Health Insurance (General Medical Services Table) Amendment Regulations 2005 (No. 2)1 Select Legislative Instrument 2005 No. 129
I, PHILIP MICHAEL JEFFERY, Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973. Dated 15 June 2005 P. M. JEFFERY Governor-General By His Excellency’s Command TONY ABBOTT Minister for Health and Ageing
1 Name of Regulations These Regulations are the Health Insurance (General Medical Services Table) Amendment Regulations 2005 (No. 2). 2 Commencement These Regulations commence on 1 July 2005. 3 Amendment of Health Insurance (General Medical Services Table) Regulations 2004 Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2004.
Schedule 1 Amendments (regulation 3) [1] Schedule 1, Part 2, after subrule 45 (1) insert (1A) Items 721 and 725 apply only to a service in relation to a patient who: (a) suffers from at least 1 medical condition that: (i) has been (or is likely to be) present for at least 6 months; or (ii) is terminal; and (b) is a person who: (i) is not: (A) an in-patient of a hospital or approved day hospital facility; or (B) a care recipient in a residential aged care facility; or (ii) being an in-patient of a hospital or approved day hospital facility, is a private patient of that hospital or facility. [2] Schedule 1, Part 2, after subrule 45 (2) insert (2A) Items 723 and 727 apply only to a service in relation to a patient who: (a) suffers from at least 1 medical condition that: (i) has been (or is likely to be) present for at least 6 months; or (ii) is terminal; and (b) requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least 1 of whom is a medical practitioner; and (c) is a person who: (i) is not: (A) an in-patient of a hospital or approved day hospital facility; or (B) a care recipient in a residential aged care facility; or (ii) being an in-patient of a hospital or approved day hospital facility, is a private patient of that hospital or facility. (2B) Item 729 applies only to a service in relation to a patient who: (a) suffers from at least 1 medical condition that: (i) has been (or is likely to be) present for at least 6 months; or (ii) is terminal; and (b) requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least 1 of whom is a medical practitioner; and (c) is not a care recipient in a residential aged care facility. [3] Schedule 1, Part 2, after subrule 45 (3) insert (4) Item 731 applies only to a service in relation to a patient who: (a) suffers from at least 1 medical condition that: (i) has been (or is likely to be) present for at least 6 months; or (ii) is terminal; and (b) requires ongoing care from at least 3 collaborating providers, each of whom provides a different kind of treatment or service to the patient, and at least 1 of whom is a medical practitioner; and (c) is a care recipient in a residential aged care facility. (5) In this rule: collaborating provider is a person who: (a) provides treatment or a service to a patient; and (b) is not a family carer of the patient. family carer includes a person who: (a) is a relative or friend of the patient; and (b) is providing care to the patient other than as a paid service. [4] Schedule 1, Part 2, after rule 45 insert 45A Limitation on items 721, 723, 725, 727, 729 and 731 (1) For any particular patient, unless exceptional circumstances exist in relation to the patient, item 721: (a) is not applicable if: (i) in the 3 months preceding the performance of the service, a service has been performed in respect of which a payment has been made under item 723, 725, 727, 729 or 731 in respect of the patient; or (ii) in the 12 months preceding the performance of the service, a service has been performed in respect of which a payment has been made under item 720 in respect of the patient; and (b) is applicable not more than once in a 12 month period. (2) For any particular patient, unless exceptional circumstances exist in relation to the patient, item 723: (a) is not applicable if: (i) in the 3 months preceding the performance of the service, a service has been performed in respect of which a payment has been made under item 727 in respect of the patient; or (ii) in the 12 months preceding the performance of the service, a service has been performed in respect of which a payment has been made under item 720 in respect of the patient; and (b) is applicable not more than once in a 12 month period. (3) For any particular patient, unless exceptional circumstances exist in relation to the patient, item 725: (a) is not applicable if, in the 3 months preceding the performance of the service, a service has been performed in respect of which a payment has been made under item 721 in respect of the patient; and (b) is applicable not more than once in a 3 month period. (4) For any particular patient, unless exceptional circumstances exist in relation to the patient, item 727: (a) is not applicable if, in the 3 months preceding the performance of the service, a service has been performed in respect of which a payment has been made under item 723 in respect of the patient; and (b) is applicable not more than once in a 3 month period. (5) For any particular patient, unless exceptional circumstances exist in relation to the patient, item 729: (a) is not applicable if: (i) in the 3 months preceding the performance of the service, a service has been performed in respect of which a payment has been made under item 725, 727, 726, 728 or 731 in respect of the patient; or (ii) in the 12 months preceding the performance of the service, a service has been performed in respect of the patient: (A) by the medical practitioner who performs the service to which item 729 would, but for this subrule, apply; and (B) in respect of which a payment has been made under item 721 or 723; and (b) is applicable not more than once in a 3 month period. (6) For any particular patient, unless exceptional circumstances exist in relation to the patient, item 731: (a) is not applicable if, in the 3 months preceding the performance of the service, a service has been performed in respect of which a payment has been made under item 721, 723, 725, 727, 729 or 730 in respect of the patient; and (b) is applicable not more than once in a 3 month period. (7) For this rule, exceptional circumstances exist in relation to a patient if there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service in respect of the patient. [5] Schedule 1, Part 2, after rule 49 insert 49A Meaning of GP management plan (1) For item 721, preparation of a GP management plan means the preparation of a comprehensive written plan describing all of the following matters: (a) the patient’s health care needs, health problems and relevant conditions; (b) management goals with which the patient agrees; (c) actions to be taken by the patient; (d) treatment and services the patient is likely to need; (e) arrangements for providing the treatment and services referred to in paragraph (d); (f) arrangements to review the plan by a day specified in the plan. (2) Preparation of the plan also includes: (a) explaining to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan; and (b) recording the plan; and (c) recording the patient’s agreement to the preparation of the plan; and (d) offering a copy of the plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and (e) adding a copy of the plan to the patient’s medical records. [6] Schedule 1, Part 2, after rule 51 insert 51A Meaning of team care arrangements (1) For item 723, co-ordinating the development of team care arrangements means a process by which the medical practitioner: (a) in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and 1 of whom may be another medical practitioner — makes arrangements for the multidisciplinary care of the patient; and (b) prepares a document that describes all of the matters specified in subrule (2); and (c) undertakes all of the activities specified in subrule (3). (2) The matters to be described for paragraph (1) (b) are: (a) treatment and service goals for the patient; and (b) treatment and services that collaborating providers will provide to the patient; and (c) actions to be taken by the patient; and (d) arrangements to review the matters mentioned in paragraphs (a), (b) and (c) by a day specified in the document. (3) The activities to be undertaken for paragraph (1) (c) are: (a) explaining the steps involved in the development of the arrangements to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and (b) discussing with the patient the collaborating providers who will contribute to the development of the team care arrangements, and provide treatment and services to the patient under those arrangements; and (c) recording the patient’s agreement to the development of team care arrangements; and (d) giving copies of the relevant parts of the document to the collaborating providers; and (e) offering a copy of the document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and (f) adding a copy of the document to the patient’s medical records. (4) In this rule: collaborating provider is a person who: (a) provides treatment or a service to a patient; and (b) is not a family carer of the patient. family carer includes a person who: (a) is a relative or friend of the patient; and (b) is providing care to the patient other than as a paid service. 51B Meaning of associated medical practitioner (1) For item 725 and item 727, an associated medical practitioner is a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) who, if not engaged in same general practice as the medical practitioner mentioned in that item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian). (2) In subrule (1): general practice means a business, consisting of one or more medical practitioners, that provides a general practice of medical services. [7] Schedule 1, Part 2, after rule 52 insert 52A Meaning of review of a GP management plan or multidisciplinary care plan (1) For item 725, review of a GP management plan, a multidisciplinary community care plan, or a multidisciplinary discharge care plan, means a process by which the medical practitioner: (a) reviews the matters mentioned in subrule 49 (1) or subrule 49A (1), as applicable; and (b) if different arrangements need to be made, makes amendments to the plan that: (i) state those new arrangements; and (ii) provide for further review of the amended plan by a date specified in the plan. (2) Review of the plan also includes: (a) explaining to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review; and (b) recording the patient’s agreement to the review of the plan; and (c) if amendments are made to the plan: (i) offering a copy of the amended plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and (ii) adding a copy of the amended plan to the patient’s medical records. [8] Schedule 1, Part 2, after rule 53 insert 53A Meaning of co-ordinate a review of team care arrangements or of a multidisciplinary care plan (1) For item 727, to co-ordinate a review of team care arrangements, a multidisciplinary community care plan, or a multidisciplinary discharge care plan, means a process by which the medical practitioner: (a) in consultation with at least 2 collaborating providers, each of whom provides a different kind of treatment or service, and 1 of whom may be another medical practitioner, reviews the matters mentioned in subrule 49 (1) or subrule 51A (2), as applicable; and (b) if different arrangements need to be made, makes amendments to the document mentioned in paragraph 51A (1) (b), or to the plan, that: (i) state those new arrangements; and (ii) provide for the review of the amended document or plan by a date specified in the document or plan. (2) Co-ordinating a review of team care arrangements or of a multidisciplinary care plan also includes: (a) explaining the steps involved in the review to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and (b) recording the patient’s agreement to the review of the team care arrangements or the plan; and (c) giving copies of the relevant parts of the amended document mentioned in paragraph (1) (b), or the amended plan, to the collaborating providers; and (d) offering a copy of the amended document or plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and (e) adding a copy of the amended document or plan to the patient’s medical records. (3) In this rule: collaborating provider is a person who: (a) provides treatment or a service to a patient; and (b) is not a family carer of the patient. family carer includes a person who: (a) is a relative or friend of the patient; and (b) is providing care to the patient other than as a paid service. 53B Meaning of contribute to a multidisciplinary care plan for items 729 and 731 (1) For items 729 and 731, to contribute to a multidisciplinary care plan or to the review of a plan includes: (a) preparing part of the plan or amendments to the plan, and adding a copy of that part or those amendments to the patient’s medical records; or (b) giving advice to a person who prepares or reviews the plan, and recording in writing, on the patient’s medical records, any advice provided to such a person. (2) In subrule (1): multidisciplinary care plan means a written plan that: (a) is prepared for a patient by: (i) a medical practitioner, in consultation with 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient, and 1 of whom may be another medical practitioner; or (ii) a collaborating provider (other than a medical practitioner), in consultation with at least 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient; and (b) describes, at least, treatment and services to be provided to the patient by the collaborating providers. (3) In this rule: collaborating provider: (a) is a person who: (i) provides treatment or a service to a patient; and (ii) is not a family carer of the patient; and (b) includes a medical practitioner. family carer includes a person who: (a) is a relative or friend of the patient; and (b) is providing care to the patient other than as a paid service. [9] Schedule 1, Part 3, Group A15, heading substitute Group A15 — GP management plans, team care arrangements and multidisciplinary care plans and case conferences
[10] Schedule 1, Part 3, Group A15, Subgroup 1, heading substitute Subgroup 1 — GP management plans, team care arrangements and multidisciplinary care plans
[11] Schedule 1, Part 3, after item 720 insert
721
Preparation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), of a GP management plan for a patient (not being a service associated with a service to which any of items 734 to 779 apply) (Item is subject to rule 45A)
120.00
[12] Schedule 1, Part 3, after item 722 insert
723
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to co-ordinate the development of team care arrangements for a patient (not being a service associated with a service to which any of items 734 to 779 apply) (Item is subject to rule 45A)
95.00
[13] Schedule 1, Part 3, after item 724 insert
725
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to review: (a) a GP management plan prepared by that medical practitioner (or an associated medical practitioner) to which item 721 applies; or (b) a multidisciplinary community care plan to which item 720 applies, or a multidisciplinary discharge care plan to which item 722 applies, prepared by that medical practitioner (or an associated medical practitioner); (not being a service associated with a service to which any of items 734 to 779 apply) (Item is subject to rule 45A)
60.00
[14] Schedule 1, Part 3, after item 726 insert
727
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to co-ordinate a review of: (a) team care arrangements co-ordinated by that medical practitioner (or an associated medical practitioner) to which item 723 applies; or (b) a multidisciplinary community care plan to which item 720 applies, or a multidisciplinary discharge care plan to which item 722 applies, prepared by that medical practitioner (or an associated medical practitioner); (not being a service associated with a service to which any of items 734 to 779 apply) (Item is subject to rule 45A)
60.00
[15] Schedule 1, Part 3, after item 728 insert
729
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to contribute to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (not being a service associated with a service to which any of items 734 to 779 apply) (Item is subject to rule 45A)
41.65
[16] Schedule 1, Part 3, after item 730 insert
731
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to contribute to: (a) a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or (b) a multidisciplinary care plan prepared for a patient by another provider before the patient is discharged from a hospital or an approved day-hospital facility, or to a review of such a plan prepared by another provider; (not being a service associated with a service to which items 734 to 779 apply) (Item is subject to rule 45A)
41.65
Note
1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See www.frli.gov.au.
