EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Midwife and Nurse Practitioner) Determination 2010
Purpose and Operation
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 Table) shall, in specified circumstances and for the purposes of specified statutory provisions, be treated as if it were so specified. The Table is set out in the Health Insurance (General Medical Services Table) Regulations which are re-made each year.
A determination made under subsection 3C(1) of the Act is a legislative instrument (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
This Health Legislation Amendment (Midwives and Nurse Practitioners) Act 2010 (the Midwives and Nurse Practitioners Act) commenced on 12 April 2010 and amended the National Health Act 1953 and the Health Insurance Act 1973 to provide for new arrangements to enhance and expand the role of midwives and nurse practitioners, working in collaboration with medical practitioners, to allow them to take a greater role in providing quality health care.
The amendments to the National Health Act 1953 and the Health Insurance Act 1973 enable participating midwives and nurse practitioners (eligible midwives and nurse practitioners who provide services in a collaborative arrangement with a medical practitioner) to request appropriate diagnostic imaging and pathology services for which Medicare benefits may be paid and to prescribe certain medicines under the Pharmaceutical Benefits Scheme (PBS). They also facilitate the development of secondary legislation to provide for such matters as referrals by these groups and the creation of new items under the Medicare scheme for the provision of midwifery and nurse practitioner services.
The Health Insurance (Midwife and Nurse practitioner) Determination 2010 (the Determination) continues the implementation of the new arrangements by creating new Medicare items for services provided by participating midwives and participating nurse practitioners.
Midwifery items
The new midwifery items will enable the payment of Medicare benefits to patients of participating midwives for antenatal, birthing and postnatal care. The items include:
- an initial antenatal attendance of at least 40 minutes duration (item 82100);
- a short antenatal attendance of up to 40 minutes duration (item 82105);
- a long antenatal attendance of more than 40 minutes duration (item 82110);
- development of a maternity care plan for a pregnant woman, where the pregnancy has progressed beyond 20 weeks (item 82115);
- management of a confinement for up to 12 hours (item 82120);
- management of a confinement in excess of 12 hours, where care of the patient is transferred from one midwife to a second midwife (item 82125);
- short postnatal attendance of up to 40 minutes duration (item 82130);
- long postnatal attendance of at least 40 minutes duration (item 82135); and
- six week postnatal attendance (item 82140), after which the woman would see her general practitioner.
Antenatal and postnatal services may be provided in a range of settings including in consulting rooms, community clinics and the woman’s home. Medicare benefits for the management of labour and delivery will only be payable where the service is provided to an admitted patient of a hospital, including a hospital birthing centre.
Nurse practitioner items
Nurse practitioners work at an advanced clinical level which includes diabetes care, emergency nursing, intensive care, women’s health, aged care, palliative care, paediatrics, urology, wound management, mental health, rural and remote health, men’s health, community health or young people’s health.
The new nurse practitioner items will enable the payment of Medicare benefits to patients of participating nurse practitioners. The new nurse practitioner items include four time-tiered consultation attendances providing for short straightforward consultations through to longer, more complex services:
- Level A consultation – item 82200;
- Level B consultation (less than 20 minutes) – item 82205;
- Level C consultation (at least 20 minutes) – item 82210; and
- Level D consultation (at least 40 minutes) – item 82215.
Medicare eligible services provided by participating nurse practitioners must be within the nurse practitioner’s scope of practice.
Details of the Determination are set out in the Attachment.
Consultation
Consultation regarding the Medicare item structure and content for services by participating midwives and participating nurse practitioners was provided via advisory groups established to advise on specific clinical issues and technical aspects. The advisory groups included practitioners from relevant medical and health professions, with experience in midwifery, nursing, general practice, obstetrics, and representatives from registration bodies, state and territory health services, regional and remote health services, Indigenous populations, and consumers.
This Determination commences on 1 November 2010.
This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
ATTACHMENT
Details of the Health Insurance (Midwife and Nurse Practitioner) Determination 2010
Part 1 Preliminary
Section 1 Name of Determination
Section 1 provides that the name of the Determination is the Health Insurance (Midwife and Nurse Practitioner) Determination 2010.
Section 2 Commencement
Section 2 provides that the Determination commences on 1 November 2010.
Section 3 Definitions
Subsection 3(1) defines terms used in the Determination.
Part 2 Midwifery services
Section 4 Interpretation
Subsection 4(1) provides that a ‘collaborative arrangement’, in respect of a patient of a participating midwife, is an arrangement mentioned in regulation 2C of the Health Insurance Regulations 1975.
Subsection 4(2) provides that in Part 2 of the Determination a participating midwife is a ‘member of a practice that provided the patient’s antenatal care’ if the midwife:
- participates in the provision of professional services as part of the practice, including as a partner in the practice or as an employee of the practice;
- provides relief services to the practice; or
- provides services at the practice as a locum.
This definition is relevant for the midwifery and confinement items (82120 and 82125).
Section 5 Treatment of midwifery services
Paragraph 5(a) provides that a relevant midwifery service specified in the Schedule to the Determination is to 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 regulations made under each Act which provide for medical services or professional services.
Paragraph 5(b) provides that a relevant service specified in Part 1 of Schedule 1 to the Determination (a midwifery service) is to be treated as if there were an item in the Table that related to the relevant service and specified a fee for that service, being the fee specified in Part 1 of Schedule 1 in relation to the service.
Section 6 Requirements – collaborative arrangements
Section 6 provides that a midwifery item in the Determination only applies where the service is provided in accordance with ‘collaborative arrangements’ in place for the patient.
This requirement is consistent with the definition of ‘participating midwife’ in subsection 3(1) of the Act, which provides that an eligible midwife is a participating midwife so far as he or she provides midwifery treatment in a collaborative arrangement of a kind or kinds specified in the regulations, with one or more medical practitioners of a kind or kinds specified in the regulations.
The Health Insurance Regulations 1975 require that collaborative arrangements between midwives and appropriate medical practitioners must provide for consultation, referral of the patient, or transfer the patient’s care as clinical needs dictate (see regulation 2C). That regulation also provides that an eligible midwife can establish a collaborative arrangement through:
a) being employed or engaged by one or more specified medical practitioners or by an entity that employs or engages one or more specified medical practitioners;
b) a written referral of a patient from a specified medical practitioner;
c) an agreement with one or more specified medical practitioners; or
d) an arrangement with one or more specified medical practitioners, with an acknowledgement by the medical practitioner/s that he or she will be collaborating in the patient’s care recorded in the patient’s records.
Section 7 Other requirements
Subsection 7(1) provides that the midwifery items in the Determination only apply where:
a) the service is personally performed by the participating midwife. Accordingly, these services cannot be performed by another practitioner on a midwife’s behalf;
b) the service is provided to a single patient at the one time. Attending multiple patients on the one occasion, such as group attendances, would not apply; and
c) the participating midwife is not an employee of a public hospital, or is an employee of a public hospital but provides services other than in his or her capacity as a public hospital employee.
Subsection 7(2) provides that subsection 7(1) applies whether or not another person provides essential assistance to the participating midwife in providing the service.
Subsection 7(3) requires that for a midwifery item to apply, the patient must be in attendance when the service is provided.
Subsections 7(4) and 7(5) provide clarification of the content of the requirement for ‘professional attendance’ in items 82100 – 82115 and items 82130 – 82140. Professional attendance includes the provision of services such as advising the patient about his or her condition, making clinical notes about the services provided to the patient and formulating a plan for the patient’s treatment. However, it does not include supplying a vaccine in connection with the service unless the cost of the vaccine has been subsidised by the Commonwealth or the State.
Section 8 Labour and delivery
Subsection 8(1) requires that for confinement items 82120 and 82125 to apply, the service must be provided during a period of exclusive and continuous care of the patient by the participating midwife. This means that the participating midwife attends the patient for the duration of the service to the exclusion of all other patients. The midwife could not be managing more that one patient on the one occasion and sharing his or her time between them.
Subsection 8(2) provides that where a patient’s care has been referred to an obstetrician or medical practitioner by a participating midwife prior to the commencement of labour, with that medical practitioner or obstetrician managing the patient’s labour and delivery, the midwife is precluded from also providing care during the confinement under items 82120 and 82125.
Subsection 8(3) recognises that there will be circumstances where the participating midwife is unable to undertake the patient’s delivery under item 82120, either because the woman’s labour exceeds twelve hours and care is transferred to a second midwife or where there is a clinical need to escalate care to a medical practitioner. This subsection enables the payment of Medicare benefits in these circumstances. Medicare benefits are not payable under item 82120 where a participating midwife routinely provides care during labour for patients that a medical practitioner intends to deliver.
Subsection 8(4) recognises that there will be circumstances where a participating midwife to whom a patient has been transferred is unable to undertake the patient’s delivery under item 82125, either because:
- the woman’s labour exceeds twenty four hours (being twelve hours under the care of the first midwife from whom the patient has been transferred and twelve hours under the care of the midwife to whom the patient was transferred) and care is transferred to another midwife; or
- there is a clinical need to escalate care to a medical practitioner.
This subsection enables the payment of Medicare benefits in these circumstances. Medicare benefits are not payable under item 82125 where a participating midwife routinely provides care during labour for patients that a medical practitioner intends to deliver.
Part 3 Nurse practitioner services
Section 9 Treatment of nurse practitioner services
Paragraph 9(a) provides that a relevant nurse practitioner service specified in the Schedule to the Determination is to 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 regulations made under each Act which provide for medical services or professional services.
Paragraph 9(b) provides that a relevant service specified in Part 2 of Schedule 1 to the Determination (a nurse practitioner service) is to be treated as if there were an item in the Table that related to the relevant service and specified a fee for that service, being the fee specified in Part 2 of Schedule 1 in relation to the service.
Section 10 Requirements – collaborative arrangements and scope of practice.
Subsection 10(1) provides that a nurse practitioner item only applies where the service is provided in accordance with collaborative arrangements in place for the patient and within the scope of practice of the participating nurse practitioner.
Subsection 10(2) provides that a collaborative arrangement, in respect of a patient of a participating nurse practitioner, is an arrangement mentioned in regulation 2F of the Health Insurance Regulations 1975.
Collaborative arrangements for participating nurse practitioners closely resemble those for participating midwives. An eligible nurse practitioner is only a participating nurse practitioner so far as he or she provides services in a collaborative arrangement of a kind or kinds specified in regulation with one or more medical practitioners of a kind or kinds specified in regulations (see subsection 3(1) of the Act).
Similarly to participating midwives, collaborative arrangements between participating nurse practitioners and medical practitioners must also provide for consultation, referral of the patient or transfer of the patient’s care as clinical needs dictate. Participating nurse practitioners can establish collaborative arrangements through the same mechanisms as participating midwives (see regulation 2F of the Health Insurance Regulations 1975).
Section 11 Other requirements
Subsection 11(1) provides that the nurse practitioner items only apply where:
a) the service is personally performed by the participating nurse practitioner. Accordingly, these services cannot be performed by another practitioner on a nurse practitioner’s behalf;
b) the services is provided to a single patient at the one time. Attending multiple patients on the one occasion, such as group attendances, would not apply;
c) the participating nurse practitioner is an employee of a private hospital, or is an employee of a public hospital but provides the services other than in his or her capacity as a public hospital employee.
Subsection 11(2) provides that subsection 11(1) applies whether or not another person provides essential assistance to the participating nurse practitioner in providing the service.
Subsection 11(3) requires that for a nurse practitioner item to apply, the patient must be in attendance when the service is provided.
Subsections 11(4) and 11(5) provide clarification of the content of the requirement for ‘professional attendance’ in the nurse practitioner items (items 82200 – 82215). The content of professional attendance for nurse practitioners is the same as that for participating midwives.
Schedule 1 Services and fees
Part 1 Midwifery services and fees
Part 1 of Schedule 1 to the Determination sets out the relevant midwifery services, assigns applicable item numbers, item descriptors and fees for the services.
Part 2 Nurse practitioner services and fees
Part 2 of Schedule 1 to the Determination sets out the relevant nurse practitioner services, assigns applicable item numbers, item descriptors and fees for the service.