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Health Insurance (Allied Health and Dental Services) Amendment Determination 2007 (No. 1)

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Health Insurance (Allied Health and Dental Services) Amendment Determination  2007 (No. 1)
Health Insurance Act 1973
I, MEGAN MORRIS, 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 10 April 2007
MEGAN MORRIS
First Assistant Secretary, Medical Benefits Division, Department of Health and Ageing
  
  
1              Name of Determination
                This Determination is the Health Insurance (Allied Health and Dental Services) Amendment Determination  2007 (No. 1).
2              Commencement
                This Determination commences on 1 May 2007.
3              Amendment of Health Insurance (Allied Health and Dental Services) Determination 2006
                Schedule 1 amends the Health Insurance (Allied Health and Dental Services) Determination 2006.
Schedule 1        Amendments
(section 3)
  
[1]           Subsection 4 (1), after definition of allied health service
insert
course of treatment, for psychological therapy and focussed psychological strategies, means up to 6 services provided by an allied mental health professional (on referral from an eligible medical practitioner).
[2]           Subsection 4 (1), definition of focussed psychological strategies, paragraph (e)
omit
therapy.
insert
therapy;
[3]           Subsection 4 (1), definition of focussed psychological strategies, after paragraph (e)
insert
                 (f)     narrative therapy (for Aboriginal and Torres Strait Islander people).
[4]           Subsection 4 (1), after definition of focussed psychological strategies
insert
GP management plan, for a patient, means a GP management plan to which item 721 or 725 of the general medical services table applies.
[5]           Subsection 4 (1), after definition of GP Mental Health Care Plan
insert
multidisciplinary care plan, for a patient, means a multidisciplinary care plan to which item 731 of the general medical services table applies.
[6]           Subsection 8 (3)
omit
items 104
insert
items 110
[7]           After subsection 8 (3)
insert
         (4)   The referral by a specialist in the practice of his or her field of psychiatry or paediatrics must be a referral to which any of items 104 to 109 of the general medical services table applies.
[8]           Schedule 1, subparagraph 8 (b) (ii)
omit
and New Zealand
[9]           Schedule 1, paragraph 9 (a)
omit
and New Zealand
[10]         Schedule 2, Part 1, items 10950 to 10970, paragraphs (a) and (b)
substitute
 
   (a)  the service is provided to a person who has:
         (i)   a chronic condition; and
        (ii)   complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and
   (b)  the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and
 
[11]         Schedule 2, Part 2, items 80000, 80010, 80100, 80110, 80125, 80135, 80150 and 80160, paragraph (b)
substitute
 
   (b)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and
 
[12]         Schedule 2, after Part 3
insert
Part 4          Services and fees — group services
Division 4.1    Diabetes education services
 
Item
Service
          Fee ($)

81100
Diabetes education health service provided to a person by an eligible diabetes educator for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services, if:
   (a)  the person has type 2 diabetes; and
   (b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
   (c)  the person is referred to an eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department of Health and Ageing, or a referral form that substantially complies with the form issued by the Department; and
   (d)  the person is not an admitted patient of a hospital; and
   (e)  the service is provided to the person individually and in person; and
   (f)  the service is of at least 45 minutes duration; and
   (g)  after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c); and
   (h)  for a service for which a private health insurance benefit is payable, the person has elected to claim the medicare benefit for the service and not the private health insurance benefit —
payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)
70.55

81105
Diabetes education health service provided to a person by an eligible diabetes educator, as a group service for the management of type 2 diabetes, if:
   (a)  the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and
   (b)  the service is provided to a person who is part of a group of between 2 and 12 patients; and
   (c)  the person is not an admitted patient of a hospital; and
   (d)  the service is provided to a person involving the personal attendance by an eligible diabetes educator; and
   (e)  the service is of at least 60 minutes duration; and
   (f)  after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible diabetes educator prepares, or contributes to, a written report to be provided to the referring medical practitioner; and
   (g)  an attendance record for the group is maintained by the eligible diabetes educator; and
   (h)  for a service for which a private health insurance benefit is payable, the person has elected to claim the medicare benefit for the service and not the private health insurance benefit —
to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125)
17.60

Division 4.2    Exercise physiology services
 
Item
Service
Fee ($)

81110
Exercise physiology health service provided to a person by an eligible exercise physiologist for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services, if:
   (a)  the person has type 2 diabetes; and
   (b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
   (c)  the person is referred to an eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department of Health and Ageing, or a referral form that substantially complies with the form issued by the Department; and
   (d)  the person is not an admitted patient of a hospital; and
   (e)  the service is provided to the person individually and in person; and
   (f)  the service is of at least 45 minutes duration; and
   (g)  after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c); and
   (h)  for a service for which a private health insurance benefit is payable, the person has elected to claim the medicare benefit for the service and not the private health insurance benefit —
payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)
70.55

81115
Exercise physiology health service provided to a person by an eligible exercise physiologist, as a group service for the management of type 2 diabetes, if:
   (a)  the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and
   (b)  the service is provided to a person who is part of a group of between 2 and 12 patients; and
   (c)  the person is not an admitted patient of a hospital; and
   (d)  the service is provided to a person involving the personal attendance by an eligible exercise physiologist; and
   (e)  the service is of at least 60 minutes duration; and
   (f)  after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible exercise physiologist prepares, or contributes to, a written report to be provided to the referring medical practitioner; and
   (g)  an attendance record for the group is maintained by the eligible exercise physiologist; and
   (h)  for a service for which a private health insurance benefit is payable, the person has elected to claim the medicare benefit for the service and not the private health insurance benefit —
to a maximum of 8 group services in a calendar year (including services in items 81105, 81115 and 81125)
17.60

Division 4.3    Dietetics services
 
Item
Service
Fee ($)

81120
Dietetics health service provided to a person by an eligible dietitian for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services, if:
   (a)  the person has type 2 diabetes; and
   (b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP management plan or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and
   (c)  the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department of Health and Ageing, or a referral form that substantially complies with the form issued by the Department; and
   (d)  the person is not an admitted patient of a hospital; and
   (e)  the service is provided to the person individually and in person; and
   (f)  the service is of at least 45 minutes duration; and
   (g)  after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c); and
   (h)  for a service for which a private health insurance benefit is payable, the person has elected to claim the medicare benefit for the service and not the private health insurance benefit —
payable once in a calendar year for this or any other assessment for group services item (including services in items 81100, 81110 and 81120)
70.55

81125
Dietetics health service provided to a person by an eligible dietitian, as a group service for the management of type 2 diabetes, if:
   (a)  the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and
   (b)  the service is provided to a person who is part of a group of between 2 and 12 patients; and
   (c)  the person is not an admitted patient of a hospital; and
   (d)  the service is provided to a person involving the personal attendance by an eligible dietitian; and
   (e)  the service is of at least 60 minutes duration; and
   (f)  after the last service in the group services program provided to the person under item 81105, 81115 or 81125, the eligible dietitian prepares, or contributes to, a written report to be provided to the referring medical practitioner; and
   (g)  an attendance record for the group is maintained by the eligible dietitian; and
   (h)  for a service for which a private health insurance benefit is payable, the person has elected to claim the medicare benefit for the service and not the private health insurance benefit —
to a maximum of 8 group services in a calendar year (including services to which items 81105, 81115 and 81125 apply)
17.60

[13]         Schedule 3, items 10975, 10976 and 10977, paragraphs (a) and (b)
substitute
 
   (a)  the service is provided to a person whose dental condition is exacerbating a chronic condition being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and
   (b)  the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and
 
[14]         Further amendments — specialist
                Subparagraphs (a) (ii) and (iii) of the following items of Part 2 of Schedule 2 are amended by omitting ‘a consultant’ and inserting ‘a specialist or consultant’:
 
80000
80010
80020
80100
80110
80120

80125
80135
80145
80150
80160
80170

[15]         Further amendments — day‑hospital facility
         (1)   The following items of Schedule 2 are amended by omitting ‘or day‑hospital facility’:
 
10950
10951
10952
10953
10954
10956

10958
10960
10962
10964
10966
10968

10970
80000
80005
80010
80015
80020

80100
80105
80110
80115
80120
80125

80130
80135
80140
80145
80150
80155

80160
80165
80170
81000
81005
81010

 
         (2)   The following items of Schedule 3 are amended by omitting ‘or day‑hospital facility’:
 
10975
10976
10977