Health Insurance (Section 3C General Medical Services – Heart Health Assessment) Determination 2019 (Cth)
Health Insurance (Section 3C General Medical Services – Heart Health Assessment) Determination 2019
__________________________________________________________________
I, ANDREW SIMPSON, delegate of the Minister for Health, make the following determination.
Dated 15 March 2019
Andrew Simpson
Assistant Secretary
MBS Reviews Unit
Medical Benefits Division
Health Financing Group
Department of Health
Contents
1. Name
2. Commencement
3. Authority
4. Definitions
5. Treatment of relevant services
6. Application of item 702
7. Application of item 117
Schedule 1 – relevant services
Name
This Determination is the Health Insurance (Section 3C General Medical Services – Heart Health Assessment) Determination 2019.
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 April 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Note: This table relates only to the provisions of this instrument as originally made.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.
Authority
This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.
Definitions
In this Determination:
Act means the Health Insurance Act 1973.
health screening service has the same meaning as in subsection 19(5) of the Act.
relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.
Schedule means a Schedule to this Determination.
Note: The following terms are defined in subsection 3(1) of the Act:
·clinically relevant service
·general medical services table
·item
·professional service
(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 and as a clinically relevant service, 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.
Application of item 702
(1) Clause 2.17.1 of the general medical services table shall have effect as if item 702 contained in the Schedule was also specified in clause 2.17.1.
(2) Clause 2.17.14 of the general medical services table shall have effect as if item 702 contained in the Schedule was also specified in clause 2.17.14.
(3) For any particular patient, item 702 is not applicable:
(a)more than once in a 12 month period; or
(b)if, prior to a service, the patient has been provided a service mentioned in Group A14 of the general medical services table within the previous 12 months.
Application of item 117
Item 117 applies only to a service provided in the course of a personal attendance by a single medical practitioner on a single patient.
A health assessment mentioned in item 117 must not include a health screening service.
A separate consultation must not be performed in conjunction with a health assessment mentioned in item 117, unless clinically necessary.
Practice nurses, Aboriginal health workers and Aboriginal and Torres Strait Islander health practitioners may assist medical practitioners in performing a health assessment mentioned in item 117, in accordance with accepted medical practice, and under the supervision of the medical practitioner.
For the purposes of subsection 7(4) of this Determination, assistance may include activities associated with:
(a)information collection; and
(b)at the direction of the medical practitioner – provision to patients of information on recommended interventions.
For any particular patient, item 117 is not applicable:
(a)more than once in a 12 month period; or
(b)if, prior to a service, the patient has been provided a service mentioned in Group A7, Subgroup 5 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 within the previous 12 months.
Schedule 1 – relevant services
| Category 1 – Professional Attendances | ||
| Group A14 – Health assessments | ||
| Item | Service | Fee ($) |
| 702 | Professional attendance for a heart health assessment by a general practitioner at consulting rooms lasting at least 20 minutes and including: (a) collection of relevant information, including taking a patient history; and (b) a basic physical examination, which may including recording blood pressure and cholesterol; and (c) initiating interventions and referrals as indicated; and (d) implementing a management plan; and (e) providing the patient with preventative health care advice and information.. | 85.60 |
| Category 1 – Professional Attendances | ||
| Group A7 – Acupuncture and Non-Specialist Practitioner Items | ||
| Subgroup 5 – Non-Specialist Practitioner health assessments | ||
| Item | Service | Fee ($) |
| 117 | Professional attendance for a heart health assessment by a medical practitioner at consulting rooms (other than a specialist or consultant physician) lasting at least 20 minutes and including: (a) collection of relevant information, including taking a patient history; and (b) a basic physical examination, which may including recording blood pressure and cholesterol; and (c) initiating interventions and referrals as indicated; and (d) implementing a management plan; and (e) providing the patient with preventative health care advice and information. | 68.50 |
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