Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 5)

EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health

Health Insurance Act 1973

Health Insurance (Allied Health Services) Amendment Determination 2012 (No. 5)

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) Regulation, which is re-made each year.

The Health Insurance (Allied Health Services) Determination 2011 (the Principal Determination) creates Medicare items that may be provided 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. 5) (the Determination) is to amend the Principal Determination to expand the number of childhood developmental disabilities for which Medicare-eligible allied health services may be provided through the Better Start for Children with Disability initiative.

Medicare benefits are payable for a number of allied health services, including psychology, speech pathology, occupational therapy and audiology health services, for children with an ‘eligible disability’ under 13 years (for diagnostic services) and under 15 years (for treatment services).  Prior to the amendment made by the Determination, eligible disabilities were:

• sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction; or
• hearing impairment that results in either a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies, or permanent conductive hearing loss and auditory neuropathy;
• Down syndrome;
• cerebral palsy; and
• Fragile X syndrome.

From 1 January 2013, the list of eligible disabilities will be expanded to also include:

• deafblindness;
• Prader-Willi syndrome;
• Williams syndrome;
• Angelman syndrome;
• Kabuki syndrome;
• Smith-Magenis syndrome;
• CHARGE syndrome;
• Cri du Chat syndrome;
• Cornelia de Lange syndrome; and
• microcephaly.

The expansion of eligible conditions is a Mid-year Economic and Fiscal Outlook 2012-13

budget measure, to enable children with one of an additional nine rare conditions to access the same Medicare items that are available to the original cohort of children under the Better Start for Children with Disability initiative (Better Start).

The Australian Government Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) is the lead agency for expansion of the Better Start eligibility criteria. Inclusion of the additional disabilities was informed by expert advice on the effectiveness of early intervention for children with a range of developmental disabilities, which was commissioned by FaHCSIA. The nine additional conditions are developmental disabilities that share functional characteristics of the conditions initially included under Better Start.

There are no changes to the Medicare services that are available through Better Start.

The Determination also makes minor machinery changes, replacing reference to “Medicare Australia” in several item descriptors with reference to “the Department of Human Services”. 

Consultation
 

FaHCSIA is the lead agency for the expansion of Better Start eligibility criteria. FaHCSIA has

consulted with numerous stakeholders regarding implementation of the expansion, including through:

• The Better Start Expert Reference Group (ERG), which advises FaHCSIA on issues pertaining to the implementation of the Better Start.  The ERG is made up of allied health professionals providing early intervention services under Better Start and representatives from the Royal Australasian College of Physicians and the Royal College of General Practitioners.  At an ERG meeting held on 13 November 2012, expert advice was sought on the nine new disabilities, including eligibility thresholds.  The ERG provided advice on relevant contacts to consult and on disability thresholds.
• Telephone consultations with a range of representatives from consumer bodies of the disabilities included in the expansion.  They provided relevant medical contacts and insight into early intervention therapies to meet the core needs of the cohort of children included in the expansion. 
• Telephone consultations with various experts in the disability areas that have been included in Better Start expansion, including geneticists, paediatricians and the Association of Genetic Support of Australasia.  They provided relevant contacts, eligibility thresholds and insight into early intervention therapies to meet the core needs of the cohort of children included in the expansion.
• Meeting with consumer group representatives and experts on 4 December 2012 to inform them of the Better Start expansion and discuss issues like disability thresholds for newly included conditions, core therapy needs of the children with these conditions and promotional opportunities.

The Department of Health and Ageing has consulted with the Department of Human Services regarding the change, and will write to relevant allied health peak bodies in December 2012.

The Determination commences on 1 January 2013.

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