Federal Register of Legislation - Australian Government

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Determinations/Health as made
This Determination amends the Health Insurance (Allied Health Services) Determination 2011 to cap the number of individual and group Psychological Therapy services and Focused Psychological Strategies services for which a person can receive medicare rebates under the 'Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative' in a calendar year to 10, and increases fees for allied health services from 1 November 2011 due to annual indexation.
Administered by: Health
Made 18 Oct 2011
Registered 26 Oct 2011
Tabled HR 31 Oct 2011
Tabled Senate 31 Oct 2011
Date of repeal 19 Mar 2014
Repealed by Health (Spent and Redundant Instruments) Repeal Regulation 2014

EXPLANATORY STATEMENT

 

Issued by Authority of the Minister for Health and Ageing

 

Health Insurance Act 1973

 

Health Insurance (Allied Health Services) Amendment Determination 2011 (No. 2)

 

 

Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by writing, determine that a health service not listed in the general medical services table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed.  This Table is set out in the Health Insurance (General Medical Services Table) Regulations, remade annually.

 

Subsection 3C(8) of the Act specifies the health services about which a determination under subsection 3C(1) of the Act may be made.  These include medical, surgical, obstetric, dental and optometrical services and any other prescribed service that relates to health.  Regulation 3A of the Health Insurance Regulations 1975 prescribes classes of allied health services as “health services” for the purposes of section 3C of the Act. 

 

This Determination amends the Health Insurance (Allied Health Services) Determination 2011.

 

Purpose

 

The purpose of this Determination is to:

·         cap the number of individual Psychological Therapy services and Focussed Psychological Strategies services for which a person can receive Medicare rebates under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative in a calendar year to 10.  The number of group sessions for Psychological Therapy services and Focussed Psychological Strategies services will also be capped at 10 in a calendar year; and

·         increase fees for allied health services from 1 November 2011 due to annual indexation.

 

Background

 

The ‘Delivering National Mental Health Reform’ package announced in the 2011-12 Budget, together with 2010 Budget and election commitments, provided investment of $2.2 billion over five years in new and expanded mental health services.  Included in this package were some changes to the Better Access initiative.

 

The Australian Government is concerned that while Better Access is a good program for those it is reaching, it is still not servicing hard to reach groups like young people, men, people living in rural and remote regions, Indigenous Australians and people living in areas of high socio‑economic disadvantage.  An independent evaluation of the Better Access initiative showed that people on lower incomes received both significantly fewer services and less funding under Better Access than those on higher incomes.

 

From 1 November 2011, the cap on the number of Medicare eligible Psychological Therapy and Focussed Psychological Strategies Services that may be accessed by eligible people with a diagnosed mental disorder will be changed from twelve sessions per year to ten.  Following an initial course of treatment (a maximum of six sessions), patients will, if necessary, be able

 

to access more sessions up to a total of ten sessions per year. Patients are also eligible for ten group sessions per calendar year in addition to their individual sessions. 

 

In making these changes the Government has consulted mental health experts and examined the available evidence, including the independent evaluation of Better Access.  After more than four years of operation, the Government has a clear sense of how the program is being used by providers and consumers.

 

The findings of the Better Access evaluation showed that almost three quarters of people who access services used between one and six sessions a year.  The majority (87 per cent) of current Better Access users received between one and ten sessions per year and will therefore be unaffected by this change.

 

The Better Access initiative was introduced to address low treatment rates for high prevalence mental disorders such as depression and anxiety, particularly presentations of mild to moderate severity where short‑term evidence‑based interventions are most likely to be useful.

 

While some people with more complex or intensive care needs may benefit from psychological interventions under Better Access, the initiative was not designed to provide intensive, ongoing therapy for people with severe, ongoing illness.

 

It is important that people get the right care for their needs.  People who currently receive more than ten allied mental health services under Better Access are likely to be patients with more complex needs and would be better suited for referral to more appropriate mental health services.  The current exceptional circumstances provision will be removed, which means there will be no option to extend the number of sessions beyond 10 per calendar year. GPs can continue to refer those people with more severe ongoing mental disorders to Medicare subsidised consultant psychiatrist services, or state/territory specialised mental health services.

 

Consultation

 

The ‘Delivering National Mental Health Reform’ package, announced in the 2011-12 Budget, followed a period of extensive engagement with the mental health sector, experts, service providers and consumers and their carers. Minister Butler, in November and December 2010, held 14 face to face forums around the country with mental health consumers and carers to hear first hand their experiences and views on options for progressing mental health reform into the future.  Minister Butler also heard views from young people during an online forum hosted by the Inspire Foundation on 8 December 2010. 

 

The Government, however, does not always consult about the precise details of a particular Budget measure prior to its announcement and in this case there were no consultations on the specific details of the Better Access changes announced in the 2011-12 Budget. 

 

No consultation was taken in relation to the increasing of fees due to annual indexation, as the change is routine and machinery in nature.

 

This Determination commences on 1 November 2011.

 

This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 


 

ATTACHMENT

 

DETAILS OF THE HEALTH INSURANCE (ALLIED HEALTH SERVICES) AMENDMENT DETERMINATION 2011 (NO. 2)

 

1                    Name of Determination

Clause 1 states that the name of the amending Determination is the Health Insurance (Allied Health Services) Amendment Determination 2011 (No. 2).  

 

2                    Commencement

Clause 2 states that the Determination commences on 1 November 2011.

 

3                    Amendment of the Health Insurance (Allied Health Services) Determination 2011

Clause 3 states that Schedules 1 and 2 amend the Health Insurance (Allied Health Services) Determination 2011.

 

Schedule 1      Amendments

 

Item 1             Subsection 4(1), definition of CPD year, paragraph (a)

This item corrects a minor drafting error in the Health Insurance (Allied Health Services) Determination 2011.

 

Item 2             Subsection 4(1), definition of GP Mental Health Treatment Plan

The definition of a GP Mental Health Treatment Plan (GPMHTP) requires amendment because items 2702 and 2710 of the general medical services table will be removed from      1 November 2011 and replaced by new items for the development of GPMHTPs. The definition of GPMHTP is amended to:

 

(i)         allow patients who have been referred for Psychological Therapy or Focussed Psychological Strategies services as part of  a  GPMHTP developed under items 2702 or 2710 of the general medical services table as in force on 31 October 2011 to continue to be able to receive these services after 1 November 2011; and

 

(ii)        provide reference to the new GPMHTP items in the general medical services table in force from 1 November 2011. 

 

Item 3             Section 6, Limitation on certain items

This item amends rule 6 to provide that individual allied health Psychological Therapy and Focussed Psychological Strategies services only apply where the service is one of the first ten ‘relevant services’ provided to a patient in that year.

 

The definition of ‘relevant service’ is also amended by omitting reference to services to which the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care Program applies.

 

‘Relevant services’ are now items 2721 – 2727 of the general medical services table and items 80000 – 80015, 80100 to 80115, 80125 – 80140 and 80150 – 80165 of the Determination.

 

The increase of the annual cap on individual Psychological Therapy and Focussed Psychological Strategies services to 18 services where ‘exceptional circumstances’ exist is also omitted.

 

Item 4             After Section 6

This item inserts a new section which limits the number of allied health group Psychological Therapy and Focussed Psychological Strategies services a patient can receive in a calendar year to 10. The limit on the number of group sessions was previously contained in the item descriptor of the relevant items, but has been included in a new rule for drafting consistency.

 

Item 5             Schedule 2, Part 2, Services and fees – psychological therapy and focussed psychological strategies, item 80000

This item corrects a minor drafting error in the Health Insurance (Allied Health Services) Determination 2011.

 

Items 6 - 9       Schedule 2, Part 2, Services and fees – psychological therapy and focussed psychological strategies, items 80020, 80120, 80145 and 80170.

The item descriptors for items 80020, 80120, 80145 and 80170 are amended by omitting the current cap of 12 group services per year and by making group services subject to new section 6A of the Determination. New section 6A caps the number of group services a patient can receive in a calendar year at 10.

 

 

Schedule 2 – Amendments

 

Item 1             Schedule 2, Parts 1 – 6, items 10950 to 82035

This Schedule sets out the relevant Medicare items provided by eligible allied health professionals.  Fees have been updated to those that apply on 1 November 2011 due to annual indexation.