Health Insurance (Midwife and Nurse Practitioner) Determination 2010 (Cth)

Case

Health Insurance (Midwife and Nurse Practitioner) Determination 2010

Health Insurance Act 1973

I, NICOLA ROXON, Minister for Health and Ageing, make this Determination under section 3C of the Health Insurance Act 1973.

Dated 4 October 2010

NICOLA ROXON

Minister for Health and Ageing

Contents

Part 1Preliminary

1Name of Determination   3

2Commencement   3

3Definitions   3

Part 2Midwifery services

4Interpretation   4

5Treatment of midwifery services   4

6Requirements  — collaborative arrangements   4

7Other requirements   4

8Labour and delivery   6

Part 3Nurse practitioner services

9Treatment of nurse practitioner services   7

10Requirements  — collaborative arrangements and scope of practice         7

11Other requirements   7

Schedule 1Services and fees   9

Part 1Midwifery services and fees   9

Part 2Nurse practitioner services and fees   12

Part 1                 Preliminary

  1. Name of Determination

This Determination is the Health Insurance (Midwife and Nurse Practitioner) Determination 2010.

  1. Commencement

This Determination commences on 1 November 2010.

  1. Definitions

(1)   In this Determination:

Act means the Health Insurance Act 1973.

relevant provisions means all provisions, relating to professional services or medical services, of:

(a)    the Act and regulations made under the Act; and

(b)    the National Health Act 1953 and regulations made under that Act.

Note   The following terms are defined in subsection 3 (1) of the Act:

·      general medical services table

·      participating midwife

·      participating nurse practitioner.

Part 2                 Midwifery services

  1. Interpretation

(1)   In this Part:

collaborative arrangement, for a participating midwife’s patient, means a collaborative arrangement mentioned in regulation 2C of the Health Insurance Regulations 1975.

delivery includes episiotomy and repair of tears.

(2)   For this Part, a participating midwife is a member of a practice that provides a patient’s antenatal care if the midwife:

(a)    participates (whether as a partner, employee or otherwise) in the provision of professional services as part of the practice; or

(b)    provides relief services to the practice; or

(c)    provides professional services as part of the practice as a locum.

  1. Treatment of midwifery services

For subsection 3C (1) of the Act, a midwifery service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:

(a)    it were both a professional service and a medical service; and

(b)    there were an item in the general medical services table that:

(i)    related to the service; and

(ii)    mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Part 1 of Schedule 1 for the service.

Note   For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.

  1. Requirements  — collaborative arrangements

For a patient, an item in Part 1 of Schedule 1 applies only if the service mentioned in that item is provided to the patient in accordance with a collaborative arrangement applying to that patient.

  1. Other requirements

(1)   Items 82100 to 82140 in Part 1 of Schedule 1 apply to a service only if:

(a)    the service is provided in the course of a personal attendance on a single patient on a single occasion by a single participating midwife; and

(b)    the midwife:

(i)    is not employed by the proprietor of a hospital that is not a private hospital; or

(ii)    both:

(A)     is employed by the proprietor of a hospital that is not a private hospital; and

(B)     provides the service otherwise than in the course of employment by that proprietor.

(2)   Subsection (1) applies whether or not another person provides essential assistance to the participating midwife in accordance with accepted clinical practice.

(3)   Items 82100 to 82140 in Part 1 of Schedule 1 do not apply to a service provided for a patient if the patient is not in attendance.

Examples — patient not in attendance

1   Completing patient records.

2   Issuing repeat prescriptions.

3   Telephone attendances. 

(4)   In items 82100 to 82115 and 82130 to 82140 in Part 1 of Schedule 1:

professional attendance includes the provision, for a patient, of any of the following services:

(a)    evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19 (5) of the Act;

(b)    formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;

(c)    giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;

(d)    if authorised by the patient — giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;

(e)    providing appropriate preventive health care;

(f)    recording the clinical details of the service or services provided to the patient.

(5)   However, a professional attendance does not include the supply of a vaccine to a patient if:

(a)    the vaccine is supplied to the patient in connection with a professional attendance mentioned in any of items 82100 to 82115 and 82130 to 82140 in Part 1 of Schedule 1; and

(b)    the cost of the vaccine is not subsidised by the Commonwealth or a State.

  1. Labour and delivery

(1)   Items 82120 and 82125 in Part 1 of Schedule 1 apply only to a service provided by a participating midwife during a period of exclusive and continuous care of a patient in labour.

(2)   Items 82120 and 82125 in Part 1 of Schedule 1 do not apply if, before labour, the patient’s care is transferred to an obstetrician or medical practitioner who provides obstetric services, for the obstetrician or practitioner to manage the labour and delivery.

(3)   Item 82120 in Part 1 of Schedule 1 applies to a service provided by a participating midwife (the first midwife) who manages a patient’s confinement, but does not undertake the delivery, only if:

(a)    the patient’s care was transferred from the first midwife to another midwife because labour had exceeded 12 hours; or

(b)    there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.

(4)   Item 82125 in Part 1 of Schedule 1 applies to services provided by a participating midwife (the second midwife) who manages a patient’s confinement, but does not undertake the delivery, only if:

(a)    the patient’s care was transferred from the second midwife to another midwife because labour had exceeded 24 hours; or

(b)    there was a clinical need to transfer the patient’s care to an obstetrician or medical practitioner who provides obstetric services.

Part 3                 Nurse practitioner services

  1. Treatment of nurse practitioner services

For subsection 3C (1) of the Act, a nurse practitioner service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:

(a)    it were both a professional service and a medical service; and

(b)    there were an item in the general medical services table that:

(i)    related to the service; and

(ii)    mentioned, for the service, a fee in relation to each State, being the fee mentioned in the item in Part 2 of Schedule 1 relating to the service.

Note   For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.

  1. Requirements  — collaborative arrangements and scope of practice

(1)   For a patient, an item in Part 2 of Schedule 1 applies only if the service mentioned in that item is:

(a)    provided to the patient in accordance with a collaborative arrangement applying to that patient; and

(b)                within the scope of practice of the participating nurse practitioner who provides the service.

(2)   In this section:

collaborative arrangement, for a participating nurse practitioner’s patient, means a collaborative arrangement mentioned in regulation 2F of the Health Insurance Regulations 1975.

  1. Other requirements

(1)   Items 82200 to 82215 in Part 2 of Schedule 1 apply to a service only if:

(a)    the service is provided in the course of a personal attendance on a single patient on a single occasion by a single participating nurse practitioner; and

(b)    the nurse practitioner:

(i)    is not employed by the proprietor of a hospital that is not a private hospital; or

(ii)    both:

(A)     is employed by the proprietor of a hospital that is not a private hospital; and

(B)     provides the service otherwise than in the course of employment by that proprietor.

(2)   Subsection (1) applies whether or not another person provides essential assistance to the participating nurse practitioner in accordance with accepted clinical practice.

(3)   Items 82200 to 82215 in Part 2 of Schedule 1 do not apply to a service provided for a patient if the patient is not in attendance.

Examples — patient not in attendance

1   Completing patient records.

2   Issuing repeat prescriptions.

3   Telephone attendances. 

(4)   In items 82200 to 82215 in Part 2 of Schedule 1:

professional attendance includes the provision, for a patient, of any of the following services:

(a)    evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19 (5) of the Act;

(b)    formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;

(c)    giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;

(d)    if authorised by the patient — giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;

(e)    providing appropriate preventive health care;

(f)    recording the clinical details of the service or services provided to the patient.

(5)   However, a professional attendance does not include the supply of a vaccine to a patient if:

(a)    the vaccine is supplied to the patient in connection with a professional attendance mentioned in any of items 82200 to 82215 in Part 2 of Schedule 1; and

(b)    the cost of the vaccine is not subsidised by the Commonwealth or a State.

Schedule 1        Services and fees

(sections 5 and 9)

Part 1          Midwifery services and fees

Item Service Fee ($)
82100

Initial antenatal professional attendance by a participating midwife, lasting at least 40 minutes, including all of the following:

   (a)  taking a detailed patient history;

   (b)  performing a comprehensive examination;

   (c)  performing a risk assessment;

   (d)  based on the risk assessment — arranging referral or transfer of the patient’s care to an obstetrician;

   (e)  requesting pathology and diagnostic imaging services, when necessary;

(f) discussing with the patient the collaborative arrangements for her maternity care and recording the arrangements in the midwife’s written records in accordance with section 2E of the Health Insurance Regulations 1975

Payable only once for any pregnancy

 51.35
82105 Short antenatal professional attendance by a participating midwife, lasting up to 40 minutes 31.10
82110 Long antenatal professional attendance by a participating midwife, lasting at least 40 minutes 51.35
82115

Professional attendance by a participating midwife, lasting at least 90 minutes, for assessment and preparation of a maternity care plan for a patient whose pregnancy has progressed beyond 20 weeks, if:

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

   (b)  the participating midwife undertakes a comprehensive assessment of the patient; and

   (c)  the participating midwife develops a written maternity care plan that contains:

         (i)   outcomes of the assessment; and

        (ii)   details of agreed expectations for care during pregnancy, labour and delivery; and

       (iii)   details of any health problems or care needs; and

       (iv)   details of collaborative arrangements that apply to the patient; and

 306.90

        (v)   details of any medication taken by the patient during the pregnancy, and any additional medication that may be required by the patient; and

       (vi)   details of any referrals or requests for pathology services or diagnostic imaging services for the patient during the pregnancy, and any additional referrals or requests that may be required for the patient; and

   (d)  the maternity care plan is explained and agreed with the patient; and

   (e)  the fee does not include any amount for the management of labour and delivery

(Includes any antenatal attendance provided on the same occasion)

Payable only once for any pregnancy
82120

Management of confinement for up to 12 hours, including delivery (if undertaken), if:

   (a)  the patient is an admitted patient of a hospital; and

   (b)  the attendance is by a participating midwife who:

         (i)   provided the patient’s antenatal care; or

        (ii)   is a member of a practice that provided the patient’s antenatal care

(Includes all attendances related to the confinement by the participating midwife)

Payable once only for any pregnancy (H)

 724.75
82125

Management of confinement, including delivery (if undertaken), when care is transferred from 1 participating midwife to another participating midwife (the second participating midwife), if:

   (a)  the patient is an admitted patient of a hospital; and

   (b)  the patient’s confinement is for longer than 12 hours; and

   (c)  the second participating midwife:

         (i)   has provided the patient’s antenatal care; or

        (ii)   is a member of a practice that provided the patient’s antenatal care

(Includes all attendances related to the confinement by the second participating midwife)

Payable only once for any pregnancy (H)

 724.75  
82130 Short postnatal professional attendance by a participating midwife, lasting up to 40 minutes, within 6 weeks after delivery 51.35
82135 Long postnatal professional attendance by a participating midwife, lasting at least 40 minutes, within 6 weeks after delivery 75.55
82140

Postnatal professional attendance by a participating midwife on  a patient, not less than 6 weeks but not more than 7 weeks after delivery of a baby, including:

   (a)  a comprehensive examination of the patient and baby to ensure normal postnatal recovery; and

   (b)  referral of the patient to a general practitioner for the ongoing care of the patient and baby

Payable only once for any pregnancy

 51.35  

Part 2          Nurse practitioner services and fees

Item Service Fee ($)
82200 Professional attendance by a participating nurse practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management 9.20
82205

Professional attendance by a participating nurse practitioner lasting less than 20 minutes and including any of the following:

   (a)  taking a history;

   (b)  undertaking clinical examination;

   (c)  arranging any necessary investigation;

   (d)  implementing a management plan;

   (e)  providing appropriate preventive health care;

for 1 or more health related issues, with appropriate documentation

 20.15      
82210

Professional attendance by a participating nurse practitioner lasting at least 20 minutes and including any of the following:

   (a)  taking a detailed history;

   (b)  undertaking clinical examination;

   (c)  arranging any necessary investigation;

   (d)  implementing a management plan;

   (e)  providing appropriate preventive health care;

for 1 or more health related issues, with appropriate documentation

 38.25
82215

Professional attendance by a participating nurse practitioner lasting at least 40 minutes and including any of the following:

   (a)  taking an extensive history;

   (b)  undertaking clinical examination;

   (c)  arranging any necessary investigation;

   (d)  implementing a management plan;

   (e)  providing appropriate preventive health care;

for 1 or more health related issues, with appropriate documentation

 56.30

Note

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

Actions
Download as PDF Download as Word Document
Cases Citing This Decision

0

Cases Cited

0

Statutory Material Cited

0