EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Midwife and Nurse Practitioner) Amendment Determination 2012 (No. 1)
Operation and Background
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 GMST) shall, in specified circumstances and for the purposes of specified statutory provisions, be treated as if it were specified in the GMST as appropriate. The GMST is set out in the Health Insurance (General Medical Services Table) Regulations which are re-made each year.
New Medicare items for services provided by participating midwives and participating nurse practitioners were created through the Health Insurance (Midwife and Nurse practitioner) Determination 2010 (the 2010 Determination).
Medicare items for clinical support provided to a patient by a participating midwife or nurse practitioner at the patient-end of a video consultation with a specialist or consultant physician were created through the Health Insurance (Telehealth Services) Determination 2011 (the Telehealth Determination). The Telehealth Determination ceased on 31 October 2011. These items were subsequently included in the Health Insurance (Midwife and Nurse Practitioner) Determination 2011, which revoked and remade the 2010 Determination.
Purpose
The purpose of the Health Insurance (Midwife and Nurse Practitioner) Amendment Determination 2012 (No. 1) (the Determination) is to:
- increase the fees for the midwife and nurse practitioner items with new fees that apply from 1 November 2012 due to the annual indexation typically applied to items in the GMST. Indexation is not applied to Medicare pathology services, and fees for nurse practitioner pathology services (items 73828 – 73837) remain unchanged;
- introduce a requirement that there be a minimum distance of 15kms by road between the specialist’s and the patient’s location for the midwife and nurse practitioner telehealth items 82150, 82151, 82152, 82220, 82221 and 82222. These items provide for the payment of Medicare benefits for participating midwives and nurse practitioners providing clinical support to a patient located in a regional, remote or outer metropolitan area who is participating in a consultation with a specialist or consultant physician via video conference; and
- implement minor technical amendments to nurse practitioner aged care telehealth items (82223, 82224 and 82225) so they are consistent in format to the amended nurse practitioner telehealth items 82220, 82221 and 82222.
The introduction of the requirement that the specialist or consultant physician is located at least 15 km by road from their patient at the time of the video consultation (‘the 15 km rule’) is aimed at ensuring that the items target services at patients for whom distance is a genuine barrier to accessing specialist services. The minimum distance between the specialist or consultant physician and patient is to be determined by the direct road route.
The 15 km rule does not apply to video consultations if the patient is a patient of an Aboriginal Medical Service, or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies
Commencement
The Determination commences on 1 November 2012.
Details of the Determination are set out in the Attachment.
The Act specifies no conditions that need to be satisfied before the power to make the Determination may be exercised.
The Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Consultation
The introduction of the 15km rule for the midwife and nurse practitioner telehealth items 82150, 82151, 82152, 82220, 82221 and 82222 implements the Australian Government Budget 2012-13 measure, Telehealth – redirection of funding. Stakeholders were advised of the details of the measure after it was announced in May 2012.
ATTACHMENT
Details of the Health Insurance (Midwife and Nurse Practitioner) Amendment Determination 2012 (No. 1)
Part 1 Preliminary
Section 1 Name of Determination
This section provides that the name of the Determination is the Health Insurance (Midwife and Nurse Practitioner) Amendment Determination 2012 (No. 1).
Section 2 Commencement
This section provides that the Determination commences on 1 November 2012.
Section 3 Amendment of the Health Insurance (Midwife and Nurse Practitioner) Determination 2011
This section provides that Schedule 1 of the Determination amends the Health Insurance (Midwife and Nurse Practitioner) Determination 2011.
Schedule 1 Amendments
Item [1] After subsection 7A(2)
This item inserts a new subsection 7A(3) which makes clear that the midwifery telehealth items 82150, 82151 and 82152 do not apply where the specialist or consultant physician providing the video consultation, or their patient, travels to a place to satisfy the 15 km rule.
Item [2] After subsection 13(2)
This item inserts a new subsection 13(3) which makes clear that the nurse practitioner telehealth items 82220, 82221, and 82222 do not apply where the specialist or consultant physician providing the video consultation, or their patient, travels to a place to satisfy the 15 km rule.
Item [3] Schedule 1, Part 1
This item sets out the indexed fee applicable to midwifery items 82100 – 82140.
Items [4], [5] and [6] Schedule 1, Part 2,
These items introduce the new 15 km minimum distance requirement for midwifery telehealth items 82150, 82151 and 82152 and set out the indexed fees for these services.
Item [7] Schedule 2, Part 2
This item sets out the indexed fees applicable to nurse practitioner items 82200 – 82215.
Items [8], [9] and [10] Schedule 2, Part 3
These items introduce the new 15 km minimum distance requirement for nurse practitioner telehealth items 82220, 82221 and 82222 and set out the indexed fees for these services.
Items [11], [12] and [13] Schedule 2, Part 3
These items amend items 82223, 82224 and 82225 so that they are consistent in format with the amended nurse practitioner telehealth items 82220, 82221 and 82222 and set out the indexed fees for these services.