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Determinations/Health as made
This instrument amends multiple instruments to introduce new items under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative.
Administered by: Health and Aged Care
Registered 24 Jan 2023
Table of contents.

Commonwealth Coat of Arms of Australia

 

Health Insurance Amendment (Better Access Services for Family and Carer Participation) Determination 2023

I, Louise Riley, delegate of the Minister for Health and Aged Care, make the following determination.

Dated               19 January 2023                                 

Louise Riley

Acting First Assistant Secretary

Medical Benefits Division

Health Resourcing Group

Department of Health and Aged Care

 


Contents

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

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

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

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

Schedule 1—Better Access services                                                                             2

Health Insurance (Allied Health Services) Determination 2014                                                  2

Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021                                                                                                                                                                   7

Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018           15

 

 


1  Name

                   This instrument is the Health Insurance Amendment (Better Access Services for Family and Carer Participation) Determination 2023.

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

Immediately after the commencement of the Health Insurance Legislation Amendment (2023 Measures No. 1) Determination 2022.

 

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 1Better Access services

Health Insurance (Allied Health Services) Determination 2014

1  Subsection 4(1) (paragraph (a) of the definition of course of treatment)

Repeal the paragraph, substitute: 

                     (a)  for psychological therapy and focussed psychological strategies—up to 6 services to which any of items 80000, 80002, 80005, 80006, 80010, 80012, 80015, 80016, 80100, 80102, 80105, 80106, 80110, 80112, 80115, 80116, 80125, 80129, 80130, 80131, 80135, 80137, 80140, 80141, 80150, 80154, 80155, 80156, 80160, 80162, 80165 or 80166 or items 91166, 91167, 91168, 91169, 91170, 91171, 91172, 91173, 91174, 91175, 91176, 91177, 91181, 91182, 91183, 91184, 91185, 91186, 91187, 91188, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204 or 91205 of the COVID-19 Determination applies, provided on referral by a medical practitioner, by any of the following persons:

                              (i)  an eligible clinical psychologist;

                             (ii)  an eligible psychologist;

                            (iii)  an eligible occupational therapist;

                            (iv)  an eligible social worker; or                   

2  Section 6

Repeal the section, substitute:

6  Limitation on certain individual items

             (1)  This section applies to items 80000, 80002, 80005, 80006, 80010, 80012, 80015, 80016, 80100, 80102, 80105, 80106, 80110, 80112, 80115, 80116, 80125, 80129, 80130, 80131, 80135, 80137, 80140, 80141, 80150, 80154, 80155, 80156, 80160, 80162, 80165 and 80166 in Schedule 2. 

             (3)  For any particular patient, an item mentioned in subsection (1) applies in a calendar year only if the service described in the item is one of the first 10 relevant services provided to the patient, or to a person other than the patient as part of the patient’s treatment, in the calendar year.

             (4)  In this section, relevant service means a service to which any of items 283, 285, 286, 287, 309, 311, 313 or 315 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 or 2721 to 2727, 2739, 2741, 2743 or 2745 of the general medical services table, or items 80000 to 80016, 80100 to 80116, 80125 to 80141, or 80150 to 80166 in Schedule 2, or items 91166, 91167, 91168, 91169, 91170, 91171, 91172, 91173, 91174, 91175, 91176, 91177, 91181, 91182, 91183, 91184, 91185, 91186, 91187, 91188, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845, 91859, 91861, 91862, 91863, 91864, 91865, 91866 or 91867 of the COVID‑19 Determination apply.

             (5)  In addition to the restrictions in subclause (3) of this section, item 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162 or 80166 applies to a service provided to a person other than the patient only if:

                     (a)  the referring practitioner or the eligible practitioner providing the service determines it is clinically appropriate to provide services to a person other than the patient, and makes a written record of this determination in the patient’s records; and

                     (b)  the eligible practitioner providing the service to a person other than the patient:

                              (i)  explains the service to the patient; and

                             (ii)  obtains the patient’s consent for the service to be provided to the other person as part of the patient’s treatment; and

                            (iii)  makes a written record of the consent; and

                     (c)  the service is provided as part of the patient’s treatment; and

                     (d)  the patient is not in attendance during the provision of the service; and

                     (e)  in the calendar year, no more than one other service to which any of items 309, 311, 313, 315, 2739, 2741, 2743, 2745, 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162, 80166, 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91859, 91861, 91862, 91863, 91864, 91865, 91866 or 91867 apply has already been provided to or in relation to the patient.

Note:          The patient’s consent may be withdrawn at any time.

3  Paragraphs 6AA(3C)(a) to (e)

Repeal the paragraphs, substitute:

                     (a)  items 283, 285, 286, 287, 309, 311, 313, 315, 371 and 372;

                     (b)  items 2721, 2723, 2725, 2727, 2739, 2741, 2743 and 2745;

                     (c)  items in Groups M6, M7 and M16 other than item 82350;

                     (d)  items 90271, 90272, 90273, 90274, 90275, 90276, 90277 and 90278;

                     (e)  items 91166, 91167, 91168, 91169, 91170, 91171, 91172, 91173, 91174, 91175, 91176, 91177, 91181 to 91188, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845, 91859, 91861, 91862, 91863, 91864, 91865, 91866, 91867, 92182, 92184, 92186, 92188, 92194, 92196, 92198, 92200, 93076, 93079, 93084. 93087, 93092, 93095, 93100, 93103, 93110, 93113, 93118, 93121, 93126, 93129, 93134 and 93137.

 

4  After section 6D

Insert:

6E  Psychological therapy and focussed psychological strategies health services provided to a person other than the patient

             (1)  For the purposes of items 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162 and 80166, referring practitioner means:

(a)    a medical practitioner who has referred the patient as part of a GP Mental Health Treatment Plan or psychiatrist assessment and management plan; or

(b)   a specialist or consultant physician specialising in the practice of their field of psychiatry; or

(c)    a specialist or consultant physician specialising in the practice of their field of paediatrics. 

5  Schedule 2 (after item 80000)

Insert:

80002

Psychological therapy health service provided in consulting rooms by an eligible clinical psychologist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible clinical psychologist by a referring practitioner; and

(c)    the service lasts at least 30 minutes but less than 50 minutes

105.45

6  Schedule 2 (after item 80005)

Insert:

80006

Psychological therapy health service provided at a place other than consulting rooms by an eligible clinical psychologist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible clinical psychologist by a referring practitioner; and

(c)    the service lasts at least 30 minutes but less than 50 minutes

131.80

7  Schedule 2 (after item 80010)

Insert:

80012

Psychological therapy health service provided in consulting rooms by an eligible clinical psychologist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible clinical psychologist by a referring practitioner; and

(c)    the service lasts at least 50 minutes

154.85

8  Schedule 2 (after item 80015)

Insert:

80016

Psychological therapy health service provided at a place other than consulting rooms by an eligible clinical psychologist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment; 

(b)   the patient has been referred to the eligible clinical psychologist by a referring practitioner; and

(c)    the service lasts at least 50 minutes

181.15

9  Schedule 2 (after item 80100)

Insert:

80102

Focussed psychological strategies health service provided in consulting rooms by an eligible psychologist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible psychologist by a referring practitioner; and

(c)    the service lasts at least 20 minutes but less than 50 minutes

74.75

10  Schedule 2 (after item 80105)

Insert:

80106

Focussed psychological strategies health service provided at a place other than consulting rooms by an eligible psychologist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible psychologist by a referring practitioner; and

(c)    the service lasts at least 20 minutes but less than 50 minutes

101.65

11  Schedule 2 (after item 80110)

Insert:

80112

Focussed psychological strategies health service provided in consulting rooms by an eligible psychologist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible psychologist by a referring practitioner; and

(c)    the service lasts at least 50 minutes

105.45

12  Schedule 2 (after item 80115)

Insert:

80116

Focussed psychological strategies health service provided at a place other than consulting rooms by an eligible psychologist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible psychologist by a referring practitioner; and

(c)    the service lasts at least 50 minutes

132.45

13  Schedule 2 (after item 80128)

Insert:

80129

Focussed psychological strategies health service provided in consulting rooms by an eligible occupational therapist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible occupational therapist by a referring practitioner; and

(c)    the service lasts at least 20 minutes but less than 50 minutes

65.85

14  Schedule 2 (after item 80130)

Insert:

80131

Focussed psychological strategies health service provided at a place other than consulting rooms by an eligible occupational therapist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible occupational therapist by a referring practitioner; and

(c)    the service lasts at least 20 minutes but less than 50 minutes

92.70

15  Schedule 2 (after item 80135)

Insert:

80137

Focussed psychological strategies health service provided in consulting rooms by an eligible occupational therapist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible occupational therapist by a referring practitioner; and

(c)    the service lasts at least 50 minutes

92.95

16  Schedule 2 (after item 80140)

Insert:

80141

Focussed psychological strategies health service provided at a place other than consulting rooms by an eligible occupational therapist to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible occupational therapist by a referring practitioner; and

(c)    the service lasts at least 50 minutes

119.85

17  Schedule 2 (after item 80153)

Insert:

80154

Focussed psychological strategies health service provided in consulting rooms by an eligible social worker to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible social worker by a referring practitioner; and

(c)    the service lasts at least 20 minutes but less than 50 minutes

65.85

18  Schedule 2 (after item 80155)

Insert:

80156

Focussed psychological strategies health service provided at a place other than consulting rooms by an eligible social worker to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible social worker by a referring practitioner; and

(c)    the service lasts at least 20 minutes but less than 50 minutes

92.70

19  Schedule 2 (after item 80160)

Insert:

80162

Focussed psychological strategies health service provided in consulting rooms by an eligible social worker to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible social worker by a referring practitioner; and

(c)    the service lasts at least 50 minutes

92.95

20  Schedule 2 (after item 80165)

Insert:

80166

Focussed psychological strategies health service provided at a place other than consulting rooms by an eligible social worker to a person other than the patient, if:

(a)    the service is part of the patient’s treatment;

(b)   the patient has been referred to the eligible social worker by a referring practitioner; and

(c)    the service lasts at least 50 minutes

119.85

Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021

21  Subsection 7(2)

After “to a patient”, insert “, or to a person other than the patient as part of the patient’s treatment,”.

22  Paragraphs 7(2)(b) to (d)

Repeal the paragraphs, substitute:

(b) items 283, 285, 286, 287, 309, 311, 313 or 315 of the Other Medical Practitioner Determination; or

(c)  items 80000 to 80016, 80100 to 80116, 80125 to 80141 or 80150 to 80166 of the Allied Health Determination.

23  Schedule 1 (paragraph 1.1.02(1)(b))

Omit “286 or 287”, substitute “286, 287, 309, 311, 313 or 315”.

24  Schedule 1 (subclause 1.1.02(2))

Omit “91842 and 91843”, substitute “91842, 91843, 91859, 91861, 91864 and 91865”.

25  Schedule 1 (paragraphs 1.1.12(3)(a) to (d))

Repeal the paragraphs, substitute:

                      (a)  psychological therapies provided to the patient, or to a person other than the patient as part of the patient’s treatment, by a clinical psychologist (items 91166, 91167, 91168, 91171, 91181, 91182, 91198 and 91199 and items in Group M6 of the Allied Health Determination); and

                     (b)  focussed psychological strategies services provided to the patient, or to a person other than the patient as part of the patient’s treatment, by a general practitioner mentioned in paragraph 2.20.7(1)(b) of the general medical services table to provide those services (items 2721 to 2745, 91818, 91819, 91842, 91843, 91859, 91861, 91864 and 91865); and

                     (c)  focussed psychological strategies services provided to the patient, or to a person other than the patient as part of the patient’s treatment, by an allied mental health professional (items 91169 to 91177, 91183 to 91188, 91194, 91195, 91196, 91197, 91200, 91201, 91202, 91203, 91204 and 91205 and items 80100 to 80175 of the Allied Health Determination); and

                     (d)  focussed psychological strategies services provided to the patient, or to a person other than the patient as part of the patient’s treatment, by a medical practitioner mentioned in paragraph 1.9.4(1)(b) of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 to provide those services (items 283, 285, 286, 287, 309, 311, 313, 315, 91820, 91821, 91844, 91845, 91862, 91863, 91866, 91867).

26  Schedule 1 (paragraphs 1.1.17(5)(a) to (e))

Repeal the paragraphs, substitute:

                     (a)  items 283, 285, 286, 287, 309, 311, 313 and 315;

                     (b)  items 2721, 2723, 2725, 2727, 2739, 2741, 2743 and 2745;

                     (c)  items in Groups M6, M7 and M16 other than item 82350;

                     (d)  items 90271, 90272, 90273, 90274, 90275, 90276, 90277 and 90278;

                     (e)  items 91166, 91167, 91168, 91169, 91170, 91171, 91172, 91173, 91174, 91175, 91176, 91177, 91181 to 91188, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845, 91859, 91861, 91862, 91863, 91864, 91865, 91866, 91867, 92182, 92184, 92186, 92188, 92194, 92196, 92198, 92200, 93076, 93079, 93084. 93087, 93092, 93095, 93100, 93103, 93110, 93113, 93118, 93121, 93126, 93129, 93134 and 93137.

27  Schedule 1 (after clause 1.1.18)

Insert:

1.1.19  Application of focussed psychological strategies health services provided to a person other than the patient

(1)  Item 91859, 91861, 91862, 91863, 91864, 91865, 91866 or 91867 applies to a service provided by a medical practitioner to a person other than the patient only if:

(a)  the medical practitioner determines it is clinically appropriate to provide focussed psychological strategies services to a person other than the patient, and makes a written record of this determination in the patient’s records; and

(b) the medical practitioner:

                              (i)  explains the service to the patient; and

                             (ii)  obtains the patient’s consent for the service to be provided to the other person as part of the patient’s treatment; and

                            (iii)  makes a written record of the consent; and

                     (c)  the service is provided as part of the patient’s treatment; and

                     (d)  the patient is not in attendance during the provision of the service; and

                     (e)  in the calendar year, no more than one other service to which any of items 309, 311, 313, 315, 2739, 2741, 2743, 2745, 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162, 80166, 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91859, 91861, 91862, 91863, 91864, 91865, 91866 or 91867 apply has already been provided to or in relation to the patient.

Note:                The patient’s consent may be withdrawn at any time.

28  Schedule 1 (after item 91821)

Insert:

91859

Telehealth attendance by a general practitioner (not including a specialist or a consultant physician), registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 30 minutes but less than 40 minutes

98.05

91861

Telehealth attendance by a general practitioner (not including a specialist or a consultant physician), registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 40 minutes

140.30

91862

Telehealth attendance by a medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 30 minutes but less than 40 minutes

78.45

91863

Telehealth attendance by a medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 40 minutes

112.25

29  Schedule 1 (after item 91845)

Insert:

91864

Phone attendance by a general practitioner (not including a specialist or a consultant physician), registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 30 minutes but less than 40 minutes

98.05

91865

Phone attendance by a general practitioner (not including a specialist or a consultant physician), registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 40 minutes

140.30

91866

Phone attendance by a medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 30 minutes but less than 40 minutes

78.45

91867

Phone attendance by a medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 40 minutes

112.25

30  Schedule 3 (subclause 3.1.5(1))

Omit “For items 91166 to 91176 and 91181 to 91188”, substitute “For items 91166 to 91177, 91181 to 91188 and 91194 to 91205”.

31  Schedule 3 (after subclause 3.1.7(2))

Insert:

(2A)  A reference in subclause (2) to a service providing a treatment to a patient includes any service to which item 309, 311, 313, 315, 2739, 2741, 2743, 2745, 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162, 80166, 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91859, 91861, 91862, 91863, 91864, 91865, 91866, or 91867 applies that is provided to another person as part of the patient’s treatment.

32  Schedule 3 (paragraphs 3.1.7(5)(a) to (e))

Repeal the paragraphs, substitute:

(a)  items 283, 285, 286, 287, 309, 311, 313 and 315;

(b)  items 2721, 2723, 2725, 2727, 2739, 2741, 2743 and 2745;

(c)  items in Groups M6, M7 and M16 other than item 82350;

(d)  items 90271, 90272, 90273, 90274, 90275, 90276, 90277 and 90278;

(e)  items 91166, 91167, 91168, 91169, 91170, 91171, 91172, 91173, 91174, 91175, 91176, 91177, 91181 to 91188, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845, 91859, 91861, 91862, 91863, 91864, 91865, 91866, 91867, 92182, 92184, 92186, 92188, 92194, 92196, 92198, 92200, 93076, 93079, 93084. 93087, 93092, 93095, 93100, 93103, 93110, 93113, 93118, 93121, 93126, 93129, 93134 and 93137.

33  Schedule 3 (after clause 3.1.8)

Insert:

3.1.9  Application of psychological therapy and focussed psychological strategies health services provided to a person other than the patient

(1)  For the purposes of items 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204 and 91205, referring practitioner means:

(a)    a medical practitioner who has referred the patient as part of a GP Mental Health Treatment Plan or psychiatrist assessment and management plan; or

(b)   a specialist or consultant physician specialising in the practice of their field of psychiatry; or

(c)    a specialist or consultant physician specialising in the practice of their field of paediatrics.

(2)  Item 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204 or 91205 applies to a service provided to a person other than the patient only if:

(a)    the referring practitioner or the eligible practitioner providing the service determines it is clinically appropriate to provide services to a person other than the patient, and makes a written record of this determination in the patient’s records; and

(b)   the eligible practitioner providing the service to a person other than the patient:

                              (i)  explains the service to the patient; and

                             (ii)  obtains the patient’s consent for the service to be provided to the other person as part of the patient’s treatment; and

                            (iii)  makes a written record of the consent; and

(c)    the service is provided as part of the patient’s treatment; and

(d)   the patient is not in attendance during the provision of the service; and

(e)    in the calendar year, no more than one other service to which any of items 309, 311, 313, 315, 2739, 2741, 2743, 2745, 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162, 80166, 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91859, 91861, 91862, 91863, 91864, 91865, 91866 or 91867 apply has already been provided to or in relation to the patient.

Note:       The patient’s consent may be withdrawn at any time.

34  Schedule 3 (after item 91167)

Insert:

91168

Telehealth attendance for a psychological therapy health service provided by an eligible clinical psychologist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible clinical psychologist by a referring practitioner; and

(c)     the service lasts at least 30 minutes but less than 50 minutes

105.45

91171

Telehealth attendance for a psychological therapy health service provided by an eligible clinical psychologist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible clinical psychologist by a referring practitioner; and

(c)     the service lasts at least 50 minutes

154.85

35  Schedule 3 (after item 91170)

Insert:

91174

Telehealth attendance for a focussed psychological strategies health service provided by an eligible psychologist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible psychologist by a referring practitioner; and

(c)     the service lasts at least 20 minutes but less than 50 minutes

74.75

91177

Telehealth attendance for a focussed psychological strategies health service provided by an eligible psychologist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible psychologist by a referring practitioner; and

(c)     the service lasts at least 50 minutes

105.45

36  Schedule 3 (after item 91173)

Insert:

91194

Telehealth attendance for a focussed psychological strategies health service provided by an eligible occupational therapist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible occupational therapist by a referring practitioner; and

(c)     the service lasts at least 20 minutes but less than 50 minutes

65.85

91195

Telehealth attendance for a focussed psychological strategies health service provided by an eligible occupational therapist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible occupational therapist by a referring practitioner; and

(c)     the service lasts at least 50 minutes

92.95

37  Schedule 3 (after item 91176)

Insert:

91196

Telehealth attendance for a focussed psychological strategies health service provided by an eligible social worker to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible social worker by a referring practitioner and

(c)     the service lasts at least 20 minutes but less than 50 minutes

65.85

91197

Telehealth attendance for a focussed psychological strategies health service provided by an eligible social worker to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible social worker by a referring practitioner; and

(c)     the service lasts at least 50 minutes

92.95

38  Schedule 3 (after item 91182)

Insert:

91198

Phone attendance for a psychological therapy health service provided by an eligible clinical psychologist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible clinical psychologist by a referring practitioner; and

(c)     the service lasts at least 30 minutes but less than 50 minutes

105.45

91199

Phone attendance for a psychological therapy health service provided by an eligible clinical psychologist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible clinical psychologist by a referring practitioner; and

(c)     the service lasts at least 50 minutes

154.85

39  Schedule 3 (after item 91184)

Insert:

91200

Phone attendance for a focussed psychological strategies health service provided by an eligible psychologist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible psychologist by a referring practitioner; and

(c)     the service lasts at least 20 minutes but less than 50 minutes

74.75

91201

Phone attendance for a focussed psychological strategies health service provided by an eligible psychologist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible psychologist by a referring practitioner; and

(c)     the service lasts at least 50 minutes

105.45

40  Schedule 3 (after item 91186)

Insert:

91202

Phone attendance for a focussed psychological strategies health service provided by an eligible occupational therapist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible occupational therapist by a referring practitioner; and

(c)     the service lasts at least 20 minutes but less than 50 minutes

65.85

91203

Phone attendance for a focussed psychological strategies health service provided by an eligible occupational therapist to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible occupational therapist by a referring practitioner; and

(c)     the service lasts at least 50 minutes

92.95

41  Schedule 3 (after item 91188)

Insert:

91204

Phone attendance for a focussed psychological strategies health service provided by an eligible social worker to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible social worker by a referring practitioner; and

(c)     the service lasts at least 20 minutes but less than 50 minutes

65.85

91205

Phone attendance for a focussed psychological strategies health service provided by an eligible social worker to a person other than the patient, if:

(a)     the service is part of the patient’s treatment;

(b)     the patient has been referred to the eligible social worker by a referring practitioner; and

(c)     the service lasts at least 50 minutes

92.95

Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018

42  Schedule 1 (clause 1.9.2)

Repeal the clause, substitute:

1.9.2      Meaning of amount under table 1.9.2

(1)          An amount under table 1.9.2, for an item mentioned in column 1 of table 1.9.2, means the sum of:

(a)     the fee for the item mentioned in column 2 of the table; and

(b)   either:

(i)    if not more than 6 patients are attended at a single attendance—the amount mentioned in column 3 for the item, divided by the number of patients attended; or

(ii)   if more than 6 patients are attended at a single attendance—the amount mentioned in column 4 for the item.

 

Table 1.9.2—Amount under clause 1.9.2

Item

Column 1

Item of the table

Column 2

Fee

Column 3

Amount if not more than 6 patients (to be divided by the number of patients) ($)

Column 4

Amount per patient if more than 6 patients ($)

1

285

The fee for item 283

21.95

1.70

2

287

The fee for item 286

21.95

1.70

3

311

The fee for item 309

21.95

1.70

4

315

The fee for item 313

21.95

1.70

(2)          A reference in subclause (1) to an attendance on a patient includes, in relation to an attendance to which item 311 or 315 applies, an attendance on a person other than a patient as part of a patient’s treatment.

43  Schedule 1 (subclause 1.9.4(1))

Omit “283, 285, 286 and 287” (wherever occurring), substitute “283, 285, 286, 287, 309, 311, 313 and 315”.

44  Schedule 1 (subclause 1.9.4(2))

Repeal the subclause, substitute:

(2)          Items 283, 285, 286, 287, 309, 311, 313 and 315 do not apply to:

(a)     a service which:

(i)    is provided to a patient, or in relation to a patient, who, in a calendar year, has already been provided with 6 services to which any of the items in Subgroup 2 of Group A20 of the general medical services table or item 283, 285, 286, 287 309, 311, 313 or 315 applies or item 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845, 91859, 91861, 91862, 91863, 91864, 91865, 91866 or 91867 of the COVID-19 Determination applies; and

(ii)   is provided before the medical practitioner managing the GP mental health treatment plan or the psychiatrist assessment and management plan has conducted a patient review and recorded in the patient’s records a recommendation that the patient have additional sessions of focussed psychological strategies in the same calendar year; or

(b)     a service which is provided to a patient, or to a person other than the patient as part of the patient’s treatment, if, in the calendar year, 10 other services to which an item in Subgroup 2 of Group A20, or item  283, 285, 286, 287, 309, 311, 313, 315, 80000 to 80016, 80100 to 80116, 80125 to 80141, 80150 to 80166, 91166, 91167, 91168, 91169, 91170, 91171, 91172, 91173, 91174, 91175, 91176, 91177, 91181, 91182, 91183, 91184, 91185, 91186, 91187, 91188, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91818, 91819, 91820, 91821, 91842, 91843, 91844, 91845, 91859, 91861, 91862, 91863, 91864, 91865, 91866 or 91867 apply, have already been provided to or in relation to the patient. 

45  Schedule 1 (after clause 1.9.4)

Insert:

1.9.5      Application of focussed psychological strategies health services provided to a person other than the patient

(1)          Item 309, 311, 313 or 315 applies to a service provided by a medical practitioner to a person other than the patient only if:

(a)      the medical practitioner determines it is clinically appropriate to provide focussed psychological strategies services to a person other than the patient, and makes a written record of this determination in the patient’s records; and

(b)      the medical practitioner:

(i)    explains the service to the patient; and

(ii)   obtains the patient’s consent for the service to be provided to the other person as part of the patient’s treatment; and

(iii)  makes a written record of the consent; and

(c)                the service is provided as part of the patient’s treatment; and

(d)     the patient is not in attendance during the provision of the service; and

(e)     in the calendar year, no more than one other service to which any of items 309, 311, 313, 315, 2739, 2741, 2743, 2745, 80002, 80006, 80012, 80016, 80102, 80106, 80112, 80116, 80129, 80131, 80137, 80141, 80154, 80156, 80162, 80166, 91168, 91171, 91174, 91177, 91194, 91195, 91196, 91197, 91198, 91199, 91200, 91201, 91202, 91203, 91204, 91205, 91859, 91861, 91862, 91863, 91864, 91865, 91866 or 91867 apply has already been provided to or in relation to the patient.

Note:    The patient’s consent may be withdrawn at any time.

46  Schedule 1 (after item 287)

Insert:

309

Professional attendance at consulting rooms by a medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 30 minutes but less than 40 minutes

78.45

311

Professional attendance at a place other than consulting rooms by a medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 30 minutes but less than 40 minutes

Amount under clause 1.9.2

313

Professional attendance at consulting rooms by a medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 40 minutes

112.25

315

Professional attendance at a place other than consulting rooms by a medical practitioner, registered with the Chief Executive Medicare as meeting the credentialling requirements for provision of this service:

(a)     for providing focussed psychological strategies for assessed mental disorders to a person other than the patient, if the service is part of the patient’s treatment; and

(b)     lasting at least 40 minutes

Amount under clause 1.9.2