EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Health Insurance Act 1973
Health Insurance (Midwife and Nurse Practitioner) Amendment Determination 2012 (No.2)
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), the Pathology Services Table (the PST) or the Diagnostic Imaging Services Table (the DIST) shall, in specified circumstances and for the purposes of specified statutory provisions, be treated as if it were specified in the GMST, the PST or the DIST, as appropriate. The GMST is set out in the Health Insurance (General Medical Services Table) Regulations, the PST is set out in the Health Insurance (Pathology Services Table) Regulations and the DIST is set out in the Health Insurance (Diagnostic Imaging Services Table) Regulations. Each of these tables is re-made each year.
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. The midwife and nurse practitioner telehealth items that had been created through the Telehealth Determination were subsequently recreated in the Health Insurance (Midwife and Nurse Practitioner) Determination 2011 (the Principal Determination), which revoked and remade the 2010 Determination.
New items were also created in the Principal Determination to enable participating nurse practitioners to provide certain simple, basic pathology tests under Medicare.
Purpose
The purpose of the Health Insurance (Midwife and Nurse Practitioner) Amendment Determination 2012 (No.2) (the Determination) is to amend the Principal Determination to:
- reflect the change in the geographic eligibility criteria that will be used for Medicare telehealth items from 1 January 2013; and
- decrease the fees for most nurse practitioner pathology services in the Principal Determination.
From 1 January 2013 telehealth eligible areas will be determined according to the Australian Standard Geographical Classification Remoteness Area (ASGC-RA) classification system which defines remoteness areas based on population and proximity to population centres. This will introduce a fairer system which will better target funding to areas where access to specialist services is limited. The consequential amendments to the telehealth items in the Principal Determination (items 82150, 82151, 82152, 82220, 82221 and 82222) are in line with amendments being made to the telehealth items in the GMST as a result of the change to the telehealth geographic eligibility criteria. The exclusion of areas classified as inner metropolitan will be removed from those items, and instead from 1 January 2013 all areas other than those classified as ‘Major Cities’ under the new classification system will be telehealth eligible areas. These changes will not affect the existing exemption in those items for patients who are a care recipient in a residential care service or patients of eligible Aboriginal Medical Services or Aboriginal Community Controlled Health Services.
The reduction in fees for most nurse practitioner pathology services (items 73828 – 73835 and 73837) is being made in line with a decrease in fees for pathology items in the PST to recover the amount of 2011/12 expenditure incurred over the agreed 2011/12 funding cap in the Pathology Funding Agreement.
The Pathology Funding Agreement governs the Australian Government outlays for pathology services and specifies the action to be taken when the yearly caps are exceeded or not achieved. The Pathology Funding Agreement’s signatories, the Australian Government (represented by the Department of Health and Ageing), the Australian Association of Pathology Practices, the Royal College of Pathologists of Australasia and the National Coalition of Public Pathology agreed to the percentage decrease that would apply to the fees in the PST.
Commencement
The Determination commences on 1 January 2013.
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
No consultation was undertaken in relation to changes to the telehealth items, as this decision was included as part of the 2012-13 Budget and was included in the 2012-13 Mid-Year Economic and Fiscal Outlook report.
The decrease in fees for nurse practitioner pathology items is consistent with decreases being made to fees for items in the PST which relate to the ongoing maintenance of the PST to reflect evidence-based best practice and appropriate funding.
The decrease in fees for items in the PST was negotiated between the signatories of the Pathology Funding Agreement; the Australian Government (represented by the Department of Health and Ageing), the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices and the National Coalition of Public Pathology.