EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Telehealth Services) Determination 2012
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 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 which are remade each year.
Purpose
The Health Insurance (Telehealth Services) Determination 2012 (the Determination) provides a new Medicare Benefits Schedule item to enable an attendance by a Practice Nurse appropriately qualified Aboriginal Health Worker or registered Aboriginal and Torres Strait Islander Health Practitioner on behalf of and under the supervision of a medical practitioner, to provide clinical support to a patient who is: participating in a video consultation with a specialist, consultant physician or psychiatrist; not a care recipient in a residential care service; located outside an inner metropolitan area; and not an admitted patient.
The Determination creates a new Medicare Benefits Schedule item and re-introduces from the date of registration the criterion that telehealth support services by a Practice Nurse or appropriately qualified Aboriginal Health Worker are able to be provided to patients located outside an inner metropolitan area. State or Territory registered Aboriginal and Torres Strait Islander Health Practitioners are now recognised as a separate professional grouping rather than as a subset of the term ‘Aboriginal Health Worker’. The term ‘Aboriginal and Torres Strait Islander Health Practitioner’ has been introduced in the Health Insurance (General Medical Services Table) Regulations. That term has been inserted into this Determination as well.
Statement of human rights compatibility
The 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.
The Determination is taken to have commenced on 1 November 2011 and is to cease at midnight on 31 October 2012. The retrospective commencement 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 that the date the determination is made. Further, the Commonwealth is the only person who is disadvantaged by the retrospective commencement date.
Consultation
As this is a change to correct a drafting oversight that aligns with the original intent of the item, no consultation with stakeholders was undertaken.
A determination made under subsection 3C(1) of the Act is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
ATTACHMENT
Details of the Health Insurance (Telehealth Services) Determination 2012.
Section 1 – Name of Determination
Section 1 provides that the title of the Determination is the Health Insurance (Telehealth Services) Determination 2012.
Section 2 – Commencement and Cessation
Section 2 provides that the Determination is taken to have commenced on 1 November 2011 and is to cease at midnight on 31 October 2012. It is the Department’s intention to seek an amendment to the Table to provide for the ability of a Practice Nurse, appropriately qualified Aboriginal Health Worker or registered Aboriginal and Torres Strait Islander Health Practitioner to provide clinical support service to a patient located outside an inner metropolitan area.
Section 3 - Definitions
Subsection 3(1) defines terms used in the Determination.
A key term is 'relevant service' which means a health service as defined in subsection 3C(8) of the Act that is specified in the Schedule to the Determination. There are 12 such relevant services in the Schedule to the Determination.
Subsection 3(2) provides that a reference in the Determination to a provision of an Act or regulations is a reference to that 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 Schedule to the Determination shall 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 that make provision 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 in respect of that service, being the fee specified in the Schedule to the Determination in relation to the service.
Section 5 Limitation on support services
Subsection 5 (1) provides that this section applies to the item in Schedule 1 of the Determination.
Subsection 5(2)(a) provides that the item referred to in subsection 5(1) applies to a service only if that service is provided in the course of a personal attendance by a single specified health professional on a single patient on a single occasion and no other service described in an item in subsection 5(2)(b) is provided to the patient on the same 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
Subsection 5(2)(b) lists the lists the items that describe the services that cannot be provided to the patient on the same occasion for the purposes of subsection 5(2)(a) .
Section 5 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.
Schedule 1 Services and fees
Practice Nurse, Aboriginal Health Worker and Aboriginal and Torres Strait Islander Health Practitioner services and fees
Schedule 1 to the Determination sets out the relevant practice nurse, Aboriginal Health Worker and Aboriginal and Torres Strait Islander Health Practitioner service, assigns an applicable item number, item descriptor and fee for the service.