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M33/2011 Determinations/Health as made
This instrument amends the MRCA Treatment Principles to refer to new Notes for Allied Health Providers, remove need for Military Rehabilitation and Compensation Commission's prior approval for pregnancy-related treatment, remove need for Military Rehabilitation and Compensation Commission's prior approval for referrals for diagnostic imaging/pathology services where bill for services is 100% or less of Medicare Benefits Schedule fee for such services and replace references to Medicare Australia with references to the Department of Human Services.
Administered by: Veterans' Affairs
Registered 01 Sep 2011
Tabling HistoryDate
Tabled HR12-Sep-2011
Tabled Senate12-Sep-2011
Date of repeal 19 Mar 2014
Repealed by Veterans' Affairs (Spent and Redundant Instruments) Repeal Regulation 2014

 

Australian Government

Military Rehabilitation and Compensation Act 2004

 

MRCA Treatment Principles (Minor & Technical Variations) Determination 2011

 

Instrument No.M33/2011

 

 

I, Warren Snowdon, Minister for Veterans’ Affairs, pursuant to subsection 286(3) of the Military Rehabilitation and Compensation Act 2004, approve this instrument made by the Military Rehabilitation and Compensation Commission.

Dated this   22nd                     day of    August                     2011

Warren Snowdon

WARREN SNOWDON

 

The Military Rehabilitation and Compensation Commission, pursuant to subsection 286(2) of the Military Rehabilitation and Compensation Act 2004, varies the MRCA Treatment Principles (Instrument No.M21 of 2004) in accordance with the Schedule.

Dated this              9th                day of              August                        2011

 

The Seal of the                                                )

Military Rehabilitation                                    )

and Compensation Commission                   )                    Seal

was affixed hereto in the                                )

presence of:                                                     )

Ian Campbell             Shane Carmody          Major General Mark Kelly AO DSC

………………………………………………………………………………………....

IAN CAMPBELL        SHANE CARMODY      Major General Mark Kelly AO DSC

CHAIR                                    MEMBER                                             MEMBER

 

 

 

 

 

 

 

[1]     Name of Instrument

This instrument is the MRCA Treatment Principles (Minor & Technical Variations) Determination 2011

 

[2]     Commencement

 

This instrument commences immediately after the MRCA Treatment Principles (Retirement Villages and Rehabilitation Appliance Schedule) Instrument 2011, apart from section 5, commences.

 

Note: the MRCA Treatment Principles (Retirement Villages and Rehabilitation Appliance Schedule) Instrument 2011, apart from section 5, commences on the day after the day it is registered on the Federal Register of Legislative Instruments.

 

[3]     Transitional

 

(a)     Where, under the Principles, a person has lodged a claim with Medicare Australia, or had some other dealing with Medicare Australia, before the commencement of this instrument, but on the commencement of this instrument the claim or dealing had not been finalised, then on the commencement of this instrument the claim or dealing is taken to have been made or entered into under the Principles as varied by this instrument as if Medicare Australia had been the Department of Human Services.

 

(b)     Where, under the Principles, and on or after 1 July 2011 and before this instrument commences, a person purportedly lodged a claim with Medicare Australia, or had some other dealing purportedly with Medicare Australia, then on the commencement of this instrument the claim or dealing is taken to have been made or entered into with the Department of Human Services.

 

Note 1: a person includes a health care provider, an entitled person, the Commission or the Department.

Note 2: a term used in [3], including in the Notes, that is defined in the MRCA Treatment Principles under the Military Rehabilitation and Compensation Act 2004 has the same meaning it has in the MRCA Treatment Principles.

Note 3: 1 July 2011 is when the Human Services Legislation Amendment Act 2011 commenced.  This Act, among other things, transferred the functions of Medicare Australia to the Department of Human Services.


 

                                Schedule

 

Part A (Notes for Provider Variations)

 

1.      Paragraph 1.4.1 (definitions)

 

omit the following definitions:

 

“Notes for Allied Mental Health Care Providers”

“Notes for Chiropractors”

“Notes for Diabetes Educators”

“Notes for Dietitians”

“Notes for Exercise Physiologists”

“Notes for Local Dental Officers”

“Notes for Occupational Therapists”

“Notes for Osteopaths”

“Notes for Physiotherapists”

“Notes for Podiatrists”

“Notes for Providers”

“Notes for Providers of Optometric Services / Dispensers of Optical Appliances”

“Notes for Social Workers”

“Notes for Speech Pathologists”

 

insert the following definitions:

 

“allied health provider” means a category of provider mentioned in the Table in 7.1A.1.

 

“Notes for Allied Health Providers” means the document approved by the Secretary to the Department entitled “Notes for Allied Health Providers, and in force on the date in Schedule 1, that sets out the terms on which, and the conditions subject to which, an allied health provider is to provide treatment to an entitled person in order for the Commission to accept financial responsibility for that treatment.

 

2.      Paragraph 3.5.1(1) (Financial responsibility)

 

Paragraph (a)

 

omit:

 

Notes for Chiropractors

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(b)(Chiropractors))

 

Paragraph (b)

 

omit:

 

Notes for Local Dental Officers

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(c)(as section 2(c) affects dentists))

 

Paragraph (c)

 

after:

 

Principles

 

insert:

 

and the Notes for Allied Health Providers (Section 1 General Information and Section 2(c)(as section 2(c) affects dental prosthetists))

 

Paragraph (d)

 

omit:

 

Notes for Local Dental Officers

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(c)(as section 2(c) affects dental specialists, including as dentists))

 

Paragraph (e)

 

omit:

 

Notes for Diabetes Educators

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(d)(Diabetes Educators)

 

Paragraph (f)

 

omit:

 

Notes for Dietitians

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(e)(Dietitians)

 

Paragraph (g)

 

omit:

 

Notes for Exercise Physiologists

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(f)(Exercise Physiologists)

 

Paragraph (ia)

 

omit:

 

the Notes for Allied Mental Health Care Providers, as they affect a neuropsychologist

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects a neuropsychologist)

 

omit the note.

 

Paragraph (ja)

 

omit:

 

Notes for Occupational Therapists

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(g)(Occupational Therapists)

 

Paragraph (j)

 

omit:

 

“Notes for Allied Mental Health Care Providers”, as they affect an occupational therapist (mental health)

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects occupational therapists (mental health))

 

Paragraph (k)

 

omit:

 

Notes for Providers of Optometric Services/Dispensers of Optical Appliances

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects optical dispensers))

 

Paragraph (l)

 

omit:

 

Notes for Providers of Optometric Services/Dispensers of Optical Appliances

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects optometrists))

 

Paragraph (m)

 

after:

 

Principles

 

insert:

 

and the Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects orthoptists))

 

Paragraph (n)

 

omit:

 

Notes for Osteopaths

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(i)(Osteopaths)

 

Paragraph (p)

 

omit:

 

Notes for Physiotherapists

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and section 2(j)(Physiotherapists)

 

Paragraph (q)

 

omit:

 

Notes for Podiatrists

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(k)( Podiatrists)

 

Paragraph (ra)

 

omit:

 

Notes for Allied Mental Health Care Providers, as they affect a clinical psychologist (including as a psychologist)

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects clinical psychologist (including as a psychologist))

 

Paragraph (r)

 

omit:

 

Notes for Allied Mental Health Care Providers, as they affect a psychologist (other than as a clinical psychologist)

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects psychologists (other than as a clinical psychologist))

 

Paragraph (sa)

 

omit:

 

Notes for Social Workers

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects social workers (other than as a social worker (mental health))

 

Paragraph (s)

 

omit:

 

Notes for Allied Mental Health Care Providers, as they affect a social worker (mental health)

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(a)(as section 2(a) affects social workers (mental health))

 

Paragraph (u)

 

omit:

 

Notes for Speech Pathologists

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(l)(Speech Pathologists))

 

3.      Paragraph 5.1.1

 

omit:

 

and in the case of a dentist, also provided in accordance with the terms and conditions in the document entitled Notes for Local Dental Officers.

 

substitute:

 

and in accordance with the Notes for Allied Health Providers (Section 1 General Information and Section 2(c)(as section 2(c) affects a dental prosthetist, dentist or dental specialist, as the case may be))

 

4.      Paragraph 5.1.2 (the Note)

 

omit:

 

Notes for Local Dental Officers

 

substitute:

 

Notes for Allied Health Providers

 

5.      Paragraph 5.4.1(d)

 

omit:

 

Notes for Local Dental Officers

 

substitute:

 

Notes for Allied Health Providers

 

6.      Paragraph 7.1.1(2)

 

omit:

 

Notes for Providers

 

substitute:

 

Notes for Allied Health Providers

 

7.      Paragraph 7.1A.1 (including the Table)

 

omit, substitute:

 

7.1A.1        In order for the Commission to accept financial responsibility for treatment provided to an entitled person by a health care provider in an item (denoted by a number) in Column A below, the treatment must have been provided in accordance with the section of the Notes for Allied Health Providers for that item in Column B below, as that section relates to the health care provider:

 

Column A                                                            Column B

 

 

 

Notes for Allied Health Providers

 

 

Provider Type

General section

Provider specific section

1

Chiropractors

Section 1 - General Information

Section 2(b) – Chiropractors

2

Clinical Psychologists

Section 2(a) – Allied Mental Health Care Providers

3

Dentists, Dental Specialists & Dental Prosthetists

Section 2(c) – Dentists, Dental Specialists and Dental Prosthetists

4

Diabetes Educators

Section 2(d) - Diabetes Educators

5

Dietitians

Section 2(e) – Dietitians

6

Exercise Physiologists

Section 2(f) – Exercise Physiologists

7

Neuropsychologists

Section 2(a) – Allied Mental Health Care Providers

8

Occupational Therapists

Section 2(g) – Occupational Therapists

9

Occupational Therapists – Mental Health

Section 2(a) – Allied Mental Health Care Providers

10

Optometrists, Orthoptists & Optical Dispensers

Section 2(h) - Optometrists, Orthoptists & Optical Dispensers

11

Osteopaths

Section 2(i) – Osteopaths

12

Physiotherapists

Section 2(j) – Physiotherapists

13

Podiatrists

Section 2(k) – Podiatrists

14

Psychologists

Section 2(a) – Allied Mental Health Care Providers

15

Social Workers

Section 2(a) – Allied Mental Health Care Providers

16

Social Workers – Mental Health

Section 2(a) – Allied Mental Health Care Providers

17

Speech Pathologists

Section 2(l) – Speech Pathologists

 

 

8.      Paragraph 7.4.1

 

omit:

 

Notes for Providers of Optometric Services /Dispensers of Optical Appliances

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects optometrists))

 

9.      Paragraph 7.4.2(b)

 

omit:

 

Notes for Providers of Optometric Services /Dispensers of Optical Appliances

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects optometrists and optical dispensers))

 

10.    Paragraph 11.4.1(d)

 

omit:

 

Notes for Providers of Optometric Services /Dispensers of Optical Appliances

 

substitute:

 

Notes for Allied Health Providers (Section 1 General Information and Section 2(h)(as section 2(h) affects optometrists and optical dispensers))

 

rearrange paragraphs in 11.4.1 consecutively

 

11.    Schedule 1 (Dates For Incorporated Documents)

 

omit, substitute:

 

 

SCHEDULE 1 DATES FOR INCORPORATED DOCUMENTS

 

 

The date for :

 

          1.       Notes for Local Medical Officers (paragraph 1.4.1);

 

2.       Department of Veterans’ Affairs Fee Schedules for Medical Services (paragraph 3.5.1);

 

3.       Notes for Allied Health Providers (paragraphs 3.5.1 and 7.1A.1);

 

4.       Optometrist Fees for Consultation (paragraph 3.5.1);

 

5.       DVA Schedule of Fees Orthoptists (paragraph 3.5.1);

 

6.       Pricing Schedule for visual aids (paragraph 3.5.1);

 

7.       The fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (commonly known as DSM-IV) (paragraph 2.4.2A);

         

8.       Fee Schedule of Dental Services for Dentists and Dental Specialists (paragraph 3.5.1);

 

9.       Fee Schedule of Dental Services for Dental Prosthetists (paragraph 3.5.1);

 

          10.     Chiropractors Schedule of Fees (paragraph 3.5.1);

 

11.     Diabetes Educators Schedule of Fees (paragraph 3.5.1);

 

12.     Dietitians Schedule of Fees (paragraph 3.5.1);

 

 

13.     Exercise Physiologists Schedule of Fees (paragraph 3.5.1);

 

 

14.     Occupational Therapists Schedule of Fees (paragraph 3.5.1);

 

 

15.     Osteopaths Schedule of Fees (paragraph 3.5.1);

 

 

16.     Physiotherapists Schedule of Fees (paragraph 3.5.1);

 

 

17.     Psychologists Schedule of Fees (paragraph 3.5.1);

 

 

18.     Podiatrists Schedule of Fees (paragraph 3.5.1);

 

19.     Social Workers Schedule of Fees (paragraph 3.5.1);

 

20.     Clinical Counsellors Schedule of Fees (paragraph 3.5.1);

 

21.     Speech Pathologists Schedule of Fees (paragraph 3.5.1);

 

22.     Australian Government Department of Veterans’ Affairs      Classification System and Schedule of Item Numbers and Fees — Community Nursing Services;

 

23.     Notes for Coordinated Veterans' Care Program Providers;

 

24.     Rehabilitation Appliances Program (RAP) National Guidelines (paragraph 11.2A.1);

 

25.     RAP National Schedule of Equipment (paragraph 11.2A.1);

 

is 10 August 2011.

 

 

 


                                    Part B (Miscellaneous Variations)

 

1.      Paragraph 4.7.2(a)

 

omit.

 

2.      Paragraph 4.7.3

 

omit, substitute:

 

4.7.3  Prior approval is not required when a LMO, other GP or medical specialist refers an entitled person to a medical specialist for diagnostic imaging or pathology services not requiring admission and the medical specialist direct bills the Department of Human Services at 100 per cent or less of the fee set out in the Medicare Benefits Schedule as full settlement of the account for the service rendered.

 

 

 


 

                 Part C (Medicare Variations)

 

1.      Paragraph 1.4.1 (Definitions)

 

“clinical psychologist”

 

Paragraph (a)

 

omit:

 

“by Medicare Australia”

 

Paragraph (b)

 

omit:

 

“Medicare Australia”

 

substitute:

 

the Department of Human Services

 

Coordinated Veterans' Care Program

 

omit:

 

“Medicare Australia”

 

substitute:

 

the Department of Human Services

 

Health Insurance Commission”

 

omit.

 

“Local Medical Officer” or “LMO”

 

Paragraph (b)

 

omit:

 

“by Medicare Australia”

 

the Note

 

omit:

 

“Medicare Australia”

 

substitute:

 

the Department of Human Services

 

Medicare Australia

 

omit.

 

“neuropsychologist”

 

omit:

 

“Medicare Australia”

 

substitute:

 

the Department of Human Services

 

“occupational therapist”

 

omit:

 

“by Medicare Australia”

 

occupational therapist (mental health)”

 

Paragraph (a)

 

omit:

 

“by Medicare Australia”

 

Paragraph (b)

 

omit:

 

“Medicare Australia”

 

substitute:

 

the Department of Human Services

 

“other GP

 

Paragraph (b)

 

omit:

 

 

“by Medicare Australia”

 

Note 2

 

omit:

 

“Medicare Australia”

 

substitute:

 

the Department of Human Services

 

“provider number”

 

omit, substitute:

 

“provider number” means the number:

 

(a)   allocated by:

 

(i)    the Chief Executive Medicare or by his or her delegate or by a person authorised by the Chief Executive Medicare — to a practitioner; or

 

(ii)   the Chief Executive Officer of Medicare Australia under the Medicare Australia Act 1973 — to a practitioner; and

 

(b)   which identifies the practitioner and the places where the practitioner practises his or her profession.

 

Note: see regulation 2 of the Health Insurance Regulations 1975. 

 

"psychologist

 

omit:

 

“by Medicare Australia”

 

social worker (mental health)”

 

Paragraph (a)

 

omit:

 

“by Medicare Australia”

 

Paragraph (b)

 

omit:

 

“Medicare Australia”

 

substitute:

 

the Department of Human Services

 

2.      Paragraph 1.4.1 (Definitions)

 

insert:

 

“Chief Executive Medicare” has the meaning it has in the Human Services (Medicare) Act 1973.

 

            “Department of Human Services” means the Department administered by the Minister administering the Human Services (Medicare) Act 1973.

 

“medicare benefit has the meaning it has in the Health Insurance Act 1973.

 

“medicare program” has the meaning it has in the Human Services (Medicare) Act 1973.

 

3.      Paragraph 3.4.4

 

omit:

 

Medicare

 

substitute:

 

the Department of Human Services as a medicare benefit

 

4.      Paragraph 3.4.5

 

omit:

 

Medicare

 

substitute:

 

the Department of Human Services as a medicare benefit

 

5.      Paragraph 3.4.6

 

omit, substitute:

 

3.4.6  The Commission will not pay or reimburse the Medicare levy or the Medicare levy surcharge or pay or reimburse health insurance fund premiums.

 

Note: see the Medicare Levy Act 1986 for the Medicare levy and Medicare levy surcharge.

 

5A.   Paragraph 3.5.2 (Note 2)

 

after:

 

office of the Department in Australia

 

insert:

 

, the Department of Human Services

 

6.      Paragraph 3.5.3 (a)

 

omit, substitute:

 

(a)   services that have been paid for, wholly or partly, by the Department of Human Services, as a medicare benefit, or by a health insurance fund; or

 

7.      Paragraph 4.1.3

 

omit:

 

          Medicare Australia

 

substitute:

 

          Department of Human Services

 

8.      Paragraph 4.3.2 (c )

 

          omit:

 

          the Health Insurance Commission

 

          substitute:

 

          Department of Human Services

 

9.      Paragraph 4.8.1(g)

 

          omit, substitute:

 

(g) services that have been paid for, wholly or partly, by the Department of Human Services, as a medicare benefit, or by a health insurance fund; or

 

10.    Paragraph 6A.4.2 (the Note)

 

omit:

 

Medicare Australia

 

substitute:

 

the Department of Human Services

 

11.    Paragraph 6A.9.2

 

omit:

 

Medicare Australia

 

substitute:

 

the Department of Human Services

 

12.    Paragraph 7.4.4

 

omit:

 

Medicare Australia

 

substitute:

 

the Department of Human Services

 

13.    Paragraph 7.4.5

 

omit:

 

Medicare Australia

 

substitute:

 

the Department of Human Services

 

14.    Paragraph 7.5.1

 

omit:

 

to whom the Health Insurance Commission has given a provider number

 

substitute:

 

who has a provider number

 

15.    Paragraph 7.6.1

 

omit:

 

(to whom the Health Insurance Commission has given a provider number)

 

substitute:

 

who has a provider number

 

16.    Paragraph 7.6.3

 

omit:

 

(to whom the Health Insurance Commission has given a provider

numberError! Reference source not found.)

 

substitute:

 

who has a provider number

 

17.    Paragraph 7.6A.1(c)

 

omit, substitute:

 

(c) the diabetes educator has a provider number.

 

18.    Paragraph 7.7.1

 

omit:

 

to whom the Health Insurance Commission has given a provider number

 

substitute:

 

who has a provider number

 

19.    Paragraph 10.13.1

 

omit:

 

Medicare Australia

 

substitute:

 

the Department of Human Services

 

19A. Part 10 Part E

 

renumber for consecutive numbering with Part D.

 

20.    Paragraph 12.2 (heading)

 

omit, substitute:

 

12.2  Treatment under Medicare Program

 

21.    Paragraph 12.2.1

 

omit:

 

Medicare

 

substitute:

 

a medicare program

 

22.    Paragraph 12.2.2

 

omit:

 

          Medicare arrangements

 

substitute:

 

a medicare program

 

omit, second occurring:

 

Medicare

 

substitute:

 

the MBS

 

23.    Paragraph 12.2.3

 

omit:

 

Medicare benefit

 

substitute:

 

medicare benefit