EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Health Insurance Act 1973
Health Insurance (Professional Services Review - Allied Health and Others) Determination 2012
The Professional Services Review (PSR) scheme is established under Part VAA of the Health Insurance Act 1973 (the Act). Section 79A of the Act provides that the object of that Part is to protect the integrity of the Commonwealth medicare benefits and pharmaceutical benefits programs (MBS and PBS respectively) and, in doing so, protect patients and the community in general from the risks associated with inappropriate practice and protect the Commonwealth from having to meet the cost of services provided as a result of inappropriate practice.
Subsection 81(1A)(a) of the Act provides that the Minister may determine by legislative instrument that a health professional of a particular kind, who provides a health service within the meaning of subsection 3C(8) of the Act is a practitioner for the purposes of Part VAA of the Act.
Subsection 81(1A)(b) of the Act provides that the Minister may determine by legislative instrument that a vocation engaged in by a health professional of a kind determined under subsection 81(1A) is a profession under Part VAA of the Act.
The Health Insurance (Professional Services Review - Allied Health and Others) Determination 2012 (the Determination) lists those health professionals who are practitioners and those vocations that are professions for the purposes of Part VAA of the Act.
At present the PSR Scheme applies only to medical practitioners, dentists, chiropractors, physiotherapists, podiatrists, optometrists, midwives, nurse practitioners and osteopaths who provide services under Medicare and the PBS.
In the 2011 calendar year, practitioners not covered by the PSR, provided over 4 million services at a cost to Medicare of $383 million. These practitioners include audiologists; diabetes educators; dieticians; exercise physiologists; mental health nurses; occupational therapists; psychologists; social workers, speech pathologists, Aboriginal and Torres Strait Islander health practitioners, Aboriginal health workers and orthoptists.
This Determination adds these health professionals and the vocations undertaken by them to the list of matters regulated by the PSR arrangements. This will enable the PSR Scheme to be applied to all health professionals who provide Medicare services.
Details of the Determination are set out in the Attachment.
The Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Determination commences on 1 January 2013.
Consultation
These changes are based on amendments to the Act by the Health Insurance Amendment (Professional Services Review) Act 2012 (the PSR Act). The PSR Act underwent an extensive consultation process. An exposure draft of the PSR Act was released for consultation on 1 April 2010 and key professional bodies, such as the Australian Medical Association and Allied Health Professions Australia indicated their support for the changes in the PSR Act.
ATTACHMENT
Details of the Health Insurance (Professional Services Review - Allied Health and Others) Determination 2012
Section 1- Name of Determination
This section provides that the name of the Determination is the Health Insurance (Professional Services Review - Allied Health and Others) Determination 2012.
Section 2 - Commencement
This section provides that the Determination commences on 1 January 2013.
Section 3 - Interpretation
This section provides that words and expressions used in the Determination have the same meaning as given to them in the Act.
Section 4 – Health Practitioners
This section provides that, in accordance with subsection 81(1A)(a) of the Act, health professionals listed in Part A of the Schedule are practitioners for the purposes of Part VAA of the Act.
Section 5 – Professions
This section provides that, in accordance with subsection 81(1A)(b) of the Act, vocations that practitioners engage in, listed in Part B of the Schedule, are professions for the purposes of Part VAA of the Act.
Schedule 1 – Practitioners and Professions for the purposes of the Professional Services Review
The table in the Schedule provides a list of practitioners and professions who are practitioners or professions for the purposes of Part VAA of the Act.