Federal Register of Legislation - Australian Government

Primary content

Regulations as made
This instrument amends the Health Insurance (Diagnostic Imaging Services Table) Regulations 2019 and the Health Insurance (General Medical Services Table) Regulations 2019 to include new measures and items more comprehensively dealing with fees for attendances and treatment in intensive care and emergency departments of private hospitals or for private patients in public hospitals.
Administered by: Health
Registered 25 Feb 2020
Tabling HistoryDate
Tabled HR26-Feb-2020
Tabled Senate27-Feb-2020
To be repealed 07 Aug 2020
Repealed by Division 1 of Part 3 of Chapter 3 of the Legislation Act 2003
Table of contents.

Commonwealth Coat of Arms of Australia

 

Health Insurance Legislation Amendment (Intensive Care and Emergency Medicine) Regulations 2020

I, General the Honourable David Hurley AC DSC (Retd), Governor‑General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulations.

Dated 20 February 2020

David Hurley

Governor‑General

By His Excellency’s Command

Greg Hunt

Minister for Health

 

  

  


Contents

1............ Name............................................................................................................................. 1

2............ Commencement............................................................................................................. 1

3............ Authority....................................................................................................................... 1

4............ Schedules...................................................................................................................... 1

Schedule 1—Emergency medicine                                                                                                         2

Health Insurance (General Medical Services Table) Regulations 2019                                     2

Schedule 2—Intensive care                                                                                                                         9

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019                               9

Health Insurance (General Medical Services Table) Regulations 2019                                     9

Schedule 3—Goals of care preparation for intensive care                                                    11

Health Insurance (General Medical Services Table) Regulations 2019                                   11

Schedule 4—Gastric lavage                                                                                                                      13

Health Insurance (General Medical Services Table) Regulations 2019                                   13

Schedule 5—Videostroboscopy                                                                                                              14

Health Insurance (General Medical Services Table) Regulations 2019                                   14

 


1  Name

                   This instrument is the Health Insurance Legislation Amendment (Intensive Care and Emergency Medicine) Regulations 2020.

2  Commencement

             (1)  Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  The whole of this instrument

1 March 2020.

1 March 2020

Note:          This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

             (2)  Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3  Authority

                   This instrument is made under the Health Insurance Act 1973.

4  Schedules

                   Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1Emergency medicine

  

Health Insurance (General Medical Services Table) Regulations 2019

1  Subclause 1.2.4(1) of Schedule 1

Omit “501”, substitute “585”.

2  Subclause 1.2.5(1) of Schedule 1

Omit “536”, substitute “417”.

3  Subclauses 1.2.5(1) and 1.2.6(1) of Schedule 1

After “14224,”, insert “14255 to 14288,”.

4  Division 2.15 of Schedule 1

Repeal the Division, substitute:

Division 2.15Group A21: Professional attendances at recognised emergency departments of private hospitals

 

Group A21—Professional attendances at recognised emergency departments of private hospitals

Column 1

Item

Column 2

Description

Column 3

Fee ($)

5001

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision‑making of ordinary complexity

59.60

5004

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision‑making of ordinary complexity

100.10

5011

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision‑making of ordinary complexity

100.10

5012

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision‑making of complexity that is more than ordinary but is not high

156.90

5013

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision‑making of complexity that is more than ordinary but is not high

197.40

5014

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision‑making of complexity that is more than ordinary but is not high

197.40

5016

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision‑making of high complexity

264.90

5017

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision‑making of high complexity

305.40

5019

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision‑making of high complexity

305.40

5021

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision‑making of ordinary complexity

44.70

5022

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision‑making of ordinary complexity

75.05

5027

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision‑making of ordinary complexity

75.05

5030

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision‑making of complexity that is more than ordinary but is not high

117.65

5031

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision‑making of complexity that is more than ordinary but is not high

148.05

5032

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision‑making of complexity that is more than ordinary but is not high

148.05

5033

Professional attendance, on a patient at least 4 years old but under 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision‑making of high complexity

198.65

5035

Professional attendance, on a patient under 4 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision‑making of high complexity

229.05

5036

Professional attendance, on a patient at least 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision‑making of high complexity

229.05

 

5039

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine for preparation of goals of care by the specialist for a gravely ill patient lacking current goals of care if:

(a) the specialist takes overall responsibility for the preparation of the goals of care for the patient; and

(b) the attendance is the first attendance by the specialist for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and

(c) the attendance is in conjunction with, or after, an attendance on the patient by the specialist that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019

144.80

 

5041

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine for preparation of goals of care by the specialist for a gravely ill patient lacking current goals of care if:

(a) the specialist takes overall responsibility for the preparation of the goals of care for the patient; and

(b) the attendance is the first attendance by the specialist for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and

(c) the attendance is not in conjunction with, or after, an attendance on the patient by the specialist that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019; and

(d) the attendance is for at least 60 minutes

272.15

 

5042

Professional attendance at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) for preparation of goals of care by the practitioner for a gravely ill patient lacking current goals of care if:

(a) the practitioner takes overall responsibility for the preparation of the goals of care for the patient; and

(b) the attendance is the first attendance by the practitioner for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and

(c) the attendance is in conjunction with, or after, an attendance on the patient by the practitioner that is described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036

108.60

 

5044

Professional attendance at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) for preparation of goals of care by the practitioner for a gravely ill patient lacking current goals of care if:

(a) the practitioner takes overall responsibility for the preparation of the goals of care for the patient; and

(b) the attendance is the first attendance by the practitioner for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and

(c) the attendance is not in conjunction with, or after, an attendance on the patient by the practitioner that is described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(d) the attendance is for at least 60 minutes

204.10

 

5  Schedule 1 (Subgroup 13 of Group T1 table, heading)

Repeal the heading, substitute:

Subgroup 13—Miscellaneous therapeutic procedures

6  Schedule 1 (Group T1 table, at the end of the table)

Add:

 

 

Subgroup 14—Management and procedures undertaken in emergency department

14255

Resuscitation of a patient provided for at least 30 minutes but less than 1 hour, by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019 (Anaes.)

150.75

14256

Resuscitation of a patient provided for at least 1 hour but less than 2 hours, by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019 (Anaes.)

289.90

14257

Resuscitation of a patient provided for at least 2 hours, by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019 (Anaes.)

577.35

14258

Resuscitation of a patient provided for at least 30 minutes but less than 1 hour, by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036 (Anaes.)

113.10

14259

Resuscitation of a patient provided for at least 1 hour but less than 2 hours, by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036 (Anaes.)

217.45

14260

Resuscitation of a patient provided for at least 2 hours, by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036 (Anaes.)

433.00

14263

Minor procedure on a patient by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019 (Anaes.)

53.05

14264

Procedure (except a minor procedure) on a patient by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019 (Anaes.)

119.45

14265

Minor procedure on a patient by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036 (Anaes.)

39.80

14266

Procedure (except a minor procedure) on a patient by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital, in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036 (Anaes.)

89.60

14270

Management, without aftercare, of all fractures and dislocations suffered by a patient that:

(a) is provided by a specialist in the practice of the specialist’s specialty of emergency medicine in conjunction with an attendance on the patient by the specialist described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019; and

(b) occurs at a recognised emergency department of a private hospital

(Anaes.)

133.95

14272

Management, without aftercare, of all fractures and dislocations suffered by a patient that:

(a) is provided by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) in conjunction with an attendance on the patient by the practitioner described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(b) occurs at a recognised emergency department of a private hospital

(Anaes.)

100.50

 

14277

Application of chemical or physical restraint of a patient by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital

150.75

 

14278

Application of chemical or physical restraint of a patient by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital

113.10

 

14280

Anaesthesia (whether general anaesthesia or not) of a patient that:

(a) is managed by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital; and

(b) occurs in conjunction with an attendance on the patient that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(c) is not anaesthesia provided by a specialist anaesthetist to which an item in Group T7 or T10 applies

150.75

 

14283

Anaesthesia (whether general anaesthesia or not) of a patient that:

(a) is managed by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital; and

(b) occurs in conjunction with an attendance on the patient that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(c) is not anaesthesia provided by a specialist anaesthetist to which an item in Group T7 or T10 applies

113.10

 

14285

Emergent intubation, airway management or both of a patient that:

(a) is managed by a specialist in the practice of the specialist’s specialty of emergency medicine at a recognised emergency department of a private hospital; and

(b) occurs in conjunction with an attendance on the patient that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(c) is not anaesthesia provided by a specialist anaesthetist to which an item in Group T7 or T10 applies

150.75

 

14288

Emergent intubation, airway management or both of a patient that:

(a) is managed by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) at a recognised emergency department of a private hospital; and

(b) occurs in conjunction with an attendance on the patient that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and

(c) is not anaesthesia provided by a specialist anaesthetist to which an item in Group T7 or T10 applies

113.10

 

7  Clause 3.1 of Schedule 1 (definition of problem focussed history)

Repeal the definition.

8  Clause 3.1 of Schedule 1 (definition of recognised emergency department)

Repeal the definition, substitute:

recognised emergency department of a private hospital means a department of the hospital that is licensed, under a law of the State or Territory in which the hospital is located, to operate as an emergency department.

Schedule 2Intensive care

  

Health Insurance (Diagnostic Imaging Services Table) Regulations 2019

1  At the end of Subdivision A of Division 2.1 of Part 2 of Schedule 1

Add:

2.1.2A  Ultrasound services—guidance for catheterisation or cannulation

                   Items in this Division do not apply to an ultrasound service used to guide:

                     (a)  catheterisation described in item 13815 of the general medical services table; or

                     (b)  cannulation described in item 13832, 13840 or 13842 of the general medical services table.

Health Insurance (General Medical Services Table) Regulations 2019

2  Schedule 1 (item 13815)

Repeal the item, substitute:

 

13815

Central vein catheterisation, including under ultrasound guidance where clinically appropriate, by percutaneous or open exposure, other than a service to which item 13318 applies (Anaes.)

115.45

 

3  Schedule 1 (after item 13830)

Insert:

 

13832

Peripheral cannulation, including under ultrasound guidance where clinically appropriate, for veno‑arterial cardiopulmonary extracorporeal life support

895.85

13834

Veno–arterial cardiopulmonary extracorporeal life support, management of—the first day

501.55

13835

Veno–arterial cardiopulmonary extracorporeal life support, management of—each day after the first

116.70

13837

Veno‑venous pulmonary extracorporeal life support, management of—the first day

501.55

13838

Veno‑venous pulmonary extracorporeal life support, management of—each day after the first

116.70

 

4  Schedule 1 (items 13842, 13847, 13848, 13851 and 13854)

Repeal the items, substitute:

 

13840

Peripheral cannulation, including under ultrasound guidance where clinically appropriate, for veno‑venous pulmonary extracorporeal life support

600.20

13842

Intra‑arterial cannulation, including under ultrasound guidance where clinically appropriate, for the purpose of intra‑arterial pressure monitoring or arterial blood sampling (or both)

95.05

13848

Counterpulsation by intra‑aortic balloon‑management, including associated consultations and monitoring of parameters by means of full haemodynamic assessment and management on several occasions on a day—each day

158.60

13851

Ventricular assist device, management of, for a patient admitted to an intensive care unit for implantation of the device or for complications arising from implantation or management of the device—first day

501.55

13854

Ventricular assist device, management of, for a patient admitted to an intensive care unit, including management of complications arising from implantation or management of the device—each day after the first day

116.70

 

Schedule 3Goals of care preparation for intensive care

  

Health Insurance (General Medical Services Table) Regulations 2019

1  Subclause 1.2.4(1) of Schedule 1

After “13210,”, insert “13899,”.

2  Subclauses 1.2.5(1) and 1.2.6(1) of Schedule 1

Omit “13888”, substitute “13899”.

3  After clause 2.38.10 of Schedule 1

Insert:

2.38.11  Limitation on item 13899

                   Item 13899 does not apply to professional attendance by a specialist on a day for preparation of goals of care for a patient if on that day the specialist performs a service for the patient that is described in item 13870 or 13873.

4  Schedule 1 (after item 13888)

Insert:

 

Subgroup 10A—Preparation of goals of care by intensive care specialist outside intensive care unit

13899

Professional attendance outside an intensive care unit for at least 60 minutes spent in preparation of goals of care for a gravely ill patient lacking current goals of care, by a specialist in the specialty of intensive care who takes overall responsibility for the preparation of the goals of care for the patient

272.15

 

5  Clause 3.1 of Schedule 1

Insert:

gravely ill patient lacking current goals of care means a patient to whom all of the following apply:

                     (a)  the patient either:

                              (i)  is suffering a life‑threatening acute illness or injury; or

                             (ii)  is suffering acute illness or injury and, apart from the illness or injury, has a high risk of dying within 12 months;

                     (b)  one or more alternatives to management of the illness or injury are clinically appropriate for the patient;

                     (c)  either:

                              (i)  there is not a record of goals of care for the patient that can readily be retrieved by providers of health care for the patient and that identifies interventions that should, or should not, be made in care of the patient; or

                             (ii)  there is such a record but it is reasonable to expect that, due to changes in the patient’s condition, the goals recorded will change substantially.

preparation of goals of care for a patient, by a medical practitioner, means the carrying out of all of the following activities by the practitioner:

                     (a)  comprehensively evaluating the patient’s medical, physical, psychological and social issues;

                     (b)  identifying major issues that require goals of care for the patient to be set;

                     (c)  assessing the patient’s capacity to make decisions about goals of care for the patient;

                     (d)  discussing care of the patient with the patient, or a person (the surrogate) who can make decisions on the patient’s behalf about care for the patient, and as appropriate with any of the following:

                              (i)  members of the patient’s family;

                             (ii)  other persons who provide care for the patient;

                            (iii)  other health practitioners;

                     (e)  offering in that discussion reasonable options for care of the patient, including alternatives to intensive or escalated care;

                      (f)  agreeing with the patient or the surrogate on goals of care for the patient that address all major issues identified;

                     (g)  recording the agreed goals so that:

                              (i)  the record can be readily retrieved by other providers of health care for the patient; and

                             (ii)  interventions that should, or should not, be made in care of the patient are identified.

Schedule 4Gastric lavage

  

Health Insurance (General Medical Services Table) Regulations 2019

1  Subclause 1.2.5(1) of Schedule 1

Omit “14200”, substitute “14124”.

2  Subclause 1.2.6(1) of Schedule 1

Omit “14200”, substitute “14124”.

3  Schedule 1 (item 14200)

Repeal the item.

Schedule 5Videostroboscopy

  

Health Insurance (General Medical Services Table) Regulations 2019

1  Schedule 1 (item 41501, column 2, paragraph (b))

After “benign”, insert “or malignant”.