Summary of funding policy
Health services are funded to actual levels of reported activity (not target). To cash flow funding during the year to the health service, the activity undertaken and reported in the previous year will be used to set the initial budget. The Prior Year Adjustment process at the end of the year will be used to adjust funding to align the total funding with the actual amount of reported activity.
What is home enteral nutrition?
Home enteral nutrition (HEN) is the administration of nutrition either orally or by feeding tube directly into the gastrointestinal tract.
Victorian funding model for public health services
HEN is funded via a specified grant with a service event target. Health service targets are updated annually, based on the latest 12 months of activity. Any recall/throughput adjustment is applied at the full rate at the end of each financial year for health services whose activity is below or over target. All non-admitted patient sessions performed within a calendar month are bundled and counted as one non-admitted patient service event per patient per calendar month, regardless of the number of sessions.
For a list of service event targets by health service and for further details on how funding adjustments are calculated refer to the Department of Health and Human Services policy and funding guidelines. The department’s funding model for HEN is consistent with the Independent Hospital Pricing Authority’s (IHPA) funding model.
What does funding cover?
Funding is to be used to purchase the feed (formula), equipment and consumables required by eligible patients for their treatment. It also includes costs associated with managing the service (it does not include consultations with health professionals funded through specialist clinics).
Health services that provide HEN services are required to register HEN clinics separately on the department’s Non-Admitted Clinic Management System (NACMS), report patient-level data using the Victorian Integrated Non-Admitted Health (VINAH) and activity using the Agency Information Management System (AIMS) Form S12.
National Disability Insurance Scheme (NDIS)
HEN is a support that is available through the NDIS for registered participants and may include support to administer HEN if the person is unable to administer HEN themselves due to their disability. Victoria currently funds HEN as a public health program. The department is reviewing funding arrangements with the National Disability Insurance Agency (NDIA) and this information should not prejudice any discussions with the NDIA. As Victoria has not yet transitioned to full roll out of the NDIS, all patients that satisfy the patient eligibility criteria mentioned below remain eligible for public health programs.
Clinical eligibility requirements are determined by individual health services. The department does not specify these requirements. However, patients must:
- be managed by a health care provider participating in the program; and
- provide consent for the use of de-identified consumer level data for monitoring and evaluation purposes.
To monitor and manage their ongoing treatment, patients will be required to attend any clinic appointments at the health service.
A patient can choose to receive HEN services as a public or private patient in a Victorian public hospital. Public and private patients who are eligible for Medicare and meet patient eligibility criteria must receive all funded HEN program services, free of charge.
In instances where a patient has previously consented to be treated as a private patient in a public hospital, a patient may rescind their consent and have future treatment funded as a public patient.
If a patient treated in a private hospital and can no longer afford private care for HEN then they may be referred to a public hospital that offers the program. If the patient meets the established clinical criteria, the patient's referral cannot be rejected on the basis that the patient has had treatment in the private hospital.
What are the requirements for health care providers?
Health care providers are required to implement and adhere to the best practice guidelines as described by the AuSPEN Clinical Practice Guidelines for Home Enteral Nutrition. Health care providers are also required to undertake clinical reviews and provide written information to patients about services, hospital arrangements and client rights and responsibilities. Hospitals are encouraged to continue to make use of the Hospital HEN Register for local patient and program management.
Non-Admitted HEN and TPN – home delivered: Funding arrangements for Victorian public health services.