Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011 (Cth)
Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011
Health Insurance Act 1973
I, Dr Richard Bartlett, 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: 4 November 2011
DR RICHARD BARTLETT
First Assistant Secretary
Medical Benefits Division
Department of Health and Ageing
Contents
1 Name of Determination
2 Commencement
3 Interpretation
4 Treatment of relevant services
5 Meaning of review of a GP mental health treatment plan
6 Application of item 2719
7 Specification of item 2719 in general medical service table
Schedule – Specified health service
1 Name of Determination
This Determination is the Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011.
2 Commencement
This Determination is taken to have commenced on 1 November 2011.
Interpretation
In this Determination, unless the contrary intention appears:
Act means the Health Insurance Act 1973.
associated medical practitioner means a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) who, if not engaged in the same general practice as the medical practitioner mentioned in item 2719, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).
exceptional circumstances means a significant change in:
(a) the patient’s clinical condition; or
(b) the patient’s care circumstances.
mental disorder means a significant impairment of any or all of an individual’s cognitive, affective and relational abilities that:
(a) may require medical intervention; and
(b) may be a recognised, medically diagnosable illness or disorder; and
(c) is not dementia, delirium, tobacco use disorder or mental retardation.
Note In relation to this definition, attention is drawn to the Diagnostic and Management Guidelines for Mental Disorders in Primary Care (ICD‑10, Chapter 5, Primary Care Version), developed by the World Health Organisation and published in 1996.
outcome measurement tool means a tool used to monitor changes in a patient’s health that occur in response to treatment received by the patient.
psychiatrist assessment and management plan means a written management plan prepared for a patient under item 291.
referral and treatment options for a patient include:
(a) support services for the patient; and
(b)psychiatric services for the patient; and
(c)subject to the applicable limitations:
(i)psychological therapies provided to a patient by a clinical psychologist (items 80000 to 80020); and
(ii)focussed psychological strategies services provided to the patient by a medical practitioner who is qualified in the way mentioned in paragraph 2.20.7(1)(b) of the general medical services table to provide those services (items 2721 to 2727); and
(iii)focussed psychological strategies services provided to the patient by an allied mental health professional (items 80100 to 80170).
Note For items 80000 to 80020 and 80100 to 80170 see the determination about allied health services under subsection 3C(1) of the Act, because of which certain health service are treated as if there were an item for the service mentioned in the general medical services table.
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.
relevant service means a health service that is specified in the Schedule.
Note The following terms are defined in subsection 3(1) of the Act:
consultant physician
general medical services table
item
medical practitioner
specialist
(2) Unless the contrary intention appears, a reference in this Determination to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
Treatment of relevant services
For subsection 3C(1) of the Act, a relevant 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) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation 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.
Meaning of review of a GP mental health treatment plan
A review of a GP mental health treatment plan means a process by which a medical practitioner:
(a) reviews the following matters mentioned in the definition of preparation of a GP mental health treatment plan in subclause 2.20. 3(1) of the general medical services table:
(i) preparation of a written plan by a medical practitioner for the patient that includes:
(A) an assessment of the patient’s mental disorder, including administration of an outcome measurement tool (except if considered clinically inappropriate);
(B) formulation of the mental disorder, including provisional diagnosis or diagnosis;
(C) treatment goals with which the patient agrees;
(D) any actions to be taken by the patient;
(E) a plan for either or both of crisis intervention and relapse prevention;
(F) referral and treatment options for the patient;
(G) arrangements for providing the referral and treatment options;
(H) arrangements to review the plan; and
(b) checks, reinforces and expands any education given under the plan; and
(c) if appropriate and if not previously provided — prepares a plan for either or both of the following:
(i) crisis intervention;
(ii) relapse prevention;
(d) re‑administers the outcome measurement tool used in the assessment mentioned in subparagraph (1) (a) (i) of the definition of preparation of a GP mental health treatment plan in subclause 2.20.3(1) of the general medical services table (except if considered clinically inappropriate); and
(e) if different arrangements need to be made — makes amendments to the plan that state those new arrangements; and
(f) explains to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review of the plan; and
(g) records the patient’s agreement to the review of the plan; and
(h) if amendments are made to the plan:
(i) offers a copy of the amended plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
(ii) adds a copy of the amended plan to the patient’s medical records.
Application of item 2719
(1) Item 2719 applies only to a patient with a mental disorder.
(2) Item 2719 applies only to:
(a) a patient in the community; and
(b) a private in-patient (including a private in-patient who is a resident of an aged care facility) being discharged from hospital; and
(c) a service provided in the course of personal attendance by a single medical practitioner on a single patient.
(3) Item 2719 applies only if the preparation of a GP mental health treatment plan under item 2702 or 2710 of the Health Insurance (General Medical Services Table) Regulations 2010 as in force on or before 31 October 2011 has been provided to the patient in the previous 12 months.
(4) Item 2719 does not apply to a service to which items 735 to 758, or item 2713 apply.
(5) Unless exceptional circumstances exist, item 2719 does not apply:
(a) more than once in a 3 month period; or
(b) within 3 months following the review of a GP mental health treatment plan for the patient under item 2712; or
(c) within 4 weeks following the preparation of a GP mental health treatment plan for the patient under any of:
(i) items 2700, 2701, 2715 or 2717; or
(ii) items 2702 or 2710 of the Health Insurance (General Medical Services Table) Regulations 2010 as in force on or before 31 October 2011.
Specification of item 2719 in general medical service table
(1) The following provisions of the general medical services table shall have effect as if item 2719 were also specified in the provision:
(a) paragraph 2.20.6(3)(c);
(b) paragraph 2.20.6(4)(b);
(c) subclause 2.20.6(7).
(2) Schedule 6, item 12, column 3 of the Health Insurance Regulations 1975 shall have effect as if item 2719 were also specified in the provision.
Schedule – Specified health service
| Item | Health Service | Fee |
| 2719 | Professional attendance by a medical practitioner (not including a specialist or consultant physician) to review a GP mental health treatment plan which he or she, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan | 69.00 |
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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