Health Insurance (General Medical Services Table) Amendment Regulations 2007 (No. 5)1

Select Legislative Instrument 2007 No. 189

I, PROFESSOR MARIE BASHIR, AC, CVO, Deputy for the 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 28 June 2007

MARIE BASHIR

Deputy for the Governor-General

By Her 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 2007 (No. 5).

2 Commencement

  These Regulations commence on 1 July 2007.

3 Amendment of Health Insurance (General Medical Services Table) Regulations 2006

  Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2006.

Schedule 1 Amendments

(regulation 3)

 

[1] Schedule 1, Part 2, subrule 14 (3), definition of accredited advanced training placement

omit

accredited advanced training placement means a placement in an advanced training position:

insert

accredited specialist training placement means a placement in a specialist training position:

[2] Schedule 1, Part 2, subrule 14 (3), definition of specialist trainee, paragraph (b)

omit

advanced

insert

specialist

[3] Schedule 1, Part 2, after subrule 44 (2B)

insert

 (2C) Items 718 and 719 apply only to a service for a patient who:

 (a) has an intellectual disability; and

 (b) is not an in‑patient of a hospital or an approved day hospital facility, or a care recipient in a residential aged care facility.

[4] Schedule 1, Part 2, after subrule 44 (3)

 (4) For items 718 and 719, a person has an intellectual disability if he or she:

 (a) has general intellectual functioning at 2 standard deviations below the average intelligence quotient; and

 (b) would benefit from assistance with daily living activities.

[5] Schedule 1, Part 2, after regulation 48B

insert

48C Meaning of health assessment in items 718 and 719

 (1) In items 718 and 719:

health assessment means the assessment of:

 (a) a patient’s physical, psychological and social function; and

 (b) whether any medical intervention and preventative health care is required.

 (2) For subrule (1), a health assessment must include the following matters to the extent they are relevant to the patient:

 (a) check dental health (including dentition);

 (b) conduct aural examination (arrange formal audiometry if audiometry has not been conducted within 5 years);

 (c) assess ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within 5 years);

 (d) assess nutritional status (including weight and height measurements) and a review of growth and development;

 (e) assess bowel and bladder function (particularly for incontinence or chronic constipation);

 (f) assess medications including:

 (i) non‑prescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications; and

 (ii) advice to carers of the common side effects and interactions; and

 (iii) consideration of the need for a formal medication review;

 (g) check immunisation status (including influenza, tetanus, hepatitis A and B, measles, mumps and rubella and pneumococcal vaccinations) with reference to the current Australian Standard Vaccination Schedule (a National Health and Medical Research Council document) for appropriate vaccination schedules;

 (h) check exercise opportunities (with the aim of moderate exercise for at least 30 minutes per day);

 (i) check whether the support provided for activities of daily living adequately and appropriately meets the patient’s needs, and consider formal review if required;

 (j) consider the need for breast examination, mammography, Papanicolaou smears, testicular examination, lipid measurement and prostate assessment as for the general population;

 (k) check for dysphagia and gastro‑oesophageal disease (especially for patients with cerebral palsy) and arrange for investigation or treatment as required;

 (l) assess risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication and fracture history) and arrange for investigation or treatment as required;

 (m) for a patient diagnosed with epilepsy — review of seizure control (including anticonvulsant drugs) and consider referral to a neurologist at appropriate intervals;

 (n) screen for thyroid disease at least every 2 years (or yearly for patients with Down syndrome);

 (o) for a patient without a definitive aetiological diagnosis — consider referral to a genetic clinic every 5 years;

 (p) assess or review of treatment for comorbid mental health issues;

 (q) consider timing of puberty and management of sexual development, sexual activity and reproductive health;

 (r) consider whether there are any signs of physical, psychological or sexual abuse.

 (3) For subrule (1), a health assessment also includes the following:

 (a) keeping a record of the health assessment;

 (b) offering the patient a written report about the health assessment;

 (c) offering the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report; and

 (d) offering the relevant disability professionals (if the practitioner considers it appropriate and the patient or, where appropriate, the patient’s carer, agrees) a copy of the report or extracts of the report.

[6] Schedule 1, Part 2, after rule 85

insert

85A Meaning of expressions used in item 10997

  In item 10997:

GP management plan means a plan under item 721 or 725.

multidisciplinary care plan means a plan under items 729 or 731.

person with a chronic disease means a person who has a care plan under items 721, 723, 725, 725, 729 or 731.

practice nurse has the meaning given by subrule 84 (1).

registered Aboriginal health worker has the meaning given by subrule 82A (1).

team care arrangements means a plan under item 723 or 727.

[7] Schedule 1, Part 2, after rule 86

insert

86A Application of items 30688, 30690, 30692 and 30694

  Item 30688, 30690, 30692 or 30694 applies to a service only if the provider makes a record of the findings of the ultrasound imaging in the patient’s notes.

[8] Schedule 1, Part 3, item 353

after

telepsychiatry consultation of

insert

not

[9] Schedule 1, Part 3, items 364, 366, 367, 369 and 370

substitute

 

364

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a face‑to‑face consultation of not more than 15 minutes duration, if:

 (a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 applies before that attendance; and

38.30

 

 (b) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

 

366

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a face‑to‑face consultation of more than 15 minutes, but not more than 30 minutes, duration, if:

 (a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 applies before that attendance; and

 (b) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

76.40

367

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a face‑to‑face consultation of more than 30 minutes, but not more than 45 minutes, duration, if:

 (a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 applies before that attendance; and

 (b) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

117.60

369

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a face‑to‑face consultation of more than 45 minutes, but not more than 75 minutes, duration, if:

 (a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 applies before that attendance; and

162.40

 

 (b) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

 

370

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry following referral of the patient to him or her by a medical practitioner — a face‑to‑face consultation of more than 75 minutes duration, if:

 (a) the patient has had a telepsychiatry consultation to which any of items 353 to 358 applies before that attendance; and

 (b) that attendance and any other attendance to which any of items 300 to 308 and 353 to 370 applies have not exceeded 50 attendances in a calendar year for the patient

188.30

[10] Schedule 1, Part 3, after item 717

insert

 

718

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) at consulting rooms for a health assessment of a patient with an intellectual disability — not being a health assessment of a patient in respect of whom, in the preceding 12 months, a payment has been made under this item or item 719

199.60

719

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) not being an attendance at consulting rooms, a hospital or residential aged care facility for a health assessment of a patient with an intellectual disability — not being a health assessment for a patient in respect of whom, in the preceding 12 months, a payment has been made under this item or item 718

222.05

[11] Schedule 1, Part 3, after item 10996

insert

 

10997

Service provided by a practice nurse or registered Aboriginal health worker to a person with a chronic disease, if:

 (a) the service is provided on behalf of and under the supervision of a medical practitioner; and

 (b) the person is not an admitted patient of a hospital; and

 (c) the person has a GP management plan, team care arrangements or multidisciplinary care plan in place and the service is consistent with the plan or arrangements;

to a maximum of 5 services per patient in a calendar year

10.60

[12] Schedule 1, Part 3, item 11820, paragraph (d)

omit

colonoscopy

insert

colonoscopy;

[13] Schedule 1, Part 3, item 11820, after paragraph (d)

insert

 

 

 (e) the service is not associated with double balloon enteroscopy

 

[14] Schedule 1, Part 3, item 15338

omit

6 or less

insert

not more than 7

[15] Schedule 1, Part 3, after item 30679

insert

 

30680

Double balloon enteroscopy, examination of the small bowel (oral approach), with or without biopsy, without intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding if the patient:

 (a) has recurrent or persistent bleeding; and

 (b) is anaemic or has active bleeding; and

 (c) has had an upper gastrointestinal endoscopy and a colonoscopy performed that did not identify the cause of the bleeding;

not in association with another item in this subgroup (other than item 30682 or 30686) (Anaes.)

1 033.90

30682

Double balloon enteroscopy, examination of the small bowel (anal approach), with or without biopsy, without intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding if the patient:

 (a) has recurrent or persistent bleeding; and

 (b) is anaemic or has active bleeding; and

 (c) has had an upper gastrointestinal endoscopy and a colonoscopy performed that did not identify the cause of the bleeding;

not in association with another item in this subgroup (other than item 30680 or 30684) (Anaes.)

1 033.90

30684

Double balloon enteroscopy, examination of the small bowel (oral approach), with or without biopsy, with 1 or more of the following procedures — polypectomy, snares, removal of foreign body, diathermy, heater probe or laser coagulation, for diagnosis and management of patients with obscure gastrointestinal bleeding if the patient:

 (a) has recurrent or persistent bleeding; and

 (b) is anaemic or has active bleeding; and

 (c) has had an upper gastrointestinal endoscopy and a colonoscopy performed that did not identify the cause of the bleeding;

not in association with another item in this subgroup (other than item 30682 or 30686) (Anaes.)

1 272.30

30686

Double balloon enteroscopy, examination of the small bowel (anal approach), with or without biopsy, with 1 or more of the following procedures — polypectomy, snares, removal of foreign body, diathermy, heater probe or laser coagulation, for diagnosis and management of patients with obscure gastrointestinal bleeding if the patient:

 (a) has recurrent or persistent bleeding; and

 (b) is anaemic or has active bleeding; and

 (c) has had an upper gastrointestinal endoscopy and a colonoscopy performed that did not identify the cause of the bleeding;

not in association with another item in this subgroup (other than item 30680 or 30684) (Anaes.)

1 272.30

30688

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis (Anaes.)

322.45

30690

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, with fine needle aspiration (including aspiration of the locoregional lymph nodes if performed, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer), not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis (Anaes.)

497.75

30692

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis (Anaes.)

322.45

30694

Endoscopic ultrasound (endoscopy with ultrasound imaging), with or without biopsy, with fine needle aspiration for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis (Anaes.)

497.75

[16] Schedule 1, Part 3, item 37220

omit

6 or less

insert

not more than 7

Note

1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See www.frli.gov.au.