EXPLANATORY STATEMENT

Health Insurance Act 1973

Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 2)

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 this Determination is to amend eligibility requirements for occupational therapy, mental health, focussed psychological strategies and Aboriginal and Torres Strait Islander health services in the Health Insurance (Allied Health Services) Determination 2011 (the Principal Determination).  These amendments are to recognise the extension of the National Registration and Accreditation Scheme for health professionals (NRAS) to the occupational therapy and Aboriginal and Torres Strait Islander health practice professions from 1 July 2012.

Background

NRAS commenced on 1 July 2010, when the medical, dental, physiotherapy, osteopathy, nursing and midwifery, pharmacy, chiropractic, optometry, podiatry and psychology professions became subject to a nationally consistent regime of registration for health practitioners and accreditation of medical education providers.

From 1 July 2012, four new health professions, including the occupational therapy and Aboriginal and Torres Strait Islander health practice professions, will also be regulated under NRAS.  This will be the first time that these professions have been regulated in some States and Territories.

As a result of the extension of NRAS from 1 July 2012, consequential amendments to the Medicare eligibility criteria for occupational therapists, Aboriginal and Torres Strait Islander health practitioners and Aboriginal health workers, are required. 

Prior to 1 July 2012, qualification requirements in the Principal Determination required occupational therapists (OTs) providing Medicare-eligible mental health and occupational therapy health services in those States and Territories offering registration to hold registration, with OTs in other jurisdictions required to be a full or part-time member of Occupational Therapy Australia (OT Australia).  All OTs providing Medicare-eligible focussed psychological strategies health services were required to be a full or part-time member of OT Australia, with OTs in States and Territories offering registration also required to hold registration.

This Determination amends the qualification requirements set out in the Principal Determination so that from 1 July 2012 all OTs wishing to provide Medicare-eligible mental health, occupational therapy and focussed psychological strategies health services in any State or Territory must be registered. 

In order to provide Medicare-eligible focussed psychological strategies health services, OTs will continue to be required to meet additional mental health credentialing requirements through OT Australia.  These mental health credentialing requirements include having a minimum of two years experience in mental health and having undertaken to observe standards set by Occupational Therapy Australia.  With the introduction of national registration for OTs, membership of OT Australia has been replaced with the requirement to be accredited with OT Australia to provide focussed psychological strategies health services.  These credentialing requirements are being retained because there is no specialist ‘mental health’ registration for occupational therapists under the NRAS and they ensure OTs have appropriate experience and training to deliver focussed psychological strategies health services.

The Principal Determination is also amended to include transitional provisions to ensure that the move to national registration for OTs does not disrupt the provision of Medicare-rebateable services to patients.

This Determination also amends qualification requirements set out in the Principal Determination for the provision of Aboriginal and Torres Strait Islander health services.  From 1 July 2012, persons registered in the Aboriginal and Torres Strait Islander health practice profession will be able to provide Aboriginal and Torres Strait Islander health services in all States and Territories.  Consistent with current policy, holders of Certificate III in Aboriginal and Torres Strait Islander Health issued before 1 July 2012 (or equivalent or higher qualifications), or Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care (or equivalent or higher qualifications), will be able to provide services in all States and Territories other than the Northern Territory and will continue to be known as ‘eligible Aboriginal health workers’.

Details of the Determination are set out in the Attachment.

Consultation

The Department has consulted with the Australian Health Practitioner Regulation Agency (AHPRA), Occupational Therapy Australia, the Aboriginal and Torres Strait Islander Health Practice Board of Australia, the National Aboriginal and Torres Strait Islander Health Worker Association (NATSIHWA), National Aboriginal Community Controlled Health (NACCHO) and the Department of Human Services (DHS) Medicare regarding implementation of NRAS for 1 July 2012, and the amendments to the Determination.

The Determination commences 1 July 2012.

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

ATTACHMENT

Details of the Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 2)

1                     Name of Determination

Section 1 provides that the name of the Determination is the Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 2).

2                     Commencement

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

3                     Amendment of the 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 1 Amendments

Item 1 Subsection 4(1), Interpretation, after definition of disability treatment and management plan

Prior to 1 July 2012, all Aboriginal and Torres Strait Islander health services under the Principal Determination were provided by ‘eligible Aboriginal health workers’.  This category was comprised of:

• in the Northern Territory, Aboriginal health workers registered under Northern Territory law; and
• in all other States and Territories, where registration was not available, persons awarded a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification). 

From 1 July 2012 NRAS enables national registration in the Aboriginal and Torres Strait Islander health practice profession. 

Item 1 inserts a new definition of an ‘eligible Aboriginal and Torres Strait Islander health practitioner’ to recognise those providers registered under NRAS.  An ‘eligible Aboriginal and Torres Strait Islander health practitioner’ is a person who is an allied health professional (AHP) in relation to the provision of an Aboriginal and Torres Strait Islander health service because he or she meets the qualification requirements in section 1 of item 1 of Schedule 1 to the Principal Determination – namely, that the person is registered in the Aboriginal and Torres Strait Islander health practice profession under the applicable law in force in the State or Territory in which the service is provided.

Item 2 Subsection 4(1), Interpretation, eligible Aboriginal health worker

Item 2 substitutes a new definition of ‘eligible Aboriginal health worker’ in the Principal Determination, being a person who is an AHP in relation to the provision of an Aboriginal and Torres Strait Islander health service because of section 2 of item 1 of Schedule 1 to the Principal Determination, and who is not providing an Aboriginal and Torres Strait Islander health service in the Northern Territory. 

New section 2 of item 1 of Schedule 1 (see item 4) provides that in a State or Territory other than the Northern Territory, a person is also an AHP in relation to the provision of an Aboriginal and Torres Strait Islander health service if a registered training organisation has awarded the person:

• a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) before 1 July 2012; or
• a Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care (or an equivalent or higher qualification). 

Prior to 1 July 2012, holders of Certificate III in Aboriginal and Torres Strait Islander Health (or equivalent or higher qualifications) were able to provide Medicare-eligible Aboriginal and Torres Strait Islander health services in all States and Territories other than the Northern Territory.  The amendments made to the definition of ‘eligible Aboriginal worker’, in conjunction with amendments the Principal Determination made by item 4 of this Determination, will allow these providers to continue to access Medicare for services provided outside the Northern Territory, even where the person is not registered under NRAS.

Item 3 Subsection 4(1), Interpretation, after Psychology Board of Australia

Item 3 inserts a new definition of ‘registered training organisation’ in subsection 4(1) of the Principal Determination, meaning a training provider registered under a law of a State, Territory or the Commonwealth to provide accredited vocational education and training. 

Item 4 Schedule 1, Qualification requirements for allied health professionals, item 1, Aboriginal and Torres Strait Islander health service

Item 4 substitutes new qualification requirements for an AHP in relation to the provision of an Aboriginal and Torres Strait Islander  health service in item 1 of Schedule 1 to the Principal Determination. 

Under new section 1 of item 1, in any State or Territory a person will be an AHP in relation to the provision of an Aboriginal and Torres Strait Islander health service if he or she is registered in the Aboriginal and Torres Strait Islander  health practitice profession under the applicable law in force in the State or Territory in which the service is provided. 

A new Note to item 1 provides that a person registered in the Aboriginal and Torres Strait Islander health practice profession is able to take the titles ‘Aboriginal and Torres Strait Islander health practitioner’, ‘Aboriginal health practitioner’ and ‘Torres Strait Islander health practitioner’. 

Under new section 2 of item 1, in any State or Territory other than the Northern Territory a person is also an AHP in relation to the provision of an Aboriginal and Torres Strait Islander  health service if a registered training organisation has awarded the person:

• a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent of higher qualification) before 1 July 2012; or
• a Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care (or an equivalent or higher qualification).

New section 2 of item 1 maintains current rules enabling a person holding a relevant Certificate III qualification to be recognised as an AHP in relation to the provision of Aboriginal and Torres Strait Islander health services in all jurisdictions other than the Northern Territory.  It also updates eligibility requirements to reflect the phasing out of the Certificate III in Aboriginal and Torres Strait Islander Health qualification and the current national Health Training Package (HLT07) qualification of Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care. 

Item 5 Schedule 1, Qualification requirements for allied health professionals, item 7, Focussed psychological strategies health service, paragraph (c)

Item 5 amends paragraph (c) of item 7 of Schedule 1 of the Principal Determination, which sets out qualification requirements for occupational therapists (OTs) to be considered an AHP in relation to the provision of a focussed psychological strategies health service. 

Paragraph (c) previously provided that, among other requirements, a person must be a full or part-time member of Occupational Therapy Australia and, in those States and Territories that offered registration for OTs, the person must be registered.

Under new paragraph (c) the requirement for registration as an OT applies in all States and Territories, reflecting the implementation of national registration for OTs under NRAS from 1 July 2012.  However, with the introduction of national registration for OTs the requirement for membership of Occupational Therapy Australia is no longer considered necessary and this has been removed.

The requirement that a person must be accredited by Occupational Therapy Australia as having two years experience in mental health and as having given an undertaking to Occupational Therapy Australia to observe the standards set out in its ‘Australian Competency Standards for Occupational Therapists in Mental Health’ as in force on 1 November 2006 has been retained. 

Item 5 also inserts a ‘transitional provision’ at the end of item 7 of the Principal Determination.  It provides that until midnight 31 October 2012 a person is also an AHP in relation to the provision of focused psychological strategies health services if he or she was such a person on 30 June 2012 because of paragraph (c) of item 7 as in force on that date (i.e. because the person met the previous qualification requirements for OTs).  The transitional period allows OTs not previously required to be registered four months in which to gain registration, during which time they will remain an AHP in relation to focussed psychological strategies health services.  This will also ensure the delivery of Medicare-eligible services to patients is not disrupted by the transition to national registration for OTs.

Item 6 Schedule 1, Qualification requirements for allied health professionals, item 8, Mental health service, paragraph (c)

Item 6 amends paragraph (c) of item 8 of Schedule 1 of the Principal Determination, which sets out qualification requirements for OTs to be considered an AHP in relation to the provision of a mental health service. 

Previously, in a State or Territory that offered registration for OTs a person was required to hold registration and, in other States and Territories, the person was required to be a full or part-time member of Occupational Therapy Australia. 

Under new paragraph (c) a person will be an AHP in relation to the provision of a mental health service if he or she is an OT who is registered to provide that kind of service under the applicable law in force in the State or Territory in which the service is provided.  There is no longer a requirement for OTs in any jurisdiction to be a member of Occupational Therapy Australia in order to be an AHP in relation to the provision of a mental health service.  These changes reflect the commencement of a national registration system for OTs from 1 July 2012. 

Item 7 Schedule 1, Qualification requirements for allied health professionals, item 8, Mental health service, paragraph (e)

Item 7 of this Determination makes a further amendment to item 8 of Schedule 1 of the Principal Determination, adding a ‘transitional provision’ at the end of the item.  It provides that until midnight 31 October 2012 a person is also an AHP in relation to the provision of a mental health service if he or she was such a person on 30 June 2012 because of paragraph (c) of item 8 as in force on that date (i.e. because the person met the previous qualification requirements for OTs).

This allows OTs who were not previously required to be registered four months to become registered, during which time they will remain an AHP in relation to the provision of a mental health service.  This will also ensure the delivery of Medicare-eligible services to patients is not disrupted by the transition to national registration for OTs.

Item 8  Schedule 1, Qualification requirements for allied health professionals, item 10, Occupational therapy health service

Item 8 amends the qualification requirements for a person to be considered an AHP in relation to the provision of an occupational therapy health service, as set out in item 10 of Schedule 1 of the Principal Determination. 

From 1 July 2012 a person must be an OT who is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. 

Item 10 of the Principal Determination further provides that until midnight 31 October 2012, a person is also an AHP in relation to the provision of an occupational therapy health service if he or she was such a person on 30 June 2012. 

This allows for a four month ‘transitional period’ during which persons who were not previously required to hold registration to provide Medicare-eligible occupational therapy health services will remain able to provide such services while they arrange for registration.  This will also ensure the delivery of Medicare-eligible services to patients is not disrupted by the transition to national registration for OTs.

Item 9 Schedule 2, Allied health services, Part 1, Services and fees – general, item 10950

Item 10 Schedule 2, Allied health services, Part 6, Services and fees – Aboriginal and Torres Strait Islander health services, item 81300

Items 9 and 10 amend the item descriptors for items 10950 and 81300 (both Aboriginal and Torres Strait Islander health services), by omitting each mention of “eligible Aboriginal health worker” and replacing with “eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner”.  

Items 10950 and 81300 were previously able to be provided by an eligible Aboriginal health worker – in the Northern Territory a person who registered under the Health Practitioners Act NT and, in the rest of Australia, a person holding Certificate III in Aboriginal and Torres Strait Islander Health or an equivalent or higher qualification. 

From 1 July 2012 items 10950 and 81300 may be provided in any State or Territory in Australia by a person who is registered as an Aboriginal and Torres Strait Islander  health practitioner under NRAS, i.e. an eligible Aboriginal and Torres Strait Islander health practitioner.  Additionally, in States and Territories other than the Northern Territory a person who has been awarded either Certificate III in Aboriginal and Torres Strait Islander Health or Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care or equivalent or higher qualifications, i.e. an eligible Aboriginal health worker, will also be able to provide items 10950 and 81300.

Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

Health Insurance (Allied Health Services) Amendment Determination 2012

(No. 2)

This Legislative Instrument 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.

Overview of the Legislative Instrument

The Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 2) (the Determination) amends the Health Insurance (Allied Health Services) Determination 2011 (the Principal Determination).

The amendments alter the qualification requirements for:

• occupational therapists wishing to provide Medicare-eligible mental health, occupational therapy or focussed psychological strategies health services under the Principal Determination; and
• Aboriginal health workers and Aboriginal and Torres Strait Islander health practitioners wishing to provide Medicare-eligible Aboriginal and Torres Strait Islander health services under the Principal Determination. 

The qualification requirements have been altered to recognise the extension of the National Registration and Accreditation Scheme (NRAS) for health professionals to the occupational therapy and Aboriginal and Torres Strait Islander health practitioner professions from 1 July 2012.  Prior to that date, registration in the occupational therapy and Aboriginal health worker professions was only required in some States and Territories in Australia.  Accordingly, registration in the relevant profession was only a qualification requirement in those jurisdictions in which it was required.  Eligibility in other jurisdictions required membership of a relevant professional body (for occupational therapists) or holding an appropriate vocational education qualification (for Aboriginal health workers).

With the introduction of national registration for occupational therapists and Aboriginal and Torres Strait Islander health practitioners, the Determination amends the Principal Determination to:

• make registration under NRAS a qualification requirement for the provision of mental health, occupational therapy or focussed psychological strategies health services by occupational therapists in all States and Territories;
• introduce a new category of provider of Aboriginal and Torres Strait Islander health services, an ‘eligible Aboriginal and Torres Strait Islander health practitioner’, to recognise providers registered in that profession under NRAS. 

Minor changes to the Principal Determination to update relevant vocational educational qualifications for Aboriginal health workers have also been made.

Human rights implications

This Legislative Instrument does not engage any of the applicable rights or freedoms.

Conclusion

This Legislative Instrument is compatible with human rights as it does not raise any human rights issues.

____________________________________

Richard Bartlett

First Assistant Secretary Medicare Benefits Division

Department of Health and Ageing