EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health

Health Insurance Act 1973

Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Amendment Determination 2018

Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by legislative instrument, determine that a health service not specified in an item in the general medical, diagnostic imaging or pathology services table (the Tables) shall, in specified circumstances and for specified statutory provisions, be treated as if it were specified in the Tables. 

Subsection 33(3) of the Acts Interpretation Act 1901 provides that where an Act confers a power to make, grant or issue any instrument of a legislative or administrative character (including rules, regulations or by-laws), the power shall be construed as including a power exercisable in the like manner and subject to the like conditions (if any) to repeal, rescind, revoke, amend, or vary any such instrument.

Purpose

On 1 July 2018 a new fee structure was created for standard and non-standard attendances performed by “medical practitioners” working in general practice. The definition of “medical practitioner” in the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 (the Principle Determination) excludes general practitioners (GPs) and specialists, who have access to their own items in the general medical services table.

The new fee structure created 94 new general practice services available to these doctors with a fee that is 80% of the equivalent specialist GP item in the general medical services table. These amendments were implemented by the Principle Determination.

The purpose of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Amendment Determination 2018 (the Determination) is to amend the Principle Determination to introduce two new items for the provision of focussed psychological strategies delivered by medical practitioners via video conference when provided to patients in rural and remote areas.

Currently, a Medicare benefit only applies when these services are provided by appropriately qualified allied health professionals, including but not limited to psychologists, occupational therapists and social workers. Medical practitioners can provide these services, but only for personal attendances.

From 1 November 2018, medical practitioners will also be able to provide focussed psychological strategies via telehealth under Medicare in rural and remote areas (Modified Monash areas 4 to 7).

This change will support the mental health, wellbeing and resilience of farming communities, and support people in rural and remote communities who choose to complete their treatment using this channel.

It is widely recognised that there is a scarcity of mental health professionals in some of the more remote areas of Australia, and this, along with mental health stigma, can act as a significant barrier for those who need to access these services.

The Determination also adjusts the fees for eight existing items in the Principle Determination.

Consultation

Consultation was undertaken with key medical groups such as the Royal Australian College of General Practitioners, the Australian College of Rural and Remote Medicine and the Rural Doctors Association of Australia.

Details of the Determination are set out in the Attachment.

The Determination commences on 1 November 2018.

The Determination is a legislative instrument for the purposes of the
Legislation Act 2003.

Authority:     Subsection 3C of the
Health Insurance Act 1973

ATTACHMENT

Details of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Amendment Determination 2018

Section 1 – Name of Determination

Section 1 provides for the Determination to be referred to as the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Amendment Determination 2018.

Section 2 – Commencement

Section 2 provides that the Determination commences on 1 November 2018.

Section 3 – Authority

Section 3 provides that the Determination is made under subsection 3C(1) of the Health Insurance Act 1973.

Section 4 – Schedules

Section 4 provides that that each instrument that is specified in a Schedule to this Determination is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Instrument has effect according to its terms.

Schedule 1 - Amendments

Item 1 - Subsection 4(1)

This item inserts a new definition into the Principal Determination to support the addition of items 371 and 372. Specifically, it inserts a definition for ‘telehealth area’, a term used within these new items.

Item 2 - Schedule 1, subclause 1.1.1(1) (Table 1.1.1 - amount under clause 1.1.1)

This item repeals and substitutes the table in subclause 1.1.1(1) to amend the fees (listed in columns 3 and 4 of table 1.1.1) for eight items (181, 183, 187, 188, 191, 202, 206 and 212). The fees for these items have been amended so the services are set at a value of 80% for the equivalent specialist GP item in the general medical services table.

Item 3 – Subsections 1.9.4(1) and 1.9.4(2)

This item applies new items 371 and 372 to subsections 1.9.4(1) and 1.9.4(2) of the Principle Determination.

Subsection 1.9.4(1) of the Principle Determination requires that:

• the service must be clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and
• the rendering medical practitioner must:
  • be registered with the Department of Human Services as being eligible to render focussed psychological strategies items; and
  • meet any training and skills requirements as determined by the General Practice Mental Health Standards Collaboration.

Subsection 1.9.4(2) limits how many focussed psychological strategies can be rendered per patient. Paragraph 1.9.4(2)(a) requires that a maximum of 6 focussed psychological strategies services can be rendered in a calendar year without requiring the patient to undergo a review by the medical practitioner managing the GP mental health treatment plan or the psychiatrist assessment and management plan. Paragraph 1.9.4(2)(b) limits the total number of focussed psychological strategies to 10 per patient in a calendar year.

Item 4 – Schedule 1 (after clause 1.9.4)

This item inserts new clause 1.9.5 after clause 1.9.4. This clause provides that items 371 and 372 do not apply if the patient or medical practitioner travels to satisfy the distance requirement.

Item 5 - Schedule 1 (after item 287)

This item inserts new items 371 and 372. These items are for the provision of Focussed psychological strategies delivered by medical practitioners via video conference to patients in Modified Monash areas 4 to 7.

Modified Monash is a geographical classification system developed by the Department of Health (the Department) for categorising metropolitan, regional, rural and remote locations according to both geographical remoteness and population size, based on population data published by the Australian Bureau of Statistics. The Department uses the Australian Statistical Geography Standard (ASGS) system as published by the Australian Bureau of Statistics in July 2011, but has different numbering system. Maps of the Modified Monash areas and the Department’s remoteness classification are available at www.doctorconnect.gov.au.

Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Amendment Determination 2018
 

This Determination is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

Overview of the Determination

On 1 July 2018 a new fee structure was created for standard and non-standard attendances performed by “medical practitioners” working in general practice. The definition of “medical practitioner” in the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 (the Principle Determination) excludes general practitioners (GPs) and specialists, who have access to their own items in the general medical services table.

The new fee structure created 94 new general practice services available to these doctors with a fee that is 80% of the equivalent specialist GP item in the general medical services table. These amendments were implemented by the Principle Determination.

The purpose of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Amendment Determination 2018 (the Determination) is to amend the Principle Determination to introduce two new items for the provision of focussed psychological strategies delivered by medical practitioners via video conference when provided to patients in rural and remote areas.

Currently, a Medicare benefit only applies when these services are provided by appropriately qualified allied health professionals, including but not limited to psychologists, occupational therapists and social workers. Medical practitioners can provide these services, but only for personal attendances.

From 1 November 2018, medical practitioners will also be able to provide focussed psychological strategies via telehealth under Medicare in rural and remote areas (Modified Monash areas 4 to 7).

This change will support the mental health, wellbeing and resilience of farming communities, and support people in rural and remote communities who choose to complete their treatment using this channel.

It is widely recognised that there is a scarcity of mental health professionals in some of the more remote areas of Australia, and this, along with mental health stigma, can act as a significant barrier for those who need to access these services.

The Determination also adjusts the fees for eight existing items in the Principle Determination.

Human rights implications

The Determination engages Articles 9 and 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the rights to health and social security.

The Right to Health

The right to the enjoyment of the highest attainable standard of physical and mental health is contained in Article 12(1) of the ICESCR. The UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not a right for each individual to be healthy, but is a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.

The Committee reports that the ‘highest attainable standard of health’ takes into account the country’s available resources. This right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs, and conditions necessary for the realisation of the highest attainable standard of health.

The Right to Social Security

The right to social security is contained in Article 9 of the ICESCR. It requires that a country must, within its maximum available resources, ensure access to a social security scheme that provides a minimum essential level of benefits to all individuals and families that will enable them to acquire at least essential health care. Countries are obliged to demonstrate that every effort has been made to use all resources that are at their disposal in an effort to satisfy, as a matter of priority, this minimum obligation.

The Committee reports that there is a strong presumption that retrogressive measures taken in relation to the right to social security are prohibited under ICESCR. In this context, a retrogressive measure would be one taken without adequate justification that had the effect of reducing existing levels of social security benefits, or of denying benefits to persons or groups previously entitled to them. However, it is legitimate for a Government to re-direct its limited resources in ways that it considers to be more effective at meeting the general health needs of all society, particularly the needs of the more disadvantaged members of society.

Analysis

This Determination will maintain rights to health and social security by ensuring access to publicly subsidised health services which are clinically effective, safe and cost-effective.

Conclusion

This Determination is compatible with human rights as it has a positive effect on human rights issues.

Celia Street

Assistant Secretary

Diagnostic Imaging and Pathology Branch

Medical Benefits Division

Department of Health