Health Insurance (Section 3C – Midwife and Nurse Practitioner) Amendment Determination 2019 (Cth)

Case

Health Insurance (Section 3C – Midwife and Nurse Practitioner) Amendment Determination 2019

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I, ELIZABETH DOWD, delegate of the Minister for Health, make the following determination. 

Dated        5 April 2019

Elizabeth Dowd

Assistant Secretary

MBS Policy and Specialist Services Branch

Medical Benefits Division

Health Financing Group

Department of Health

Contents

1.           Name

2.           Commencement

3.           Authority

4.           Schedules

Schedule 1 – Amendments

Health Insurance (Midwife and Nurse Practitioner) Determination 2015

  1. Name

This Determination is the Health Insurance (Section 3C – Midwife and Nurse Practitioner) Amendment Determination 2019.

  1. Commencement

(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 1 July 2019

Note:          This table relates only to the provisions of this instrument as originally made.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.

(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.

  1. Authority     

This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.

  1. Schedules

Each instrument that is specified in a Schedule to this Determination is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Determination has effect according to its terms.

Schedule 1 – Amendments

Health Insurance (Midwife and Nurse Practitioner) Determination 2015

  1. Schedule 1 (below the heading)

Repeal Parts 1 and 2, substitute:

Part 1           Midwifery services and fees

Group M13 – Midwifery services
Subgroup 1 – MBS items for participating midwives
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 6 of the Health Insurance Regulations 2018

Payable only once for any pregnancy

 54.25
82105 Short antenatal professional attendance by a participating midwife, lasting up to 40 minutes 32.80
82110 Long antenatal professional attendance by a participating midwife, lasting at least 40 minutes 54.25
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

 324.10

        (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 by a participating midwife, 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, unless paragraph 8(3)(c) of this Determination applies (H)

 765.35
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)

 765.35  
82130 Short postnatal professional attendance by a participating midwife, lasting up to 40 minutes, within 6 weeks after delivery 54.25
82135 Long postnatal professional attendance by a participating midwife, lasting at least 40 minutes, within 6 weeks after delivery 79.75
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

 54.25  

Part 2           Telehealth midwifery services and fees

Group M13 – Midwifery services
Subgroup 2 – Telehealth attendances
Item Service Fee ($)
82150

A professional attendance lasting less than 20 minutes (whether or not continuous) by a participating midwife that requires the provision of clinical support to a patient who:

    a)  is participating in a video consultation with a specialist practising in his or her speciality of obstetrics or a specialist or consultant physician practising in his or her speciality of paediatrics; and

    b)  is not an admitted patient; and

    c)  is located:

         (i)   both:

(A)   within a telehealth eligible area; and

(B)   at the time of the attendance—at least 15 kms by road from the specialist or consultant physician mentioned in paragraph (a); or

        (ii)   in Australia if the patient is a patient of:

(A)   an Aboriginal Medical Service; or

(B)   an Aboriginal Community Controlled Health Service for which a direction made under subsection 19(2) of the Act applies.

28.75
82151

A professional attendance lasting at least 20 minutes (whether or not continuous) by a participating midwife that requires the provision of clinical support to a patient who:

    a)  is participating in a video consultation with a specialist practising in his or her speciality of obstetrics or a specialist or consultant physician practising in his or her speciality of paediatrics; and

    b)  is not an admitted patient; and

    c)  is located:

         (i)   both:

(A)   within a telehealth eligible area; and

(B)   at the time of the attendance—at least 15 kms by road from the specialist or consultant physician mentioned in paragraph (a); or

        (ii)   in Australia if the patient is a patient of:

(A)   an Aboriginal Medical Service; or

(B)   an Aboriginal Community Controlled Health Service for which a direction made under subsection 19(2) of the Act applies.

 54.55
82152

A professional attendance lasting at least 40 minutes (whether or not continuous) by a participating midwife that requires the provision of clinical support to a patient who:

    a)  is participating in a video consultation with a specialist practising in his or her speciality of obstetrics or a specialist or consultant physician practising in his or her speciality of paediatrics; and

    b)  is not an admitted patient; and

    c)  is located:

         (i)   both:

(A)   within a telehealth eligible area; and

(B)   at the time of the attendance—at least 15 kms by road from the specialist or consultant physician mentioned in paragraph (a); or

        (ii)   in Australia if the patient is a patient of:

(A)   an Aboriginal Medical Service; or

(B)   an Aboriginal Community Controlled Health Service for which a direction made under subsection 19(2) of the Act applies.

80.20

  1. Schedule 2 (below the heading)

Repeal Parts 1, 2 and 3, substitute:

Part 1           Nurse practitioner pathology services and fees

Group P9 – Simple basic pathology tests
Item Service Fee ($)
73828 Semen examination for presence of spermatozoa by a participating nurse practitioner 6.90
73829 Leucocyte count, erythrocyte sedimentation rate, examination of blood film (including differential leucocyte count), haemoglobin, haematocrit or erythrocyte count by a participating nurse practitioner  ‑ 1 test 4.55
73830 2 tests described in item 73829 by a participating nurse practitioner 6.35
73831 3 or more tests described in item 73829 by a participating nurse practitioner 8.15
73832 Microscopy of urine, whether stained or not, or catalase test by a participating nurse practitioner 4.55
73833 Pregnancy test by 1 or more immunochemical methods by a participating nurse practitioner 10.15
73834 Microscopy for wet film other than urine, including any relevant stain by a participating nurse practitioner 6.90
73835 Microscopy of Gram‑stained film, including (if performed) a service described in item 73832 or 73834 by a participating nurse practitioner 8.65
73836 Chemical tests for occult blood in faeces by reagent stick, strip, tablet or similar method by a participating nurse practitioner 2.35
73837 Microscopy for fungi in skin, hair or nails by a participating nurse practitioner  – 1 or more sites 6.90

Part 2           Nurse practitioner services and fees

Group M14 – Nurse practitioners
Subgroup 1 – Nurse practitioners
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 9.75
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

 21.30
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

 40.40
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

 59.50

Part 3           Telehealth nurse practitioner services and fees

Group M14 – Nurse practitioners
Subgroup 2 – Telehealth attendance
Item Service Fee ($)
82220

A professional attendance lasting less than 20 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who:

    a)  is participating in a video consultation with a specialist or consultant physician; and

    b)  is not an admitted patient; and

    c)  is located:

         (i)   both:

(A)   within a telehealth eligible area; and

(B)   at the time of the attendance—at least 15 kms by road from the specialist or consultant physician mentioned in paragraph (a); or

        (ii)   in Australia if the patient is a patient of:

(A)   an Aboriginal Medical Service; or

(B)   an Aboriginal Community Controlled Health Service for which a direction made under subsection 19(2) of the Act applies.

 28.75
82221

A professional attendance lasting at least 20 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who:

    a)  is participating in a video consultation with a specialist or consultant physician; and

    b)  is not an admitted patient; and

    c)  is located:

         (i)   both:

(A)   within a telehealth eligible area; and

(B)   at the time of the attendance—at least 15 kms by road from the specialist or consultant physician mentioned in paragraph (a); or

        (ii)   in Australia if the patient is a patient of:

(A)   an Aboriginal Medical Service; or

(B)   an Aboriginal Community Controlled Health Service for which a direction made under subsection 19(2) of the Act applies.

 54.55
82222

A professional attendance lasting at least 40 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who:

    a)  is participating in a video consultation with a specialist or consultant physician; and

    b)  is not an admitted patient; and

    c)  is located:

         (i)   both:

(A)   within a telehealth eligible area; and

(B)   at the time of the attendance—at least 15 kms by road from the specialist or consultant physician mentioned in paragraph (a); or

        (ii)   in Australia if the patient is a patient of:

(A)   an Aboriginal Medical Service; or

(B)   an Aboriginal Community Controlled Health Service for which a direction made under subsection 19(2) of the Act applies.

80.20
Subgroup 3 – Telehealth attendance at a residential aged care facility
82223

A professional attendance lasting less than 20 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who:

    a)  is participating in a video consultation with a specialist or consultant physician; and

    b)  either:

         (i)   is a care recipient receiving care in a residential care service; or

        (ii)   is at consulting rooms situated within such a complex if the patient is a care recipient receiving care in a residential aged care service; and

    c)  the professional attendance is not provided at a self-contained unit.

28.75
82224

A professional attendance lasting at least 20 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who:

    a)  is participating in a video consultation with a specialist or consultant physician; and

    b)  either:

         (i)   is a care recipient receiving care in a residential care service; or

        (ii)   is at consulting rooms situated within such a complex if the patient is a care recipient receiving care in a residential aged care service; and

    c)  the professional attendance is not provided at a self-contained unit.

 54.55
82225

A professional attendance lasting at least 40 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who:

    a)  is participating in a video consultation with a specialist or consultant physician; and

    b)  either:

         (i)   is a care recipient receiving care in a residential care service; or

        (ii)   is at consulting rooms situated within such a complex if the patient is a care recipient receiving care in a residential aged care service; and

    c)  the professional attendance is not provided at a self-contained unit.

 80.20
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