Health Insurance (Allied Health Services) Determination 2010

Overview

The Health Insurance (Allied Health Services) Determination 2010 was introduced to address the need for updating fees and the names of allied health organisations under the Health Insurance Act 1973. Enacted by the Minister for Health and Ageing, the primary objective of this Determination is to align with the annual indexation of fees and to reflect the recent name changes of allied health provider organisations. This Determination revokes the previous Health Insurance (Allied Health Services) Determination 2009 (No.2) and comes into effect on 1 November 2010. It includes updated fees and revised names of allied health organisations, such as the change from OT Australia to Occupational Therapy Australia and from Australian Association of Exercise and Sports Science (AESS) to Exercise and Sports Science Australia (ESSA). No consultation was deemed necessary for this Determination as the changes are minor and administrative in nature, not altering the existing arrangements.

Scope and Application

The Health Insurance (Allied Health Services) Determination 2010 applies to allied health services that are prescribed under Regulation 3A of the Health Insurance Regulations 1975. This includes services provided by eligible allied health professionals such as occupational therapists, exercise and sports scientists, and psychologists, among others. The Determination is relevant to these allied health professionals, their patients, and health insurance providers. The geographic reach of the Act is national, as it applies across Australia. There are no stated exclusions or exemptions in this Determination, but it is important to note that the services covered are those that fall under the specified classes of allied health services. The Act allows for the extension or restriction of application through subordinate instruments, which in this case is the Determination itself. The primary purpose of this Determination is to update the fees for these services due to annual indexation and to update the names of two allied health organisations due to name changes. The Determination revokes the previous version, the Health Insurance (Allied Health Services) Determination 2009 (No.2), and comes into effect on 1 November 2010.

Key Provisions

The Health Insurance (Allied Health Services) Determination 2010, under section 3C of the Health Insurance Act 1973, sets out the determination for specific health services that are not listed in the general medical services table to be treated as if they were listed under certain conditions (section 1). Regulation 3A of the Health Insurance Regulations 1975 identifies 16 classes of allied health services that are considered "health services" for the purposes of section 3C of the Act. This Determination replaces the previous Health Insurance (Allied Health Services) Determination 2009 (No.2) and comes into effect on 1 November 2010. It updates the fees due to annual indexation and corrects the names of two allied health organisations, changing "OT Australia" to "Occupational Therapy Australia" and "Australian Association of Exercise and Sports Science (AESS)" to "Exercise and Sports Science Australia (ESSA)" (section 2, 3, and 4). The Determination imposes obligations on allied health professionals to meet the qualification requirements set out in Schedule 1 and provide the services listed in Schedule 2, which includes individual allied health services, psychological therapy and focused psychological strategies services, pregnancy support counselling services, group allied health services for patients with type 2 diabetes, and allied health services for children with autism or any other PDD (Schedule 1 and 2). These professionals must adhere to the fees and service descriptors specified in the Determination. Failure to comply with the provisions of the Determination may result in penalties under the Health Insurance Act 1973. While the Determination itself does not specify penalties, the Act allows for civil and criminal consequences for breaches, including fines and imprisonment, depending on the severity of the offence (section 3C(8)). The specific penalties would be determined by the courts in the context of the Act and other relevant laws.