Health Insurance (General Medical Services Table) Amendment (Obstetrics) Regulations 2017 (Cth)

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Health Insurance (General Medical Services Table) Amendment (Obstetrics) Regulations 2017

I, General the Honourable Sir Peter Cosgrove AK MC (Ret’d), Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulations.

Dated 24 August 2017

Peter Cosgrove

Governor‑General

By His Excellency’s Command

Greg Hunt

Minister for Health

Contents

1Name

This instrument is the Health Insurance (General Medical Services Table) Amendment (Obstetrics) Regulations 2017.

2Commencement
  1. (1)

    Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.

The whole of this instrument

The later of:

(a) 1 November 2017; and

(b) immediately after the commencement of section 1 of the Health Insurance (Extended Medicare Safety Net) Determination 2017.

However, the provisions do not commence at all if the event mentioned in paragraph (b) does not occur.

1 November 2017

(paragraph (b) applies)

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

  1. (2)

    Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3Authority

This instrument is made under the Health Insurance Act 1973.

4Schedules

Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1—Amendments

Health Insurance (General Medical Services Table) Regulations 2017

1

Subclause 1.2.2(1) of Schedule 1

After “16404,” insert “16407, 16408, 16508, 16509, 16533, 16534,”.

2

Subclause 1.2.3(1) of Schedule 1

Omit “16590, 16591”, substitute “16407, 16508, 16509, 16533, 16534”.

  1. 3

    Schedule 1 (at the end of the cell at item 105, column headed “Description”)

Add “, other than a service to which item 16404 applies”.

  1. 4

    Clause 2.40.1 of Schedule 1 (definition of midwife)

Repeal the definition.

5

Clauses 2.40.2 and 2.40.3 of Schedule 1

Repeal the clauses, substitute:

2.40.2Meaning of midwife in items 16400 and 16408

In items 16400 and 16408:

midwife means a person:

  1. (a)

    who is registered under a law of a State or Territory as a midwife; and

  2. (b)

    who is employed by, or whose services are otherwise retained by, a medical practitioner or a practice operated by a medical practitioner.

6

Clause 2.40.6 of Schedule 1

Repeal the clause.

  1. 7

    Schedule 1 (item 16401, column headed “Description”)

Omit “, other than a service to which item 104 applies”.

  1. 8

    Schedule 1 (item 16406, column headed “Description”)

Omit “, as part of a single course of treatment, at 32‑36 weeks of the patient’s pregnancy”, substitute “by an obstetrician or general practitioner, as part of a single course of treatment”.

9

Schedule 1 (after item 16406)

Insert:

16407

Postnatal professional attendance (other than a service to which any other item applies) if the attendance:

(a) is by an obstetrician or general practitioner; and

(b) is in hospital or at consulting rooms; and

(c) is between 4 and 8 weeks after the birth; and

(d) lasts at least 20 minutes; and

(e) includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(f) is for a pregnancy in relation to which a service to which item 82140 applies is not provided

Payable once only for a pregnancy

71.70

16408

Postnatal attendance (other than attendance at consulting rooms, a hospital or a residential aged care facility or a service to which any other item applies) if the attendance:

(a) is by:

(i) a midwife (on behalf of and under the supervision of the medical practitioner who attended the birth); or

(ii) an obstetrician; or

(iii) a general practitioner; and

(b) is between 1 week and 4 weeks after the birth; and

(c) lasts at least 20 minutes; and

(d) is for a patient who was privately admitted for the birth; and

(e) is for a pregnancy in relation to which a service to which item 82130, 82135 or 82140 applies is not provided

Payable once only for a pregnancy

53.40

  1. 10

    Schedule 1 (item 16508, column headed “Description”)

Omit “intra‑uterine growth retardation”, substitute “fetal growth restriction”.

  1. 11

    Schedule 1 (item 16508, column headed “Description”)

Omit “each attendance”, substitute “each professional attendance (other than a service to which item 16533 applies)”.

  1. 12

    Schedule 1 (item 16509, column headed “Description”)

Omit “each attendance”, substitute “each professional attendance (other than a service to which item 16534 applies)”.

  1. 13

    Schedule 1 (item 16515, column headed “Description”)

Omit “delivery” (wherever occurring), substitute “birth”.

  1. 14

    Schedule 1 (item 16515, column headed “Fee ($)”)

Omit “450.65”, substitute “630.85”.

  1. 15

    Schedule 1 (item 16518, column headed “Description”)

Omit “delivery”, substitute “birth”.

  1. 16

    Schedule 1 (item 16519, column headed “Description”)

Omit “delivery”, substitute “birth”.

  1. 17

    Schedule 1 (item 16520, column headed “Fee ($)”)

Omit “811.05”, substitute “630.85”.

18

Schedule 1 (item 16522)

Repeal the item, substitute:

16522

Management of labour and birth, or birth alone, (including caesarean section), on or after 23 weeks gestation, if in the course of antenatal supervision or intrapartum management one or more of the following conditions is present, including postnatal care for 7 days:

(a) fetal loss;

(b) multiple pregnancy;

(c) antepartum haemorrhage that is:

(i) of greater than 200 ml; or

(ii) associated with disseminated intravascular coagulation;

(d) placenta praevia on ultrasound in the third trimester with the placenta within 2 cm of the internal cervical os;

(e) baby with a birth weight less than or equal to 2,500 g;

(f) trial of vaginal birth in a patient with uterine scar where there has been a planned vaginal birth after caesarean section;

(g) trial of vaginal breech birth where there has been a planned vaginal breech birth;

(h) prolonged labour greater than 12 hours with partogram evidence of abnormal cervimetric progress as evidenced by cervical dilatation at less than 1 cm/hr in the active phase of labour (after 3 cm cervical dilatation and effacement until full dilatation of the cervix);

(i) acute fetal compromise evidenced by:

(i) scalp pH less than 7.15; or

(ii) scalp lactate greater than 4.0;

(j) acute fetal compromise evidenced by at least one of the following significant cardiotocograph abnormalities:

(i) prolonged bradycardia (less than 100 bpm for more than 2 minutes);

(ii) absent baseline variability (less than 3 bpm);

(iii) sinusoidal pattern;

(iv) complicated variable decelerations with reduced (3 to 5 bpm) or absent baseline variability;

(v) late decelerations;

(k) pregnancy induced hypertension of at least 140/90 mm Hg associated with:

(i) at least 2+ proteinuria on urinalysis; or

(ii) protein‑creatinine ratio greater than 30 mg/mmol; or

(iii) platelet count less than 150 x 109/L; or

(iv) uric acid greater than 0.36 mmol/L;

(l) gestational diabetes mellitus requiring at least daily blood glucose monitoring;

(m) mental health disorder (whether arising prior to pregnancy, during pregnancy or postpartum) that is demonstrated by:

(i) the patient requiring hospitalisation; or

(ii) the patient receiving ongoing care by a psychologist or psychiatrist to treat the symptoms of a mental health disorder; or

(iii) the patient having a GP mental health treatment plan; or

(iv) the patient having a management plan prepared in accordance with item 291;

(n) disclosure or evidence of domestic violence;

(o) any of the following conditions either diagnosed pre‑pregnancy or evident at the first antenatal visit before 20 weeks gestation:

(i) pre‑existing hypertension requiring antihypertensive medication prior to pregnancy;

(ii) cardiac disease (co‑managed with a specialist physician and with echocardiographic evidence of myocardial dysfunction);

(iii) previous renal or liver transplant;

(iv) renal dialysis;

(v) chronic liver disease with documented oesophageal varices;

(vi) renal insufficiency in early pregnancy (serum creatinine greater than 110 mmol/L);

(vii) neurological disorder that confines the patient to a wheelchair throughout pregnancy;

(viii) maternal height of less than 148 cm;

(ix) a body mass index greater than or equal to 40;

(x) pre‑existing diabetes mellitus on medication prior to pregnancy;

(xi) thyrotoxicosis requiring medication;

(xii) previous thrombosis or thromboembolism requiring anticoagulant therapy through pregnancy and the early puerperium;

(xiii) thrombocytopenia with platelet count of less than 100,000 prior to 20 weeks gestation;

(xiv) HIV, hepatitis B or hepatitis C carrier status positive;

(xv) red cell or platelet iso‑immunisation;

(xvi) cancer with metastatic disease;

(xvii) illicit drug misuse during pregnancy

(H) (Anaes.)

1,629.35

19

Schedule 1 (item 16525)

Repeal the item.

  1. 20

    Schedule 1 (item 16527, column headed “Description”)

Omit “delivery” (wherever occurring), substitute “birth”.

  1. 21

    Schedule 1 (item 16527, column headed “Fee ($)”)

Omit “450.65”, substitute “630.85”.

  1. 22

    Schedule 1 (item 16528, column headed “Fee ($)”)

Omit “811.05”, substitute “630.85”.

23

Schedule 1 (after item 16528)

Insert:

16530

Management of pregnancy loss, from 14 weeks to 15 weeks and 6 days gestation, other than a service to which item 16531, 35640 or 35643 applies (Anaes.)

384.35

16531

Management of pregnancy loss, from 16 weeks to 22 weeks and 6 days gestation, other than a service to which item 16530, 35640 or 35643 applies (Anaes.) (H)

768.70

16533

Pregnancy complicated by acute intercurrent infection, fetal growth restriction, threatened premature labour with ruptured membranes or threatened premature labour treated by intravenous therapy, requiring admission to hospital—each professional attendance lasting at least 40 minutes that is not a routine antenatal attendance, to a maximum of 3 services per pregnancy (H)

105.55

16534

Pre‑eclampsia, eclampsia or antepartum haemorrhage, treatment of—each professional attendance lasting at least 40 minutes that is not a routine antenatal attendance, to a maximum of 3 services per pregnancy (H)

105.55

24

Schedule 1 (items 16590 and 16591)

Repeal the items, substitute:

16590

Planning and management, by a practitioner, of a pregnancy if:

(a) the practitioner intends to take primary responsibility for management of the pregnancy and any complications, and to be available for the birth; and

(b) the patient intends to be privately admitted for the birth; and

(c) the pregnancy has progressed beyond 28 weeks gestation; and

(d) the practitioner has maternity privileges at a hospital or birth centre; and

(e) the service includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(f) a service to which item 16591 applies is not provided in relation to the same pregnancy

Payable once only for a pregnancy

372.75

16591

Planning and management, by a practitioner, of a pregnancy if:

(a) the pregnancy has progressed beyond 28 weeks gestation; and

(b) the service includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(c) a service to which item 16590 applies is not provided in relation to the same pregnancy

Payable once only for a pregnancy

142.65

  1. 25

    Schedule 1 (item 16606, column headed “Description”)

Omit “foetus”, substitute “fetus”.

26

Schedule 1 (items 16633 and 16636)

Repeal the items.

  1. 27

    Schedule 1 (item 20855, column headed “Description”)

Omit “delivery”, substitute “birth”.

  1. 28

    Schedule 1 (item 20946, column headed “Description”)

Omit “delivery”, substitute “birth”.

  1. 29

    Schedule 1 (item 20958, column headed “Description”)

Omit “delivery”, substitute “birth”.

  1. 30

    Schedule 1 (item 51306, column headed “Description”)

Omit “delivery”, substitute “birth”.

  1. 31

    Schedule 1 (item 51309, column headed “Description”)

Omit “delivery”, substitute “birth”.

  1. 32

    Schedule 1 (item 51312, column headed “Description”)

Omit “16615, 16627 and 16633”, substitute “16615 and 16627”.

  1. 33

    Dictionary (definition of amount under clause 2.40.2)

Repeal the definition.

34

Dictionary

Insert:

birth, in items 16515, 16519, 16522, 16527, 16528, 16590, 20855, 20946, 20958, 51306 and 51309, includes the following:

  1. (a)

    induction of labour by surgical or intravenous infusion methods;

  2. (b)

    forceps or vacuum extraction;

  3. (c)

    caesarean section;

  4. (d)

    breech birth;

  5. (e)

    management of multiple births;

  6. (f)

    episiotomy;

  7. (g)

    repair of tears;

  8. (h)

    evacuation of the products of conception by manual removal.

35

Dictionary (definition of delivery)

Repeal the definition.

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