Health Insurance (Allied Health Services) Amendment Determination 2008 (No. 1)

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Health Insurance (Allied Health Services) Amendment Determination 2008 (No. 1)1
Health Insurance Act 1973
I, ANTONY KINGDON, First Assistant Secretary, Medical Benefits Division, Department of Health and Ageing, make this Determination under subsection 3C (1) of the Health Insurance Act 1973.
Dated 16 June 2008
ANTONY KINGDON
First Assistant Secretary, Medical Benefits Division,
Department of Health and Ageing
 
 
1              Name of Determination
                This Determination is the Health Insurance (Allied Health Services) Amendment Determination  2008 (No. 1).
2              Commencement
                This Determination commences on 1 July 2008.
3              Amendment of Health Insurance (Allied Health Services) Determination 2007
                Schedule 1 amends the Health Insurance (Allied Health Services) Determination 2007.
Schedule 1        Amendments
(section 3)
  
[1]           Subsection 5 (1), definition of course of treatment
substitute
course of treatment means:
                (a)    for psychological therapy and focussed psychological strategies — up to 6 services provided, on referral by a medical practitioner, by any of the following persons:
                          (i)    an eligible clinical psychologist;
                         (ii)    an eligible psychologist;
                         (iii)    an eligible occupational therapist;
                        (iv)    an eligible social worker; and
               (b)    for pervasive developmental disorder services — up to 10 services provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:
                          (i)    an eligible psychologist;
                         (ii)    an eligible speech pathologist;
                         (iii)    an eligible occupational therapist.
[2]           Subsection 5 (1), after definition of OT Australia
insert
PDD treatment and management plan, for a patient, means a plan for the treatment and management of the patient’s pervasive developmental disorder to which item 135 or 289 of the general medical services table applies.
[3]           Section 6, heading
substitute
6              Treatment of allied health services
[4]           Section 9, heading
substitute
9              Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services
[5]           Subsections 9 (2) and (3)
omit
referral to
insert
referral of a service to
[6]           Subsection 9 (3)
omit
131
insert
133
[7]           Subsection 9 (4)
omit
referral to
insert
referral of a service to
[8]           After section 9
insert
10            Referrals by psychiatrists and paediatricians for pervasive developmental disorder services
         (1)   This section applies to items 82000 to 82025 in Schedule 2.
         (2)   For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 296 to 370 (except item 359) of the general medical services table apply.
         (3)   For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 131 of the general medical services table apply.
         (4)   For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which item 289 of the general medical services table applies.
         (5)   If a child has previously been provided with a service mentioned in item 289, a consultant physician specialising in the practice of his or her field of psychiatry may only refer the child for a service to which any of items 296 to 370 (excepting item 359) of the general medical services table apply.
         (6)   For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral to which item 135 of the general medical services table applies.
         (7)   If a child has previously been provided with a service mentioned in item 135, a consultant physician specialising in the practice of his or her field of paediatrics may only refer the child for a service to which any of items 110 to 131 of the general medical services table apply.
11            Effect of election to claim private health insurance for an allied health service
                An item in Schedule 2 applies to an allied health service only if a private health insurance benefit has not been claimed for the service.
[9]           Schedule 1, item 14
substitute
14.
Psychological therapy health service
A person is an allied health professional in relation to the provision of a psychological therapy health service if the person:
   (a)  is registered, without any limitation, with the Psychologists Registration Board established under the applicable law in force in the State or Territory where the service is provided; and
   (b)  either:
         (i)   is a member of the Australian College of Clinical Psychologists of the Australian Psychological Society (APS); or
        (ii)   has been assessed by the APS as meeting the requirements for membership of that College and continues to meet those requirements.
[10]         Schedule 2, items 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968 and 10970, paragraph (h)
omit
[11]         Schedule 2, items 80000 and 80010, after paragraph (a)
insert
              (aa)    the service is provided to the person individually and in person; and
[12]         Schedule 2, item 80020, after paragraph (a)
insert
              (aa)    the service is provided in person; and
[13]         Schedule 2, items 80100 and 80110, after paragraph (a)
insert
              (aa)    the service is provided to the person individually and in person; and
[14]         Schedule 2, item 80120, after paragraph (a)
insert
              (aa)    the service is provided in person; and
[15]         Schedule 2, items 80125 and 80135, after paragraph (a)
insert
              (aa)    the service is provided to the person individually and in person; and
[16]         Schedule 2, item 80145, after paragraph (a)
insert
              (aa)    the service is provided in person; and
[17]         Schedule 2, items 80150 and 80160, after paragraph (a)
insert
              (aa)    the service is provided to the person individually and in person; and
[18]         Schedule 2, item 80170, after paragraph (a)
insert
              (aa)    the service is provided in person; and
[19]         Schedule 2, items 81000, 81005 and 81010, after paragraph (b)
insert
              (ba)    the service is provided to the woman individually and in person; and
[20]         Schedule 2, item 81100, paragraph (h)
omit
[21]         Schedule 2, item 81105, paragraph (d)
substitute
               (d)    the service is provided in person; and
[22]         Schedule 2, items 81105 and 81110, paragraph (h)
omit
[23]         Schedule 2, item 81115, paragraph (d)
substitute
               (d)    the service is provided in person; and
[24]         Schedule 2, items 81115 and 81120, paragraph (h)
omit
[25]         Schedule 2, item 81125, paragraph (d)
substitute
               (d)    the service is provided in person; and
[26]         Schedule 2, item 81125, paragraph (h)
omit
[27]         Schedule 2, after Part 4
insert
Part 5          Services and fees — pervasive developmental disorder
Item
Service
Fee ($)

82000
Psychology health service provided to a child aged under 13 years by an eligible psychologist if:
   (a)  the child was referred to the eligible psychologist by an eligible practitioner:
         (i)   to assist with the diagnosis of the child by the practitioner; or
        (ii)   to contribute to the child’s PDD treatment and management plan; and
        (b)   the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
90.15

 
   (c)  the eligible psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and
   (d)  the child is not an admitted patient of a hospital; and
   (e)  the service is provided to the child individually and in person; and
   (f)  the service is at least 50 minutes duration;
to a maximum of 4 services (including services to which this item or items 82005 and 82010 apply)
This item is subject to sections 10 and 11
 

82005
Speech pathology health service provided to a child aged under 13 years by an eligible speech pathologist if:
   (a)  the child was referred to the eligible speech pathologist by an eligible practitioner:
         (i)   to assist with the diagnosis of the child by the practitioner: or
        (ii)   to contribute to the child’s PDD treatment and management plan; and
   (b)  the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
   (c)  the eligible speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and
   (d)  the child is not an admitted patient of a hospital; and
   (e)  the service is provided to the child individually and in person; and
   (f)  the service is at least 50 minutes duration;
to a maximum of 4 services (including services to which this item or items 82000 and 82010 apply)
This item is subject to sections 10 and 11
79.40

82010
Occupational therapy health service provided to a child aged under 13 years by an eligible occupational therapist if:
   (a)  the child was referred to the eligible occupational therapist by an eligible practitioner:
         (i)   to assist with the diagnosis of the child by the practitioner: or
        (ii)   to contribute to the child’s PDD treatment and management plan; and
   (b)  the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
   (c)  the eligible occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of that service; and
   (d)  the child is not an admitted patient of a hospital; and
   (e)  the service is provided to the child individually and in person; and
79.40

 
   (f)  the service is at least 50 minutes duration;
to a maximum of 4 services (including services to which this item or items 82000 and 82005 apply)
 

82015
Psychology health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible psychologist, if:
   (a)  the child has been diagnosed with a PDD; and
   (b)  the child, while aged under 13 years, received a PDD treatment and management plan; and
   (c)  the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and
   (d)  the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
   (e)  the eligible psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and
   (f)  on the completion of the course of treatment, the eligible psychologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and
   (g)  the child is not an admitted patient of a hospital; and
   (h)  the service is provided to the child individually and in person; and
    (i)  the service is at least 30 minutes duration;
to a maximum of 20 services (including services to which this item or items 82020 and 82025 apply)
This item is subject to sections 10 and 11
90.15

82020
Speech pathology health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible speech pathologist, if:
   (a)  the child has been diagnosed with a PDD; and
   (b)  the child, while aged under 13 years, received a PDD treatment and management plan; and
   (c)  the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and
   (d)  the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
   (e)  the eligible speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and
79.40

 
   (f)  on the completion of the course of treatment, the eligible speech pathologist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and
   (g)  the child is not an admitted patient of a hospital; and
   (h)  the service is provided to the child individually and in person; and
    (i)  the service is at least 30 minutes duration;
to a maximum of 20 services (including services to which this item or items 82015 and 82025 apply)
This item is subject to sections 10 and 11
 

82025
Occupational therapy health service provided to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) by an eligible occupational therapist if:
   (a)  the child has been diagnosed with a PDD; and
   (b)  the child, while aged under 13 years, received a PDD treatment and management plan; and
   (c)  the child was referred by an eligible practitioner for services consistent with the child’s PDD treatment and management plan; and
   (d)  the eligible practitioner is a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics; and
   (e)  the eligible occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for the provision of those services; and
   (f)  on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring eligible practitioner on assessments carried out, treatment provided and recommendations on future management of the child’s condition; and
   (g)  the child is not an admitted patient of a hospital; and
   (h)  the service is provided to the child individually and in person; and
    (i)  the service is at least 30 minutes duration;
to a maximum of 20 services (including services to which this item or items 82015 and 82020 apply)
This item is subject to sections 10 and 11
79.40

[28]         Further amendments — substitutions
Provision
omit
insert

Schedule 2, items 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968 and 10970, subparagraph (g) (iii)
matters; and
matters;

Schedule 2, items 80000, 80005, 80010, 80015
sections 8 and 9
sections 8, 9 and 11

Schedule 2, item 80020
section 9
sections 9 and 11

Schedule 2, items 80100, 80105, 80110, 80115
sections 8 and 9
sections 8, 9 and 11

Schedule 2, item 80120
section 9
sections 9 and 11

Schedule 2, items 80125, 80130, 80135 and 80140
sections 8 and 9
sections 8, 9 and 11

Schedule 2, item 80145
section 9
sections 9 and 11

Schedule 2, items 80150, 80155, 80160 and 80165
sections 8 and 9
sections 8, 9 and 11

Schedule 2, item 80170
section 9
sections 9 and 11

Schedule 2, item 81100, paragraph (g)
paragraph (c); and
paragraph (c);

Schedule 2, item 81105, paragraph (g)
educator; and
educator;

Schedule 2, item 81110, paragraph (g)
paragraph (c); and
paragraph (c);

Schedule 2, item 81115, paragraph (g)
physiologist; and
physiologist;

Schedule 2, item 81120, paragraph (g)
paragraph (c); and
paragraph (c);

Schedule 2, item 81125, paragraph (g)
dietitian; and
dietitian;

[29]         Further amendments — insertions
Provision
after
insert

Schedule 2, items 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968 and 10970
calendar year
This item is subject to section 11

Schedule 2, items 81000, 81005 and 81010
appropriate
This item is subject to section 11

Schedule 2, item 81100
81120)
This item is subject to section 11

Schedule 2, item 81105
81125)
This item is subject to section 11

Schedule 2, item 81110
81120)
This item is subject to section 11

Schedule 2, item 81115
81125)
This item is subject to section 11

Schedule 2, item 81120
81120)
This item is subject to section 11

Schedule 2, item 81125
81125 apply)
This item is subject to section 11

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.
 

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