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Health Insurance Amendment Regulations 2010 (No. 1)

Authoritative Version
  • - F2010L01978
  • No longer in force
SLI 2010 No. 230 Regulations as made
These Regulations amend the Health Insurance Regulations 1975 to allow participating midwives and nurse practitioners to render services for which Medicare benefits are payable.
Administered by: Health
Registered 21 Jul 2010
Tabling HistoryDate
Tabled HR28-Sep-2010
Tabled Senate28-Sep-2010
Date of repeal 19 Mar 2014
Repealed by Health (Spent and Redundant Instruments) Repeal Regulation 2014

Health Insurance Amendment Regulations 2010 (No. 1)1

Select Legislative Instrument 2010 No. 230

I, MARIE BASHIR, Administrator of the Government 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 19 July 2010

MARIE BASHIR

Administrator

By Her Excellency’s Command

NICOLA ROXON


Contents

                        1     Name of Regulations                                                        2

                        2     Commencement                                                              2

                        3     Amendment of Health Insurance Regulations 1975             2

Schedule 1             Amendments commencing on 1 July 2010 or the day after registration    3

Schedule 2             Amendments commencing on 1 November 2010         12

 

 


1              Name of Regulations

                These Regulations are the Health Insurance Amendment Regulations 2010 (No. 1).

2              Commencement

                These Regulations commence as follows:

                 (a)     regulations 1 to 3 and Schedule 1 — on the later of the following:

                          (i)     1 July 2010;

                         (ii)     the day after they are registered;

                (b)     Schedule 2 — on 1 November 2010.

3              Amendment of Health Insurance Regulations 1975

                Schedules 1 and 2 amend the Health Insurance Regulations 1975.


Schedule 1        Amendments commencing on 1 July 2010 or the day after registration

(regulation 3)

 

[1]           Regulation 2, after definition of approved collection centre

insert

collaborative arrangement:

                (a)    for a participating midwife — means a collaborative arrangement mentioned in regulation 2C; or

               (b)    for a participating nurse practitioner — means a collaborative arrangement mentioned in regulation 2F.

[2]           Regulation 2, after definition of Medical Board

insert

National Law means the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld).

Nursing and Midwifery Board means the Nursing and Midwifery Board of Australia established under section 31 of the National Law.

obstetrician means a medical practitioner who is a specialist in the specialty of obstetrics and gynaecology (however described).

obstetric specified medical practitioner means a medical practitioner mentioned in paragraph 2B (1) (a) or (b).

paediatrician means a medical practitioner who is a specialist in the specialty of paediatrics and child health (however described).

[3]           Regulation 2, after definition of servicing provider

insert

specified medical practitioner:

                (a)    for a participating midwife — means a medical practitioner mentioned in regulation 2B; or

               (b)    for a participating nurse practitioner — means a medical practitioner mentioned in regulation 2F.

[4]           Regulation 2, after definition of treatment provider

insert

usual general practitioner, for a patient, includes a medical practitioner nominated by the patient.

[5]           Regulation 2, note

substitute

Note   Several other words and expressions used in these Regulations have a meaning given by subsection 3 (1) of the Act. For example:

·      consultant physician

·      eligible midwife

·      eligible nurse practitioner

·      general practitioner

·      hospital-substitute treatment

·      hospital treatment

·      medical practitioner

·      midwife

·      nurse practitioner

·      participating midwife

·      participating nurse practitioner

·      practitioner

·      private health insurer

·      specialist.

[6]           After regulation 2A

insert

2B           Specified medical practitioners

         (1)   For the definition of participating midwife in subsection 3 (1) of the Act, the following kinds of medical practitioner are specified:

                (a)    an obstetrician;

               (b)    a medical practitioner who provides obstetric services;

                (c)    a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative arrangement.

         (2)   For the definition of participating nurse practitioner in subsection 3 (1) of the Act, all kinds of medical practitioner are specified.

         (3)   In this regulation:

hospital authority has the meaning given by subsection 84 (1) of the National Health Act 1953.

2C           Collaborative arrangements — participating midwives

         (1)   For the definition of participating midwife in subsection 3 (1) of the Act, each of the following is a kind of collaborative arrangement for an eligible midwife:

                (a)    the midwife is employed or engaged by 1 or more obstetric specified medical practitioners, or by an entity that employs or engages 1 or more obstetric specified medical practitioners;

               (b)    a patient is referred in writing to the midwife for midwifery treatment by a specified medical practitioner;

                (c)    an agreement mentioned in regulation 2D for the midwife;

               (d)    an arrangement mentioned in regulation 2E for the midwife.

         (2)   For subregulation (1), the arrangement must provide for:

                (a)    consultation between the midwife and an obstetric specified medical practitioner; and

               (b)    referral of a patient to a specified medical practitioner; and

                (c)    transfer of a patient’s care to an obstetric specified medical practitioner.

         (3)   A collaborative arrangement, other than an arrangement mentioned in regulation 2E, may apply to more than 1 patient.

         (4)   However, an acknowledgement mentioned in paragraph 2E (1) (c) may apply for more than 1 patient.

2D           Agreement between eligible midwife and 1 or more specified medical practitioners

         (1)   An agreement may be made between:

                (a)    an eligible midwife; and

               (b)    1 or more specified medical practitioners.

         (2)   The agreement must be in writing and signed by the eligible midwife and the other parties mentioned in paragraph (1) (b).

2E           Arrangement  — midwife’s written records

         (1)   An eligible midwife must record the following for a patient in the midwife’s written records:

                (a)    the name of at least 1 specified medical practitioner who is, or will be, collaborating with the midwife in the patient’s care (a named medical practitioner);

               (b)    that the midwife has told the patient that the midwife will be providing midwifery services to the patient in collaboration with 1 or more specified medical practitioners in accordance with this regulation;

                (c)    acknowledgement by a named medical practitioner that the practitioner will be collaborating in the patient’s care;

               (d)    plans for the circumstances in which the midwife will do any of the following:

                          (i)    consult with an obstetric specified medical practitioner;

                         (ii)    refer the patient to a specified medical practitioner;

                         (iii)    transfer the patient’s care to an obstetric specified medical practitioner.

         (2)   The midwife must also record the following in the midwife’s written records:

                (a)    any consultation or other communication between the midwife and an obstetric specified medical practitioner about the patient’s care;

               (b)    any referral of the patient by the midwife to a specified medical practitioner;

                (c)    any transfer by the midwife of the patient’s care to an obstetric specified medical practitioner;

               (d)    when the midwife gives a copy of the hospital booking letter (however described) for the patient to a named medical practitioner — acknowledgement that the named medical practitioner has received the copy;

                (e)    when the midwife gives a copy of the patient’s maternity care plan prepared by the midwife to a named medical practitioner — acknowledgement that the named medical practitioner has received the copy;

                (f)    if the midwife requests diagnostic imaging or pathology services for the patient — when the midwife gives the results of the services to a named medical practitioner;

                (g)    that the midwife has given a discharge summary (however described) at the end of the midwife’s care for the patient to:

                          (i)    a named medical practitioner; and

                         (ii)    the patient’s usual general practitioner.

2F           Collaborative arrangements — participating nurse practitioners

         (1)   For the definition of participating nurse practitioner in subsection 3 (1) of the Act, each of the following is a kind of collaborative arrangement for an eligible nurse practitioner:

                (a)    the nurse practitioner is employed or engaged by 1 or more specified medical practitioners, or by an entity that employs or engages 1 or more specified medical practitioners;

               (b)    a patient is referred in writing to the nurse practitioner for treatment by a specified medical practitioner;

                (c)    an agreement mentioned in regulation 2G for the nurse practitioner;

               (d)    an arrangement mentioned in regulation 2H for the nurse practitioner.

         (2)   For subregulation (1), the arrangement must provide for:

                (a)    consultation between the nurse practitioner and a medical practitioner; and

               (b)    referral of a patient to a medical practitioner; and

                (c)    transfer of a patient’s care to a medical practitioner.

         (3)   A collaborative arrangement, other than an arrangement mentioned in regulation 2H, may apply to more than 1 patient.

         (4)   However, an acknowledgement mentioned in paragraph 2H (1) (c) may apply for more than 1 patient.

2G           Agreement between eligible nurse practitioner and 1 or more specified medical practitioners

         (1)   An agreement may be made between:

                (a)    an eligible nurse practitioner; and

               (b)    1 or more specified medical practitioners.

         (2)   The agreement must be in writing and signed by the eligible nurse practitioner and the other parties mentioned in paragraph (1) (b).

2H           Arrangement — nurse practitioner’s written records

         (1)   An eligible nurse practitioner must record the following for a patient in the nurse practitioner’s written records:

                (a)    the name of at least 1 specified medical practitioner who is, or will be, collaborating with the nurse practitioner in the patient’s care (a named medical practitioner);

               (b)    that the nurse practitioner has told the patient that the nurse practitioner will be providing services to the patient in collaboration with 1 or more specified medical practitioners in accordance with this regulation;

                (c)    acknowledgement by a named medical practitioner that the practitioner will be collaborating in the patient’s care;

               (d)    plans for the circumstances in which the nurse practitioner will do any of the following:

                          (i)    consult with a medical practitioner;

                         (ii)    refer the patient to a medical practitioner;

                         (iii)    transfer the patient’s care to a medical practitioner;

                (e)    any consultation or other communication between the nurse practitioner and a medical practitioner about the patient’s care;

                (f)    any transfer by the nurse practitioner of the patient’s care to a medical practitioner;

                (g)    any referral of the patient by the nurse practitioner to a medical practitioner;

                (h)    if the nurse practitioner gives a copy of a document mentioned in subregulation (2) or (3) to a named medical practitioner — when the copy is given;

                 (i)    if the nurse practitioner gives a copy of a document mentioned in subregulation (4) or (5) to the patient’s usual general practitioner — when the copy is given.

         (2)   If the nurse practitioner refers the patient to a specialist or consultant physician, or if the nurse practitioner requests diagnostic imaging or pathology services for the patient, the nurse practitioner must give a copy of the referral, or the results of the services, to a named medical practitioner if:

                (a)    the nurse practitioner:

                          (i)    consults with the named medical practitioner; or

                         (ii)    refers the patient to the named medical practitioner; or

                         (iii)    transfers the patient’s care to the named medical practitioner; and

               (b)    the named medical practitioner asks the nurse practitioner for a copy of the referral or results.

         (3)   Also, the nurse practitioner must give a named medical practitioner a record of the services provided by the nurse practitioner to the patient if:

                (a)    the nurse practitioner:

                          (i)    consults with the named medical practitioner; or

                         (ii)    refers the patient to the named medical practitioner; or

                         (iii)    transfers the patient’s care to the named medical practitioner; and

               (b)    the named medical practitioner asks the nurse practitioner for the record.

         (4)   If the nurse practitioner refers the patient to a specialist or consultant physician, or requests diagnostic imaging or pathology services for the patient, and the patient’s usual general practitioner is not a named medical practitioner, the nurse practitioner must give a copy of the referral, or the results of the services, to the patient’s usual general practitioner.

         (5)   Also, if the patient’s usual general practitioner is not a named medical practitioner, the nurse practitioner must give the patient’s usual general practitioner a record of the services provided by the nurse practitioner to the patient.

         (6)   However, subregulations (4) and (5) apply only if the patient consents.

[7]           After regulation 14

insert

14A         Eligibility requirements for midwives

                For paragraph 21 (1) (b) of the Act, a midwife must meet any registration standard for an eligible midwife developed by the Nursing and Midwifery Board for subsection 38 (2) of the National Law.

Note   Subsection 38 (2) of the National Law deals with developing registration standards about matters for health practitioners.

Schedule 2        Amendments commencing on 1 November 2010

(regulation 3)

 

[1]           Regulation 2, definition of provider number, paragraph (a)

omit

an approved pathology practitioner or an optometrist; and

insert

approved pathology practitioner, optometrist, participating midwife or participating nurse practitioner; and

[2]           Regulation 2, definition of referring practitioner, paragraph (c)

omit

dental practitioner.

insert

dental practitioner; and

[3]           Regulation 2, definition of referring practitioner, after paragraph (c)

insert

               (d)    if the referral:

                          (i)    arises out of a midwifery service provided by a participating midwife; and

                         (ii)    is to an obstetrician or paediatrician;

                        a participating midwife; and

                (e)    if the referral:

                          (i)    arises out of a nurse practitioner service provided by a participating nurse practitioner; and

                         (ii)    is to a specialist or consultant physician;

                        a participating nurse practitioner.

[4]           Regulation 2, definition of treatment provider, paragraph (c)

omit

optometrist.

insert

optometrist; or

[5]           Regulation 2, definition of treatment provider, after paragraph (c)

insert

               (d)    a participating midwife; or

                (e)    a participating nurse practitioner.

[6]           Regulation 3A, table, after item 8

insert

8A

Midwifery

[7]           Regulation 3A, table, after item 9

insert

9A

Nurse practitioner services

[8]           Regulation 9A

substitute

9A           Requests for pathology services by electronic means

         (1)   For paragraph 16A (4) (b) of the Act, subregulation (2) applies if:

                (a)    a request for a pathology service is made or confirmed by electronic means; and

               (b)    a practitioner, participating midwife or participating nurse practitioner is identified as the person who made the request or confirmation:

                          (i)    by name, number or other means in the request or confirmation; or

                         (ii)    by the electronic system used to make the request or confirmation.

         (2)   The request or confirmation is taken to have been made by the person unless the person shows that he or she did not make the request or confirmation.

[9]           After subregulation 13 (1B)

insert

      (1C)   For subsection 19 (6) of the Act, either or both of the following particulars are prescribed for professional services provided by a participating midwife or participating nurse practitioner:

                (a)    the name and address of the participating midwife or participating nurse practitioner;

               (b)    the provider number of the participating midwife or participating nurse practitioner.

[10]         After subregulation 13 (8)

insert

      (8A)   For subsection 19 (6) of the Act, subregulation (8B) applies if a participating midwife or participating nurse practitioner:

                (a)    attends a person more than once on the same day; and

               (b)    on each occasion provides a professional service to the person.

      (8B)   The time each attendance starts is prescribed as a particular for the participating midwife or participating nurse practitioner.

[11]         Paragraph 13 (9) (a)

omit each mention of

practitioner

insert

practitioner, participating midwife or participating nurse practitioner

[12]         Subregulation 13 (13)

substitute

       (13)   For subsection 19 (6) of the Act, the following particulars are prescribed for professional services other than those mentioned in subregulation (13A):

                (a)    the name of the practitioner, optometrist, participating midwife or participating nurse practitioner who provided the professional service;

               (b)    a statement that the professional service was provided by that person;

                (c)    either:

                          (i)    the address of the place of practice where the service was provided; or

                         (ii)    both:

                                   (A)     if the service was provided at a place of practice for which that person has been allocated a provider number — the provider number; and

                                   (B)     in any other case — the provider number allocated to that person for any place where he or she practices.

    (13A)   Subregulation (13) does not apply to a professional service to which any of the following items relate:

                (a)    an item in the pathology services table other than items 73801 to 73811 (inclusive);

               (b)    any of items 12500 to 12533 (inclusive), 15000 to 15600 (inclusive) and 16003 to 16015 (inclusive) of the general medical services table;

                (c)    an item in the diagnostic imaging services table.

[13]         Subparagraph 20 (2) (c) (i)

omit

a physiotherapist or a podiatrist

insert

a physiotherapist, a podiatrist, a participating midwife or a participating nurse practitioner

[14]         Paragraph 25A (1) (b)

omit

medical practitioner,

insert

medical practitioner or participating midwife,

[15]         Regulation 25A, example

substitute

Example

The circumstances described by this regulation would include a booking fee or request for payment by a medical practitioner or participating midwife, or a person acting on behalf of the medical practitioner, employed by, or under contract to, a public hospital, for costs or charges of the medical practitioner or participating midwife for performing a public hospital service:

(a)     by attending a public patient in the hospital to deliver a baby; or

(b)     associated with the delivery of a baby for a public patient; or

(c)     requested or required by a public patient in connection with the delivery of a baby.

[16]         Subregulation 29 (4A)

omit each mention of

general practitioner

insert

general practitioner, participating midwife or participating nurse practitioner


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.