Health Insurance (Other non-referred services) Determination 2012

Link to law: https://www.comlaw.gov.au/Details/F2012L00090

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Health Insurance (Other non-referred services) Determination 2012
Health Insurance Act 1973
I, RICHARD BARTLETT, delegate of the Minister for Health, make this Determination under subsection 3C (1) of the Health Insurance Act 1973.
Dated                        27 January                2012
RICHARD BARTLETT
FIRST ASSISTANT SECRETARY
MEDICAL BENEFITS DIVISION
DEPARTMENT OF HEALTH AND AGEING
 
Contents
1                             Name of Determination                                                                       3
2                             Commencement                                                                                  3
3                             Definitions                                                                                          3
4                             Treatment of relevant services                                                             3
5                             Application of this section to certain general practitioners                     4
6                             Application of items                                                                            4
7                             Meaning of amount under section 7                                                     4
Schedule 1              Relevant services and fees                                                                 6
 
 
 
1              Name of Determination
                This Determination is the Health Insurance (Other non-referred services) Determination 2012.
2              Commencement and cessation
                This Determination commences on the day it is registered and ceases at midnight on 31 October 2012.
3              Definitions
(1)  In this Determination:
Act means the Health Insurance Act 1973.
relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act.
relevant service means a service specified in the Schedule.
residential aged care facility means a facility where residential care (within the meaning given by section 41-3 of the Aged Care Act 1997) is provided.
Schedule means the schedule to the Determination.
Note   Unless a contrary intention appears, an expression used in this Determination has the same meaning as in the Act  — see section 13 of the Legislative Instruments Act 2003.  Terms defined in the Act include:
·        general medical services table
·        general practitioner
·        item
·        medical practitioner
·        professional service
(2)  Unless the contrary intention appears, a reference in this Determination to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to that provision as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
4              Treatment of relevant services
A relevant service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:
(a)  it were both a professional service and a medical service; and
(b)  there were an item in the general medical services table that:
(i)  related to the service; and
(ii)  specified for the service a fee for each State, being the fee mentioned in the item in the Schedule for the service.
Note   For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.
5              Application of this section to certain general practitioners
(1)  This section applies to a general practitioner if:
(a)  the practitioner is the subject of a final determination that is in force under section 106TA of the Act; and
(b)  the determination contains a direction, given under subparagraph 106U(1)(g)(i) of the Act, that the practitioner be disqualified for a professional service; and
(c)  the determination states that the practitioner is disqualified for a service mentioned in an item in Group A1 of the general medical services table; and
(d)  the practitioner provides a service mentioned in an item in the Schedule.
6              Specification of items 
(1)  The following provisions of the general medical services table shall have effect as if items 90052 – 90096 in the Schedule were also specified in the provision:
(a)  clause 1.2.1;
(b)  subclause 1.2.3(1);
(c)  paragraph 1.2.3(3)(a);
(d)  subclause 1.2.4(1);
(e)  subclause 1.2.5(1); and
(e)  clause 1.2.7.
(2)  Schedule 6 to the Health Insurance Regulations 1975 shall have effect as if items 90052 – 90096 in the Schedule were also specified in column 3 of Schedule 6.
7              Meaning of amount under section 7
In an item of the Schedule mentioned in column 2 of the table below:
amount under section 7 means the sum of:
(a)  the fee mentioned in column 3 for the item; and
(b)  either:
(i)  if a practitioner attends not more than 6 patients in a single attendance — the amount mentioned in column 4 for the item, divided by the number of patients attended; or
(ii) if a practitioner attends more than 6 patients in a single attendance — the amount mentioned in column 5 for the item.
Table
 
Item
Item of the Schedule
Fee
Amount if not more than 6 patients (to be divided by the number of patients)
Amount if more than 6 patients

1
90058
$8.50
$15.50
$0.70

2
90059
$16.00
$17.50
$0.70

3
90060
$35.50
$15.50
$0.70

4
90065
$57.50
$15.50
$0.70

5
90092
$8.50
$27.95
$1.25

6
90093
$16.00
$31.55
$1.25

7
90095
$35.50
$27.95
$1.25

8
90096
$57.50
$27.95
$1.25


.
 
Schedule           Relevant services and fees
(section 3)
 
Item
Description
Fee $

90052
Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which another item applies) — each attendance, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
11.00

90053
Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes in duration (other than a service to which another item applies) — each attendance, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
21.00

90054
Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes in duration (other than a service to which another item applies) — each attendance, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
38.00

90057
Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which another item applies) — each attendance
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
61.00

90058
Professional attendance (other than attendance at consulting rooms or a residential aged care facility or a service to which another item applies), lasting not more than 5 minutes — an attendance on 1 or more patients at 1 place on 1 occasion — each patient, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
Amount under section 7

90059
Professional attendance (other than attendance at consulting rooms or a residential aged care facility or a service to which another item applies), lasting more than 5 minutes but not more than 25 minutes — an attendance on 1 or more patients at 1 place on 1 occasion — each patient, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
Amount under section 7

90060
Professional attendance (other than attendance at consulting rooms or a residential aged care facility or a service to which another item applies) lasting more than 25 minutes, but not more than 45 minutes — an attendance on 1 or more patients at 1 place on 1 occasion — each patient, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
Amount under section 7

90065
Professional attendance (other than attendance at consulting rooms or a residential aged care facility or a service to which another item applies) lasting more than 45 minutes — an attendance on 1 or more patients at 1 place on 1 occasion — each patient, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
Amount under section 7

90092
Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of not more than 5 minutes in duration — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion —each patient, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
Amount under section 7

90093
Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of more than 5 minutes in duration but not more than 25 minutes in duration — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
Amount under section 7

90095
Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of more than 25 minutes in duration but not more than 45 minutes — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
Amount under section 7

90096
Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self‑contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (other than accommodation in a self‑contained unit) of more than 45 minutes in duration — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient, by:
(a) a medical practitioner (not being a general practitioner); or
(b) a general practitioner to whom section 5 applies.
Amount under section 7

 
Note
1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See http://www.frli.gov.au