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Determinations/Health as amended, taking into account amendments up to Health Insurance Legislation Amendment (Section 3C General Medical and Diagnostic Imaging Services – Medicare Indexation) Determination 2021
This instrument prescribes 73 new temporary Medicare Benefits Schedule items for GP and allied health chronic disease management services for care recipients in residential aged care facilities.
Administered by: Health
Registered 07 Jul 2021
Start Date 01 Jul 2021
End Date 14 Sep 2021
To be ceased 30 Jun 2022
Ceased by Self Ceasing
Table of contents.

Commonwealth Coat of Arms of Australia

Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020

made under subsection 3C(1) of the

Health Insurance Act 1973

Compilation No. 1

Compilation date:                              1 July 2021

Includes amendments up to:            F2021L00426

Registered:                                         7 July 2021

About this compilation

This compilation

This is a compilation of the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020 that shows the text of the law as amended and in force on 1 July 2021 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self-repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

  

  

  


Contents

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

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

4............ Cessation....................................................................................................................... 1

Schedule 1—Amendments                                                                                                              2

Part 1— Preliminary                                                                                                                                      2

5............ Definitions..................................................................................................................... 2

6............ Treatment of relevant services....................................................................................... 4

7............ References in this instrument to items include items prescribed under sections 3C and 4 of the Act        4

8............ Effect of election to claim private health insurance for an allied health service.............. 4

9............ Limitation on admitted patients...................................................................................... 4

Part 2— General practice planning and contribution items for care recipients in residential aged care facilities                                                                                                                                                5

10.......... General provisions for items in Part 2........................................................................... 5

11.......... Application provisions for contribution to multidisciplinary care plan items for care recipients in residential aged care facilities......................................................................................................................... 5

12.......... Application provisions for health assessment items for care recipients in residential aged care facilities of Aboriginal and Torres Strait Islander descent........................................................................................ 6

Part 3— Chronic disease management allied health items for care recipients in residential aged care facilities                                                                                                                                                8

13.......... Flagfall for items in Part 3............................................................................................. 8

14.......... Claiming limitation for chronic disease management items for care recipients in residential aged care facilities       8

Part 4— Chronic disease management allied health items for care recipients in residential aged care facilities of Aboriginal and Torres Strait Islander descent                                30

15.......... Flagfall for items in Part 4........................................................................................... 30

16.......... Claiming limitation for chronic disease management items for care recipients in residential aged care facilities of Aboriginal and Torres Strait Islander descent.............................................................. 30

Part 5—Allied health group items for care recipients in residential aged care facilities 49

17.......... Flagfall for items in Part 5........................................................................................... 49

18.......... Claiming limitation for allied health group service items for care recipients in residential aged care facilities           49

Endnotes                                                                                                                                                               54

Endnote 1—About the endnotes                                                                                                      54

Endnote 2—Abbreviation key                                                                                                          55

Endnote 3—Legislation history                                                                                                       56

Endnote 4—Amendment history                                                                                                     57


1  Name

       This instrument is the Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020.

3  Authority

This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

4  Cessation

Unless earlier revoked, this instrument ceases as if revoked on 30 June 2022.

Schedule 1—Amendments

 

Part 1— Preliminary

 

5  Definitions

             (1)  In this instrument:

Act means the Health Insurance Act 1973.

admitted patient means means a patient who is receiving a service that is provided:

(a)   as part of an episode of hospital treatment; or

(b)   as part of an episode of hospital‑substitute treatment in respect of which the person to whom the treatment is provided chooses to receive a benefit from a private health insurer.

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

eligible Aboriginal and Torres Strait Islander health practitioner has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible Aboriginal health worker has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible audiologist has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible chiropractor has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible diabetes educator has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible dietitian has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible exercise physiologist has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible mental health nurse has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible mental health worker has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible occupational therapist has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible osteopath has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible physiotherapist has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible podiatrist has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible psychologist has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

eligible speech pathologist has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

phone attendance means a professional attendance by telephone where the health practitioner:

(c)   has the capacity to provide the full service through this means safely and in accordance with professional standards; and

(d)   is satisfied that it is clinically appropriate to provide the service to the patient; and

(e)   maintains an audio link with the patient.

relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations under that Act.

residential aged care facility has the meaning given by the general medical services table.

shared care plan has the meaning given by the Health Insurance (Allied Health Services) Determination 2014.

telehealth attendance means a professional attendance by video conference where the rendering health practitioner:

(a)   has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and

(b)   is satisfied that it is clinically appropriate to provide the service to the patient; and

(c)   maintains a visual and audio link with the patient; and

(d)   is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.

Note: The following terms are defined in subsection 3(1) of the Act:

·      general medical services table

·      hospital treatment

·      hospital-substitute treatment

·      item

·      medical practitioner

·      Chief Executive Medicare

·      professional service

6  Treatment of relevant services

For subsection 3C(1) of the Act, a relevant health service, provided in accordance with this instrument and as a clinically relevant health service, is to be treated, for the relevant provisions, as if:

(a)    it were both a professional service and a medical service; and

(b)    there were an item in the general medical services table that:

(i)          related to the health service; and

(ii)          specified in respect of the health service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

7  References in this instrument to items include items prescribed under sections 3C and 4 of the Act

A reference in this instrument to an item includes a reference to an item:

(a)   relating to a health service that, under a determination in force under subsection 3C(1) of the Act;

(b)   relating to a professional service that, under the general medical services table in force under section 4 of the Act;

 is treated as if there were an item in the Schedule that relates to the service.

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

An item in Parts 3 to 5 to this instrument does not apply to a service if a private health insurance benefit has been claimed for the service.

9  Limitation on admitted patients

An item in this instrument does not apply to a service performed for an admitted patient.


Part 2— General practice planning and contribution items for care recipients in residential aged care facilities

 

10  General provisions for items in Part 2

Personal attendance

(1)    Items in Part 2 apply only to a service provided in the course of a personal attendance by a single practitioner on a single patient.

Flag fall

(2)    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 93469 or 93470 applies is the amount listed in the item plus $67.35.

(3)    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 93475 or 93479 applies is the amount listed in the item plus $48.90.

11  Application provisions for contribution to multidisciplinary care plan items for care recipients in residential aged care facilities

Application provision

 (1)  Items 93469 and 93475 do not apply to a service unless the person with the multidisciplinary care plan suffers from at least one medical condition that:

(a)  has been (or is likely to be) present for at least 6 months; or

(b)  is terminal.

Claimining limitation

(2)  Items 93469 and 93475 do not apply to a service if:

(a)  the service is associated with a service to which items 235 to 240, 735 to 758,  apply; or

(b)  the person has received a service to which item 229 to 233, 721, 723, 729, 731 or 732, 92024, 92025, 92026, 92027, 92028, 92055, 92056, 92057, 92058, 92059, 92068, 92069, 92070, 92071, 92072, 92099, 92100, 92101, 92102, 92103 applied in the previous 3 months;

unless there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the service for the patient.

Meaning of terms

 (3) In items 93469 and 93475:

multidisciplinary care plan means a a written plan that:

(a)  is prepared for a care recipient by a collaborating provider (other than a general practitioner), in consultation with at least 2 other collaborating providers, each of whom provides a different kind of treatment or service to the patient; and

(b)  describes, at least, treatment and services to be provided to the patient by the collaborating providers.

In this subclause, a collaborating provider is a person, including a medical practitioner, who:

(a)  provides treatment or a service to a patient; and

(b)  is not an unpaid carer of the patient.

12  Application provisions for health assessment items for care recipients in residential aged care facilities of Aboriginal and Torres Strait Islander descent

Claimining limitation provisions for health assessment items for Aboriginal and Torres Strait Islander people(s) in residential care

(1)  Items 93470 and 93479 do not apply to a service if the person has received a service to which item 228, 715, 92004, 92011, 92016, or 92023 applied in the previous 9 months.

Application provisions for health assessment items for Aboriginal and Torres Strait Islander people(s) in residential care

(2)  Clause 2.15.14 of the general medical services table shall have effect as if items 93470 and 93479 were also specified in the clause.

 

Group A43 – Care Reciepient of a Residental Aged Care Facility planning and contribution items

 

Item

Service

Fee($)

Subgroup 1—GP planning and contribution items in RACF

93469

Professional attendance by a general practitioner at a residential aged care facility to contribute to a multidisciplinary care plan, prepared by that facility, or to a review of such a plan prepared by such a facility, if the practitioner performs any of the following:

(a) prepares part of a multidisciplinary care plan and adding a copy of that part of the plan to the person’s medical records; or

(b) preparing amendments to part of a multidisciplinary care plan and adding a copy of the amendments to the person’s medical records;

(c) giving advice to a practitioner who prepares part of a multidisciplinary care plan and recording in writing, on the person’s medical records, any advice provided to the practitioner; or

(d) giving advice to a practitioner who reviews part of a multidisciplinary care plan and recording in writing, on the person’s medical records, any advice provided to the practitioner

not more than once in a 3 month period

86.15

 

93470

Professional attendance by a general practitioner at a residential aged care facility to perform a health assessment of a person who is:

(a) of Aboriginal or Torres Strait Islander descent; and

(b) a care recipient in a residential aged care facility

not more than once in a 9 month period

259.80

 

Subgroup 2—Medical practitioner planning and contribution items in RACF

 

93475

Professional attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician) at a residential aged care facility to contribute to a multidisciplinary care plan, prepared by that facility, or to a review of such a plan prepared by such a facility, if the practitioner performs any of the following:

(a) prepares part of a multidisciplinary care plan and adding a copy of that part of the plan to the person’s medical records; or

(b) preparing amendments to part of a multidisciplinary care plan and adding a copy of the amendments to the person’s medical records;

(c) giving advice to a practitioner who prepares part of a multidisciplinary care plan and recording in writing, on the person’s medical records, any advice provided to the practitioner; or

(d) giving advice to a practitioner who reviews part of a multidisciplinary care plan and recording in writing, on the person’s medical records, any advice provided to the practitioner

not more than once in a 3 month period

68.90

93479

Professional attendance by a medical practitioner (not including a general practitioner, specialist or a consultant physician) at a residential aged care facility to perform a health assessment of a person who is:

(a) of Aboriginal or Torres Strait Islander descent; and

(b) a care recipient in a residential aged care facility

not more than once in a 9 month period

207.85

 


 

Part 3— Chronic disease management allied health items for care recipients in residential aged care facilities

 

13  Flagfall for items in Part 3

(1)   For the first patient attended during one attendance by the allied health practitioner at one residential aged care facility on one occasion, the fee for the health service described in whichever item in Part 3 applies is the amount listed in the item plus $48.95.

(2)  Items 93537 and 93538 are not applicable to subclause (1).

14  Claiming limitation for chronic disease management items for care recipients in residential aged care facilities

Maximum of 5 chronic disease management assessment and standard items

(1)  For any particular person, an item in subgroup 1 or 3 of Group M29 or Group M3 is not applicable more than 5 times in a calendar year (in total for all items).

Maximum of 5 additional chronic disease management physical therapy items

 (2)  For any particular person, an item in subgroup 2 of Group M29 is not applicable more than 5 times in a calendar year (in total for all items).

Note : Items in Group M3 are prescribed in the Health Insurance (Allied Health Services) Determination 2014.

 

Group M29 – Additional allied health services

 

Item

Service

 

 

Fee($)

 

Subgroup 1—Intial/long allied health services in RACF

93501

Aboriginal and Torres Strait Islander health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93502

Diabetes education health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible diabetes educator if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible diabetes educator gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93503

Audiology health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible audiologist if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible audiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible audiologist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93504

Exercise physiology health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible exercise physiologist if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93505

Dietetics health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible dietitian if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible dietitian by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible dietitian gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93506

Mental health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible mental health worker if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible mental health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible mental health worker gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93507

Occupational therapy health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible occupational therapist if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible occupational therapist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93508

Physiotherapy health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible physiotherapist if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible physiotherapist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93509

Podiatry health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible podiatrist if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible podiatrist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible podiatrist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93510

Chiropractic health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible chiropractor if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible chiropractor by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible chiropractor gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93511

Osteopathy health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible osteopath if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible osteopath by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible osteopath gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93512

Psychology health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible psychologist if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible psychologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible psychologist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

 

93513

Speech pathology health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible speech pathologist if all of the following apply:

(a)  the person’s chronic or complex care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(b)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (c)   the person is referred to the eligible speech pathologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible speech pathologist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

 

Subgroup 2—Physical therapy items in RACF

93518

Additional exercise physiology health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible exercise physiologist if all of the following apply:

(a)  the person has received 5 services, to which an item in subgroup 1 or 3 of Group M29 or Group M3 applied (in total for all items), in that calendar year;

(b)  the person’s chronic or complex care needs are assessed as requiring additional exercise physiology therapy services in a calendar year;

(c)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (d)   the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(f)   the service is at least 20 minutes in duration; and

  (g)  after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

 

93519

Additional occupational therapy health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible occupational therapist if all of the following apply:

(a)  the person has received 5 services, to which an item in subgroup 1 or 3 of Group M29 or Group M3 applied (in total for all items), in that calendar year;

(b)  the person’s chronic or complex care needs are assessed as requiring additional occupational therapy services in a calendar year;

(c)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (d)   the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(f)   the service is at least 20 minutes in duration; and

  (g)  after the service, the eligible occupational therapist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

 

93520

Additional physiotherapy health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible physiotherapist if all of the following apply:

(a)  the person has received 5 services, to which an item in subgroup 1 or 3 of Group M29 or Group M3 applied (in total for all items), in that calendar year;

(b)  the person’s chronic or complex care needs are assessed as requiring additional physiotherapy services in a calendar year;

(c)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (d)   the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(f)   the service is at least 20 minutes in duration; and

  (g)  after the service, the eligible physiotherapist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

 

 

 

Subgroup 3—Subsequent/standard allied health services in RACF

 

93524

Aboriginal and Torres Strait Islander health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner if all of the following apply:

  (a)   the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

 

93525

Diabetes education health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible diabetes educator if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible diabetes educator gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93526

Audiology health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible audiologist if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible audiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible audiologist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93527

Exercise physiology health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible exercise physiologist if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93528

Dietetics health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible dietitian if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible dietitian by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible dietitian gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93529

Mental health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible mental health worker if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible mental health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible mental health worker gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93530

Occupational therapy health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible occupational therapist if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible occupational therapist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93531

Physiotherapy health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible physiotherapist if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible physiotherapist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93532

Podiatry health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible podiatrist if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible podiatrist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible podiatrist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93533

Chiropractic health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible chiropractor if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible chiropractor by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible chiropractor gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93534

Osteopathy health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible osteopath if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible osteopath by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible osteopath gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93535

Psychology health service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible psychologist if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible psychologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible psychologist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93536

Speech pathology service provided to a care recipient in a residential aged care facility, at a residential aged care facility, by an eligible speech pathologist if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible speech pathologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible speech pathologist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93537

Telehealth attendance provided to a care recipient in a residential aged care facility, by an eligible allied health practitioner, if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475 applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible allied health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible allied health practitioner gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93538

Phone attendance provided to a care recipient in a residential aged care facility, by an eligible allied health practitioner, if all of the following apply:

(a)  the service is provided to a person whose chronic or complex care needs is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care;

  (b)   the person is referred to the eligible allied health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible allied health practitioner gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80


 

Part 4— Chronic disease management allied health items for care recipients in residential aged care facilities of Aboriginal and Torres Strait Islander descent

 

15  Flagfall for items in Part 4

(1)  For the first patient attended during one attendance by the allied health practitioner at one residential aged care facility on one occasion, the fee for the health service described in whichever item in Part 4 applies is the amount listed in the item plus $48.95.

(2)  Items 93592 and 93593 are not applicable to subclause (1).

16  Claiming limitation for chronic disease management items for care recipients in residential aged care facilities of Aboriginal and Torres Strait Islander descent

Maximum of 5 chronic disease management assessment and standard items

(1)  For any particular person, an item in subgroup 1 or 3 of Group M30 or Group M11 is not applicable more than 5 times in a calendar year (in total for all items).

Maximum of 5 additional chronic disease management physical therapy items

 (2)  For any particular person, an item in subgroup 2 of Group M30 is not applicable more than 5 times in a calendar year (in total for all items).

Note : Items in Group M11 are prescribed in the Health Insurance (Allied Health Services) Determination 2014.

 

Group M30 – Allied health services for Indigenous Australians in RACF

 

Item

Service

 

 

Fee($)

 

Subgroup 1—Initial/long allied health service for Indigenous Australians in RACF

93546

Aboriginal and Torres Strait Islander health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)     the person is referred to the eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93547

Diabetes education health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible diabetes educator if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible diabetes educator by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible diabetes educator gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93548

Audiology health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible audiologist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible audiologist by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible audiologist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93549

Exercise physiology health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible exercise physiologist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible exercise physiologist by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93550

Dietetics health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible dietitian if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible dietitian by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible dietitian gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93551

Mental health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible mental health worker if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible mental health worker by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible mental health worker gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93552

Occupational therapy health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible occupational therapist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible occupational therapist by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible occupational therapist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93553

Physiotherapy health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible physiotherapist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible physiotherapist by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible physiotherapist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93554

Podiatry health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible podiatrist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible podiatrist by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible podiatrist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93555

Chiropractic health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible chiropractor if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible chiropractor by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible chiropractor gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93556

Osteopathy health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible osteopath if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible osteopath by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible osteopath gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93557

Psychology health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible psychologist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible psychologist by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible psychologist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

93558

Speech pathology health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible speech pathologist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

(b)     the person’s health care needs are assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs;

(c)  the person is referred to the eligible speech pathologist by a medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(e)   the service is at least 30 minutes in duration; and

(f)   after the service, the eligible speech pathologist gives a written report to the referring medical practitioner

not more than once in a calendar year

97.15

Subgroup 2—Physical therapy items in RACF

93571

Additional exercise physiology health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible exercise physiologist if all of the following apply:

(a)  the person has received 5 services, to which an item in subgroup 1 or 3 of Group M30 or Group M11 applied (in total for all items), in that calendar year;

(b)  the person’s health care needs are assessed as requiring additional exercise physiology therapy services in a calendar year;

(c)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (d)   the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(f)   the service is at least 20 minutes in duration; and

  (g)  after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93572

Additional occupational therapy health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible occupational therapist if all of the following apply:

(a)  the person has received 5 services, to which an item in subgroup 1 or 3 of Group M30 or Group M11 applied (in total for all items), in that calendar year;

(b)  the person’s health care needs are assessed as requiring additional occupational therapy services in a calendar year;

(c)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (d)   the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(f)   the service is at least 20 minutes in duration; and

  (g)  after the service, the eligible occupational therapist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93573

Additional physiotherapy health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible physiotherapist if all of the following apply:

(a)  the person has received 5 services, to which an item in subgroup 1 or 3 of Group M30 or Group M11 applied (in total for all items), in that calendar year;

(b)  the person’s health care needs are assessed as requiring additional physiotherapy health services in a calendar year;

(c)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (d)   the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(f)   the service is at least 20 minutes in duration; and

  (g)  after the service, the eligible physiotherapist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

Subgroup 3—Subsequent/standard allied health services in RACF

93579

Aboriginal and Torres Strait Islander health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible Aboriginal health worker or eligible Aboriginal and Torres Strait Islander health practitioner gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93580

Diabetes education health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible diabetes educator if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible diabetes educator  gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93581

Audiology health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible audiologist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible audiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible audiologist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93582

Exercise physiology health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible exercise physiologist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93583

Dietetics health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible dietitian if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible dietitian by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible dietitian gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93584

Mental health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible mental health worker if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible mental health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible mental health worker gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93585

Occupational therapy health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible occupational therapist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible occupational therapist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93586

Physiotherapy health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible physiotherapist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible physiotherapist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93587

Podiatry health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible podiatrist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible podiatrist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible podiatrist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93588

Chiropractic health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible chiropractor if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible chiropractor by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible chiropractor gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93589

Osteopathy health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible osteopath if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible osteopath by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible osteopath gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93590

Psychology health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an eligible psychologist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the eligible psychologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the eligible psychologist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93591

Speech pathology health service provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an speech pathologist if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the speech pathologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the speech pathologist gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93592

Telehealth attendance provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an by an eligible allied health practitioner if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the by an eligible allied health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the by an eligible allied health practitioner gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80

93593

Phone attendance provided to a care recipient in a residential aged care facility of Aboriginal or Torres Strait Islander descent, at a residential aged care facility, by an by an eligible allied health practitioner if all of the following apply:

(a)  the service is provided to a person whose need for allied health treatment services has been identified by:

(i)      a health assessment service to which items 228, 715, 92004, 92011, 92016, 92023, 93470 or 93479 applies; or

(ii)    a shared care plan; or

  (b)   the person is referred to the by an eligible allied health practitioner by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department;

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

(d)   the service is at least 20 minutes in duration; and

  (e)  after the service, the by an eligible allied health practitioner gives a written report to the referring medical practitioner

         (i)   if the service is the only service under the referral—in relation to that service; or

        (ii)   if the service is the first or last service under the referral—in relation to that service; or

       (iii)   if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of—in relation to those matters

64.80


 

Part 5—Allied health group items for care recipients in residential aged care facilities

 

17  Flag fall for items in Part 5

For the first patient attended during one attendance by the allied health practitioner at one residential aged care facility on one occasion, the fee for the health service described in whichever item in Part 5 applies is the amount listed in the item plus $48.95.

18  Claiming limitation for allied health group service items for care recipients in residential aged care facilities

Maximum of 1 group assessment service item

(1)  For any particular person, an item in subgroup 1 of Group M31 or 81100, 81110, 81120 is not applicable more than 1 time in a calendar year (in total for all items).

Maximum of 8 group therapy items

(2)  For any particular person, an item in subgroup 2 of Group M31 or 81105, 81115,  81125 is not applicable more than 8 times in a calendar year (in total for all items).

Maximum of 2 additional physical group therapy items

 (3)  For any particular person, an item in subgroup 3 of Group M31 is not applicable more than 2 times in a calendar year.

Note : Items in 81100, 81105, 81110, 81115, 81120 and 81125 are prescribed in the Health Insurance (Allied Health Services) Determination 2014.

 

Group M31 – Allied health group services in RACF

 

Item

Service

 

 

Fee($)

 

Subgroup 1—Assessment for allied health group services in RACF

93606

Diabetes education health service provided to a care recipient in a residential aged care facility with type 2 diabetes, at a residential aged care facility, by an eligible diabetes educator for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a)   the person’s type 2 diabetes is assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs; and

(b)   the service is provided to a person whose type 2 diabetes is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care; and

(c)   the person is referred to an eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

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

(e)   the service is of at least 45 minutes duration; and

(f)   after the service, the eligible diabetes educator gives a written report to the referring medical practitioner

97.15

 

93607

Exercise physiology health service provided to a care recipient in a residential aged care facility with type 2 diabetes, at a residential aged care facility, by an eligible exercise physiologist for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a)   the person’s type 2 diabetes is assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs; and

(b)   the service is provided to a person whose type 2 diabetes is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care; and

(c)   the person is referred to an eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

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

(e)   the service is of at least 45 minutes duration; and

(f)   after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner

97.15

 

93608

Dietetics health service provided to a care recipient in a residential aged care facility with type 2 diabetes, at a residential aged care facility, by an eligible dietitian for assessing the person’s suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs and preparing the person for the group services if:

(a)   the person’s type 2 diabetes is assessed, including taking a comprehensive patient history and identifying an appropriate treatment program based on the person’s needs; and

(b)   the service is provided to a person whose type 2 diabetes is being managed under:

(i)      a multidisciplinary care plan for a residential aged care recipient to which items 232, 731, 92027, 92058, 92071, 92102, 93469 or 93475  applies; or

(ii)    a shared care plan; or

(iii)   a GP Management Plan and Team Care Arrangements, where the chronic or complex condition was being treated prior to the person receiving residential care; and

(c)   the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department, or a referral form that contains all the components of the form issued by the Department; and

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

(e)   the service is of at least 45 minutes duration; and

(f)   after the service, the eligible dietitian gives a written report to the referring medical practitioner

97.15

 

Subgroup 2—Allied health group services in RACF

93613

Diabetes education health service provided to a care recipient in a residential aged care facility with type 2 diabetes, at a residential aged care facility, by an eligible diabetes educator as a group service for the management of type 2 diabetes if:

(a)   the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110, 81120, 93284, 93286, 93606, 93607 or 93608; and

(b)   the service is provided to a person who is part of a group of between 2 and 12 patients; and

(c)   the service is provided in person; and

(d)   the service is of at least 60 minutes duration; and

(e)   after the last service in the group services program provided to the person under item 81105, 81115, 81125, 93285, 93613, 93614, 93615 the eligible diabetes educator prepares, or contributes to, a written report to be provided to the referring medical practitioner

20.70

 

 

93614

Exercise physiology health service provided to a care recipient in a residential aged care facility with type 2 diabetes, at a residential aged care facility, by an eligible exercise physiologist as a group service for the management of type 2 diabetes if:

(a)   the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110, 81120, 93284, 93286, 93606, 93607 or 93608; and

(b)   the service is provided to a person who is part of a group of between 2 and 12 patients; and

(c)   the service is provided in person; and

(d)   the service is of at least 60 minutes duration; and

(e)   after the last service in the group services program provided to the person under item 81105, 81115, 81125, 93285, 93613, 93614, 93615 the eligible exercise physiologist prepares, or contributes to, a written report to be provided to the referring medical practitioner

20.70

 

93615

Dietetics health service provided to a care recipient in a residential aged care facility with type 2 diabetes, at a residential aged care facility, by an eligible dietitian as a group service for the management of type 2 diabetes if:

(a)   the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110, 81120, 93284, 93286, 93606, 93607 or 93608; and

(b)   the service is provided to a person who is part of a group of between 2 and 12 patients; and

(c)   the service is provided in person; and

(d)   the service is of at least 60 minutes duration; and

(e)   after the last service in the group services program provided to the person under item 81105, 81115, 81125, 93285, 93613, 93614, 93615 the eligible dietitian prepares, or contributes to, a written report to be provided to the referring medical practitioner

20.70

 

Subgroup 3—Physical group therapy items in RACF

93620

Additional exercise physiology health service provided to a care recipient in a residential aged care facility with type 2 diabetes, at a residential aged care facility, by an eligible exercise physiologist as a group service for the management of type 2 diabetes if:

(a)   the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110, 81120, 93284, 93286, 93606, 93607 or 93608; and

(b)  the person has received 8 services, to which an item in subgroup 2 of Group M31 or 81105, 81115,  81125 applied (in total for all items), in that calendar year.

(c)   the service is provided to a person who is part of a group of between 2 and 12 patients; and

(d)   the service is provided in person; and

(e)   the service is of at least 60 minutes duration; and

(f)  after the last service to which this item applies was provided to a person in a calendar year, the eligible exercise physiologist gives a written report to the referring medical practitioner

20.70

 

 


Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

Endnote 2—Abbreviation key

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

/sub‑subparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

Sub‑Ch = Sub‑Chapter(s)

cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

commenced or to be commenced

 

Endnote 3—Legislation history

 

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Section 3C General Medical – Expansion of GP and Allied Health Chronic Disease Management Services for Care Recipients of a Residential Aged Care Facility) Determination 2020

9 Dec 2020 (F2020L01552)

10 Dec 2020 (s 2(1) item 1)

 

Health Insurance Legislation Amendment (Section 3C General Medical and Diagnostic Imaging Services – Medicare Indexation) Determination 2021

8 Apr 2021 (F2021L00426)

Sch 1 (items 405–418): 1 July 2021 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

s 2.............................................

rep LA s 48D

Schedule 1

 

Part 2

 

c 10...........................................

rs F2021L00426

Group A43 Table......................

am F2021L00426

Part 3

 

c 13...........................................

am F2021L00426

Group M29 Table.....................

am F2021L00426

Part 4

 

c 15...........................................

am F2021L00426

Group M30 Table.....................

am F2021L00426

Part 5

 

c 17...........................................

rs F2021L00426

Group M31 Table.....................

am F2021L00426