the most suitable treatment.

Chronic Airways Disease, Pulmonary Fibrosis and other respiratory disease Oxygen will be provided where the following criteria is met. The client’s:

  • PaO2 is equal to or less than 55 mmHg in the absence of complicating factors.
  • PaO2 is equal to or less than 60 mmHg where significant complicating factors such as chronic anaemia, pulmonary hypertension, or polycythaemia exist.
  • Treatment of the respiratory condition should be optimised, and a stable state achieved where possible, before blood gases are obtained.

The oxygen flow that maintains a PaO2> 60 mmHg (SaO2> 90%) should be identified where possible.

Asthma – A client that has experienced repeated episodes of sudden life-threatening asthma despite compliance with appropriate maintenance therapy.

Terminal Malignancy – The client has cancer, with lung involvement causing hypoxaemia, and a life expectancy of less than six months.

Nocturnal Hypoxaemia – The client has isolated nocturnal hypoxaemia with nocturnal oxygen saturation equal to or less than 90 percent for more than 5% of the night, based on continuous overnight SaO2 monitoring during sleep, and secondary effects of chronic hypoxia such as daytime somnolence, polycythaemia or right heart failure are present. Where possible, an oxygen flow that maintains SaO2 greater than 90% should be identified.

Hypoxia with exercise (Exertional Hypoxaemia) –The client experiences exercise induced oxygen desaturation on either a walk or step test to SaO2 < 90% while breathing room air, PLUS a demonstrable improvement in exercise performance on supplemental oxygen.

Please provide the results that demonstrate this as justification. An oxygen flow to achieve improvement should also be established.

The client will be provided with equipment best suited to their needs to facilitate 2 hours use/day in the most cost efficient manner.  Should additional supplies be required, these should be requested by the assessing health provider.

Cardiac Disorders - The client’s PaO2 at rest is less than 55 mmHg on room air in the absence of significant complicating factors, or 60 mmHg where significant complicating factors exist (see above).

In isolated cases of extreme cardiac disability, oxygen may be prescribed without blood gas measurements in the following circumstances:

  • Severe intractable angina on maximal drug therapy where further surgery is not clinically appropriate.
  • Recurrent episodic pulmonary oedema, severe pulmonary hypertension or severe chronic cardiac failure where no other drug therapy or interventional procedures are possible.

These indications are to be primarily thought of as palliative care.

Nebuliser Therapy - It is considered inappropriate for oxygen cylinders to be used for nebuliser therapy, as a nebuliser pump is adequate, and avoids any risk of hyperoxia.

Other - Assessing health providers may prescribe a variety of oxygen therapies including portable oxygen.

Special Circumstances - Requests for HMOT outside the Guidelines should be discussed with the DVA Rehabilitation Appliances Program on
1800 550 457 (option 1).

Review arrangements

Reviewing the client on HMOT

A client should be regularly reviewed by the assessing health provider to ensure the prescription is still suitable for the client’s condition.

This may be undertaken separately or as a part of an annual review process.

Request for treatment

For a Gold Card holder

  1. An assessment needs to be conducted by a suitably qualified health provider to determine the clinical need and the most suitable treatment.
  2. The suitably qualified health provider should complete the D0804 - Application for Home Medical Oxygen Therapy and/or Respiratory Home Therapy Appliances form and forward it to one of the contracted suppliers detailed on the last page of the form.

For a White Card holder

  1. An assessment needs to be conducted by a suitably qualified health provider to determine the clinical need and the most suitable treatment.
  2. Ring DVA on 1800 550 457 or email rapgeneralenquiries [at] dva.gov.au to check eligibility under the client’s accepted disability(ies).
  3. If the client is eligible, the suitably qualified health provider should complete the D0804 - Application for Home Medical Oxygen Therapy and/or Respiratory Home Therapy Appliances form and ensure the client’s medical condition for which the therapy is required is on the form. Forward the form to one of the contracted suppliers detailed on the last page of the form.
  4. The supplier will seek prior approval if required from DVA.

For Urgent or Palliative Requests

In exceptional circumstances, our suppliers can deliver under urgent emergency arrangements. In these circumstances, the assessing health provider will need to tick ‘Yes’ to the question at the top of the HMOT form ‘Is this an urgent request for home oxygen?’ and send the D0804 - Application for Home Medical Oxygen Therapy and/or Respiratory Home Therapy Appliances form to the supplier. The supplier may contact the assessing health provider to discuss the delivery requirements.

For Clients that are residents of or on respite in a Residential Aged Care Facility (RACF)

It is the responsibility of the RACF to provide any oxygen therapy regardless of whether the client is in low or high care. DVA will not provide oxygen to a client in a RACF. Under the Aged Care Act 1997, the Commonwealth provide funding to RACF’s for the provision of ongoing oxygen treatment to residents who require oxygen on an ongoing basis rather than for episodic or short-term illnesses, such as bronchitis.

If a client requires portable oxygen to enable them to continue treatment whilst on social outings and weekend visits, it is the responsibility of the RACF to provide this to the client.

DVA is not responsible for the supply of ongoing oxygen treatment for entitled persons receiving respite care in a Commonwealth funded RACF.

All RACF’s can apply to the Department of Health for an oxygen supplement for residents in need of and receiving oxygen treatment on an ongoing basis. This includes residents receiving respite care and is irrespective of the classification level of the resident.

For Clients in rural or remote areas

Where access to an appropriate assessing health provider is not possible in these areas, the GP/LMO, can prescribe for these patients. The relevant assessing health provider’s name and address should be provided on the form at ‘Other Assessing Health Provider Details’, together with details of the endorsing Specialist (if practical).

Ceasing HMOT

It is the responsibility of the client’s assessing health provider to notify the supplier if HMOT is no longer clinically indicated. The supplier will arrange to collect the DVA funded equipment.

When a client moves into a RACF for Respite Care or on a permanent basis, it is the responsibility of the veteran or their next of kin to notify the DVA HMOT supplier to suspend or cease the supply.

On the death of a veteran, it is the responsibility of the veteran’s next of kin to notify the DVA HMOT supplier to cease the supply.

Additional information

Ancillary equipment

Ancillary equipment (Oxygen conserving device, Flow meter/regulator, Carry bag and Trolley) are listed in, and can be prescribed on the D0804 - Application for Home Medical Oxygen Therapy and/or Respiratory Home Therapy Appliances.

National Disability Insurance Scheme (NDIS)

HMOT can be provided by either DVA’s Rehabilitation Appliances Program or the NDIS through an individual care plan.

Essential Medical Equipment Payment (EMEP)

DVA clients on HMOT may be eligible for the EMEP to assist with the costs of running essential medical equipment using the HMOT. The assessing health provider may like to discuss this with the client. To find out more and for the relevant claim forms, visit DVA EMEP website.

Australian Standards and legislative requirements

All HMOT devices provided by DVA under contracted arrangements are listed with the Therapeutic Goods Administration.

Health Provider Hotline

1800 550 457
Health Providers can contact DVA for any enquiries by calling the Provider Hotline: (Please press Option 1 when prompted for RAP).