Common Form of Undertaking for Participating Optometrists Amendment Instrument 2014
Health Insurance Act 1973
I, Dr Megan Keaney, delegate of the Minister of Health, pursuant to subsection 23A(3) of the Health Insurance Act 1973 make the following instrument.
Dated 15 December 2014
Dr Megan Keaney
A/g Assistant Secretary and Medical Advisor
Medical Specialist Services Branch
Medical Benefits Division
Department of Health
1. Name of Instrument
3. Variation replaces previous Common Form of Undertaking
5. Common Form of Undertaking for Participating Optometrists
1 Name of Instrument
This Instrument is called the Common Form of Undertaking for Participating Optometrists Amendment Instrument 2014 (the Instrument).
This Instrument commences on 1 January 2015.
3 Amendment of the Common Form of Undertaking for Participating Optometrists
Attachment A of this Instrument omits Attachment A of the Common Form of Undertaking for Participating Optometrists (the Principal Instrument) F2005L03325, and substitutes Attachment A to this Instrument.
In accordance with subsection 23A (3) of the Health Insurance Act 1973 the Australian Optometrical Association has been consulted in relation to this variation to the Principal Instrument.
5 Common Form of Undertaking for Participating Optometrists
The form contained in Attachment A and Schedules to Attachment A of this Instrument are the Common Form of Undertaking to be given by optometrists who wish to become participating optometrists under the Health Insurance Act 1973.
Common Form of Undertaking for
Sections 23A and 23B
Health Insurance Act 1973
For the purposes of section 23A of the Health Insurance Act 1973 (the Act)
I, ___________________________ (full name in BLOCK letters)
of ____________________________ (address for correspondence)
__ an optometrist registered to practice optometry in a State or Territory of Australia; or
__ a person who employs optometrists to provide services in the course of the practice of their profession; or
__ both of the above
(Choose one of the above options by marking a cross in the appropriate box)
who wishes to become a Participating Optometrist, hereby give the following undertaking to the Minister for Health.
(Where an undertaking is made on behalf of a company or partnership, which employs optometrists, it should be signed by a person who has the authority to make such undertakings on behalf of the company or, in the case of a partnership, by one of the partners on behalf of the partnership)
1 The Minister has, pursuant to subsection 23A(1) of the Act, after consultation with Optometry Australia, drawn up a Common Form of Undertaking (the Undertaking) to be given by an optometrist who wishes to become a Participating Optometrist. Definitions, interpretation and other formalities relating to this Undertaking are at Schedule 1.
2 Date on which an Undertaking comes into force
2.1 An Undertaking comes into force on the day on which it is accepted by the Minister.
3 Services to which this Undertaking relates
3.1 This Undertaking relates to any clinically relevant service ordinarily rendered by an optometrist in relation to consultation on ocular or vision problems, but does not include:
(a) an attendance for the sole purpose of delivering a prescribed visual aid or appliance or adjusting or repairing such an aid or appliance;
(b) an attendance for the purpose of filling a prescription written by another practitioner;
(c) an attendance on behalf of teaching institutions on patients of supervised students of optometry;
(d) an attendance by an optometrist on:
(i) any dependant of the optometrist;
(ii) a practice partner of the optometrist or any dependants of that partner;
(iii) an employer of the optometrist or any dependants of that employer; or
(e) anything done or any service provided at any premises other than those specified in this Undertaking.
4 Premises to which this Undertaking relates
4.1 Where this Undertaking is signed by a person who employs optometrists to provide services in the course of the practice of optometry, the premises to which this Undertaking relates are those:
(a) specified in Schedule 2; and
(b) any other premises at which a domiciliary visit is made.
5 Termination of Undertaking
5.1 This Undertaking shall continue to be in force until it is:
(i) terminated by the Participating Optometrist under subsection 23B(6) of the Act; or
(ii) a final determination under section 106TA takes effect and that determination contains a direction under paragraph 106U(1)(e) that the Minister’s acceptance of the undertaking is taken to be wholly revoked by the Minister.
5.2 In relation to clause 5.1 (i) a Participating Optometrist may, at any time, terminate an Undertaking, either wholly or in so far as it covers particular premises, by serving, as prescribed, a notice of termination to the Chief Executive Medicare, specifying a date of termination not earlier than 30 days after the day on which the notice is served.
6.1 I undertake that when I charge a fee greater than the Medicare benefit, I will inform the patient of the Medicare benefit payable for the Item, at the time of the consultation and that the additional fee will not attract benefits.
6.2 I undertake that I will obtain the patient's informed consent to the release of information to me if it is necessary for me to seek patient information from the Chief Executive Medicare in order to determine appropriate itemisation of accounts, receipts or bulk-billed claims.
6.3 I undertake that I will not include an amount that relates to a service to which this Undertaking and a Medicare item apply in any charge made for appliances.
6.4 I undertake that I will not include a fee for a visit made or a service provided which is not a service to which this Undertaking applies in any charge made in respect of a Medicare item.
7 Billing procedures
7.1 I undertake to issue a receipt, or an account and a receipt, as the case may require, for all attendances made by myself, or on my behalf, to which a Medicare item applies, except where an assignment of benefit is made in accordance with section 20A of the Act.
7.2 I undertake that any receipt or account issued as provided in subclause 7.1 will contain the details of the particulars prescribed in regulations made from time to time pursuant to subsection 19(6) of the Act.
7.3 I undertake that I will ensure that no fee is charged, nor an assignment of benefit made under section 20A of the Act for an attendance to which one of Items 10921-10930 inclusive relates before the date on which the patient takes delivery of the contact lenses.
7.4 I undertake that I will ensure that in respect of each service:
(a) only one original of the receipt or account is issued; and
(b) where a duplicate receipt or account is issued it is clearly marked ''duplicate''.
7.5 I undertake that I will take all reasonable steps to ensure that all items are billed in accordance with this Undertaking and the appropriate Medicare items.
7.6 I undertake to accept the relevant Medicare benefit as full payment for the consultation where an assignment of benefit is made in accordance with section 20A of the Act. I accept that additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient.
8.1 I undertake that I will ensure that a patient is referred to a medical practitioner when it becomes apparent to the Attending Optometrist that the condition of the patient is such that it would be more appropriate for treatment to be undertaken by a medical practitioner.
8.2 I undertake that I will refer patients to other optometrists solely on the basis of the clinical needs of the patient.
9.1 I undertake that I will ensure that patients are informed that they are entitled to a copy of their spectacle prescription, and that they are free to have the prescribed spectacles dispensed by any person of their choice.
9.2 I undertake that I will ensure that where a contact lens prescription is prepared for the patient, the contact lens prescription is available to the patient at the completion of the prescription and fitting process.
10.1 I undertake that any notice sent to a patient by me or on my behalf suggesting re-examination will be sent solely on the basis of the clinical needs of the patient.
11.1 I undertake that I will not advertise or allow any person to advertise on my behalf in a manner that would lead to claims for Medicare benefits for services that are not Clinically Relevant Services as defined in the Act.
12 Notification of changes in practice details
12.1 I, as an employer of optometrists, undertake that in the event of a change in, or addition to, the details of the practice, as set out in Schedule 2, I will provide the Chief Executive Medicare with details of the change or addition within 28 days of the change or addition.
13 Supply of Information
13.1 I undertake to furnish to the Minister such information relating to the rendering of services under this Undertaking as is from time to time reasonably requested by the Minister.
Definitions, Interpretation and Other Formalities
In this Undertaking:
(a) "Act" means the Health Insurance Act 1973;
(b) "Attending Optometrist" means an optometrist as defined in subsection 3(1) of the Act, who renders the service;
(c) "Clinically Relevant Service" means a service rendered by an optometrist that is generally accepted in the optometrical profession as being necessary for the appropriate treatment of the patient to whom it is rendered;
(d) "Commonwealth" means the Commonwealth of Australia;
(e) "Department of Health " means the Australian Government Department of Health or, where the subject matter of the Undertaking is transferred to another Australian Government Department or Agency, that other Department or Agency;
(f) "Domiciliary Visit" means a professional attendance to which an item in the General Medical Services Table relates, given at the request of patients, either at their place of residence or at a nursing home, hospital or other temporary place of residence of the patient;
(g) “General Medical Services Table” means a table of medical services prescribed under section 4 of the Act in the Regulations, as varied from time to time;
(h) “Medicare benefit” means a benefit payable by the Commonwealth in relation to a professional service to which Medicare item applies;
(i) “Medicare item” means an item specified in the General Medical Services Table;
(j) "Minister" means the Minister responsible for administering the Department of Health and includes:
(i) any other Minister of the Commonwealth of Australia who is for the time being acting for that Minister;
(ii) a person to whom the relevant powers or functions of the Minister are for the time being delegated;
(k) "optometrist" for the purposes of sections 23A and 23B of the Act, includes a person who employs optometrists to provide services in the course of the practice of their profession;
(l) “Optometry Australia” for the purposes of this Undertaking is the organisation that is referred to in section 23A of the Act as the “Australian Optometrical Association”.
(m) "Participating Optometrist" means an optometrist or other person in respect of whom there is in force an Undertaking given by that person and accepted by the Minister under section 23B of the Act;
(n) "Person" includes a body politic or corporation as well as an individual;
(o) "Service" means a professional service specified in a Medicare item that relates to an
attendance by a Participating Optometrist.
In this Undertaking, unless the contrary intention appears:
(a) a reference to a clause refers to the relevant clause to this Undertaking;
(b) a reference to a Schedule is to the relevant Schedule of this Undertaking and if a Schedule is at any time varied extends to the Schedule as so varied;
(c) words in the singular include the plural and words in the plural include the singular;
(d) the terms “I” and “me” refer to the company or the body corporate where a company or a body corporate is making an undertaking; and
(e) words and expressions used in the Undertaking have the meaning given to them in Schedule 1 of the Undertaking and the Act.
3 Operation of Undertaking
If the Act or the Regulations are amended this Undertaking will be read as amended to comply with the then current form of the Act or Regulations.
Any amendments to the Undertaking will be notified to the Participating Optometrist by way of publication in the Government Notices Gazette.
4 Variation of Undertaking
This Undertaking may be deemed to be varied under sub-section 23B(5) of the Act.
Any notice or other communication to the Participating Optometrist under, or for the purpose of, this Undertaking by the Minister other than in clause 3 above, shall be deemed to have been duly given or made if it is in writing signed by or on behalf of the Minister or in the case of a delegate signed by that delegate and is sent by prepaid post addressed to the Participating Optometrist at the address shown in Schedule 3 for the forwarding of notices or at such other address as is notified in writing, from time to time, by the Participating Optometrist.
Any notice, or other communication to the Minister under, or for the purpose of, this Undertaking by the Participating Optometrist shall be deemed to have been duly given or made if it is in writing, signed by or on behalf of the Participating Optometrist, addressed to the Minister and is served personally or by being sent by prepaid post, addressed to Provider Eligibility and Accreditation Section, Medicare and Veterans Branch, Department of Human Services, PO Box 1001, Tuggeranong ACT 2901.
A notice, or other communication sent by post shall be deemed to have been received by the Participating Optometrist or the Minister as the case may be, when it would have been delivered in the ordinary course of mail delivery.
Premises to which this Undertaking relates
The premises specified for the purposes of this Undertaking are located at:
Address for correspondence
Notices or other communications to the Participating Optometrist relating to this Undertaking should be directed to:
[Name & Address]
[Phone number & email]