Federal Register of Legislation - Australian Government

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Determinations/Health as made
This instrument lists 16 new Medicare Benefits Schedule (MBS) items to support general practices to administer the COVID-19 vaccine.
Administered by: Health
Registered 25 Feb 2021
Tabling HistoryDate
Tabled HR15-Mar-2021
Tabled Senate15-Mar-2021
Table of contents.

Commonwealth Coat of Arms of Australia 

 

Health Insurance (Section 3C General Medical Services – General Practice Attendance for Assessing Patient Suitability for a COVID-19 Vaccine) Determination 2021

I, Paul McBride, delegate of the Minister for Health and Aged Care, make the following determination.

Dated        25 February 2021

 

 

 

 

 

Paul McBride

First Assistant Secretary

Medical Benefits Division

Health Resourcing Group

Department of Health

 

 

 

 

 

  

  


Contents

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

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

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

4.  Definitions............................................................................................................................... 1

5.  Treatment of relevant services................................................................................................. 3

6.  Application of general provisions of the general medical services table.................................. 3

8.  Restrictions on items............................................................................................................... 4

Schedule – relevant services                                                                                         5

 


1.  Name

              This instrument is the Health Insurance (Section 3C General Medical Services – General Practice Attendance for Assessing Patient Suitability for a COVID-19 Vaccine) Determination 2021.

2.  Commencement

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

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  The whole of this instrument

The day after registration.

 

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

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

3.  Authority

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

4.  Definitions

 (1)        In this instrument:

Act means the Health Insurance Act 1973.

after-hours period means any of the following:

(a)                    a public holiday;

(b)                   a Sunday;

(c)                    before 8 am, or after 1 pm, on a Saturday;

(d)                   before 8 am, or after 8 pm, on a day other than a day mentioned in paragraphs (a) to (c).

bulk-billed: a medical service is bulk-billed if:

(a)                    a medicare benefit is payable to a person in relation to the service; and

(b)                   under an agreement entered into under section 20A of the Act:

                                                           (i)            the person assigns to the medical practitioner by whom, or on whose behalf, the service is provided, the person’s right to the payment of the medicare benefit; and

                                                         (ii)            the medical practitioner accepts the assignment in full payment of the practitioner’s fee for the service provided.

eligible for a COVID-19 vaccine: a patient is eligible for a COVID-19 vaccine if the patient is at least 18 years of age.

Health Practitioner Regulation National Law has the meaning given by the Health Insurance Regulations 2018.

Modified Monash 1 area means an area that is not a Modified Monash 2 area, Modified Monash 3 area, Modified Monash 4 area, Modified Monash 5 area, Modified Monash 6 area or Modified Monash 7 area.

Modified Monash 2 area has the meaning given by Part 7 of the general medical services table.

Modified Monash 3 area has the meaning given by Part 7 of the general medical services table.

Modified Monash 4 area has the meaning given by Part 7 of the general medical services table.

Modified Monash 5 area has the meaning given by Part 7 of the general medical services table.

Modified Monash 6 area has the meaning given by Part 7 of the general medical services table.

Modified Monash 7 area has the meaning given by Part 7 of the general medical services table.

practice location has the meaning given by Part 7 of the general medical services table.

relevant health professional means a person who is registered in a health profession regulated under the Health Practitioner Regulation National Law, other than the medical profession.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.

Schedule means a Schedule to this instrument.

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

·         clinically relevant service;

·         general medical services table;

·         hospital-substitute treatment;

·         hospital treatment;

·         item;

·         medical practitioner;

·         professional service.

 (2)   Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

 

5.  Treatment of relevant services

 

(1)          For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated for the purposes of the provisions specified in subsection (2) 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 service; and

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

(2)          For the purposes of subsection (1), each provision of the following laws that relates to medical services, professional services or items is specified:

(a)                   the Act;

(b)                   the regulations made under the Act;

(c)                   the National Health Act 1953;  

(d)                  the regulations made under the National Health Act 1953.

(3)          However, subsection 19(4) of the Act is not specified for the purposes of subsection (1).

 6.  Application of general provisions of the general medical services table

Clause 1.2.8 of the general medical services table shall have effect as if each of the items in the Schedule were also specified in that clause.

7.  Services may be rendered on behalf of a medical practitioner

An item in the Schedule applies to a service whether the service is provided:

(a)                    by a medical practitioner; or

(b)                   on behalf of a medical practitioner by a relevant health professional.   

Note: see subsection 3(17) of the Act for when a service is taken to be rendered on behalf of a medical practitioner.

8.  Restrictions on items

Availability of COVID-19 vaccine at service location

 

(1)        An item in the Schedule only applies to a service if:

(a)                    for a service provided at a practice location - a dose of a COVID-19 vaccine is immediately available for administration to the patient at that location; or

(b)                   for a service provided from a practice location - a dose of a COVID-19 vaccine is immediately available for administration to the patient at the location at which the service is provided.

Restrictions on co-claiming with items 10988, 10990, 10991 or 10992

(2)        An item in the Schedule does not apply to a service if the service is associated with a service to which any of items 10988, 10990, 10991 or 10992 in the general medical services table applies.

Exclusion of hospital treatment and hospital-substitute treatment

(3)        An item in the Schedule does not apply to a service if the service is provided as part of an episode of hospital treatment or hospital-substitute treatment.

 

Schedule – relevant services

 

Group A44 – General Practice Attendance for Assessing Patient Suitability for a COVID-19 Vaccine

Subgroup 1— Assessing Patient Suitability for the First Dose of a COVID-19 Vaccine

Item

Service

Fee ($)

93624

Professional attendance by a general practitioner for the purpose of assessing a patient’s suitability for the first dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

(c)   the service is bulk-billed;

(d) the service is provided at, or from, a practice location in a Modified Monash 1 area

 36.15

93625

Professional attendance by a general practitioner for the purpose of assessing a patient’s suitability for the first dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in:

(i)  a Modified Monash 2 area; or

(ii) a Modified Monash 3 area; or

(iii) a Modified Monash 4 area; or

(iv) a Modified Monash 5 area; or

(v) a Modified Monash 6 area; or

(vi) a Modified Monash 7 area

43.90

93626

Professional attendance by a medical practitioner (other than a general practitioner) for the purpose of assessing a patient’s suitability for the first dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in a Modified Monash 1 area

28.20

93627

Professional attendance by a medical practitioner (other than a general practitioner) for the purpose of assessing a patient’s suitability for the first dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in:

(i)  a Modified Monash 2 area; or

(ii) a Modified Monash 3 area; or

(iii) a Modified Monash 4 area; or

(iv) a Modified Monash 5 area; or

(v) a Modified Monash 6 area; or

(vi) a Modified Monash 7 area

39.75

Subgroup 2— After-Hours Assessing Patient Suitability for the First Dose of a COVID-19 Vaccine

93634

Professional attendance by a general practitioner for the purpose of assessing a patient’s suitability for the first dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in a Modified Monash 1 area;

 (e) the service is rendered in an after-hours period

50.45

93635

Professional attendance by a general practitioner for the purpose of assessing a patient’s suitability for the first dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in:

(i)  a Modified Monash 2 area; or

(ii) a Modified Monash 3 area; or

(iii) a Modified Monash 4 area; or

(iv) a Modified Monash 5 area; or

(v) a Modified Monash 6 area; or

(vi) a Modified Monash 7 area;

 (e) the service is rendered in an after-hours period

58.20

93636

Professional attendance by a medical practitioner (other than a general practitioner) for the purpose of assessing a patient’s suitability for the first dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in a Modified Monash 1 area;

(e) the service is rendered in an after-hours period

39.95

93637

Professional attendance by a medical practitioner (other than a general practitioner) for the purpose of assessing a patient’s suitability for the first dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in:

(i)  a Modified Monash 2 area; or

(ii) a Modified Monash 3 area; or

(iii) a Modified Monash 4 area; or

(iv) a Modified Monash 5 area; or

(v) a Modified Monash 6 area; or

(vi) a Modified Monash 7 area;

 (e) the service is rendered in an after-hours period

51.15

Subgroup 3— Assessing Patient Suitability for the Second or Subsequent Dose of a COVID-19 Vaccine

93644

Professional attendance by a general practitioner for the purpose of assessing a patient’s suitability for the second or subsequent dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in a Modified Monash 1 area

28.50

93645

Professional attendance by a general practitioner for the purpose of assessing a patient’s suitability for the second or subsequent dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in:

(i)  a Modified Monash 2 area; or

(ii) a Modified Monash 3 area; or

(iii) a Modified Monash 4 area; or

(iv) a Modified Monash 5 area; or

(v) a Modified Monash 6 area; or

(vi) a Modified Monash 7 area

32.40

93646

Professional attendance by a medical practitioner (other than a general practitioner) for the purpose of assessing a patient’s suitability for the second or subsequent dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in a Modified Monash 1 area

20.55

93647

Professional attendance by a medical practitioner (other than a general practitioner) for the purpose of assessing a patient’s suitability for the second or subsequent dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in:

(i)  a Modified Monash 2 area; or

(ii) a Modified Monash 3 area; or

(iii) a Modified Monash 4 area; or

(iv) a Modified Monash 5 area; or

(v) a Modified Monash 6 area; or

(vi) a Modified Monash 7 area

28.20

Subgroup 4— After-Hours Assessing Patient Suitability for the Second or Subsequent Dose of a COVID-19 Vaccine

93653

Professional attendance by a general practitioner for the purpose of assessing a patient’s suitability for the second or subsequent dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in a Modified Monash 1 area;

 (e) the service is rendered in an after-hours period

42.80

93654

Professional attendance by a general practitioner for the purpose of assessing a patient’s suitability for the second or subsequent dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in:

(i)  a Modified Monash 2 area; or

(ii) a Modified Monash 3 area; or

(iii) a Modified Monash 4 area; or

(iv) a Modified Monash 5 area; or

(v) a Modified Monash 6 area; or

(vi) a Modified Monash 7 area;

(e) the service is rendered in an after-hours period

46.70

93655

Professional attendance by a medical practitioner (other than a general practitioner) for the purpose of assessing a patient’s suitability for the second or subsequent dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in a Modified Monash 1 area;

 (e) the service is rendered in an after-hours period

32.30

93656

Professional attendance by a medical practitioner (other than a general practitioner) for the purpose of assessing a patient’s suitability for the second or subsequent dose of a COVID-19 vaccine if all of the following apply:

(a)   one or both of the following is undertaken, where clinically relevant:

(i) a short patient history;

  (ii) limited examination and management;

 (b)  the patient is eligible for a COVID-19 vaccine;

 (c)  the service is bulk-billed;

 (d) the service is provided at, or from, a practice location in:

(i)  a Modified Monash 2 area; or

(ii) a Modified Monash 3 area; or

(iii) a Modified Monash 4 area; or

(iv) a Modified Monash 5 area; or

(v) a Modified Monash 6 area; or

(vi) a Modified Monash 7 area;

 (e) the service is rendered in an after-hours period

39.60