Health Insurance (Allied Health Services) Amendment Determination 2014 (No. 1)

Administered by Department of Health, Disability and Ageing

Legislation au F2014L00203 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health

Health Insurance Act 1973

 

Health Insurance (Allied Health Services) Amendment Determination 2014 (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 2014 (No. 1) (the Determination) is to amend the Health Insurance (Allied Health Services) Determination 2014 (the Principal Determination) to add Rett’s disorder as an eligible disability for which Medicare-eligible allied health services may be provided through the Better Start for Children with Disability initiative.  The Determination also removes redundant provisions and corrects minor errors.

Medicare benefits are payable for a number of allied health services, including psychology, speech pathology, occupational therapy and audiology health services, for children under 13 years (for diagnostic services) and under 15 years (for treatment services) with ‘autism or another pervasive developmental disorder’ or an ‘eligible disability’.

Under the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-4) Rett’s disorder was considered a pervasive developmental disorder.  However under DSM-5, published in 2013, Rett’s disorder is no longer considered a pervasive developmental disorder. To ensure that children with Rett’s disorder are not disadvantaged by the removal of Rett’s disorder as a pervasive developmental disorder in DSM-5, from 1 March 2014 the list of eligible disabilities will expand to include Rett’s disorder. The addition of Rett’s disorder as an ‘eligible disability’ will ensure that eligible children diagnosed with Rett’s disorder will continue to be able to access the relevant Medicare items by virtue of having an ‘eligible disability’.

The Determination also amends item 18 of Schedule 1 to the Principal Determination, which specifies qualification requirements for speech pathologists to be eligible to provide Medicare services.  The Principal Determination previously provided that a Queensland speech pathologist who had been eligible to provide Medicare services because they were registered under the (now repealed) Speech Pathologists Registration Act 2001 (Qld) on 30 April 2013 would continue to be eligible until 31 August 2013.

 

From 1 September 2013 all speech pathologists in Australia have been required to hold membership of Speech Pathology Australia to be eligible to provide Medicare services.  The Determination removes the redundant grandfathering provision.

The Determination also corrects an erroneous reference in the item descriptors of items 82000 to 82035, omitting references to the Department of Human Resources and replacing with reference to the Department of Human Services.

Consultation

The Department of Social Services (DSS) is the lead agency for the Better Start for Children with Disabilities initiative.  In June and July 2013 the (then) Department of Families, Housing, Community Services and Indigenous Affairs (now DSS) held consultations in all capital cities on the impact of the adoption of DSM-5 in Australia.

 

Attendees at the consultations include representatives from:

  •         Children with Disability Australia
  •         Carers NSW and Carers NT
  •         Mental Health Council Australia
  •         the allied health peak bodies of Speech Pathology Australia
  •         Occupational Therapy Australia
  •         the Australian Psychological Society
  •         The Royal Australian and New Zealand College of Psychiatrists
  •         The Royal Australasian College of Physicians
  •         State and territory education
  •         National Disability Insurance Agency (NDIA)
  •         State and National Offices of the Department of Social Services
  •         a range of allied health professionals from government and non-government organisations.

A national workshop of key experts was also held on 30 July by the then Department of Families, Housing, Community Services and Indigenous Affairs.

The finding of the consultation process was support for Rett’s disorder to be included separately as an eligible diagnosis under the Better Start for Children with Disability initiative.

The determination commences on 1 March 2014.

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

 

 

 

 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 2014 (No. 1)

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 2014 (No. 1) (the Determination):

  • adds Rett’s disorder as an eligible childhood development disability for which Medicare-eligible allied health services may be provided through the Better Start for Children with Disability initiative;
  • removes a grandfathering provision in relation to qualifications required for Queensland speech pathologists to provide Medicare funded services, as the provision ceased to have effect on 1 September 2013 and is now redundant; and
  • corrects a number of erroneous references to the Department of Human Resources, replacing these with reference to Department of Human Services.

Human Rights Implications

This Legislative Instrument engages the following human rights:

Right to health and social security

This Legislative Instrument facilitates ongoing access to Medicare funded health care services for children with Rett’s disorder.

Medicare benefits are payable for a number of allied health services, including psychology, speech pathology, occupational therapy and audiology health services, for children under 13 years (for diagnostic services) and under 15 years (for treatment services) with ‘autism or another pervasive developmental disorder’ or an ‘eligible disability’.

Under the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-4) Rett’s disorder was considered a pervasive developmental disorder.  However under DSM-5, published in 2013, Rett’s disorder is no longer considered a pervasive developmental disorder.

To ensure that children with Rett’s disorder are not disadvantaged by the removal of Rett’s disorder as a pervasive developmental disorder in DSM-5, from 1 March 2014 the list of eligible disabilities will expand to include Rett’s disorder. The addition of Rett’s disorder as an ‘eligible disability’ will ensure that eligible children diagnosed with Rett’s disorder will continue to be able to access the relevant Medicare items by virtue of having an ‘eligible disability’.

 

This amendment promotes the rights of children with Rett’s disorder in terms of access to affordable health services.  

There are no human rights implications in relation to the removal of the grandfathering provisions for speech pathologists, or the correction of minor errors in terminology.

Conclusion

This Legislative Instrument is compatible with human rights.

 

Richard Bartlett

First Assistant Secretary

Medical Benefits Division

Department of Health

 

 

 

 

 

 

 

Overview

The Health Insurance (Allied Health Services) Amendment Determination 2014 (No. 1) was enacted to amend the Health Insurance (Allied Health Services) Determination 2014, addressing a specific gap identified in the eligibility criteria for Medicare-funded allied health services under the Better Start for Children with Disability initiative. This amendment was necessary due to the reclassification of Rett's disorder in the DSM-5, which removed it from the category of pervasive developmental disorders, potentially impacting access to Medicare benefits. The determination was made under the authority of the Minister for Health and aims to ensure that children diagnosed with Rett’s disorder continue to receive the necessary allied health services without financial barriers. The enactment of this amendment ensures that children with Rett’s disorder are not disadvantaged by the changes in diagnostic classifications and promotes equitable access to health care services. The determination also removes outdated provisions regarding the qualifications of Queensland speech pathologists, as the specific registration criteria under the repealed Speech Pathologists Registration Act 2001 (Qld) became redundant with the implementation of new national standards on 1 September 2013. Additionally, it corrects minor errors in terminology to ensure the accuracy and clarity of the legislative instrument. The enactment body for this determination is the Parliament of Australia, ensuring legislative compliance and alignment with the overarching objectives of the Health Insurance Act 1973.

Scope and Application

The Health Insurance (Allied Health Services) Amendment Determination 2014 (No. 1) is an instrument made under the Health Insurance Act 1973, which pertains to the provision of Medicare-eligible allied health services for children with certain disabilities. This Determination applies to children diagnosed with Rett’s disorder, ensuring they can access allied health services such as psychology, speech pathology, occupational therapy, and audiology under the Better Start for Children with Disability initiative. It also rectifies qualification requirements for speech pathologists and corrects errors in terminology from previous regulations. The amendment is designed to align with the updated Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ensuring no child with Rett’s disorder is disadvantaged by changes in diagnostic classifications. This Determination is applicable nationally and commenced on 1 March 2014, providing a clear pathway for continued access to necessary health services for eligible children.

Key Provisions

The Health Insurance (Allied Health Services) Amendment Determination 2014 (No. 1) amends the Health Insurance (Allied Health Services) Determination 2014 by including Rett's disorder as an eligible disability for Medicare-eligible allied health services under the Better Start for Children with Disability initiative. This change is effective from 1 March 2014, ensuring that children diagnosed with Rett's disorder continue to have access to Medicare-funded services. The amendment addresses the shift in diagnostic criteria from DSM-4 to DSM-5, which reclassified Rett's disorder from a pervasive developmental disorder to a separate condition. Additionally, the Determination removes a grandfathering provision for Queensland speech pathologists, which had allowed them to provide Medicare services under specific conditions until 31 August 2013. Since 1 September 2013, all speech pathologists in Australia must hold membership with Speech Pathology Australia to be eligible for Medicare services. The Determination also corrects minor errors, such as replacing references to the Department of Human Resources with the Department of Human Services. The Determination imposes several obligations on parties and entities it governs. Firstly, it mandates that speech pathologists in Australia must be members of Speech Pathology Australia to provide Medicare services. This requirement ensures that professionals delivering allied health services meet the necessary professional standards and qualifications. Secondly, allied health service providers must adhere to the eligibility criteria for children with Rett's disorder and other specified disabilities to qualify for Medicare benefits. This includes ensuring that children diagnosed with Rett's disorder are recognised as eligible for the relevant services. Furthermore, the Determination requires that any amendments or updates to the General Medical Services Table and related regulations are communicated and implemented correctly to avoid confusion or service disruptions. Failure to comply with the provisions of the Determination can result in various consequences. Firstly, speech pathologists who do not meet the membership requirement with Speech Pathology Australia may not be eligible to provide Medicare-funded services, leading to potential service gaps for eligible children. Secondly, allied health service providers who do not correctly apply the eligibility criteria for children with Rett's disorder may face scrutiny or penalties for providing services to ineligible patients. While the Determination does not explicitly state penalties for non-compliance, breaches of Medicare regulations can lead to financial penalties, sanctions, or legal actions under other relevant legislation, such as the Health Insurance Act 1973. These penalties can vary depending on the severity and frequency of the breach but may include fines or other corrective measures to ensure compliance with the Act's requirements.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.