Health Insurance (Allied Health Services) Determination 2009

Overview

The Health Insurance (Allied Health Services) Determination 2009 is an instrument made under the authority of the Health Insurance Act 1973, enacted to address gaps in the coverage of allied health services under the Medicare Benefits Schedule. This Determination was introduced to ensure that certain allied health services are adequately covered and accessible to the public. It was issued by the Minister for Health and Ageing and commenced on 1 July 2009, following consultations with relevant bodies such as the Australian Association of Social Workers and internal discussions within the Department of Health and Ageing. The primary policy objective of this Determination is to update and refine the qualifications and registration requirements for allied health professionals, particularly those providing mental health services, and to align the terminology with the latest changes in the Health Insurance (General Medical Services Table) Regulations. This legislative instrument serves to revoke the previous Health Insurance (Allied Health Services) Determination 2008, incorporating necessary amendments to ensure the continued provision and coverage of allied health services under the Medicare scheme.

Scope and Application

The Health Insurance (Allied Health Services) Determination 2009 applies to allied health services specified within the Medicare Benefits Schedule under the Health Insurance Act 1973, particularly focusing on services provided by allied health professionals such as social workers, psychologists, and other specified health service providers. This legislation extends to all entities and individuals involved in the provision of these services, ensuring they meet the outlined qualification and registration requirements to be eligible for Medicare rebates. The Act operates on a national level within Australia, influencing how allied health services are funded and accessed through the Medicare system. Certain exclusions may apply based on the specific criteria and item numbers listed in the Schedules of the Determination, and it is important to note that services not listed in the Medicare Benefits Schedule are not covered unless specifically determined by the Minister under subsection 3C(1) of the Act. The scope of the Act may be further refined or expanded through subordinate instruments, which are created under the authority of the Minister for Health and Ageing.

Key Provisions

The Health Insurance (Allied Health Services) Determination 2009, pursuant to subsection 3C(1) of the Health Insurance Act 1973, specifies that certain health services not listed in the general medical services table will be treated as listed under particular circumstances. The key provisions are outlined in Sections 1 through 4 and Schedules 1 and 2 of the Determination. Section 1 names the Determination as the Health Insurance (Allied Health Services) Determination 2009, while Section 2 establishes that it takes effect from 1 July 2009. Section 3 revokes the previous 2008 Determination, and Section 4 provides definitions, including updating the term 'GP Mental Health Care Plan' to 'GP Mental Health Treatment Plan'. Schedule 1 details the qualification requirements for allied health professionals, and Schedule 2 lists the Medicare items for services provided by eligible professionals, including updates to service descriptors and fees. The Act imposes several obligations on allied health professionals and entities. They must meet the qualification requirements outlined in Schedule 1 to access Medicare benefits for specific services. For instance, professionals providing mental health and pregnancy counselling services must comply with updated standards from the Australian Association of Social Workers. Furthermore, the professionals need to ensure their services align with the Medicare items and fees detailed in Schedule 2. This includes correctly identifying and billing for services under the updated GP Mental Health Treatment Plans and other specified items. Failure to comply with the requirements set forth in the Determination can lead to various consequences. While the specific penalties for breach are not detailed within the text, the general provisions of the Health Insurance Act 1973 allow for both civil and criminal penalties for non-compliance. Typically, such breaches may result in fines or other financial penalties for entities or individuals. Additionally, persistent or significant breaches could potentially lead to more severe consequences, including legal action against the offending parties. The exact nature and severity of the penalties would depend on the specific circumstances of the breach and the discretion of the courts or relevant authorities.