Key messages

  • Changes to the ambulance payment guidelines have been amended in response to health sector feedback.
  • These changes include redefined ‘clinically necessary’ terminology.
  • Restrictions on patient choice have been removed.
  • The ‘Community Service Obligation’ definition has also changed.

Ambulance transport payment guidelines have been improved in response to feedback from the health sector and findings from the mini-review of the 2014 funding model and fee schedule.

Changes include a focus on improved patient experience, appropriate use of ambulance transport and improvements to billing processes and administration.

Clearer ‘clinically necessary’ definition

The new definition reinforces that ambulance transport is only for patients who require clinical assistance for transport. It must be clinically necessary for the patient to travel by ambulance.

This definition has been developed to assist health services to decide whether ambulance transport is necessary for their patients, or whether alternative transport is more appropriate. The definition does not consider the reason why a patient is being transported; for example, between facilities. These decisions are ones for the clinicians in conjunction with their patients.

For transport to be considered clinically necessary, the patient must require active clinical monitoring/care or clinical supervision/management during transport. This is provided by a paramedic, health professional or qualified patient transport officer or attendant.

Patient choice restrictions removed

The Patient initiated transfer form has been removed and patients who wish to move to a different healthcare provider are able to make this decision in conjunction with their clinician.

The sending hospital remains responsible for the payment of inter-hospital ambulance transport and any alternative arrangements can be negotiated at the health service level.

References to community mental health patients removed

These transports are now aligned with other emergency transports from the community.

‘Concession’ definition has changed

The previous guidelines used the term ‘Community Service Obligation’ patients to refer to patients who are entitled to a concession under the state concession scheme. The updated guidelines have consolidated a number of patient cohorts under this classification, which is now referred to as 'concession'.

The concession definition now captures additional patient cohorts:

  • verified asylum seekers who are on Bands 4-6 of the Status Resolution Support Service (SRSS)
  • a person who is subject to an order under the Mental Health Act 2014, Sentencing Act 1991 or Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 requiring them to be compulsorily assessed or treated in a designated mental health service. This includes compulsory, security and forensic patients.

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