EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Requirements for Allied Health Professionals) Determination 2005
Subregulation 3A(2) of the Health Insurance Regulations 1975 (the Regulations) enables the Minister to make a written determination specifying additional requirements that must be met by allied health professionals who provide certain allied health services.
An allied health professional must meet the applicable requirements in subregulation 3A(2) of the Regulations and in this Determination in order to be able to provide certain allied health services that will be eligible for a Medicare benefit. The circumstances in which an allied health service will attract a Medicare benefit and the relevant fees are described in the items created under the Medicare Benefits Schedule, as set out in a separate Determination made by the Minister under section 3C of the Health Insurance Act 1973 (the Act) – the Health Insurance (Allied Health and Dental Services) Determination 2005. An amendment to this Determination (Health Insurance (Allied Health and Dental Services) Determination Amendment 2005 (No. 2) prescribes the fees and requirements for an eligible exercise physiology service.
The purpose of this Determination is to revoke the previous Determination and add exercise physiology eligibility requirements. This Determination specifies additional eligibility requirements for the following types of allied health professionals:
- Aboriginal health workers
- Audiologists
- Dietitians
- Mental health workers
- Occupational therapists
- Podiatrists
- Speech pathologists
- Diabetes educators
- Exercise Physiologists
All but diabetes educators and exercise physiologists were previously specified in the previous Determination, Health Insurance (Requirements for Allied Health Professionals) Determination 2004. Diabetes educators were added under Health Insurance (Requirements for Allied Health Professionals) Amendment Determination 2004. This new Determination replaces these Determinations.
Details of this Determination are set out in the Attachment.
The Determination commences on 1 January 2006.
Consultation
The Department of Health and Ageing consulted with the allied health and dental care initiative’s consultative group regarding the inclusion of exercise physiologists. The group includes representatives from the Australian Divisions of General Practice, the Australian Medical Association, the Royal Australian College of General Practitioners, the Rural Doctors Association, all national peak bodies representing eligible allied health professional groups, the Australian Dental Association and Medicare Australia. The Australian Association of Exercise and Sports Science were also involved in developing the requirements of the item.
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (REQUIREMENTS FOR ALLIED HEALTH PROFESSIONALS) DETERMINATION 2004
Section 1 provides for the Determination to be referred to as the Health Insurance (Requirements for Allied Health Professionals) Determination 2005.
Section 2 provides for the Determination to commence on 1 January 2006.
Section 3 revokes the earlier Determination.
Section 4 provides an explanation of terms used in the Determination.
Section 5 explains that the purpose of the Determination is to specify additional requirements that must be met by allied health professionals who provide certain allied health services. These requirements are in addition to the eligibility requirements specified in paragraphs 3A(2)(a) and (b) of the Health Insurance Regulations 1975.
Section 6 sets out the eligibility requirements that apply to Aboriginal health workers.
Section 7 sets out the eligibility requirements that apply to audiologists.
Section 8 sets out the eligibility requirements that apply to dietitians.
Section 9 sets out the eligibility requirements that apply to mental health workers. A mental health worker is an allied health professional who provides a mental health service, including an Aboriginal health worker, a mental health nurse, an occupational therapist, a psychologist, and a social worker.
Section 10 sets out the eligibility requirements that apply to occupational therapists.
Section 11 sets out the eligibility requirements that apply to podiatrists.
Section 12 sets out the eligibility requirements that apply to speech pathologists.
Section 13 sets out the eligibility requirements that apply to diabetes educators.
Section 14 sets out the eligibility requirements that apply to exercise physiologists.
Overview
The Health Insurance (Requirements for Allied Health Professionals) Determination 2005 was enacted to address the need for specifying additional requirements that allied health professionals must meet to provide certain allied health services eligible for Medicare benefits. This Determination, made under the authority of the Health Insurance Act 1973, was introduced to replace the previous Determination and to add new eligibility requirements for exercise physiologists, thereby ensuring that allied health services attract the appropriate Medicare benefits. The Department of Health and Ageing undertook consultations with various stakeholders, including representatives from allied health and dental care, to develop the requirements for these allied health professionals. This new Determination came into effect on 1 January 2006 and sets forth eligibility requirements for various allied health professionals, including Aboriginal health workers, audiologists, dietitians, mental health workers, occupational therapists, podiatrists, speech pathologists, diabetes educators, and exercise physiologists.
Scope and Application
The Health Insurance (Requirements for Allied Health Professionals) Determination 2005 applies to allied health professionals who provide certain allied health services in Australia and are seeking eligibility for a Medicare benefit. This includes professionals such as Aboriginal health workers, audiologists, dietitians, mental health workers, occupational therapists, podiatrists, speech pathologists, diabetes educators, and exercise physiologists. To be eligible for a Medicare benefit, these professionals must meet the requirements set out in this Determination in addition to those specified in subregulation 3A(2) of the Health Insurance Regulations 1975. This Determination revokes previous requirements and introduces new eligibility criteria for exercise physiologists. It is applicable nationally across Australia and came into effect on 1 January 2006. The Minister for Health and Ageing has the authority to amend this Determination through subordinate instruments, as per subregulation 3A(2) of the Regulations.
Key Provisions
The Health Insurance (Requirements for Allied Health Professionals) Determination 2005 (the Determination) provides specific eligibility criteria that allied health professionals must meet to offer certain allied health services that are eligible for a Medicare benefit. This Determination supplements the requirements outlined in subregulation 3A(2) of the Health Insurance Regulations 1975 (the Regulations). Allied health professionals must meet these requirements to qualify for Medicare benefits for the services they provide, as detailed in the Medicare Benefits Schedule under the Health Insurance (Allied Health and Dental Services) Determination 2005. This Determination not only updates the previous Determination but also introduces new requirements for exercise physiologists, thereby replacing the Health Insurance (Requirements for Allied Health Professionals) Determination 2004 and its subsequent amendments.
The Determination lays out various obligations for allied health professionals, including Aboriginal health workers, audiologists, dietitians, mental health workers, occupational therapists, podiatrists, speech pathologists, diabetes educators, and exercise physiologists. Each category of allied health professional has specific eligibility criteria, such as educational qualifications, registration with a relevant professional body, and sometimes additional training or experience in specific areas. For instance, mental health workers, which include a range of professionals such as mental health nurses, psychologists, and social workers, must provide a mental health service. These obligations ensure that only qualified professionals who meet the specified standards can provide services that attract Medicare benefits.
Failure to comply with the requirements set out in this Determination can lead to serious consequences. Allied health professionals who do not meet the eligibility criteria cannot claim Medicare benefits for the services they provide. This lack of compliance could result in financial penalties or other administrative actions taken by Medicare Australia. While the Determination does not explicitly state criminal or civil penalties for non-compliance, it is clear that not adhering to the specified requirements will result in the professionals being ineligible for Medicare benefits, which could significantly impact their ability to operate and be reimbursed for their services.
The Determination was developed through consultation with various stakeholders, including representatives from general practice, medical associations, peak bodies for allied health professional groups, and the Australian Dental Association. This collaborative approach ensures that the requirements are practical, evidence-based, and reflect the current standards of practice within the allied health professions. The Australian Association of Exercise and Sports Science was also involved in setting the requirements for exercise physiologists. This comprehensive consultation process aims to balance the need for high-quality health services with the practicalities of delivering these services within the Australian healthcare system.