Explanatory Statement
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Allied Health Services) Amendment Determination 2008 (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 circumstance 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 2007.
A determination made under subsection 3C(1) of the Act is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Subsection 3C(8) of the Act provides that the health services that may be subject to a determination made under subsection 3C(1) of the Act 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.
This Determination amends the Health Insurance (Allied Health Services) Determination 2007.
This Determination makes the following changes to the Health Insurance (Allied Health Services) Determination 2007:
- identifies that Medicare benefits can be paid , from 1 July 2008, for new allied health services for children with autism or any other pervasive developmental disorder; and
- makes minor amendments to clarify the operation of some of the allied health items that have been in existence prior to 1 July 2008.
Details of this Determination are set out in the Attachment.
This Determination commences on 1 July 2008.
Consultation
The Department of Health and Ageing (DoHA) consulted with the relevant professional groups (Australian Psychological Society, Speech Pathology Australia, and Occupational Therapy Australia) representing allied health professionals who will be eligible to provide the new pervasive developmental disorder (PDD) items.
DoHA also consulted with the relevant professional groups (Royal Australian and New Zealand College of Psychiatrists, and the Royal Australian College of Physicians) representing consultant physician psychiatrists and paediatricians who will refer children to the new allied health PDD services.
The Australian Medical Association was included in consultations, given that GPs will be the first point of contact in referring appropriate patients to psychiatrists and paediatricians.
In addition, DoHA interacted regularly with Medicare Australia to ensure that the technical aspects of the PDD allied health services were correctly developed and that the Medicare system is capable of administering the new services from 1 July 2008.
DoHA has also advised the Australian Psychological Society of the minor change to the credentialing requirements in place for clinical psychologists under the allied mental health items.
Outside of these external consultations, it should also be noted that key issues associated with the new PDD allied health services were discussed with appropriate internal areas within DoHA (most specifically the Medicare Eligibility section and the Private Health Insurance area). Additionally, all proposed amendments to the Determination were negotiated through the DoHA Legal Services Branch.
Attachment
Details of the health insurance (allied health services) AMENDMENT determination 2008 (NO. 1)
This Explanatory Statement sets out the amendments to the Health Insurance (Allied Health Services) Determination 2007.
Preliminary
Section 1 provides for the Determination to be referred to as the Health Insurance (Allied Health Services) Amendment Determination 2008 (No. 1).
Section 2 provides for the Determination to commence on 1 July 2008.
Section 3 amends the previous Health Insurance (Allied Health Services) Determination 2007.
Section 5 defines specific terms used in this Determination. The following minor amendments have been made to definitions of some terms.
The definition of ‘course of treatment’ has been revised to allow for the different interpretation of the term that will apply to the new allied health pervasive developmental disorder (PDD) Medicare services. Under the previous Determination, the term only applied to allied mental health Medicare services.
A definition of ‘PDD treatment and management plan’ has been added to make clear what this new Medicare service is, as allied health professionals will only be able to provide PDD treatment services to children who have previously claimed a PDD treatment and management plan item..
Section 6 confirms that the Medicare items set out in Schedule 2 of the Determination are to be treated for the purposes of the relevant acts and regulations as if they were both professional services and medical services, and as if they were items in the general medical services table.
Section 6 has been reworded slightly so as to more accurately convey the interpretation of what an allied health service entails in relation to the Determination.
Section 9 sets out the referral arrangements that apply to mental health Medicare items in Part 2 of Schedule 2. The heading for this section has been altered to make clear that the section only applies to these specific items.
A minor change has also been made to wording within section 9 to make the content of the section clearer and more accurate. An additional change was also made to clarify that referrals to allied mental health Medicare items can now be made from additional consultant paediatrician Medicare services.
Section 10 has been added to the Determination to set out the referral processes that will be in place for the allied health PDD Medicare services.
Section 11 has been added to the Determination to make clear that Medicare items for services provided by allied health professionals will only be claimable under Medicare where a private health insurance benefit has not been claimed for the same service. Section 11 applies to all allied health Medicare services contained in Schedule 2 of the Determination.
Schedule 1
This Schedule sets out the qualification requirements for allied health professionals providing services under the Medicare items in Schedule 2.
Paragraph 14 has been amended to identify the Australian Psychological Society as the appropriate organisation for:
assessing clinical psychologist eligibility to provide psychological therapy services; and
ensuring that clinical psychologist’s maintain their eligibility over time.
Schedule 2
This Schedule sets out the relevant Medicare items (including the item numbers, service descriptors and fees) for services provided by eligible allied health professionals.
− Part 1 applies to individual allied health services (items 10950 to 10970).
− Part 2 applies to psychological therapy and focussed psychological strategies services (items 80000 to 80170).
− Part 3 applies to pregnancy support counselling services (items 81000 to 81010).
− Part 4 applies to group allied health services for patients with type 2 diabetes (items 81100 to 81125).
− Part 5 applies to allied health services for children with autism or any other PDD (items 82000 to 82025).
Fees for all items in Parts 1, 2, 3 4 & 5 of Schedule 2 have been indexed from 1 November 2007.
A number of alterations have been made to Schedule 2, Part 1 of the Determination, including:
Removal of the private health insurance clause from all item descriptors, as this clause is now covered under the new section 11 of the Determination.
Reworking of the descriptors for all items to ensure that they read correctly following removal of the private health insurance clause.
Addition of wording to make clear that all of these items are now subject to the private health insurance rider outlined in section 11 of the Determination.
Alterations have also been made to Schedule 2, Part 2 of the Determination, including:
Addition of a new clause into the descriptors of all items to clarify that these services must be provided to the patient ‘in person’.
Addition of wording to make clear that all of these items are now subject to the private health insurance rider outlined in section 11 of the Determination.
Further alterations have been made to Schedule 2, Part 3 of the Determination, including:
Addition of a new clause into the descriptors of all items to clarify that these services must be provided to the patient ‘in person’.
Addition of wording to make clear that all of these items are now subject to the private health insurance rider outlined in section 11 of the Determination.
Final alterations were also made to Schedule 2, Part 4 of the Determination, involving:
Addition of a new clause into the descriptors of all items to clarify that these services must be provided to the patient ‘in person’.
Reworking of the descriptors for all items to ensure that they read correctly following removal of the private health insurance clause.
Addition of wording to make clear that all of these items are now subject to the private health insurance rider outlined in section 11 of the Determination.
Schedule 2, Part 5 of the Determination provides new content which clarifies that Medicare benefits can be paid, from 1 July 2008, for new allied health services for children with autism or any other pervasive developmental disorder. Full descriptions of these items, including: guidance on how they are intended to operate; patient and provider eligibility; and the Medicare fees attached to each item have been outlined here.