Explanatory Statement
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by writing, determine that a health service not listed in the general medical services table (the Table) shall, in specified circumstance and for specified statutory provisions, be treated as if it were so listed. This Table is set out in the Health Insurance (General Medical Services Table) Regulations, remade annually.
Purpose
The purpose of the Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011 (the Determination) is to remedy a drafting oversight and enable patients who have had a GP mental health treatment plan prepared for them under item 2702 or 2710 of the Health Insurance (General Medical Services Table) Regulations 2010 to access medicare benefits for a review of that plan.
Background
Prior to 1 November 2011, GP mental health treatment plans were provided under items 2702 and 2710 in the Health Insurance (General Medical Services Table) Regulations 2010. With the revocation of those regulations and their remaking as the Health Insurance (General Medical Services Table) Regulations 2011, items 2702 and 2710 were replaced by four new items for the preparation of a GP mental health treatment plan, items 2700, 2701, 2715 and 2717.
Item 2712 of the Table provides for the review of a GP mental health treatment plan. In accordance with subclause 2.20.6(4) of the Table, medicare benefits may only be paid for item 2712 where certain prerequisites are met, one of which is that a GP mental health treatment plan has been prepared for the patient in the previous 12 months (paragraph 2.20.6(4)(a)). Due to a drafting oversight, paragraph 2.20.6(4)(a) of the new Health Insurance (General Medical Services Table) Regulations 2011 provides that only GP mental health treatment plans prepared under new items 2700, 2701, 2715 and 2717 will trigger eligibility for a review of a plan under item 2712. Accordingly, patients who had received a plan under items 2702 or 2710 within the previous 12 months are not eligible to access a review of the plan under item 2712.
This Determination creates a new item for the review of a GP mental health treatment plan, corresponding to item 2712, to ensure that patients who have received a plan in the previous 12 months under items 2702 or 2710 are able to receive medicare benefits for a review of that plan.
Commencement
This Determination will be taken to commence on 1 November 2011. The retrospective commencement is necessary to enable patients to receive benefits for services provided from that date to review a GP mental health treatment plan prepared for them before 1 November 2011.
The retrospective commencement of this Determination does not contravene subsection 12(2) of the Legislative Instruments Act 2003. Subsection 3C(2) of the Act provides that a determination made under that section may be expressed to take effect on a day earlier than the date the determination is made. Further, the Commonwealth is the only person who is disadvantaged by the retrospective commencement date.
Consultation
No consultation took place in the making of this Determination as the changes are to address an oversight in the drafting of the Health Insurance (General Medical Services Table) Regulations 2011.
This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Attachment
Details of the health insurance (Review of GP Mental health treatment plan) determination 2011
Section 1 Name of Determination
Section 1 provides that the name of the Determination is the Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011.
Section 2 Commencement
Section 2 provides that the Health Insurance (Review of GP Mental Health Treatment Plan) Determination 2011 (the Determination) is taken to commence on 1 November 2011.
Section 3 Interpretation
Subsection 3(1) defines terms used in the Determination.
Subsection 3(2) provides that a reference to a provision of the Act or the National Health Act 1953, or regulations made under those Acts, is a reference to the provision as in force from time to time.
Section 4 Treatment of relevant services
Paragraph 4(a) provides that a relevant service specified in the Determination will 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 4(b) provides that a relevant service specified in the Schedule to the Determination is to be treated as if there were an item in the Table that related to the service and specified a fee for that service, being the fee specified in the Schedule to the Determination in relation to the service.
Section 5 Meaning of review of a GP mental health treatment plan
Section 5 defines the term ‘review of a GP mental health treatment plan’, which involves a medical practitioner:
• reviewing specified aspects of the preparation of a GP mental health treatment plan. including assessment of the patient’s mental disorder, devising treatment goals agreed with the patient, crisis intervention or relapse prevention plans and options for referring or treating the patient;
• checking, reinforcing and expanding education given under the plan;
• readministering the outcome measurement tool, if clinically appropriate;
• explaining to the patient, and with the patient’s consent his or her carer, what is involved in reviewing the plan and recording the patient’s agreement to the review;
• preparing a plan for crisis intervention or relapse prevention, if these are appropriate and have not previously been provided; and
• making any necessary amendments to the plan and, if the plan is amended, retaining a copy of the amended plan in the patient’s medical records and offering a copy to the patient and/or the patient’s carer.
This reflects the definition of ‘review of a GP mental health treatment plan’ currently found in clause 2.20.4 of the Table.
Section 6 Application of item 2719
Subsection 6(1) provides that item 2719 will only apply to a patient with a mental disorder. A mental disorder is defined in subsection 3(1) of the Determination as a significant impairment of any or all of a person’s cognitive, affective and relational abilities that may need medical intervention and may be a recognised and diagnosable disorder. Dementia, delirium, tobacco use disorder or mental retardation are not mental disorders under the Determination. This subsection reflects the conditions applying to item 2712 under subclause 2.20.6(1) of the Table.
Subsection 6(2) provides that item 2719 only applies to a patient who is in the community or is a private in-patient (including one who is resident in an aged-care facility) being discharged from hospital. The subsection also provides that item 2719 only applies where the service is provided during a personal attendance by a single medical practitioner on a single patient. This subsection reflects the conditions applying to item 2712 under subclause 2.20.6(2) of the Table.
Subsection 6(3) enables a patient who has received a GP mental health treatment plan within the last 12 months under item 2702 or 2710 of the Health Insurance (General Medical Services Table) Regulations 2010, as those regulations were in force on or before 31 October 2011, to access item 2719. This subsection remedies a drafting oversight in subclause 2.20.6(4) of the Table that prevents patients who have received GP mental health treatment plans under items 2702 or 2710 from accessing a review of that plan as a Medicare-eligible service under item 2712.
Subsection 6(4) prevents item 2719 from applying to a service to which any of items 735-758 (GP management plan, team care arrangements and multidisciplinary care plan items) or item 2713 (professional attendance in relation to a mental disorder) apply. This subsection reflects the conditions applying to item 2712 under paragraph 2.20.6(5)(a) of the Table.
Subsection 6(5) provides that unless exceptional circumstances exist, item 2719 does not apply more than once in a three month period, within three months following the provision of item 2712 to the patient, or within 4 weeks following the preparation of a GP mental health treatment plan for the patient under:
• items 2700, 2701, 2715 or 2717 of the current Table; or
• items 2702 or 2710 of the Health Insurance (General Medical Services Table) Regulations 2010, as those regulations were in force on or before 31 October 2011.
This subsection reflects the conditions applying to item 2712 under paragraph 2.20.6(5)(b) of the Table.
Section 7 Specification of item 2719 in general medical services table
Paragraph 3C(1)(b) of the Act gives the Determination the power to specify that regulations made under the Act shall have effect as if the items specified in the Determination were also specified in provisions of the regulations.
Subsection 7(1) provides that paragraphs 2.20.6(3)(c) and 2.20.6(4)(b), and subclause 2.20.6(7), of the Table, shall have effect as if item 2719 were also specified in those provisions. This means that:
• the preparation of a GP mental health treatment plan items 2700, 2701, 2715 and 2717 cannot be claimed within 3 months from the provision of item 2719;
• a patient will be eligible to access the review of a GP mental health treatment plan item 2712 if the patient has had his or her plan reviewed under item 2719 in the previous 12 months; and
• item 2713 (professional attendance in relation to a mental disorder) will not apply in association with item 2719.
Subsection 7(2) provides that column 3 of item 12 of Schedule 6 to the Health Insurance Regulations 1975 shall have effect as if item 2719 were also specified in the item. Where an item is specified in Schedule 6 of the Health Insurance Regulations 1975, medicare benefits are payable at 100% of the schedule fee.
Schedule Specified health services
The Schedule to the Determination sets out the relevant service and assigns an item number and fee for the service.