EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Allied Health and Dental Services)
Amendment Determination 2005 (No 1)
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by writing, determine that a health service not listed in the Medicare Benefits Schedule shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed.
A determination made under subsection 3C(1) is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Subsection 3C(8) provides that the health services that may be subject to a determination made under subsection 3C(1) include dental services and any other prescribed service that relates to health. Regulation 3A of the Health Insurance Regulations 1975 prescribes 12 classes of allied health services as “health services” for the purposes of section 3C of the Act.
The purpose of this Determination is to amend the Health Insurance (Allied Health and Dental Services) Determination 2005. The changes streamline administrative arrangements for the allied health and dental care initiative, introduced on 1 July 2004 under the Australian Government’s Strengthening Medicare package. The changes also reflect the introduction of the new chronic disease management items, and subsequent removal of care planning items from the General Medical Services Table after 31 October 2005.
Details of this Determination are set out in the Attachment.
This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Determination commences on 1 November 2005.
Consultation
The Department of Health and Ageing consulted with the allied health and dental care initiative’s consultative group about these changes and gained its agreement. The group includes representatives from the Australian Divisions of General Practice, the Australian Medical Association, the Royal Australian College of General Practitioners, the Rural Doctors Association, all national peak bodies representing eligible allied health professional groups, the Australian Dental Association and Medicare Australia.
DETAILS OF THE HEALTH INSURANCE (ALLIED HEALTH AND DENTAL SERVICES) AMENDMENT DETERMINATION 2005 (No 1)
Preliminary
Section 1 provides for the Determination to be referred to as the Health Insurance (Allied Health and Dental Services) Amendment Determination 2005 (No 1).
Section 2 provides for the Determination to commence on 1 November 2005.
Section 3 indicates that Schedule 1 amends the Health Insurance (Allied Health and Dental Services) Determination 2005.
Schedule 1 – Amendments
Item 1 amends the definition of enhanced primary care multidisciplinary care plan to reflect the removal of Medicare Benefits Schedule (MBS) items 720, 722 and 730 from the General Medical Services Table after 31 October 2005. These items have been superseded by chronic disease management MBS items 721, 723 and 731.
Item 2 provides a definition of repealed general medical services table to support the definition of enhanced primary care multidisciplinary care plan at Item 1.
Items 3 to 14 amend the reporting requirements for allied health professionals as set out in paragraph (g) of each allied health item in Schedule 1, Part 2 of the Health Insurance (Allied Health and Dental Services) Determination 2005. The amendment removes the need for an eligible allied health professional to report back to the referring medical practitioner after every service where they provide multiple services to a patient under the one referral. In these cases, the eligible allied health professional is required to report back to the referring medical practitioner after the first and last service only, and to provide additional reports if there are matters that the referring medical practitioner would reasonably expect to be informed of.
Items 15 to 18 amend the requirement that the medical practitioner uses a referral form issued by the Commission as set out in paragraph (c) of each allied health item in Schedule 1, Part 2 and paragraph (d) of each dental item set out in Schedule 2, Part 2 of the Health Insurance (Allied Health and Dental Services) Determination 2005. The amendment requires the medical practitioner to use a referral form issued by the Department (of Health and Ageing), or that substantially complies with the form issued by the Department. As the Department has removed the requirement that copies of referral forms for allied health and dental care services form accompany Medicare claims, they will no longer be issued by the Commission (now Medicare Australia).
Overview
The Health Insurance (Allied Health and Dental Services) Amendment Determination 2005 (No 1) was enacted to streamline the administrative arrangements for the allied health and dental care initiative, introduced on 1 July 2004 under the Australian Government’s Strengthening Medicare package. This Determination, made under subsection 3C(1) of the Health Insurance Act 1973, amends the Health Insurance (Allied Health and Dental Services) Determination 2005 to reflect changes such as the introduction of new chronic disease management items and the removal of certain care planning items from the General Medical Services Table after 31 October 2005. The policy objective of this amendment is to enhance the efficiency of the allied health and dental care initiative while ensuring that the services provided are appropriately managed within the Medicare framework. The Department of Health and Ageing consulted extensively with relevant stakeholders, including representatives from general practice, medical associations, allied health professional groups, and the Australian Dental Association, to gain agreement on these changes.
Scope and Application
The Health Insurance (Allied Health and Dental Services) Amendment Determination 2005 (No 1) applies to the administration and provision of allied health and dental services in Australia, and is a legislative instrument under the Legislative Instruments Act 2003. The Determination amends the Health Insurance (Allied Health and Dental Services) Determination 2005 to reflect changes in the Medicare Benefits Schedule and the removal of certain items from the General Medical Services Table, effective from 31 October 2005. It applies to allied health professionals and medical practitioners involved in providing and referring for these services. This Determination is a Commonwealth instrument, extending its application across the entire country. The amendment streamlines administrative processes for allied health and dental care services, particularly in light of the introduction of chronic disease management items and the removal of certain care planning items from the General Medical Services Table. The Determination is effective from 1 November 2005 and consultation has been conducted with relevant stakeholders, including representatives from allied health professional groups, medical associations, and Medicare Australia.
Key Provisions
The main operative sections of the Health Insurance (Allied Health and Dental Services) Amendment Determination 2005 (No 1) (the Determination) focus on amending the Health Insurance (Allied Health and Dental Services) Determination 2005. Specifically, Section 3 of the Determination indicates that Schedule 1 amends the earlier determination, which initially facilitated the allied health and dental care initiative introduced under the Australian Government's Strengthening Medicare package on 1 July 2004. The amendments reflect the removal of certain care planning items from the General Medical Services Table and the introduction of new chronic disease management items, effective from 31 October 2005. These changes aim to streamline administrative arrangements and ensure that the services provided align with the updated Medicare Benefits Schedule (MBS) items.
The Determination imposes several obligations on parties involved in allied health and dental services under the Health Insurance Act 1973. Firstly, eligible allied health professionals must now report back to the referring medical practitioner only after the first and last service provided to a patient under one referral, unless there are additional matters that the practitioner would reasonably expect to be informed of. Secondly, medical practitioners must use a referral form issued by the Department of Health and Ageing or one that substantially complies with the Department's form when referring patients for allied health or dental services. This change also eliminates the requirement for copies of referral forms to accompany Medicare claims, as these forms will no longer be issued by Medicare Australia (formerly the Commission).
The Determination does not explicitly outline specific offences, penalties, or consequences for non-compliance. However, it is important to note that the Health Insurance Act 1973 and related regulations impose various penalties for breaches of the Act's provisions. These may include fines, imprisonment, or both, depending on the severity of the breach. Additionally, non-compliance with the Determination's requirements could potentially lead to the denial of Medicare rebates for services provided, impacting the financial viability of the healthcare providers involved. Therefore, it is crucial for all parties to adhere to the Determination's stipulations to avoid any adverse consequences.