EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Telehealth Services) Determination 2011
Purpose and Operation
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may determine in writing that a health service not listed in an item in the General Medical Services Table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. The Table is set out in the Health Insurance (General Medical Services Table) Regulations 2010 which is re-made each year.
A determination made under subsection 3C(1) of the Act is a legislative instrument (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
The Health Insurance (Telehealth Services) Determination 2011 (the Determination) creates new Medicare items for video consultation services provided by a range of specialists or consultant physicians to patients in eligible areas of Australia. These new items will increase access to specialist services for people in locations where it is often difficult to obtain specialist consultations, such as in rural and regional areas, and in aged care services and Aboriginal Medical Services. The items will assist to reduce the time and costs associated with accessing health care for these patients such as travel and accommodation costs.
The Determination also creates new Medicare items for assistance provided to the patient by a medical practitioner, practice nurse, Aboriginal health worker, midwife or nurse practitioner at the patient-end of a video consultation with a specialist.
Specialist items
The 11 new specialist telehealth items specified in Schedule 1 Part 1 of this Determination will enable telehealth services to be provided in conjunction with 55 existing Medicare specialist consultation items. These new items must be billed in association with one of the existing Medicare items as stipulated in the new telehealth item descriptor.
The fee for the new specialist items are derived by reference to the fee for the associated existing item that the item is rendered with, being 50 per cent of the associated item. This augmented fee recognises that the provision of a professional attendance via video conferencing involves increased administrative and professional complexity.
Support items
The 23 new telehealth support items specified in Schedule 1 Parts 2, 3, 4 and 5 of this Determination will enable support services to be provided by a range of practitioners during a video consultation with a specialist or consultant physician. These new items are time-tiered consultations with the fees provided recognising the added complexities involved in providing a supporting attendance for a specialist video consultation.
Details of the Determination are set out in the Attachment.
Consultation
On the 30 November 2010 the Government invited submissions from the public on a discussion paper on the telehealth initiative entitled ‘Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations’. The Government received nearly 70 submissions that have contributed to the formation of the telehealth initiative. There has also been considerable consultation with the Telehealth Advisory Group (TAG) on all aspects of the telehealth initiative. The TAG includes key stakeholders from across the medical profession and the new telehealth MBS items have been developed with their assistance. The TAG includes members from:
Aged Care Industry IT Council
Australian Association of Consultant Physicians
Australian Association of Practice Managers
Australasian College of Dermatologists
Australian College of Midwives
Australian College of Nurse Practitioners
Australian College of Rural and Remote Medicine
Australian General Practice Network
Australian Medical Association
Australian Nursing Federation
Australian and New Zealand College of Anaesthetists
Australian and New Zealand Society for Geriatric Medicine
Australian Practice Nurses Association
Consumers Health Forum
Council of Remote Area Nurses Australia plus
National Aboriginal Community Controlled Health Organisation
National E-Health Transition Authority
National Rural Health Alliance
Royal Australasian College of Physicians
Royal Australian College of Nursing
Royal Australasian College of Surgeons
Royal Australian College of General Practitioners
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Royal Australian and New Zealand College of Ophthalmologists
Royal Australian and New Zealand College of Psychiatrists
Rural Doctors Association of Australia
Royal Flying Doctor Service
ATTACHMENT
Notes on sections in the Determination
Part 1 Preliminary
Section 1 Name of Determination
Section 1 provides the name of the Determination.
Section 2 Commencement and term
Section 2 provides that the Determination commences on 1 July 2011 and terminates at midnight 31 October 2011.
Section 3 Definitions
Section 3 defines terms used in this Determination.
Subsection 3(2) provides that a reference to a provision of an Act or Regulations, 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 Schedule 1 to the Determination is to be treated as if there were an item in the General Medical Services 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 Amount under clause 5
Section 5 prescribes that when the fee payable for an item in Schedule 1 Part 1 of the Determination refers to the amount under clause 5, this means the fee for that item is 50% of the fee payable for the item with which the relevant service is associated.
Section 6 Amount under Table 1
Section 6 provides that in Schedule 1 Part 2 of the Determination, the ‘amount under Table 1’ refers to the amount determined in Table 1 of section 7 of the Determination.
Section 7 Limitation on support services
Subsection 7(1) provides that this section applies to the items in Parts 2 - 5 of Schedule 1 of the Determination.
Subsection 7(2)(a) provides that the items referred to in subsection 7(1) apply to a service only if that service is provided in the course of a personal attendance by a single medical practitioner on a single patient on a single occasion.
Subsection 7(2)(b) provides that only one of the support services described in subsection 7(1) can be provided to a patient on a single occasion. Any other support service provided to the patient in the course of the video conference with the specialist will not be billable under the MBS. For example, if a general practitioner supports a telehealth attendance but requires a practice nurse to attend the support service because they are required to leave the room, only one support service is billable.
Section 7 does not prevent a specified health professional who provides a telehealth support service from providing other MBS billable services to the patient immediately before or after the telehealth service.
Section 8 Midwifery services
Subsection 8(1) provides that the midwifery items in Part 4 Schedule 1 of the Determination only apply where:
a) the service is provided to the patient in accordance with a collaborative arrangement, as defined in subsection 3(1) of this Determination, for a midwife’s patient;
b) the participating midwife is not an employee of a public hospital, or is an employee of a public hospital but provides services other than in his or her capacity as a public hospital employee.
Subsection 8(2) provides that subsection 8(1) applies whether or not another person provides essential assistance to the participating midwife in providing the service.
Section 9 Nurse practitioner services
Subsections 9(1)(a) and 9(1)(b) provide that a nurse practitioner item only applies where the service is provided in accordance with collaborative arrangements in place for the patient and within the scope of practice of the participating nurse practitioner.
Subsection 9(1)(c) provides that the nurse practitioner items only apply where the participating nurse practitioner is not an employee of a public hospital, or is an employee of a public hospital but provides services other than in his or her capacity as a public hospital employee.
Subsection 9(2) provides that subsection 9(1) applies whether or not another person provides essential assistance to the participating midwife in providing the service.
Schedule 1 Services and fees
Part 1 Specialist services and fees
Part 1 of Schedule 1 to the Determination sets out the relevant specialist services, assigns applicable item numbers, item descriptors and fees for the services.
Part 2 Medical Practitioner services and fees
Part 2 of Schedule 1 to the Determination sets out the relevant medical practitioner services, assigns applicable item numbers, item descriptors and fees for the service.
Part 3 Practice Nurse and Aboriginal Health Worker services and fees
Part 3 of Schedule 1 to the Determination sets out the relevant practice nurse and Aboriginal Health Worker services, assigns applicable item numbers, item descriptors and fees for the service.
Part 4 Midwifery services and fees
Part 4 of Schedule 1 to the Determination sets out the relevant midwifery services, assigns applicable item numbers, item descriptors and fees for the service.
Part 5 Nurse practitioner services and fees
Part 5 of Schedule 1 to the Determination sets out the relevant nurse practitioner services, assigns applicable item numbers, item descriptors and fees for the service.