Explanatory Statement
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Allied Health Services) Amendment Determination 2010
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 2009.
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 2009 (No. 2).
The amendments:
- omit references to two Chronic Disease Management (CDM) items for the review of CDM care plans (items 725 and 727) and substitute with references to a new item number (732) that replaces them from 1 May 2010.
- make minor changes to Aboriginal and Torres Strait Islander language in order to make it make it more precise and in keeping with cultural sensitivity requirements.
This Determination commences on 1 May 2010.
Consultation
The replacement of two CDM review items with one MBS item is an outcome of the MBS Review of Primary Care Items which was conducted in 2008-09 and involved consultation with numerous external stakeholders, including GP organisations, allied health providers, nurses and consumers. Internal stakeholders within the Department of Health and Ageing (DoHA) and other Australian Government stakeholders were also consulted as part of the review. The need to make slight change to Indigenous language emerged from consultation within DoHA.
Attachment
Details of the health insurance (allied health services) AMENDMENT determination 2010
This Explanatory Statement sets out the amendments to the Health Insurance (Allied Health Services) Determination 2009 (No. 2).
Preliminary
Section 1 provides for the Determination to be referred to as the Health Insurance (Allied Health Services) Amendment Determination 2010.
Section 2 provides for the Determination to commence on 1 May 2010.
Section 3 amends the Health Insurance (Allied Health Services) Determination 2009 (No. 2).
Section 4 defines specific terms used in this Determination. The following minor amendments have been made.
The definition of GP Management Plan has been amended to replace the reference to item 725 with a reference to item 732.
The definition of ‘Team Care Arrangements’ Plan has been amended to replace the reference to item 727 with a reference to item 732.
Schedule 1 - Qualification requirements for allied health professionals
Minor changes have been made to the Indigenous language used for the Aboriginal and Torres Strait Islander health services and for the mental health service.
Schedule 2 – Allied health services
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).
Changes have been made to the Indigenous language used for items 10950, 81300, 81305, 81310, 81315, 81320, 81325, 81330, 81335, 81340, 81345, 81350, 81355, 81360.
Overview
The Health Insurance (Allied Health Services) Amendment Determination 2010 was enacted to address gaps and ensure precision in the Medicare Benefits Schedule (MBS) for allied health services, particularly in relation to Chronic Disease Management (CDM) and Indigenous language sensitivity. This Amendment Determination to the Health Insurance Act 1973 was issued under the authority of the Minister for Health and Ageing and commenced on 1 May 2010. The primary policy objective of this Amendment Determination is to streamline the MBS for allied health services by replacing two CDM review items with a new item, thereby improving the efficiency and clarity of the MBS. Additionally, the Amendment Determination makes minor changes to Aboriginal and Torres Strait Islander language to align with cultural sensitivity requirements. This was achieved through extensive consultation with external stakeholders, including GP organisations, allied health providers, nurses, and consumers, as well as internal stakeholders within the Department of Health and Ageing and other Australian Government stakeholders.
Scope and Application
The Health Insurance (Allied Health Services) Amendment Determination 2010 amends the Health Insurance (Allied Health Services) Determination 2009 (No. 2) and applies to health services that are not listed in the general medical services table but are deemed to be listed under specified circumstances and statutory provisions as per subsection 3C(1) of the Health Insurance Act 1973. This includes allied health services prescribed under Regulation 3A of the Health Insurance Regulations 1975, such as services provided by eligible allied health professionals for chronic disease management, mental health support, and specialised services for children with autism or other pervasive developmental disorders. The Determination applies nationally across Australia and is effective from 1 May 2010. It makes precise amendments to the item numbers for certain Chronic Disease Management care plan reviews and makes minor changes to the language used for Aboriginal and Torres Strait Islander health services to enhance cultural sensitivity. The amendments reflect outcomes from consultations with external and internal stakeholders, including general practitioners, allied health providers, nurses, and consumers, as part of the Medicare Benefits Schedule Review of Primary Care Items conducted in 2008-09.
Key Provisions
The Health Insurance (Allied Health Services) Amendment Determination 2010 (No. 2) (the Determination) amends the Health Insurance (Allied Health Services) Determination 2009 (No. 2) and commences on 1 May 2010 (s. 2). This Determination primarily makes adjustments to the Chronic Disease Management (CDM) care plans and modifies the Indigenous language used for Aboriginal and Torres Strait Islander health services and for mental health services. The changes are detailed in Section 3 and are aimed at ensuring more precise language and cultural sensitivity in the provision of health services.
The Determination requires that the references to two CDM items for the review of CDM care plans (items 725 and 727) be omitted and replaced with a new item number (732) effective from 1 May 2010 (s. 3). Additionally, it mandates minor changes to Aboriginal and Torres Strait Islander language to enhance cultural sensitivity and precision in the provision of health services (s. 3). These adjustments apply to various items listed in Schedule 2, including items 10950, 81300 to 81360, among others.
Parties governed by this Determination, including allied health professionals, health service providers, and patients, must adhere to the updated item numbers and language as stipulated in the Determination. Health service providers must ensure that they are using the correct item numbers when billing for services, and allied health professionals need to be aware of the changes in terminology to ensure accurate communication and service provision. Patients should be informed about these changes to avoid any confusion regarding their health care plans and services.
Failure to comply with the requirements of the Determination may result in improper billing and potential disputes with health insurers. While the Determination does not explicitly state specific penalties for non-compliance, breaches of related provisions under the Health Insurance Act 1973 can lead to substantial fines and legal consequences. For example, under the Act, penalties for fraudulent claims can include fines of up to $22,200 for individuals and $111,000 for corporations, as well as potential imprisonment terms (s. 120D). Therefore, it is crucial for all parties to adhere to the updated provisions to avoid any legal ramifications.