Health Insurance (General Medical Services Table) Amendment Regulations 2008 (No. 2) (Cth)

Health Insurance (General Medical Services Table) Amendment Regulations 2008 (No. 2)¹

Select Legislative Instrument 2008 No. 112

I, PHILIP MICHAEL JEFFERY, Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.

Dated 19 June 2008

P. M. JEFFERY

Governor‑General

By His Excellency’s Command

NICOLA ROXON

Minister for Health and Ageing

Name of Regulations

These Regulations are the Health Insurance (General Medical Services Table) Amendment Regulations 2008 (No. 2).

Commencement

These Regulations commence on 1 July 2008.

Amendment of Health Insurance (General Medical Services Table) Regulations 2007

Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2007.

Schedule 1 Amendments

(regulation 3)

[1]Schedule 1, Part 2, subrule 3 (1), after definition of open reduction

insert

patient’s usual medical practitioner means a medical practitioner:

(a)who has provided the majority of services to the patient in the past 12 months; or

(b)who is likely to provide the majority of services to the patient in the following 12 months; or

(c)located at a medical practice that:

(i)has provided the majority of services to the patient in the past 12 months; or

(ii)is likely to provide the majority of services to the patient in the next 12 months.

practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice.

[2] Schedule 1, Part 2, subrule 3 (1), after definition of referring practitioner

insert

registered Aboriginal health worker means a person registered as an Aboriginal health worker under the Health Practitioners Act (NT) who is employed by, or whose services are otherwise retained by, a general practice or health service in the Northern Territory in relation to which the Minister has made a direction under subsection 19 (2) of the Act.

[3] Schedule 1, Part 2, rule 10, heading

omit

291 to 388

insert

289 to 388

[4] Schedule 1, Part 2, subrule 10 (1)

omit

291 to 388

insert

289 to 388

[5] Schedule 1, Part 2, after rule 19

insert

19AApplication of items 135 and 289

(1)A service described in item 135 applies only once to a patient and only if the patient has not received a service described in item 289.

(2)A service described in item 289 applies only once to a patient and only if the patient has not received a service described in item 135.

[6] Schedule 1, Part 2, after subrule 20 (1)

insert

(1A)Items 709 and 711 apply only to a service for a patient who:

(a)is a child in Australia who is 4 years old; and

(b)is receiving or has received the immunisation recommended for a 4 year old child by the National Immunisation Program Schedule (valid from 1 July 2007), a Department of Health and Ageing document.

(1B)A service described in item 709 applies only once to a patient and only if the patient has not received a service described in item 711.

(1C)A service described in item 711 applies only once to a patient and only if the patient has not received a service described in item 709.

[7] Schedule 1, Part 2, after subrule 20 (2)

insert

(2A)Item 713 applies only to a service for a patient who:

(a)is at least 40 years old and less than 50 years old; and

(b)has a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool; and

(c)is not an in‑patient of a hospital or an approved day hospital facility.

(2B)In subrule (2A) and item 713, Australian Type 2 Diabetes Risk Assessment Tool means the type 2 diabetes risk assessment developed by the International Diabetes Institute on behalf of the Council of Australian Government’s ‘Reducing the risk of type 2 diabetes’ initiative.

[8] Schedule 1, Part 2, after rule 22

insert

22AMeaning of Healthy Kids Check in items 709 and 711

(1)In this rule and items 709 and 711:

Healthy Kids Check means the assessment of:

(a)a patient’s physical health, general wellbeing and development; and

(b)whether any medical intervention is required.

(2)A Healthy Kids Check should generally be undertaken by a patient’s usual medical practitioner, but may also be undertaken by any medical practitioner (including a general practitioner) or by a practice nurse on behalf of a medical practitioner.

(3)If a practice nurse who undertakes a Healthy Kids Check identifies any problems because of the Healthy Kids Check, the patient must be reviewed by the patient’s usual medical practitioner who will arrange referrals and follow‑up as required.

(4)A Healthy Kids Check must include the following basic physical examinations and assessments:

(a)height and weight (plot and interpret growth curve, and calculate BMI);

(b)eyesight;

(c)hearing;

(d)oral health (teeth and gums);

(e)toileting;

(f)allergies.

(5)A Healthy Kids Check must also include the following:

(a)information collection, including taking a patient history and undertaking examinations and investigations as required;

(b)making an overall assessment of the patient;

(c)initiating interventions or referrals as appropriate;

(d)providing health advice and information to the patient’s parent or carer, using a healthy habits for life guide, a publication of the Department of Health and Ageing, and other relevant information such as a parent‑held child health record.

(6)The medical practitioner or practice nurse must:

(a)note if a copy of a healthy habits for life guide has been provided by Medicare Australia to the patient; and

(b)record evidence that the immunisation recommended for a 4 year old child has been given to the patient.

[9] Schedule 1, Part 2, after rule 24

insert

24AMeaning of type 2 diabetes risk evaluation in item 713

(1)For item 713, a type 2 diabetes risk evaluation means:

(a)a review of the risk factors underlying a patient’s high risk score as identified by the Australian Type 2 Diabetes Risk Assessment Tool; and

(b)initiating interventions, if appropriate, to address risk factors or exclusion of diabetes.

(2)For subrule (1), risk factors include the following:

(a)lifestyle risk factors, such as smoking, physical inactivity and poor nutrition;

(b)biomedical risk factors, such as high blood pressure, impaired glucose metabolism and excess weight;

(c)a family history of a chronic disease.

(3)The type 2 diabetes risk evaluation must include the following:

(a)evaluating a patient’s high risk score, as determined by the Australian Type 2 Diabetes Risk Assessment Tool which has been completed by the patient within a period of 3 months prior to undertaking the type 2 diabetes risk evaluation;

(b)updating the patient’s history and undertaking physical examinations and clinical investigations in accordance with relevant guidelines;

(c)making an overall assessment of the patient’s risk factors and of the results of relevant examinations and investigations;

(d)initiating interventions, if appropriate, including referrals and follow‑up relating to the management of any risk factors identified;

(e)providing the patient with advice and information (such as the Lifescript resources produced by the Department of Health and Ageing), including strategies to achieve lifestyle and behaviour changes if appropriate.

(4)The type 2 diabetes risk evaluation should generally be undertaken by the patient’s usual medical practitioner.

(5)The medical practitioner providing the service mentioned in item 713 is responsible for the overall conduct of the type 2 diabetes risk evaluation provided to the patient.

(6)Elements of the type 2 diabetes risk evaluation may be delegated by the medical practitioner providing the service mentioned in item 713 to a practice nurse, a registered Aboriginal health worker or other qualified health professional, in accordance with accepted medical practice and under the supervision of the medical practitioner.

[10] Schedule 1, Part 2, subrule 27 (10)

omit

[11] Schedule 1, Part 2, rule 60

substitute

Meaning of outer metropolitan specialist trainee in items 5906, 5908, 5910 and 5912

(1)In items 5906, 5908, 5910 and 5912:

outer metropolitan specialist trainee means a medical practitioner who meets all of the following criteria:

(a)is a participant in the Outer Metropolitan Specialist Training Program administered by the Department;

(b)is currently enrolled in, and undertaking a training course in, an approved specialist college;

(c)is undertaking a placement in a structured training program of the approved specialist college that provides experience not available in teaching hospitals:

(i)as part of an accredited ‘advanced’ training placement, or a training placement approved by the Department, that fully counts towards training time and other formal requirements; and

(ii)as a college trainee with access to medicare benefits that are limited to attendances provided at a practice nominated by the approved specialist college for a specified period.

(2)For subrule (1), approved specialist college means a specified body listed in Schedule 5 to the Health Insurance Regulations 1975 (excluding the Royal College of General Practitioners).

[12] Schedule 1, Part 2, subrule 65 (1), definition of registered Aboriginal health worker

omit

[13] Schedule 1, Part 2, subrule 66 (1)

omit

[14] Schedule 1, Part 2, subrule 66 (2)

omit

(2)

[15] Schedule 1, Part 2, subrules 68 (1), 69 (1) and 70 (1), definition of practice nurse

omit

[16] Schedule 1, Part 2, rule 71, definitions of practice nurse and registered Aboriginal health worker

omit

[17] Schedule 1, Part 2, subrule 72 (1), definition of practice nurse

omit

[18] Schedule 1, Part 2, after rule 78

insert

78AApplication of items 13020 to 51318

An item in the range 13020 to 51318 does not apply to a service described in that item if the service is provided at the same time as, or in connection with, the provision of a pain pump for post‑surgical pain management.

[19] Schedule 1, Part 2, after rule 113

insert

113AApplication of item 35321

Item 35321 does not apply to the service described in that item if the service is provided at the same time as, or in connection with, endovenous laser treatment for varicose veins.

[20] Schedule 1, Part 3, after item 133

insert

135

Professional attendance of at least 45 minutes duration at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty of paediatrics, following referral of the patient to the consultant by a medical practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient aged under 13 years with a pervasive developmental disorder including autism, if the consultant paediatrician does the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (assisted by 1 or more allied health providers, if appropriate);

(b) develops a treatment and management plan, which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

238.30

(ii) an opinion on risk assessment, with treatment options and decisions, including appropriate care pathways;

(iii) consideration of appropriate medications;

(d) provides a copy of the treatment and management plan to 1 or more allied health providers, if appropriate, for the treatment of the patient;

(not being an attendance on a patient for whom payment has previously been made under this item or item 289)

(Item is subject to rule 19A)

[21] Schedule 1, Part 3, before item 291

insert

289

Professional attendance of at least 45 minutes duration at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to the consultant by a medical practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient aged under 13 years with a pervasive developmental disorder including autism, if the consultant psychiatrist does the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (assisted by 1 or more allied health providers if appropriate);

(b) develops a treatment and management plan which must include the following:

(i) an assessment and diagnosis of the patient’s condition;

(ii) an opinion on risk assessment, with treatment options and decisions, including appropriate care pathways;

(iii) consideration of appropriate medications;

238.30

(d) provides a copy of the treatment and management plan to 1 or more allied health providers, if appropriate, for the treatment of the patient;

(not being an attendance on a patient for whom payment has previously been made under this item or item 135)

(Item is subject to rule 19A)

[22] Schedule 1, Part 3, after item 708

insert

709

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) at consulting rooms for a Healthy Kids Check for a patient who is receiving or has received the immunisation recommended for a 4 year old child — not being an attendance on a patient for whom a service has been provided under this item or item 711

(Item is subject to rule 20)

45.00

[23] Schedule 1, Part 3, after item 710

insert

711

Service provided by a practice nurse of a Healthy Kids Check for a patient who is receiving or has received the immunisation recommended for a 4 year old child if:

(a) the service is provided on behalf of, and under the supervision of, a medical practitioner (including a general practitioner, but not including a specialist or consultant physician); and

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

(not being an attendance on a patient for whom a service has been provided under this item or item 709)

(Item is subject to rule 20)

45.00

[24] Schedule 1, Part 3, after item 712

insert

713

Attendance by a medical practitioner (including a general practitioner but not including a specialist or consultant physician), at a place other than a hospital, for a type 2 diabetes risk evaluation for a patient who:

(a) is at least 40 years old and less than 50 years old; and

(b) has a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool;

(not being a type 2 diabetes risk evaluation of a patient for whom, in the last 3 years, a payment has been made under this item or item 717)

(Item is subject to rule 20)

60.00

[25] Schedule 1, Part 3, item 16018

substitute

16018

Administration of 153 Sm‑lexidronam for the relief of bone pain due to skeletal metastases (as indicated by a positive bone scan) where hormonal therapy or chemotherapy have failed, and:

(a) the disease is poorly controlled by conventional radiotherapy; or

(b) conventional radiotherapy is inappropriate, due to the wide distribution of sites of bone pain

2 205.70

[26] Schedule 1, Part 3, item 18292

after

toxin

insert

except those services to which items 18354, 18356 and 18358 apply

[27] Schedule 1, Part 3, after item 20146

insert

20147

Initiation of management of anaesthesia for squint repair

107.40

[28] Schedule 1, Part 3, after item 20225

insert

20230

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the head or face

214.80

[29] Schedule 1, Part 3, after item 20352

insert

20355

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the neck

214.80

[30] Schedule 1, Part 3, after item 20474

insert

20475

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior thorax

179.00

[31] Schedule 1, Part 3, after item 20703

insert

20704

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior upper abdomen

179.00

[32] Schedule 1, Part 3, after item 20862

insert

20863

Initiation of management of anaesthesia for nephrectomy

179.00

[33] Schedule 1, Part 3, after item 20904

insert

20905

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the perineum

179.00

[34] Schedule 1, Part 3, after item 20910

insert

20911

Initiation of management of anaesthesia for endoscopic ureteroscopic surgery including laser procedures

89.50

[35] Schedule 1, Part 3, item 20920, column 3

substitute

71.60

[36] Schedule 1 Part 3, item 20942

omit

colpotomy, colpectomy or colporrhaphy

insert

vaginal procedures (including repair operations and urinary incontinence procedures)

[37] Schedule 1, Part 3, after item 21150

insert

21155

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the anterior or posterior pelvis

179.00

[38] Schedule 1, Part 3, after item 21274

insert

21275

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the upper leg

179.00

[39] Schedule 1, Part 3, after item 21440

insert

21445

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the knee or popliteal area

179.00

[40] Schedule 1, Part 3, after item 21532

insert

21535

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the lower leg

179.00

[41] Schedule 1, Part 3, after item 21682

insert

21685

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the shoulder or axilla

179.00

[42] Schedule 1, Part 3, after item 21780

insert

21785

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the upper arm or elbow

179.00

[43] Schedule 1, Part 3, after item 21860

insert

21865

Initiation of management of anaesthesia for microvascular free tissue flap surgery involving the forearm, wrist or hand

179.00

[44] Schedule 1, Part 3, after item 21980

insert

21981

Anaesthetic agent allergy testing, using skin sensitivity methods on a patient with a history of anaphylactic or anaphylactoid reaction or cardiovascular collapse in association with the administration of anaesthesia agents

71.60

[45] Schedule 1, Part 3, item 22007

omit

Awake endotracheal

insert

Endotracheal

[46] Schedule 1, Part 3, item 30487

omit

biopsy (Anaes.)

insert

biopsy, as an independent procedure (Anaes.)

[47] Schedule 1, Part 3, item 35321

after

(Assist.)

insert

(Item is subject to rule 113A)

[48] Schedule 1, Part 3, item 35700

omit

, for other than reversal of previous sterilisation

[49] Schedule 1, Part 3, items 37616 and 37619

omit

for other than reversal of previous elective sterilisation,

[50] Schedule 1, Part 3, item 42644

substitute

42644

Cornea or sclera, removal of embedded foreign body from — not more than once on the same day by the same practitioner (excluding after‑care) (Anaes.)

65.10

[51] Schedule 1, Part 3, after item 42740

insert

42741

Posterior juxtascleral depot injection of a therapeutic substance, for the treatment of subfoveal choroidal neovascularisation due to age‑related macular degeneration, 1 or more of (Anaes.)

271.60

[52] Schedule 1, Part 3, items 49503 and 49506

omit

or any other single procedure

Note

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