Health Insurance (Allied Health Services) Amendment Determination 2008 (No. 1) (Cth)

Case

Health Insurance (Allied Health Services) Amendment Determination 2008 (No. 1)1

Health Insurance Act 1973

I, ANTONY KINGDON, First Assistant Secretary, Medical Benefits Division, Department of Health and Ageing, make this Determination under subsection 3C (1) of the Health Insurance Act 1973.

Dated 16 June 2008

ANTONY KINGDON

First Assistant Secretary, Medical Benefits Division,

Department of Health and Ageing

  1. Name of Determination

This Determination is the Health Insurance (Allied Health Services) Amendment Determination  2008 (No. 1).

  1. Commencement

This Determination commences on 1 July 2008.

  1. Amendment of Health Insurance (Allied Health Services) Determination 2007

Schedule 1 amends the Health Insurance (Allied Health Services) Determination 2007.

Schedule 1        Amendments

(section 3)

[1]           Subsection 5 (1), definition of course of treatment

substitute

course of treatment means:

(a)    for psychological therapy and focussed psychological strategies — up to 6 services provided, on referral by a medical practitioner, by any of the following persons:

(i)    an eligible clinical psychologist;

(ii)    an eligible psychologist;

(iii)    an eligible occupational therapist;

(iv)    an eligible social worker; and

(b)    for pervasive developmental disorder services — up to 10 services provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:

(i)    an eligible psychologist;

(ii)    an eligible speech pathologist;

(iii)    an eligible occupational therapist.

[2]           Subsection 5 (1), after definition of OT Australia

insert

PDD treatment and management plan, for a patient, means a plan for the treatment and management of the patient’s pervasive developmental disorder to which item 135 or 289 of the general medical services table applies.

[3]           Section 6, heading

substitute

  1. Treatment of allied health services

[4]           Section 9, heading

substitute

  1. Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services

[5]           Subsections 9 (2) and (3)

omit

referral to

insert

referral of a service to

[6]           Subsection 9 (3)

omit

131

insert

133

[7]           Subsection 9 (4)

omit

referral to

insert

referral of a service to

[8]           After section 9

insert

  1. Referrals by psychiatrists and paediatricians for pervasive developmental disorder services

(1)   This section applies to items 82000 to 82025 in Schedule 2.

(2)   For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 296 to 370 (except item 359) of the general medical services table apply.

(3)   For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 131 of the general medical services table apply.

(4)   For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which item 289 of the general medical services table applies.

(5)   If a child has previously been provided with a service mentioned in item 289, a consultant physician specialising in the practice of his or her field of psychiatry may only refer the child for a service to which any of items 296 to 370 (excepting item 359) of the general medical services table apply.

(6)   For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral to which item 135 of the general medical services table applies.

(7)   If a child has previously been provided with a service mentioned in item 135, a consultant physician specialising in the practice of his or her field of paediatrics may only refer the child for a service to which any of items 110 to 131 of the general medical services table apply.

  1. Effect of election to claim private health insurance for an allied health service

   An item in Schedule 2 applies to an allied health service only if a private health insurance benefit has not been claimed for the service.

[9]           Schedule 1, item 14

substitute

14.

Psychological therapy health service

A person is an allied health professional in relation to the provision of a psychological therapy health service if the person:

   (a)  is registered, without any limitation, with the Psychologists Registration Board established under the applicable law in force in the State or Territory where the service is provided; and

   (b)  either:

         (i)   is a member of the Australian College of Clinical Psychologists of the Australian Psychological Society (APS); or

        (ii)   has been assessed by the APS as meeting the requirements for membership of that College and continues to meet those requirements.

[10]         Schedule 2, items 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968 and 10970, paragraph (h)

omit

[11]         Schedule 2, items 80000 and 80010, after paragraph (a)

insert

(aa)    the service is provided to the person individually and in person; and

[12]         Schedule 2, item 80020, after paragraph (a)

insert

(aa)    the service is provided in person; and

[13]         Schedule 2, items 80100 and 80110, after paragraph (a)

insert

(aa)    the service is provided to the person individually and in person; and

[14]         Schedule 2, item 80120, after paragraph (a)

insert

(aa)    the service is provided in person; and

[15]         Schedule 2, items 80125 and 80135, after paragraph (a)

insert

(aa)    the service is provided to the person individually and in person; and

[16]         Schedule 2, item 80145, after paragraph (a)

insert

(aa)    the service is provided in person; and

[17]         Schedule 2, items 80150 and 80160, after paragraph (a)

insert

(aa)    the service is provided to the person individually and in person; and

[18]         Schedule 2, item 80170, after paragraph (a)

insert

(aa)    the service is provided in person; and

[19]         Schedule 2, items 81000, 81005 and 81010, after paragraph (b)

insert

(ba)    the service is provided to the woman individually and in person; and

[20]         Schedule 2, item 81100, paragraph (h)

omit

[21]         Schedule 2, item 81105, paragraph (d)

substitute

(d)    the service is provided in person; and

[22]         Schedule 2, items 81105 and 81110, paragraph (h)

omit

[23]         Schedule 2, item 81115, paragraph (d)

substitute

(d)    the service is provided in person; and

[24]         Schedule 2, items 81115 and 81120, paragraph (h)

omit

[25]         Schedule 2, item 81125, paragraph (d)

substitute

(d)    the service is provided in person; and

[26]         Schedule 2, item 81125, paragraph (h)

omit

[27]         Schedule 2, after Part 4

insert

Part 5          Services and fees — pervasive developmental disorder

Item Service Fee ($)
82000

Psychology health service provided to a child aged under 13 years by an eligible psychologist if:

   (a)  the child was referred to the eligible psychologist by an eligible practitioner:

         (i)   to assist with the diagnosis of the child by the practitioner; or

        (ii)   to contribute to the child’s PDD treatment and management plan; and

        (b)   the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and

 90.15

   (c)  the eligible psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and

   (d)  the child is not an admitted patient of a hospital; and

   (e)  the service is provided to the child individually and in person; and

   (f)  the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item or items 82005 and 82010 apply)

This item is subject to sections 10 and 11
82005

Speech pathology health service provided to a child aged under 13 years by an eligible speech pathologist if:

   (a)  the child was referred to the eligible speech pathologist by an eligible practitioner:

         (i)   to assist with the diagnosis of the child by the practitioner: or

        (ii)   to contribute to the child’s PDD treatment and management plan; and

   (b)  the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and

   (c)  the eligible speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and

   (d)  the child is not an admitted patient of a hospital; and

   (e)  the service is provided to the child individually and in person; and

   (f)  the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item or items 82000 and 82010 apply)

This item is subject to sections 10 and 11

 79.40
82010

Occupational therapy health service provided to a child aged under 13 years by an eligible occupational therapist if:

   (a)  the child was referred to the eligible occupational therapist by an eligible practitioner:

         (i)   to assist with the diagnosis of the child by the practitioner: or

        (ii)   to contribute to the child’s PDD treatment and management plan; and

   (b)  the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and

   (c)  the eligible occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and

   (d)  the child is not an admitted patient of a hospital; and

   (e)  the service is provided to the child individually and in person; and

 79.40

   (f)  the service is at least 50 minutes duration;

to a maximum of 4 services (including services to which this item or items 82000 and 82005 apply)
82015

Psychology health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible psychologist, if:

   (a)  the child has been diagnosed with a PDD; and

   (b)  the child, while aged under 13 years, received a PDD treatment and management plan; and

   (c)  the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and

   (d)  the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and

   (e)  the eligible psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and

   (f)  on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

   (g)  the child is not an admitted patient of a hospital; and

   (h)  the service is provided to the child individually and in person; and

    (i)  the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item or items 82020 and 82025 apply)

This item is subject to sections 10 and 11

 90.15
82020

Speech pathology health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible speech pathologist, if:

   (a)  the child has been diagnosed with a PDD; and

   (b)  the child, while aged under 13 years, received a PDD treatment and management plan; and

   (c)  the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and

   (d)  the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and

   (e)  the eligible speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and

 79.40

   (f)  on the completion of the course of treatment, the eligible speech pathologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

   (g)  the child is not an admitted patient of a hospital; and

   (h)  the service is provided to the child individually and in person; and

    (i)  the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item or items 82015 and 82025 apply)

This item is subject to sections 10 and 11
82025

Occupational therapy health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible occupational therapist if:

   (a)  the child has been diagnosed with a PDD; and

   (b)  the child, while aged under 13 years, received a PDD treatment and management plan; and

   (c)  the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and

   (d)  the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and

   (e)  the eligible occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and

   (f)  on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and

   (g)  the child is not an admitted patient of a hospital; and

   (h)  the service is provided to the child individually and in person; and

    (i)  the service is at least 30 minutes duration;

to a maximum of 20 services (including services to which this item or items 82015 and 82020 apply)

This item is subject to sections 10 and 11

 79.40

[28]         Further amendments — substitutions

Provision

omit

insert
Schedule 2, items 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968 and 10970, subparagraph (g) (iii) matters; and matters;
Schedule 2, items 80000, 80005, 80010, 80015 sections 8 and 9 sections 8, 9 and 11
Schedule 2, item 80020 section 9 sections 9 and 11
Schedule 2, items 80100, 80105, 80110, 80115 sections 8 and 9 sections 8, 9 and 11
Schedule 2, item 80120 section 9 sections 9 and 11
Schedule 2, items 80125, 80130, 80135 and 80140 sections 8 and 9 sections 8, 9 and 11
Schedule 2, item 80145 section 9 sections 9 and 11
Schedule 2, items 80150, 80155, 80160 and 80165 sections 8 and 9 sections 8, 9 and 11
Schedule 2, item 80170 section 9 sections 9 and 11
Schedule 2, item 81100, paragraph (g) paragraph (c); and paragraph (c);
Schedule 2, item 81105, paragraph (g) educator; and educator;
Schedule 2, item 81110, paragraph (g) paragraph (c); and paragraph (c);
Schedule 2, item 81115, paragraph (g) physiologist; and physiologist;
Schedule 2, item 81120, paragraph (g) paragraph (c); and paragraph (c);
Schedule 2, item 81125, paragraph (g) dietitian; and dietitian;

[29]         Further amendments — insertions

Provision

after

insert
Schedule 2, items 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968 and 10970 calendar year This item is subject to section 11
Schedule 2, items 81000, 81005 and 81010 appropriate This item is subject to section 11
Schedule 2, item 81100 81120) This item is subject to section 11
Schedule 2, item 81105 81125) This item is subject to section 11
Schedule 2, item 81110 81120) This item is subject to section 11
Schedule 2, item 81115 81125) This item is subject to section 11
Schedule 2, item 81120 81120) This item is subject to section 11
Schedule 2, item 81125 81125 apply) This item is subject to section 11

Note

1.       All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See

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