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Determinations/Health as made
This instrument amends the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Determination 2020 and Health Insurance (Allied Health Services) Determination 2014 to prescribe 50 new Medicare Benefits Schedule items for mental health treatment planning and review for care recipients in an aged care facility.
Administered by: Health
Registered 09 Dec 2020
Tabling HistoryDate
Tabled HR10-Dec-2020
Table of contents.

Commonwealth Coat of Arms of Australia

 

Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Amendment (Care Recipient in a Residential Aged Care Facility) Determination 2020

I, Paul McBride, delegate of the Minister for Health, make the following Determination.

Dated 8 December 2020

Paul McBride

First Assistant Secretary

Medical Benefits Division

Health Resourcing Group

Department of Health

 

 

 


Contents

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

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

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

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

Schedule 1— Amendments................................................................................................... 2

Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Determination 2020..................................................................................................... 2

Health Insurance (Allied Health Services) Determination 2014.................................... 22

 

 


1  Name

                        This instrument is the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Amendment (Care Recipient in a Residential Aged Care Facility) Determination 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

10 December 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 subsection 3C(1) of 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 1— Amendments

Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Determination 2020

 

1          Subsection 5(1) (after the definition of better access subsequent treatment service)

 

Insert:

            care recipient has the meaning given by the general medical services table.

2             Subsection 5(1) after (the definition of person who is in a COVID-19 impacted area)

 

Insert:

preparation of a GP mental health treatment plan has the meaning given by the general medical services table.

3             Subsection 5(1) definition of GP mental health treatment plan

 

Repeal and substitute:

(a) items 2700, 2701, 2715 or 2717 of the general medical services table;

(b) items 272, 276, 281 or 282 of the Other Medical Practitioner Determination;

(c) items 92112, 92113, 92116, 92117, 92118, 92119, 92122, 92123, 92124, 92125, 92128, 92129, 92130, 92131, 92134 or 92135 of the COVID 19 Determination;

(d) items 93400 to 93411 and 93431 to 93442 of this Determination.

 

4             Subsection 7(2)

 

Repeal the subsection and substitute:

 

An item in Schedule 1 or Schedule 2 of this instrument does not apply if a person has received 10 better access subsequent treatment services for that calendar year.

5             Subsection 8(1)

Repeal the subsection.

6             Subsection 8(2)

Repeal the subsection and substitute:

(2)   Items 93300 to 93311 and 93287, 93288, 93291 and 93292 apply to a service which is provided by a medical practitioner:

(a)   whose name is entered in the register maintained by the Chief Executive Medicare under section 33 of the Human Services (Medicare) Regulations 2017; and

(b)   who is identified in the register as a medical practitioner who can provide services to which Subgroup 2 of Group A20 of the general medical services table applies or items 283, 285, 286, 287, 371 and 372 of the Other Medical Practitioner Determination applies; and

(c)   who meets any training and skills requirements, as determined by the General Practice Mental Health Standards Collaboration for providing services to which Subgroup 2 of Group A20 of the general medical services table applies or items 283, 285, 286, 287, 371 and 372 of the Other Medical Practitioner Determination applies.

7             Subsection 8(4)

Repeal the subsection, substitute:

Items 93301, 93302, 93304, 93305, 93307, 93308, 93310, 93311, 93404 to 93411 and 93435 to 93442 do not apply to a service unless the service is performed by the patient’s usual medical practitioner.

8             Section 9                                                                                                                       

Repeal and substitute:

9  Effect of election to claim private health insurance for an allied health service

An item in Group M25, M26, M27 and M28 in a Schedule to this instrument do not apply to a service if a private health insurance benefit has been claimed for the service.

10 Application of items in Group A42

General application of items

(1)    Items 93400, 93401, 93402, 93403, 93421, 93431, 93432, 93433, 93434 and 93451 apply only in the course of personal attendance by a single medical practitioner on a single patient.

 

(2)    Items in Subgroup 1, 2, 3 and 4 of Group A42 apply only to a patient with a mental disorder.

Claiming restrictions for treatment plan and review items

 (3)  Items 93400 to 93411 and 93431 to 93442 do not apply to a service to which items 80020, 80021, 80120, 80121, 80145, 80146, 80170 and 80171 of the allied health services determination apply.

Practitioner training

             (4)   Items 93402, 93403, 93406, 93407, 93410, 93411, 93433, 93434, 93437, 93438, 93441 and 93442 apply only if the medical practitioner providing the service has successfully completed mental health skills training accredited by the General Practice Mental Health Standards Collaboration.

Note:      The General Practice Mental Health Standards Collaboration operates under the auspices of the Royal Australian College of General Practitioners.

Definition

 (5) In review items 93421, 93422 and 93423:

associated general practitioner means a general practitioner (not including a specialist or consultant physician) who, if not engaged in the same general practice as the general practitioner mentioned in that item, performs the service described in the item at the request of the patient (or the patient’s guardian).

 

(6)  In review items 93451, 93452 and 93453:

associated medical practitioner means a medical practitioner who, if not engaged in the same general practice as the medical practitioner mentioned in the item, performs the service mentioned in the item at the request of the patient (or the patient or the patient’s guardian).

 

11  Fee in relation to the first patient during each attendance at a residential aged care facility

 

(1)   For the first patient attended during one attendance by a general practitioner at one residential aged care facility on one occasion, the fee for the medical service described in whichever of items 93400, 93401, 93402, 93403, 93421, 93287 and 93288 applies is the amount listed in the item plus $66.75.

 

(2)   For the first patient attended during one attendance by a medical practitioner at one residential aged care facility on one occasion, the fee for the medical service described in whichever of items 93431, 93432, 93433, 93434, 93451, 93291 and 93292 applies is the amount listed in the item plus $48.55.

9             Schedule 1 (items 93300, 93303, 93306 and 93309)

Repeal paragraph (b), substitute (wherever occurring):

(b)   the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and

 

10           Schedule 1 (after item 93303)

 

Insert:

 

93287

Professional attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and

(b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and

(c) the service lasts at least 30 minutes, but less than 40 minutes

112.50

93288

Professional attendance by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and

(b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and

(c)  the service lasts at least 40 minutes

161.00

11           Schedule 1 (after item 93309)

Insert:

93291

Professional attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and

(b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and

(c)  the service lasts at least 30 minutes, but less than 40 minutes

90.00

93292

Professional attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician), for the purpose of providing focussed psychological strategies for assessed mental disorders if:

(a) the person is a care recipient in a residential aged care facility (but not as an admitted patient of a hospital); and

(b) the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and

(c)  the service lasts at least 40 minutes

128.80

 

Group A42 – Mental health planning for care recipients of an residential aged care facility

 

Item

Service

 

 

Fee($)

 

Subgroup 1—GP mental health treatment plans for care recipients of an residential aged care facility

93400

Professional attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 20 minutes, but less than 40 minutes

87.00

93401

Professional attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

128.05

93402

Professional attendance, by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 20 minutes, but less than 40 minutes

110.45

93403

Professional attendance, by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

162.70

Subgroup 2—GP mental health treatment plan review for care recipients of an residential aged care facility

93421

Professional attendance by a general practitioner to review a GP mental health treatment plan which the general practitioner, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan (but not as an admitted patient of a hospital) if:

(a)    the person is a care recipient in a residential aged care facility; and

(b)   one of the following services has been provided to the patient:

(i)     a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or 

(ii)   a psychiatrist assessment and management plan; and

(c) the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services

87.00

Subgroup 3—Non specialist practitioner mental health treatment plans for care recipients of an residential aged care facility

93431

Professional attendance by a medical practitioner who has not undertaken mental health skills training (not including a general practitioner, specialist or a consultant physician), for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the service lasts at least 20 minutes, but less than 40 minutes

69.55

93432

Professional attendance by a medical practitioner who has not undertaken mental health skills training (not including a general practitioner, specialist or a consultant physician), for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the service lasts at least 40 minutes

102.45

93433

Professional attendance, by a medical practitioner who has undertaken mental health skills training (but not including a general practitioner, specialist or consultant physician), for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 20 minutes, but less than 40 minutes

88.35

93434

Professional attendance, by a medical practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

130.15

Subgroup 4— Non specialist practitioner mental health treatment plan review for care recipients of an residential aged care facility

93451

Professional attendance by a medical practitioner to review a GP mental health treatment plan which the medical practitioner, or an associated medical practitioner has prepared, or to review a Psychiatrist Assessment and Management Plan (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) one of the following services has been provided to the patient:

(i) a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or

(ii) a psychiatrist assessment and management plan; and

(c) the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services

69.55

12           Schedule 1 (after item 93333)

Insert:

93312

Psychological therapy health service provided to a person (but not as an admitted patient of a hospital), by an eligible clinical psychologist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 30 minutes but less than 50 minutes duration

102.85

93313

Psychological therapy health service provided to a person (but not as an admitted patient of a hospital), by an eligible clinical psychologist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 50 minutes duration

151.05

13           Schedule 1 (after item 93350)

Insert:

93316

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible psychologist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 20 minutes but less than 50 minutes duration

72.90

14           Schedule 1 (after item 93353)

Insert:

93319

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital), by an eligible psychologist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 50 minutes duration

102.85

15           Schedule 1 (after item 93359)

Insert:

93322

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible occupational therapist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 20 minutes but less than 50 minutes duration

64.20

93323

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible occupational therapist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 50 minutes duration

90.70

16           Schedule 1 (after item 93365)

Insert:

93326

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible social worker if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and

(c)  the service is provided to the person individually and in person; and

(d)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e)  on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 20 minutes but less than 50 minutes duration

64.20

93327

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible social worker if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by a medical practitioner working in general practice, a psychiatrist or a paediatrician who makes a written record of the need for additional mental health treatment services; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 50 minutes duration

90.70

17           Schedule 2 (items 93301, 93302, 93304, 93305, 93307, 93308, 93310 and 93311)

Repeal paragraph (b), substitute (wherever occurring):

(b)   the service is clinically indicated under a GP mental health treatment plan or a psychiatrist assessment and management plan; and

18           Schedule 2 (after item 93311)

Insert:

Group A42 – Mental health planning for care recipients of an residential aged care facility

Item

Service

Fee($)

Subgroup 1— GP mental health treatment plans for care recipients of an residential aged care facility

93404

Telehealth attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 20 minutes but less than 40 minutes

87.00

93405

 

Telehealth attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

128.05

93406

 

Telehealth attendance by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 20 minutes but less than 40 minutes

110.45

93407

Telehealth attendance by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

162.70

93408

Phone attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 20 minutes but less than 40 minutes

87.00

93409

Phone attendance by a general practitioner who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

128.05

93410

Phone attendance by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 20 minutes but less than 40 minutes

110.45

93411

Phone attendance by a general practitioner who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

162.70

Subgroup 2— GP mental health treatment plan review for care recipients of an residential aged care facility

93422

 

Telehealth attendance by a general practitioner to review a GP mental health treatment plan which the general practitioner, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan (but not as an admitted patient of a hospital) if:

(a)     the person is a care recipient in a residential aged care facility; and

(b)     one of the following services has been provided to the patient:

(i)       a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or

(ii)     a psychiatrist assessment and management plan; and

(c)   the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services

87.00

93423

 

Phone attendance by a general practitioner to review a GP mental health treatment plan which the general practitioner, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan (but not as an admitted patient of a hospital) if:

(a)      the person is a care recipient in a residential aged care facility; and

(b)     one of the following services has been provided to the patient:

(i)       a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or

(ii)     a psychiatrist assessment and management plan; and

(c)   the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services

87.00

Subgroup 3— Non specialist practitioner mental health treatment plans for care recipients of an residential aged care facility

93435

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 20 minutes but less than 40 minutes

69.55

93436

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

102.45

93437

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 20 minutes but less than 40 minutes

88.35

93438

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

130.15

93439

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 20 minutes but less than 40 minutes

69.55

93440

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has not undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

102.45

93441

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) of at least 20 minutes but less than 40 minutes

88.35

93442

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician), who has undertaken mental health skills training, for the preparation of a GP mental health treatment plan for a patient (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) the service lasts at least 40 minutes

130.15

Subgroup 4— Non specialist practitioner mental health treatment plan review for care recipients of an residential aged care facility

93452

 

Telehealth attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) to review a GP mental health treatment plan which the medical practitioner, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) one of the following services has been provided to the patient:

(i) a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or

(ii) a psychiatrist assessment and management plan; and

(c)   the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services

69.55

93453

 

Phone attendance by a medical practitioner (not including a general practitioner, specialist or consultant physician) to review a GP mental health treatment plan which the medical practitioner, or an associated medical practitioner has prepared, or to review a psychiatrist assessment and management plan (but not as an admitted patient of a hospital) if:

(a) the person is a care recipient in a residential aged care facility; and

(b) one of the following services has been provided to the patient:

(i) a mental health treatment plan under items 93400 to 93411 or 93431 to 93442; or

(ii) a psychiatrist assessment and management plan; and

(c)   the reviewing practitioner modifies the person’s GP mental health treatment plan or psychiatrist assessment and management plan to record that they recommend the person have an additional number of better access treatment services

69.55

19           Schedule 2 (after item 93367)

  Insert:

Schedule 3Services and fees—initial psychological therapy and focussed psychological strategies

1  Limitation on certain individual items

             (1)  This section applies to items 93375, 93376, 93381, 93382, 93383, 93384, 93385 and 93386.

             (2)  For any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is one of the first 10 relevant services provided to the patient in the calendar year.

(1)   In this section relevant service means a service to which any of items 2721 to 2727 of the general medical services table, or items 80000 to 80015, 80100 to 80115, 80125 to 80140, or 80150 to 80165 in the allied health services determination, or items 91166, 91167, 91169, 91170, 91172, 91173, 91175, 91176, 91181, 91182, 91183, 91184, 91185, 91186, 91187, 91188, 91818, 91819, 91820, 91821, 91842, 91843, 91844 and 91845 of the COVID‑19 Determination, or items 283 and 286 in the Other Medical Practitioner Determination apply.

2   Referrals by psychiatrists for psychological therapy and focussed psychological  strategies health services

             (1)  This section applies to items 93375, 93376, 93381, 93382, 93383, 93384, 93385 and 93386.

             (2)  The referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 293 to 370 of the general medical services table or items 91827, 91828, 91829, 91830, 91831, 91837, 91838, 91839, 91840, 91841, 92436, 92437, 92458, 92459, 92460, 92476, 92477, 92498, 92499 and 92500 of the COVID‑19 Determination applies.

             (3)   The referral by a specialist in the practice of his or her field of psychiatry or paediatrics must be a referral for a service to which any of items 104 to 109 of the general medical services table or items 91822, 91823, 91832 or 91833 of the COVID‑19 Determination applies.

3  Fee in relation to the first patient during each attendance at a residential aged care facility

For the first patient attended during one attendance by an allied health professional at one residential aged care facility on one occasion, the fee for the medical service described in whichever of items 93312, 93313, 93316, 93319, 93322, 93323, 93326, 93327, 93375, 93376, 93381 to 93386 applies is the amount listed in the item plus $47.05.

 

Group M27 – Initial  Psychological Therapy Services

Item

Service

Fee($)

93375

Psychological therapy health service provided to a person (but not as an admitted patient of a hospital), by an eligible clinical psychologist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by:

(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 30 minutes but less than 50 minutes duration

102.85

93376

 

Psychological therapy health service provided to a person (but not as an admitted patient of a hospital), by an eligible clinical psychologist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by:

(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 50 minutes duration

151.05

Group M28 – Initial  Focussed Psychological Strategies (Allied Mental Health)

93381

 

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible psychologist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by:

(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 20 minutes but less than 50 minutes duration

72.90

93382

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital), by an eligible psychologist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by:

(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry;  and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 50 minutes duration

102.85

93383

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible occupational therapist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by:

(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or (ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 20 minutes but less than 50 minutes duration

64.20

93384

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible occupational therapist if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by:

(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 50 minutes duration

90.70

93385

Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible social worker if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by:

(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; and

(c)  the service is provided to the person individually and in person; and

(d)  at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e)  on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 20 minutes but less than 50 minutes duration

64.20

93386

 Focussed psychological strategies health service provided to a person (but not as an admitted patient of a hospital) by an eligible social worker if:

(a) the person is a care recipient in a residential aged care facility; and

(b)  the person is referred by:

(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or

(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry;  and

(c) the service is provided to the person individually and in person; and

(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and

(e) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and

(f)  the service is at least 50 minutes duration

90.70

Health Insurance (Allied Health Services) Determination 2014

20           After subsection 6A(2)

Insert:

(3)    An item listed in subsection (2) does not apply if the mental health treatment plan was provided under items 93400 to 93411 and 93431 to 93442 of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Mental Health Services) Determination 2020.