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 2007 (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 general medical services table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. This Table is set out in the Health Insurance (General Medical Services Table) Regulations.
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 16 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 2006. It adds new items to the Medicare Benefits Schedule, which will allow a rebate to be paid for allied health group services provided by eligible diabetes educators, exercise physiologists and dietitians on referral from a GP. The Determination also makes some minor amendments to clarify existing arrangements for allied health services already payable under Medicare.
Details of this Determination are set out in the Attachment.
The Determination commences on 1 May 2007.
Consultation
The Department of Health and Ageing consulted with the relevant allied health peak bodies (the Dietitians Association of Australia, the Australian Diabetes Educators Association, and the Australian Association for Exercise and Sports Science) and representatives from the Australian General Practice Network, the Australian Medical Association, the Royal Australian College of General Practitioners, and the Rural Doctors Association of Australia.
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (ALLIED HEALTH AND DENTAL SERVICES) AMENDMENT DETERMINATION 2007 (No. 1)
Preliminary
Section 1 provides for the Determination to be referred to as the Health Insurance (Allied Health and Dental Services) Amendment Determination 2007 (No. 1).
Section 2 provides for the Determination to commence on 1 May 2007.
Section 3 indicates that Schedule 1 of this Determination amends the Health Insurance (Allied Health and Dental Services) Determination 2006.
Schedule 1 – Amendments
Item 1 adds a definition of “course of treatment” for the psychological therapy and focussed psychological strategies items.
Item 2 changes a full stop to a semi colon.
Item 3 adds “narrative therapy for Aboriginal and Torres Strait Islander people” to the list of evidence based psychological therapies included under focussed psychological strategies.
Items 4 and 5 add definitions of a “GP management plan” and “multidisciplinary care plan” for the allied health group items created under Part 4 of this Determination.
Items 6 and 7 clarify the item numbers applicable for referrals by consultant physicians specialising in paediatrics and psychiatry under the allied mental health items.
Items 8 and 9 amends the name of the professional college credentialing mental health nurses following a name change for the organisation.
Item 10 clarifies the wording used to describe patient eligibility for the allied health services under items 10950 to 10970.
Item 11 clarifies the requirements for the medical practitioner to review the need for a further course of treatment under the items listed.
Item 12 sets out the service requirements and schedule fees for new allied health group services for patients with type 2 diabetes (items 81100 to 81125).
Item 13 clarifies the wording used to describe patient eligibility for dental care services under items 10975 to 10977.
Item 14 clarifies that a specialist or consultant physician may refer patients to a clinical psychologist under the items listed.
Item 15 deletes now redundant references to “day-hospital facility” in the allied health and dental items listed.
Overview
The Health Insurance (Allied Health and Dental Services) Amendment Determination 2007 (No. 1) was enacted to address the gap in the existing Medicare Benefits Schedule by incorporating new allied health services and making minor adjustments to the existing provisions under the Health Insurance Act 1973. This Amendment Determination was introduced by the Minister for Health and Ageing and is aimed at enhancing the coverage of essential health services by allowing rebates for allied health group services provided by eligible diabetes educators, exercise physiologists, and dietitians. The policy objective behind this amendment is to improve patient access to critical health services and ensure that the Medicare Benefits Schedule remains comprehensive and responsive to the evolving healthcare needs of the Australian population.
The determination was developed following consultations with various allied health peak bodies and healthcare professional associations to ensure that the amendments reflect the current best practices and requirements in allied health and dental services. By incorporating these new services into the Medicare Benefits Schedule, the Amendment Determination seeks to streamline the process for patients to receive rebates for essential allied health and dental services, thereby promoting better health outcomes and reducing the financial burden on patients. This amendment commenced on 1 May 2007, marking a significant step towards enhancing the accessibility and effectiveness of allied health services within the Australian healthcare system.
Scope and Application
The Health Insurance (Allied Health and Dental Services) Amendment Determination 2007 (No. 1) amends the Health Insurance (Allied Health and Dental Services) Determination 2006, thereby extending its application to include new services and clarifying existing arrangements for allied health services under Medicare. The Amendment Determination applies to eligible diabetes educators, exercise physiologists, dietitians, and dental professionals who provide services on referral from a general practitioner (GP). These services are now subject to the provisions of the Health Insurance Act 1973 and the Health Insurance (General Medical Services Table) Regulations, enabling rebates to be paid for specified allied health group services and certain dental services. The Amendment Determination operates on a national level, affecting health professionals and patients across Australia. It is important to note that this Determination does not include any stated exclusions or thresholds; however, the specific eligibility criteria and conditions for rebates are outlined within the Amendment Determination and the related Medicare Benefits Schedule. The Amendment Determination commences on 1 May 2007, and its provisions are subject to the legislative instruments outlined in the Health Insurance Act 1973 and the Legislative Instruments Act 2003.
Key Provisions
The Health Insurance (Allied Health and Dental Services) Amendment Determination 2007 (No. 1) introduces amendments to the Health Insurance (Allied Health and Dental Services) Determination 2006, effective from 1 May 2007 as per Section 2. These amendments, detailed in Schedule 1, include several updates to definitions and item numbers. For instance, Section 1 of Schedule 1 adds a definition for "course of treatment" in the context of psychological therapy and focused psychological strategies items. It also includes minor punctuation changes, such as replacing a full stop with a semicolon in Section 2, and adding "narrative therapy for Aboriginal and Torres Strait Islander people" to the list of evidence-based psychological therapies under focused psychological strategies in Section 3.
In terms of obligations, the Determination imposes specific requirements on providers and patients for allied health and dental services. For example, Section 4 introduces definitions for "GP management plan" and "multidisciplinary care plan" relevant to the new allied health group items. It also refines the eligibility criteria for patients under certain items, such as those listed in Sections 10 and 13, which detail the conditions under which patients can receive rebates for allied health services and dental care. Furthermore, Section 11 outlines the requirements for medical practitioners to review the need for further courses of treatment.
Failure to comply with the provisions of this Determination may result in civil or administrative penalties. For instance, incorrect billing or misrepresentation of services could lead to financial penalties or the requirement to refund overpaid rebates. Although the Determination does not specify criminal penalties, breaches of health insurance regulations generally can attract fines and, in severe cases, criminal charges under other related legislation. The specific penalties would be determined based on the nature and severity of the breach, in accordance with the overarching Health Insurance Act 1973.