EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Follow up service – Indigenous persons) Determination 2008
Issued by the authority of the Minister for Health and Ageing
Background
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by writing, determine that a health service not listed in the general medical services table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. The Table is set out in the Health Insurance (General Medical Services Table) Regulations 2008 which are remade each year.
A determination made under subsection 3C(1) is a legislative instrument (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
- Health Insurance (Follow up service – Indigenous persons) Determination 2008
The Health Insurance (Follow up service – Indigenous persons) Determination 2008 (the Determination) will permit the payment of a Medicare benefit for a practice nurse or registered Aboriginal health worker to provide a follow up service on behalf of a general practitioner (GP) for an Indigenous person who has received a health check.
The Determination provides for a single new item (item 10987) for a follow up service to a health check provided by a practice nurse or a registered Aboriginal health worker for up to five services in a calendar year per person. Examples of follow up services include:
- Education regarding medication compliance and associated monitoring;
- Checks on clinical progress and service access; and
- Prevention advice for chronic conditions and associated follow up.
Details of this Determination are set out in the Attachment.
This Determination commences on 1 November 2008.
Consultation
The Department of Health and Ageing (DOHA) consulted with the relevant medical and nursing groups (Australian Medical Association, Royal Australian College of General Practitioners, Rural Doctors Association of Australia, Australian General Practice Network, Australian Practice Nurses Association, Royal College of Nursing, Australia, Australian Nursing Federation), whose members will be involved in the provision of this service.
DOHA also consulted with the National Aboriginal Community Controlled Health Organisation (through its nominee, Aboriginal Medical Services Alliance NT), as practice nurses and registered Aboriginal Health Workers of Indigenous Community Controlled Health Organisations will also be able to provide this service.
In addition, DOHA liaised with Medicare Australia to ensure that the technical aspects of the item were correctly developed and that the Medicare system is capable of administering the new service from 1 November 2008.
All Agencies consulted were supportive of this item.
ATTACHMENT
Notes on sections in the Determination
Section 1
Section 1 provides the name of Determination is the Health Insurance (Follow up service – Indigenous persons) Determination 2008.
Section 2
Section 2 provides that the Determination commences on 1 November 2008.
Section 3
- Section 3 defines terms used in the Determination. Key terms are: Practice nurse - which means a registered or enrolled nurse employed or otherwise retained by a general practice or by a health service for which a direction under subsection 19(2) of the Act applies.
- Registered Aboriginal health worker – which means a person in the Northern Territory who is registered as an Aboriginal health worker under the Health Practitioners Act (NT) and is employed or otherwise retained by a general practice or by a health service for which a direction under subsection 19(2) of the Act applies.
These terms are used in Schedule 1 of the Determination in describing the requirements of the new item.
Section 4
Paragraph 4(a) provides that a relevant service specified in the Schedule to the Determination shall be treated as if it were both a professional service and a medical service for the purposes of the provisions of the Act, the National Health Act 1953 and the regulations made under those Acts that make provision for medical or professional services.
Paragraph 4(1)(b) provides that a relevant service specified in the Schedule to the Determination (ie item 10987) is to be treated as if there were an item in the general medical services table that related to the service and which specifies a fee in respect of that service, being the fee specified in the Determination in relation to the service.
Subsection 4(2) provides that Schedule 6 of the Health Insurance Regulations 1975 (the Regulation) has effect as if the item in Schedule 1 of the Determination were also specified in Schedule 6 of the Regulations. The effect of this is that the benefit amount is 100% of the fee listed in the Determination.
Schedule 1
This Schedule to the Determination sets out the relevant service, assigns the applicable item number, item descriptor and fee for the service.