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This instrument amends the Health Insurance (Allied Health Services) Determination 2014 and 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 to enable a Medicare benefit to be paid where allied health practitioners participate in case conferences to manage the care of certain patients.
Administered by: Health
Registered 15 Sep 2021
Table of contents.

Commonwealth Coat of Arms of Australia

 

Health Insurance Legislation Amendment (Section 3C General Medical Services – Allied Health Case Conference) Determination 2021

I, Travis Haslam, delegate of the Minister for Health and Aged Care, make the following Determination.

Dated   14 September 2021

Travis Haslam

Acting First Assistant Secretary

Medical Benefits Division

Health Resourcing Group

Department of Health

 

 

 


Contents

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

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

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

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

Schedule 1— Allied Health Case Conference Amendments......................................... 2

Schedule 2— Definition of eligible allied health practitioner.......................................... 7

 

 


1  Name

                        This instrument is the Health Insurance Legislation Amendment (Section 3C General Medical Services – Allied Health Case Conference) 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

1 November 2021

 

                Note:        This table relates only to the provisions of this instrument as originally made.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

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

3  Authority

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

4  Schedules

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


 

Schedule 1— Allied Health Case Conference Amendments

Health Insurance (Allied Health Services) Determination 2014

1.    Section 5 (definition of Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018)

Repeal the definition.

2.    After Section 13

Insert:

14 Application of case conference items generally

(1)   This Section applies to items 10955, 10957, 10959, 82001, 82002 and 82003 in Schedule 2.

(2)   For the purposes of an item mentioned in subsection (1):

(a)    community case conference has the meaning given by clause 7.1.1 of the general medical services table;

(b)   multidisciplinary case conference has the meaning given by clause 1.1.4 of the general medical services table;

(c)    multidisciplinary case conference team has the meaning given by clause 1.1.5 of the general medical services table as if the items were also specified in subparagraph 1.1.5(1)(b)(i); and

(d)   participate has the meaning given by clause 2.16.16 of the general medical services table.

Patient and multidisciplinary case conference team member attendance requirements

(3)   An item mentioned in subsection (1) may apply to a service provided for a patient if the patient is not in attendance.

(4)   An item mentioned in subsection (1) does not apply to a service if the minimum number of members of the multidisciplinary case conference team are not in attendance.

(5)   For subsection (4), the minimum number of members is 3.

(6)   For subsections (3) and (4), attendance is taken to include attending in person, by phone or by video conference.

Note: this is consistent with the requirements of the incorporated meaning of multidisciplinary case conference team in subsection (2).

Attendance options for the eligible allied health practitioner

(7)   For the purposes of an item mentioned in subsection (1), attendance by the eligible allied health practitioner may:

(a)    be provided in person, by phone or by video conference; and

(b)   differ from the means of attendance provided by other members of the multidisciplinary case conference team.

15 Limitations on case conference items for chronic disease management

(1)   This Section applies to items 10955, 10957 and 10959 in Schedule 2.

Eligible patients

(2)   An item mentioned in subsection (1) only applies to a service if the patient who the service is provided to:

(a)     has at least one medical condition that:

                                                                                         (i)            has been (or is likely to be) present for at least six months; or

                                                                                       (ii)            is terminal; and

(b)   is not an admitted patient of a hospital.

Frequency limitations

(3)   An item mentioned in subsection does not apply to a service if the service has been performed in the last 3 months.

 

Additional requirements on the multidisciplinary case conference team

(4)   An item mentioned in subsection (1) only applies to a service if the patient requires ongoing care from a multidisciplinary case conference team which includes at least one medical practitioner (including a general practitioner, but not a specialist or consultant physician).

Eligible allied health practitioners

(5)   For the purposes of the items mentioned in subsection (1), eligible allied health practitioner means:

(a)    an eligible Aboriginal health worker;

(b)   an eligible Aboriginal and Torres Strait Islander health practitioner;

(c)    an eligible diabetes educator;

(d)   an eligible audiologist;

(e)    an eligible dietitian;

(f)    an eligible mental health worker;

(g)    an eligible occupational therapist;

(h)   an eligible exercise physiologist;

(i)     an eligible physiotherapist;

(j)     an eligible podiatrist;

(k)   an eligible chiropractor;

(l)     an eligible osteopath;

(m) an eligible psychologist; or

(n)   an eligible speech pathologist.

16 Limitations on case conference items for autism and other pervasive developmental disorders

(1)   This Section applies to items 82001, 82002 and 82003 in Schedule 2.

Eligible patients

(2)   An item mentioned in subsection (1) only applies to a service if the patient:

(a)    is a child under 13 years of age; and

(b)   has been diagnosed with, or is suspected of having:

                                                                                   (i)      autism or another pervasive developmental disorder; or

                                                                                 (ii)      an eligible disability; and

(c)    is not an admitted patient of a hospital.

Additional requirements on the multidisciplinary case conference team

(3)   An item mentioned in subsection (1) only applies to a service if the patient requires ongoing care from a multidisciplinary case conference team which includes:

(a)    if the patient has been diagnosed with, or is suspected of having:

                                                                                   (i)      autism or another pervasive developmental disorder, a consultant physician in the practice of the consultant physician’s specialty of paediatrics or psychiatry; or

                                                                                 (ii)      an eligible disability, a specialist or consultant physician practising in their specialty, or a general practitioner.

Eligible allied health practitioners

(4)   For the purposes of the items mentioned in subsection (1), eligible allied health practitioner means:

(a)    an eligible Aboriginal health worker;

(b)   an eligible Aboriginal and Torres Strait Islander health practitioner;

(c)    an eligible psychologist;

(d)   an eligible speech pathologist;

(e)    an eligible occupational therapist;

(f)    an eligible audiologist;

(g)    an eligible optometrist;

(h)   an eligible mental health nurse;

(i)     an eligible mental health worker;

(j)     an eligible orthoptist; or

(k)   an eligible physiotherapist.

                  

3.    Schedule 2 (after item 10970)

Insert:

Subgroup 1 – Chronic disease management case conference services

10955

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in:

(a)    a community case conference; or

(b)   a multidisciplinary case conference in a residential aged care facility;

if the conference lasts for at least 15 minutes, but for less than 20 minutes (other than a service associated with a service to which another item in this Group applies)

50.85

10957

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in:

(a)    a community case conference; or

(b)   a multidisciplinary case conference in a residential aged care facility;

if the conference lasts for at least 20 minutes, but for less than 40 minutes (other than a service associated with a service to which another item in this Group applies)

87.15

10959

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in:

(a)    a community case conference; or

(b)   a multidisciplinary case conference in a residential aged care facility;

if the conference lasts for at least 40 minutes (other than a service associated with a service to which another item in this Group applies)

145.10

4.    Schedule 2 (after item 82035)

Insert:

Subgroup 1 – Autism, pervasive developmental disorder and disability case conference services

82001

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in a community case conference if the conference lasts for at least 15 minutes, but for less than 20 minutes (other than a service associated with a service to which another item in this Group applies)

50.85

82002

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in a community case conference if the conference lasts for at least 20 minutes, but for less than 40 minutes (other than a service associated with a service to which another item in this Group applies)

87.15

82003

Attendance by an eligible allied health practitioner, as a member of a multidisciplinary case conference team, to participate in a community case conference if the conference lasts for at least 40 minutes (other than a service associated with a service to which another item in this Group applies)

145.10

 


 

Schedule 2— Definition of eligible allied health practitioner

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

1.    Subsection 5(1)

Insert:

                   eligible allied health practitioner means:

(a)    an eligible Aboriginal and Torres Strait Islander health practitioner;

(b)   an eligible Aboriginal health worker;

(c)    an eligible audiologist;

(d)   an eligible chiropractor;

(e)    an eligible diabetes educator;

(f)    an eligible dietitian;

(g)    an eligible exercise physiologist;

(h)   an eligible mental health nurse;

(i)     an eligible mental health worker;

(j)     an eligible occupational therapist;

(k)   an eligible osteopath;

(l)     an eligible physiotherapist;

(m) an eligible podiatrist;

(n)   an eligible psychologist; or

(o)   an eligible speech pathologist.