Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 2)1
Select Legislative Instrument 2012 No. 139
I, QUENTIN BRYCE, Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following regulation under the Health Insurance Act 1973.
Dated 28 June 2012
QUENTIN BRYCE
Governor-General
By Her Excellency’s Command
TANYA PLIBERSEK
Contents
1 Name of regulation
2 Commencement
3 Amendment of Health Insurance (General Medical Services Table) Regulations 2011—Schedule 1
4 Amendment of Health Insurance (General Medical Services Table) Regulations 2011—Schedule 2
Schedule 1 Amendments taken to have commenced on 1 November 2011
Schedule 2 Amendments commencing on 1 July 2012
This regulation is the Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 2).
This regulation commences, or is taken to have commenced, as follows:
(a) 1 November 2011— sections 1 to 3 and Schedule 1; and
(b) 1 July 2012—section 4 and Schedule 2.
3 Amendment of Health Insurance (General Medical Services Table) Regulations 2011—Schedule 1
Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2011.
4 Amendment of Health Insurance (General Medical Services Table) Regulations 2011—Schedule 2
Schedule 2 amends the Health Insurance (General Medical Services Table) Regulations 2011.
Schedule 1 Amendments taken to have commenced on 1 November 2011
(section 3)
[1] Schedule 1, subclause 1.2.2 (2)
substitute
(2) An attendance on a patient by a specialist or consultant physician:
(a) includes an attendance on a patient if:
(i) the patient declares that a written referral of the patient was completed by a medical practitioner; or
(ii) in an emergency, the patient has not been referred to the specialist, or consultant physician, if the specialist or consultant physician decides that it is necessary in the patient’s interests to provide the service mentioned in the item as soon as practicable without a referral; but
(b) does not include an attendance on a patient if:
(i) the attendance forms part of a single course of treatment for the patient in which the first service was provided to the patient more than 12 months (or another period, if any, set by the referring practitioner in, or in connection with, the referral) before the attendance; and
(ii) a later referral has not been made.
[2] Schedule 1, subclause 1.2.3 (2)
substitute
(2) A professional attendance includes the provision, for a patient, of any of the following services:
(a) evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19 (5) of the Act;
(b) formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions;
(c) giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment;
(d) if authorised by the patient — giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment;
(e) providing appropriate preventive health care;
(f) recording the clinical details of the service or services provided to the patient.
[3] Schedule 1, subclause 2.3.1 (1)
omit
a medical practitioner (other than a vocationally‑registered general practitioner, a specialist to a consultant physician), if:
insert
a general practitioner, if:
[4] Schedule 1, clause 2.3.1, Group A2 table
substitute
Group A2 — Other non‑referred attendances to which no other item applies | ||
Item | Description | Fee $ |
52 | Professional attendance at consulting rooms of not more than 5 minutes in duration (other than a service to which any other item applies)—each attendance, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | 11.00 |
53 | Professional attendance at consulting rooms of more than 5 minutes in duration but not more than 25 minutes (other than a service to which any other item applies)—each attendance, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | 21.00 |
54 | Professional attendance at consulting rooms of more than 25 minutes in duration but not more than 45 minutes (other than a service to which any other item applies)—each attendance, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | 38.00 |
57 | Professional attendance at consulting rooms of more than 45 minutes in duration (other than a service to which any other item applies)—each attendance, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | 61.00 |
58 | Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies), not more than 5 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | Amount under clause 2.1.1 |
59 | Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one place on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | Amount under clause 2.1.1 |
60 | Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one place on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | Amount under clause 2.1.1 |
65 | Professional attendance (other than an attendance at consulting rooms or a residential aged care facility or a service to which any other item in the table applies) of more than 45 minutes in duration—an attendance on one or more patients at one place on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | Amount under clause 2.1.1 |
92 | Professional attendance (other than 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 (that is not accommodation in a self‑contained unit) of not more than 5 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion — each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | Amount under clause 2.1.1 |
93 | Professional attendance (other than 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 (that is not accommodation in a self‑contained unit) of more than 5 minutes in duration but not more than 25 minutes—an attendance on one or more patients at one residential aged care facility on one occasion — each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | Amount under clause 2.1.1 |
95 | Professional attendance (other than 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 (that is not accommodation in a self‑contained unit) of more than 25 minutes in duration but not more than 45 minutes—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by: (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies | Amount under clause 2.1.1 |
96 | Professional attendance (other than 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 (that is not accommodation in a self‑contained unit) of more than 45 minutes in duration—an attendance on one or more patients at one residential aged care facility on one occasion—each patient, by: | Amount under clause 2.1.1 |
| (a) a medical practitioner (who is not a general practitioner); or (b) a general practitioner to whom clause 2.3.1 applies |
|
[5] Schedule 1, clause 2.17.11, Group A15 table
substitute
Group A15 — GP management plans, team care arrangements and multidisciplinary care plans and case conferences | ||
Item | Description | Fee $ |
Subgroup 1 — GP management plans, team care arrangements and multidisciplinary care plans | ||
721 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), for preparation of a GP management plan for a patient (other than a service associated with a service to which any of items 735 to 758 apply) | 138.75 |
723 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to coordinate the development of team care arrangements for a patient (other than a service associated with a service to which any of items 735 to 758 apply) | 109.95 |
729 | Contribution by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to a multidisciplinary care plan prepared by another provider or a review of a multidisciplinary care plan prepared by another provider (other than a service associated with a service to which any of items 735 to 758 apply) | 67.70 |
731 | Contribution by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), to: (a) a multidisciplinary care plan for a patient in a residential aged care facility, prepared by that facility, or to a review of such a plan prepared by such a facility; or | 67.70 |
| (b) a multidisciplinary care plan prepared for a patient by another provider before the patient is discharged from a hospital, or to a review of such a plan prepared by another provider (other than a service associated with a service to which items 735 to 758 apply) |
|
732 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to review or coordinate a review of: (a) a GP management plan prepared by a medical practitioner (or an associated medical practitioner) to which item 721 applies; or (b) team care arrangements which have been coordinated by the medical practitioner (or an associated medical practitioner) to which item 723 applies | 69.35 |
[6] Schedule 1, clause 2.17.18, Group A15 table, items 735 to 758
substitute
735 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and coordinate: (a) a community case conference; or (b) a multidisciplinary case conference in a residential aged care facility; or (c) a multidisciplinary discharge 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 items 721 to 732 apply) | 67.95 |
739 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and coordinate: (a) a community case conference; or (b) a multidisciplinary case conference in a residential aged care facility; or | 116.40 |
| (c) a multidisciplinary discharge 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 items 721 to 732 apply) |
|
743 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a multidisciplinary case conference team, to organise and coordinate: (a) a community case conference; or (b) a multidisciplinary case conference in a residential aged care facility; or (c) a multidisciplinary discharge case conference; if the conference lasts for at least 40 minutes (other than a service associated with a service to which items 721 to 732 apply) | 194.00 |
747 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), 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; or (c) a multidisciplinary discharge 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 items 721 to 732 apply) | 49.95 |
750 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), 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; or (c) a multidisciplinary discharge 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 items 721 to 732 apply) | 85.60 |
758 | Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), 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; or (c) a multidisciplinary discharge case conference; if the conference lasts for at least 40 minutes (other than a service associated with a service to which items 721 to 732 apply) | 142.60 |
[7] Schedule 1, clause 2.40.1
substitute
2.40.1 Definitions for item 16400
In item 16400:
midwife means a person:
(a) who is registered under a law of a State or Territory as a midwife; and
(b) who is employed by, or whose services are otherwise retained by, a medical practitioner or a practice operated by a medical practitioner.
nurse means a person:
(a) who is registered under a law of a State or Territory as a registered nurse or enrolled nurse; and
(b) who is employed by, or whose services are otherwise retained by, a medical practitioner or a practice operated by a medical practitioner.
practice location has the same meaning as in clause 2.31.1.
[8] Schedule 1, paragraph 2.40.5 (1) (a)
omit
the nurse
insert
the midwife, nurse
Schedule 2 Amendments commencing on 1 July 2012
(section 4)
[1] Schedule 1, subclause 1.1.3 (2), examples
omit
Aboriginal health care workers
insert
Aboriginal health workers
[2] Schedule 1, Division 2.1, heading, note
omit
A25,
[3] Schedule 1, paragraph 2.16.4 (2) (b)
omit
a registered Aboriginal health worker
insert
an Aboriginal and Torres Strait Islander health practitioner
[4] Schedule 1, subclause 2.16.4 (3)
omit
a registered Aboriginal health worker
insert
an Aboriginal and Torres Strait Islander health practitioner
[5] Schedule 1, subclause 2.16.14 (4)
omit
registered Aboriginal health workers
insert
Aboriginal and Torres Strait Islander health practitioners
[6] Schedule 1, subclause 2.20.6 (4)
omit
in the previous 12 months
[7] Schedule 1, Division 2.25
omit
[8] Schedule 1, Division 2.30, heading
substitute
Division 2.30 Group M12—Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner
[9] Schedule 1, paragraph 2.30.2 (2) (a)
omit
registered Aboriginal health worker
insert
Aboriginal and Torres Strait Islander health practitioner
[10] Schedule 1, subclause 2.30.4 (1)
omit
a registered Aboriginal health worker
insert
an Aboriginal and Torres Strait Islander health practitioner
[11] Schedule 1, paragraph 2.30.4 (1) (a)
omit
registered Aboriginal health worker
insert
Aboriginal and Torres Strait Islander health practitioner
[12] Schedule 1, clause 2.30.5
omit
a registered Aboriginal health worker
insert
an Aboriginal and Torres Strait Islander health practitioner
[13] Schedule 1, paragraphs 2.30.5 (a) to (c)
omit each mention of
health worker
insert
health practitioner
[14] Schedule 1, clause 2.30.5, Group M12 table
substitute
Group M12 — Services provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner | |||
Item | Description | Fee $ | |
Subgroup 1 — Video conferencing consultation support service provided by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner | |||
10983 | Attendance by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of, and under the supervision of a medical practitioner, to provide clinical support to a patient who is: (a) participating in a video conferencing consultation; and (b) is not a care recipient in a residential care service; and (c) is not an admitted patient; and (d) is located either at an: (i) Aboriginal Medical Service; or (ii) Aboriginal Community Controlled Health Service for which a direction made under subsection 19 (2) of the Act applies | 31.80 | |
Subgroup 2 — Video conferencing consultation support service provided at a residential care service, on behalf of a medical practitioner | |||
10984 | Attendance by a practice nurse, an Aboriginal health worker or an Aboriginal and Torres Strait Islander health practitioner on behalf of, and under the supervision of, a medical practitioner, to provide clinical support to a patient participating in a video conferencing consultation, who is a care recipient in a residential care service The clinical support may be provided at consulting rooms in the residential care service if the patient is a care recipient in the residential care service | 31.80 | |
Subgroup 3 — Services provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner | |||
10986 | A Healthy Kids Check in accordance with clause 2.16.4 provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner for a patient who is receiving or has received the immunisation recommended for a 4 year old child if: (a) the Healthy Kids Check is provided on behalf of, and under the supervision of, a medical practitioner (including a general practitioner, but not including a specialist or consultant physician); and (b) the patient is not an in‑patient of a hospital | 57.10 | |
10987 | Follow‑up service, to a maximum of 10 services per patient in a calendar year, provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for an Indigenous person who has received a health check 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 service is consistent with the needs identified through the health assessment | 23.55 | |
10988 | Immunisation provided to a person by an Aboriginal and Torres Strait Islander health practitioner if: (a) the immunisation 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 | 11.80 | |
10989 | Treatment of a person’s wound (other than normal aftercare) provided by an Aboriginal and Torres Strait Islander health practitioner if: (a) the treatment 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 | 11.80 | |
10997 | Service provided by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner to a person with a chronic disease, to a maximum of 5 services for each patient in a calendar year, if: (a) the service is provided on behalf of and under the supervision of a medical practitioner; and | 11.80 | |
| (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 |
| |
[15] Schedule 1, clause 2.37.3
omit
In items 13200 to 13209 and 13215 to 13221:
insert
In items 13200 to 13209 and 13212 to 13221.
[16] Schedule 1, clause 2.37.9, Group T1 table, item 13318
omit
(via jugular or subclavian vein) —
[17] Schedule 1, clause 2.37.9, Group T1 table, item 13815
omit
(via jugular, subclavian or femoral vein)
[18] Schedule 1, subclause 2.40.5 (1)
omit each mention of
registered Aboriginal Health Worker
insert
Aboriginal and Torres Strait Islander health practitioner
[19] Schedule 1, clause 2.40.6, Group T4 table, item 16400
omit
a registered Aboriginal Health Worker
insert
an Aboriginal and Torres Strait Islander health practitioner
[20] Schedule 1, clause 2.43.9, Group T10 table, item 22020
omit
(via jugular, subclavian or femoral vein)
[21] Schedule 1, clause 2.44.17, Group T8 table, item 37219
substitute
37219 | Prostate, needle biopsy of, using prostatic ultrasound techniques and obtaining one or more prostatic specimens, being a service associated with a service to which item 55600 or 55603 applies (Anaes.) (Assist.) | 275.60 |
[22] Dictionary
insert
Aboriginal and Torres Strait Islander health practitioner means a person:
(a) who is registered under a law of a State or Territory as an Aboriginal and Torres Strait Islander health practitioner; and
(b) who is employed by, or whose services are otherwise retained by, a medical practitioner in a general practice or a health service to which a direction made under subsection 19 (2) of the Act applies.
[23] Dictionary, definition of outer metropolitan specialist trainee
omit
[24] Dictionary, definition of registered Aboriginal Health Worker
omit
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.comlaw.gov.au.