Untitled document

Health Insurance (Health Care Homes) Determination 2017

Health Insurance Act 1973

I, Michael Ryan, delegate of the Minister for Health, make this Determination under subsection 3C (1) of the Health Insurance Act 1973.

Dated 29 September 2017

MICHAEL RYAN

ACTING ASSISTANT SECRETARY

MBS POLICY AND SPECIALIST SERVICES BRANCH

MEDICAL BENEFITS DIVISION

DEPARTMENT OF HEALTH

Contents

1.  Name

2.  Commencement

3.  Authority

4.  Definitions

5.    Treatment of relevant services

6.    Limitiation on item 6087

7.    Effect of bulk-billing

8.    Application of provisions of the general medical services table

Schedule 1 – relevant services

1. Name

This Determination is the Health Insurance (Health Care Homes) Determination 2017.

1. Commencement

This Determination is taken to:

(a)     have commenced on 1 October 2017; and

(b)     is repealed at the end of 30 November 2019.

1. Authority  

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

4.         Definitions 

1. In this Determination:

Act means the Health Insurance Act 1973.

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.

Health Care Homes trial site means a medical practice:

(a)    in respect of which a grant was made by the Commonwealth under the Health Care Homes Grant Program; and

(b)     that is participating in the Health Care Homes Program.

Health Care Homes Program means the program of that name administered by the Department of Health. 

Schedule means a Schedule to this Determination.

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

·clinically relevant service

·item

·general medical services table

·medical practitioner

·participating nurse practitioner

·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.

5.         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.

6.         Limitiation on item 6087

For item 6087:

(a)        the service must be provided to the patient for the purposes of the Health Care Homes Program; and

(b)        the service may be provided to the patient individually or as part of a group.

7.         Effect of bulk-billing

Item 6087 does not apply to a relevant service if:

(a) the person to whom medicare benefit is or would, but for this section, be payable, enters into an agreement for the purposes of section 20A of the Act to assign his or her right to the payment of the benefit to the medical practitioner or participating nurse practitioner by whom, or on whose behalf, the service is provided; and

(b)        the medical practitioner or participating nurse practitioner accepts the assignment in full payment of his or her fee for the service provided.

8.         Application of provisions of the general medical services table

Clauses 1.2.7 and 1.2.7A of the general medical service table have effect as if item 6087 were also specified in those provisions.

Schedule 1 – relevant services

Group A34 – Health Care Homes
Item	Service	Fee ($)
6087	Attendance, including by telephone or videoconference, on a patient participating in the Health Care Homes Program by or on behalf of a medical practitioner (including a general practitioner but not including a specialist or consultant physician) or participating nurse practitioner employed or otherwise engaged by the Health Care Home trial site at which the patient is enrolled - each patient.	1.15