Health Insurance (Professional Services Review - Allied Health and Others) Determination 2012

Overview

The Health Insurance (Professional Services Review - Allied Health and Others) Determination 2012, issued under the Health Insurance Act 1973, aims to extend the scope of the Professional Services Review (PSR) scheme to encompass additional health professionals who provide services under Medicare and the Pharmaceutical Benefits Scheme (PBS). This Determination, enacted by the Parliament of Australia, was introduced to address a gap in the PSR scheme that previously only covered medical practitioners, dentists, and several other specified health professionals. The objective of the PSR scheme is to safeguard the integrity of the Medicare and PBS programs by preventing inappropriate practices and reducing unnecessary costs to the Commonwealth. The Determination lists additional health professionals, such as audiologists, diabetes educators, dieticians, and psychologists, thereby expanding the scheme to cover all health professionals who provide Medicare services. This legislative instrument, which commenced on 1 January 2013, was developed following extensive consultations with key professional bodies, including the Australian Medical Association and Allied Health Professions Australia, which supported the changes introduced by the Health Insurance Amendment (Professional Services Review) Act 2012.

Scope and Application

The Health Insurance (Professional Services Review - Allied Health and Others) Determination 2012 extends the scope of the Professional Services Review (PSR) scheme under Part VAA of the Health Insurance Act 1973 to encompass a broader range of health professionals. This legislative instrument, issued by the Minister for Health, aims to protect the integrity of the Commonwealth's Medicare and Pharmaceutical Benefits Schemes (MBS and PBS) by ensuring that all health professionals providing services under these schemes are subject to appropriate review processes. The Determination applies to health professionals including 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, who were previously not covered by the PSR arrangements. By listing these health professionals and their respective vocations in the Schedule, the Determination ensures that the PSR scheme can be uniformly applied to all health professionals who provide Medicare services, thereby mitigating risks associated with inappropriate practice and preventing unnecessary costs to the Commonwealth. The Determination commences on 1 January 2013 and is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

Key Provisions

The Health Insurance (Professional Services Review - Allied Health and Others) Determination 2012 (the Determination) is a legislative instrument that outlines the practitioners and professions covered by the Professional Services Review (PSR) scheme under Part VAA of the Health Insurance Act 1973. Section 4 of the Determination specifies that certain health professionals, including 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, are recognised as practitioners for the purposes of the PSR scheme. Section 5 of the Determination lists the vocations these professionals engage in as professions covered by Part VAA of the Act. The Determination imposes obligations on the listed health professionals to comply with the requirements of the PSR scheme. These obligations include participating in professional services reviews to ensure the integrity of the Medicare and Pharmaceutical Benefits Schemes (MBS and PBS). The scheme aims to prevent inappropriate practice and protect both patients and the community from associated risks, while also safeguarding the Commonwealth from unnecessary costs. Breaches of the provisions under the PSR scheme may result in various consequences. The Health Insurance Act 1973 includes provisions for both civil and criminal penalties. For civil penalties, offenders may be liable to fines that can reach up to a significant amount, as specified by the relevant legislation. Criminal penalties may also apply, leading to potential imprisonment for serious or repeated violations of the Act's requirements. The exact penalties are detailed within the broader Health Insurance Act 1973 and may vary based on the nature and severity of the breach.