EXPLANATORY STATEMENT

Health Insurance Act 1973

Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 1)

Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may determine in writing that a health service not specified in an item in the General Medical Services Table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so specified.  The Table is set out in the Health Insurance (General Medical Services Table) Regulations (the Regulations), which are re-made each year.

Purpose

The purpose of the Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 1) (the Determination) is to amend the maximum number of psychological therapy and focussed psychological strategies allied health services available to a patient in a calendar year under the Health Insurance (Allied Health Services) Determination 2011 (the Principal Determination).

Background

The ‘Delivering National Mental Health Reform’ package announced in the 2011-12 Budget, together with 2010 Budget and election commitments, provided investment of $2.2 billion over five years in new and expanded mental health services. These changes included the reduction in the number of Medicare rebates available for allied mental health services from 12 (up to 18 in ‘exceptional circumstances’) to 10 for individuals each calendar year under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative and they took effect from 1 November 2011.

On 1 February 2012 the Minister for Mental Health and Ageing, the Hon Mark Butler MP announced that the Government will be reinstating the additional six allied mental health services available under ‘exceptional circumstances’ from 1 March 2012, for a limited period up to 31 December 2012.

The standard number of allied mental health services for which an individual can receive a Medicare rebate will continue to be 10 services per calendar year.  However from 1 March to 31 December 2012 individuals will be able to receive up to an additional six allied mental health services under ‘exceptional circumstances’. This means that eligible individuals can receive up to 16 services where ‘exceptional circumstances’ apply.

The transition arrangements for the Better Access allied mental health services will end on 31 December 2012 which means that from 1 January 2013 the number of individual allied mental health services for which a person can receive a Medicare rebate will be 10 individual services per calendar year.

Individuals will continue to be able to receive Medicare rebates for 10 group therapy services per calendar year, on top of their individual allied mental health services during the 2012 calendar year and beyond.

Although Better Access was neither designed nor intended to provide intensive, ongoing therapy for people with severe and persistent mental illness, the Australian Government acknowledges that there are some people with more complex needs who are using the services provided under the Better Access initiative for care and support.

The Government recognises that some of the new mental health services announced as part of the $2.2 billion over five years Delivering National Mental Health Reform 2011-12 Budget package need time to build further capacity before they are able to provide care and support to people with more complex needs or people with severe and persistent mental illness.

The reintroduction of ‘exceptional circumstances’ up to 31 December 2012 provides time for allied mental health professionals and consumers to adapt to the new arrangements and time for the new mental health services to be able to build capacity to effectively respond to the needs of people with more complex needs.

Details of the Determination are in the Attachment.

Consultation

No consultation took place in the making of this Determination.  However, in making this Determination the Government has taken into consideration the recommendations made by the Senate Community Affairs References Committee and has listened to feedback from consumers, allied mental health professionals, general practitioners and peak professional organisations.

Human rights statement of compatibility

The Determination is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

The Determination commences 1 March 2012.

ATTACHMENT

Details of the Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 1)

Section 1 – Name of Determination

Section 1 provides that the name of the Determination is the Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 1).

Section 2 – Commencement

Section 2 provides that the Determination commences on 1 March 2012.

Section 3 – Amendment of Health Insurance (Allied Health Services) Determination 2011

Section 3 provides that the Schedule to the Determination amends the Health Insurance (Allied Health Services) Determination 2011 (the Principal Determination).

Schedule –Amendments

Item 1

Item 1 amends section 6 of the Principal Determination.  Section 6 of the Principal Determination currently limits the number of Medicare-eligible individual psychological therapy and focussed psychological strategies allied health services that may be provided to a patient in a calendar year to ten.  Item 1 substitutes a new section 6 in the Principal Determination. 

New subsection 6(1) provides that the section applies to psychological therapy and focussed psychological strategies allied health services for individuals (items 80000 – 80015, 80100 – 80115, 80125 – 80140 and 80150 – 80165 in the Principal Determination).

New subsection 6(2) provides that from 1 March 2012 until midnight 31 December 2012, any of the psychological therapy and focussed psychological strategies services for individuals mentioned in subsection 6(1) will only apply to a patient in a calendar year if the service is either:

• one of the first ten ‘relevant services’ provided to the patient in the year; or
• if ‘exceptional circumstances' exist, one of the first sixteen ‘relevant services’ provided to the patient in the year.

New subsection 6(3) provides that from 1 January 2013, any of the individual psychological therapy and focussed psychological strategies services mentioned in subsection 6(1) will only apply to a patient in a calendar year if the service is one of the first ten ‘relevant services’ provided to the patient in the year. 

New subsection 6(4) defines the terms ‘relevant service’ and ‘exceptional circumstances’.  A ‘relevant service’ is a service to which any of items 2721 to 2727 of the Table (focussed psychological strategies services provided by a medical practitioner who practises in general practice), or the individual psychological therapy or focussed psychological strategies items in the Principal Determination, applies.  ‘Exceptional circumstances’ will exist in relation to a patient where:

• the patient has already received at least ten relevant services in a calendar year; and
• the practitioner who referred the patient for psychological therapy or focussed psychological strategies services is satisfied that there has been a significant change in the patient’s condition or care circumstances that necessitates the patient being referred for further relevant services.