HIV treatment and care for people not eligible for Medicare

Directive number: QH-HSD-055:2023
Effective date: 9 October 2023
Review date: 9 October 2026
Supersedes: N/A

Purpose

The purpose of this health service directive is to ensure that Queensland Health meets the obligations of the Federation Funding Agreement – Health (FFA) for Access to HIV treatment for people who are not eligible for Medicare. The State of Queensland signed this Agreement on 21 June 2023 and the Program commenced on 1 July 2023. This directive fulfils criteria four and five in section 47 (1) of the Hospital and Health Boards Act 2011, ensuring consistent approaches to the delivery of health services and supporting agreements entered into by the State.

Scope

This directive applies to all Hospital and Health Services.

Principles

• Queensland Health is committed to the equitable provision of HIV treatment and medical care for people ineligible for Medicare, consistent with the Federation Funding Agreement – Health (FFA) for Access to HIV treatment for people who are not eligible for Medicare.
• This Agreement supports Queensland Health in meeting international and national goals for the virtual elimination of HIV transmission in Australia.
• The Program is a joint initiative of the Commonwealth, States and Territories to be delivered through jurisdictional public health infrastructure and excludes care or treatment through private health services. The Federation Funding Agreement – Health (FFA) for Access to HIV treatment for people who are not eligible for Medicare specifies eligibility for the program, roles and responsibilities of the Commonwealth, States and Territories and reporting requirements.

Outcomes

All Hospital and Health Services shall achieve the following outcomes:

• Provision of free outpatient HIV-related medical care to Medicare-ineligible people currently residing in Queensland beyond a short-term stay through public health facilities, such as sexual health clinics or a public hospital.
• Provision of free HIV antiretroviral medications listed on the Pharmaceutical Benefits Scheme (PBS) and available through the Queensland Health (QH) List of Approved Medicines (LAM) to Medicare-ineligible people resident in Queensland via public hospital pharmacies.
• Medicare-ineligible people presenting as an inpatient for care related to HIV are not covered under this Program and hospitals should continue to treat these patients according to existing local policies and protocols.
• The cost of care or treatment related to diagnosing HIV, comorbidities, or any other health condition arising from taking HIV antiretroviral medications is not covered under this Program.

Mandatory requirements

All Health and Hospital Services shall:

• Determine if an individual meets the criteria for entry into the Program as detailed in the protocol QH-HSDPTL-055-1.
• Provide free HIV-related public outpatient consultations to Medicare ineligible persons in the Program by medical professionals appropriately trained and credentialed to provide HIV-related care.
• Provide free HIV-related pathology services such as viral load testing and CD4 count to Medicare ineligible persons in the Program.
• Provide free HIV antiretroviral medications listed on the PBS and available through the QH LAM to Medicare-ineligible people resident in Queensland via public hospital pharmacies.
• Forgo any HIV medication co-payment revenue.
• Record all dispensing under this Program in i.Pharmacy as detailed in the protocol QH-HSDPTL-055-1.
• Submit their annual activity report to BBVCDU@health.qld.gov.au by 10 July each year as specified in protocol QH-HSDPTL-055-1.
• Meet all other requirements as detailed in protocol QH-HSDPTL-055-1.

Related or governing legislation, policy and agreements

• Federation Funding Agreement – Health (FFA) for Access to HIV treatment for people who are not eligible for Medicare.
• Hospital and Health Boards Act 2011 (Qld).

Supporting documents

• Federation Funding Schedule: Communicable diseases of public health concern – Access to HIV treatment for people who are not eligible for Medicare.
• HIV treatment and care for people who are not eligible for Medicare - Health Service Directive Protocol QH-HSDPTL-055-1.
• Co-payment waiver for HIV medication- Health Service Directive QH-HSD-056.
• Note: HIV treatment and care for people who are not eligible for Medicare - Statewide guideline QH-GDL-972 has been rescinded.

Business area contact

Susan Greenbank, Advanced Public Health Officer on 07 3328 9711 or Susan.Greenbank@health.qld.gov.au

Review

Approval and implementation

Directive Custodian

Executive Director, Communicable Diseases Branch, Queensland Public Health and Scientific Services.

Approval by Chief Executive

Human rights

This Program is a public health program intended to support the national and international objective of the virtual elimination of HIV in Australia. It will enable people living with HIV who are not eligible for Medicare, to meaningfully reduce their viral load and risk of ongoing HIV transmission for the duration of their stay in Australia or until they transition to another program such as Medicare.

Definitions of terms used in this directive

1. Sourced from the Federation Funding Agreement – Health for Access to HIV treatment for people who are not eligible for Medicare

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