A user receives covered services from the provider or establishment where they registered, with prescribed portability where that is not possible; a provider or establishment that cannot deliver the necessary service must transfer the user to one that can, in the prescribed manner and on prescribed terms; users must enter the system at primary health care level and follow the prescribed referral pathways, and lose entitlement to Fund-purchased services if they do not; the Fund contracts accredited providers at primary and hospital level in line with those pathways (section 7(2)). Treatment is not funded where the provider shows there is no medical necessity, no cost-effective intervention under a health technology assessment, or the product or treatment is outside the Formulary, save for the prescribed exceptions (section 7(4)).
The graph holds this control, the 0 it maps to, and the evidence behind each claim, over MCP and REST.