Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 9)1
I, PHILIP MICHAEL JEFFERY, Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.
Dated 16 December 2004
P. M. JEFFERY
Governor-General
By His Excellency’s Command
TONY ABBOTT
Minister for Health and Ageing
1 Name of Regulations
These Regulations are the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 9).
2 Commencement
These Regulations commence on 1 January 2005.
3 Amendment of Health Insurance (General Medical Services Table) Regulations 2004
Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2004.
Schedule 1 Amendments
(regulation 3)
[1] Schedule 1, Part 2, subrule 7 (1)
omit
2727 and 10900
insert
2727, 5000 to 5267 and 10900
[2] Schedule 1, Part 2, paragraph 7 (2) (a)
omit
items 3 to 96,
insert
items 3 to 96 and 5000 to 5267,
[3] Schedule 1, Part 2, after subrule 9 (13)
insert
(14) In items 5003, 5007 and 5010, amount under rule 9 means an amount equal to the sum of:
(a) the fee for item 5000; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $21.55 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.55.
(15) In items 5023, 5026 and 5028, amount under rule 9 means an amount equal to the sum of:
(a) the fee for item 5020; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $21.55 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.55.
(16) In items 5043, 5046 and 5049, amount under rule 9 means an amount equal to the sum of:
(a) the fee for item 5040; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $21.55 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.55.
(17) In items 5063, 5064 and 5067, amount under rule 9 means an amount equal to the sum of:
(a) the fee for item 5060; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $21.55 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — $1.55.
(18) In items 5220, 5240 and 5260, amount under rule 9 means an amount equal to the sum of:
(a) $18.50; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $15.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents.
(19) In items 5223, 5243 and 5263, amount under rule 9 means an amount equal to the sum of:
(a) $26.00; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $17.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents.
(20) In items 5227, 5247 and 5265, amount under rule 9 means an amount equal to the sum of:
(a) $45.50; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $15.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents.
(21) In items 5228, 5248 and 5267, amount under rule 9 means an amount equal to the sum of:
(a) $67.50; and
(b) either:
(i) if not more than 6 patients are attended at a single attendance — $15.50 divided by the number of patients attended; or
(ii) if more than 6 patients are attended at a single attendance — 70 cents.
[4] Schedule 1, Part 2, after rule 15
insert
15A Application of items 5000 to 5267
An item in the range 5000 to 5267 applies only to a professional attendance that is initiated:
(a) on a public holiday; or
(b) on a Sunday; or
(c) before 8 am, or after 1 pm, on a Saturday; or
(d) before 8 am, or after 8 pm, on any day other than a Saturday, Sunday or public holiday.
[5] Schedule 1, Part 2, after subrule 84 (2)
insert
(3) If the cost of the vaccine supplied in connection with a service described in item 10993 is not subsidised by the Commonwealth or a State, the service is taken not to include the supply of that vaccine.
[6] Schedule 1, Part 3, items 1 and 2
omit
attendance, other than an attendance between 11 pm and 7 am,
insert
attendance (other than an attendance between 11 pm and 7 am)
[7] Schedule 1, Part 3, items 97 and 98
omit
attendance, other than an attendance between 11 pm and 7 am,
insert
attendance (other than an attendance between 11 pm and 7 am)
[8] Schedule 1, Part 3, after item 2727
insert
Group A22 — General practitioner after-hours attendances to which no other item applies | ||||
5000 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — each attendance | 24.10 | ||
5003 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 9 | ||
5007 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 9 | ||
5010 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in a residential aged care facility (not being accommodation in a self-contained unit) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 9 | ||
5020 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 5040 or 5060 applies — each attendance | 40.85 | ||
5023 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 5043 or 5063 applies — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 9 | ||
5026 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 5046 or 5064 applies — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 9 | ||
5028 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) by a general practitioner involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or a professional attendance of less than 20 minutes duration involving components of a service to which item 5049 or 5067 applies — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 9 | ||
5040 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 5060 applies — each attendance | 68.55 | ||
5043 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, or a professional attendance of less than 40 minutes duration involving components of a service to which item 5063 applies — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 9 | ||
5046 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 5064 applies — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 9 | ||
5049 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) by a general practitioner involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or a professional attendance of less than 40 minutes duration involving components of a service to which item 5067 applies — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 9 | ||
5060 | Professional attendance at consulting rooms (not being a service to which any other item applies) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — each attendance | 96.20 | ||
5063 | Professional attendance, other than a service to which any other item applies, and not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility by a general practitioner taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 9 | ||
5064 | Professional attendance at an institution (not being a service to which any other item applies) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 9 | ||
5067 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) by a general practitioner involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or a professional attendance of at least 40 minutes duration for implementation of a management plan — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 9 | ||
Group A23 — Other non-referred after-hours attendances to which no other item applies | ||||
5200 | Professional attendance at consulting rooms of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 21.00 | ||
5203 | Professional attendance at consulting rooms of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 31.00 | ||
5207 | Professional attendance at consulting rooms of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 48.00 | ||
5208 | Professional attendance at consulting rooms of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — each attendance | 71.00 | ||
5220 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 9 | ||
5223 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 9 | ||
5227 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 9 | ||
5228 | Professional attendance (not being an attendance at consulting rooms, an institution, a hospital or a residential aged care facility) of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients on 1 occasion — each patient | Amount under rule 9 | ||
5240 | Professional attendance at an institution of not more than 5 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 9 | ||
5243 | Professional attendance at an institution of more than 5 minutes duration but not more than 25 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 9 | ||
5247 | Professional attendance at an institution of more than 25 minutes duration but not more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 9 | ||
5248 | Professional attendance at an institution of more than 45 minutes duration (not being a service to which any other item applies) by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 institution on 1 occasion — each patient | Amount under rule 9 | ||
5260 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) of not more than 5 minutes duration by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 9 | ||
5263 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) of more than 5 minutes duration but not more than 25 minutes duration by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 9 | ||
5265 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) of more than 25 minutes duration but not more than 45 minutes by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 9 | ||
5267 | Professional attendance (not being a service to which any other item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (not being accommodation in a self-contained unit) of more than 45 minutes duration by a medical practitioner (not being a general practitioner) — an attendance on 1 or more patients at 1 residential aged care facility on 1 occasion — each patient | Amount under rule 9 | ||
[9] Further amendments — Schedule 1, Part 3
Item | omit | insert |
1 | 98.05 | 108.05 |
2 | 98.05 | 108.05 |
97 | 84.05 | 94.05 |
98 | 84.05 | 94.05 |
601 | 117.25 | 127.25 |
602 | 117.25 | 127.25 |
697 | 101.50 | 111.50 |
698 | 101.50 | 111.50 |
Notes
1. These Regulations amend Statutory Rules 2004 No. 308, as amended by 2004 No. 343.
2. Notified in the Commonwealth of Australia Gazette on 23 December 2004.