EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 4)
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 the purposes of specified statutory provisions, be treated as if it were specified in the Table. The Table is set out in the Health Insurance (General Medical Services Table) Regulations, which are re-made each year.
The Health Insurance (Allied Health Services) Determination 2011 (the Principal Determination) creates Medicare items that may be provided as Medicare-eligible services by appropriately qualified allied health professionals, including but not limited to psychologists, osteopaths, chiropractors, physiotherapists and audiologists.
The purpose of the Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 4) (the Determination) is to amend the Principal Determination to:
- increase the fees for all allied health services in the Principal Determination from 1 November 2012 due to the annual indexation typically applied to items in the Table;
- introduce nine new items for audiology health services relating to diagnostic audiology tests; and
- remove redundant ‘transitional’ provisions relating to qualification requirements for providers of focussed psychological strategies health services, mental health services and occupational therapy health services, which cease to operate from 1 November 2012.
The nine new items (items 82300 to 82332) for diagnostic audiology tests are being introduced as a 2012-13 Budget measure, to allow qualified audiologists to perform particular services, on request from an Ear, Nose and Throat (ENT) specialist (a specialist in otolaryngology head and neck surgery) or a neurologist (a specialist or consultant physician in neurology). The measure will mean that patients will receive a Medicare rebate when an audiologist provides a diagnostic test using one of the specific new items. The measure recognises the qualifications of audiologists and their capacity to performed diagnostic audiology tests independently.
The new services for audiologists are based upon services currently listed in the Table (items 11300 to 11332, excluding 11304) that may be provided by, or on behalf of, medical practitioners.
Under the new items, the providing audiologist is required to provide the requesting practitioner with a copy of the results of the services and his or her relevant written comments. These results will assist the requesting practitioner in their medical diagnosis, treatment and/or management of ear disease or related disorders in the patient.
Medicare items 11300 to 11339 (excluding item 11304) currently available to medical practitioners are not being removed from the Table. ENT specialists and neurologists will be able to continue with their existing arrangements, or request diagnostic audiology services from a Medicare-eligible audiologist.
The Determination commences on 1 November 2012.
Details of the Determination are set out in the Attachment.
The Act specifies no conditions that need to be satisfied before the power to make the Determination may be exercised.
The Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Consultation
Following the 2012-13 Budget, the Department of Health and Ageing (the Department) held discussions with a range of stakeholders regarding the measure and the process for consultation. A discussion paper on the measure was subsequently released seeking feedback on a range of issues, including the scope of the measure, clinical issues relating to the diagnostic audiology tests, audiologist requirements for Medicare eligibility, requesting and reporting arrangements, service requirements and restrictions, fees and billing and communication and education.
The discussion paper was published on the Department’s website (at www.health.gov.au/mbsonline) and distributed to the following stakeholders:
• The Australian Society of Otolaryngology Head & Neck Surgery Ltd;
• The Australasian College of Ear Nose and Throat Physicians;
• The Australian Association of Consultant Physicians Ltd;
• The Australian Medical Association;
• The Australian and New Zealand Association of Neurologists;
• General Surgeons Australia;
• The Royal Australasian College of Surgeons;
• The Royal Australasian College of Physicians;
• The Audiological Society of Australia;
• The Australian College of Audiology;
• The Australian Association of Audiologists in Private Practice;
• The Consumer Health Forum of Australia;
• The Deafness Forum of Australia;
• The Department of Human Services; and
• The Department of Veterans Affairs.
Twelve submissions were received from medical groups, audiology groups, consumer groups and individuals in response to the Department’s discussion paper (noting that the submission from the Audiological Society of Australia included additional feedback and comments from numerous members).
Stakeholder feedback received throughout the consultation process informed the parameters for the measure and the development of the new diagnostic audiology items, including the requesting arrangements and the specific diagnostic tests to be available through the new items.
ATTACHMENT
Details of the Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 4)
Part 1 Preliminary
Section 1 Name of Determination
This section provides that the name of the Determination is the Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 4).
Section 2 Commencement
This section provides that the Determination commences on 1 November 2012.
Section 3 Amendment of the Health Insurance (Allied Health Services) Determination 2011
This section provides that Schedule 1 of the Determination amends the Health Insurance (Allied Health Services) Determination 2011 (the Principal Determination).
Schedule 1 Amendments
Item [1] After section 11
This item inserts a new section 12 in the Principal Determination which sets out requirements for requests for diagnostic audiology services. New subsection 12(2) provides that a request must be in writing and include:
- the date of request;
- the name of the requesting practitioner and either his or her provider number or address of place of practice; and
- a description of the service requested.
A request can be for multiple services to be provided as part of the one audiological assessment, but cannot be for more than one assessment (subsection 12(3)).
Item [2] Schedule 1, item 7, Focussed psychological strategies health service
Item [3] Schedule 1, item 8, Mental health service
Item [4] Schedule 1, item 10, Occupational therapy health service
These items omit from the qualification requirements for a person to be an allied health professional (AHP) in relation to focussed psychological strategies health services, mental health services and occupational therapy health services, respectively, a ‘transitional’ provision that ceased to operate from 1 November 2012.
National registration for the occupational therapy profession commenced from 1 July 2012. The transitional provisions allowed occupational therapists who had been recognised as AHPs in relation to focussed psychological strategies health services, mental health services and occupational therapy health services before 1 July 2012 a three month period ending midnight 31 October 2012 to arrange for their registration by the Occupational Therapy Board of Australia.
Item [5] Schedule 2
This item inserts indexed fees for items 10950 – 81360 in Schedule 2 of the Principal Determination.
Item [6] Schedule 2, after Part 6
This item inserts a new Part 7 in Schedule 2 of the Principal Determination. Part 7 is made up of nine new audiology health services for diagnostic audiology tests. Each service is assigned an item descriptor, item number and fee.
The new services are:
- brain stem evoked response audiometry (item 82300);
- non-determinate audiometry (item 82306);
- air conduction audiogram (item 82309);
- air and bone conduction audiogram or air conduction and speech discrimination audiogram (item 82312);
- air and bone conduction and speech discrimination audiogram (item 82315);
- air and bone conduction and speech discrimination audiogram with other cochlear tests (item 82318);
- impedance audiogram involving tympanometry and measurement of static compliance and acoustic reflex (not being a service associated with a service to which item 82309, 82312, 82315 or 82318 applies) (item 82324);
- impedance audiogram involving tympanometry and measurement of static compliance and acoustic reflex (being a service associated with a service to which item 82309, 82312, 82315 or 82318 applies) (item 82327);
- oto-acoustic emission audiometry for the detection of a permanent congenital hearing impediment performed on a child or infant (item 82332).
The new diagnostic audiology services in items 82300 and 82306 may only be provided on written request from a specialist in otolaryngology head and neck surgery. The new diagnostic audiology services in items 82309 to 82332 may only be provided on written request from a specialist in otolaryngology head and neck surgery or specialist or consultant physician in neurology.
It is also a requirement for all new services that, following performance of the service, the audiologist must provide a copy of the results with relevant comments to the requesting practitioner.