{"id":"F2018L00932","name":"Health Insurance (Allied Health Services) Amendment (Other Medical Practitioner) Determination 2018","slug":"health-insurance-allied-health-services-amendment-other-medical-practitioner-determination-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":97639,"registerId":"commonwealth-F2018L00932-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name","content":"#### 1 Name\n\nThis Determination is the Health Insurance (Allied Health Services) Amendment (Other Medical Practitioner) Determination 2018.","sortOrder":0},{"sectionNumber":"2","sectionType":"section","heading":"Commencement","content":"#### 2 Commencement\n\nThis Determination commences immediately after the commencement of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018.","sortOrder":1},{"sectionNumber":"3","sectionType":"section","heading":"Authority","content":"#### 3 Authority\n\nThis Determination is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":2},{"sectionNumber":"4","sectionType":"section","heading":"Schedules","content":"#### 4 Schedules\n\nEach instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.\n\n  \nSchedule 1 Amendment\n\nHealth Insurance (Allied Health Services) Determination 2014\n\n1 Subsection 4(1) (definition of GP Management Plan)\n\nRepeal the definition, substitute:\n\nGP Management Plan, for a patient, means a GP management plan to which item 721 or 732 of the general medical services table or item 229 or 233 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 applies.\n\n2 Subsection 4(1) (definition of GP Mental Health Treatment Plan)\n\nRepeal paragraph (b) of the definition, substitute:\n\n(b) a GP Mental Health Treatment Plan for the patient to which item 2700, 2701, 2715 or 2717 of the general medical services table or item 272, 276, 281 or 282 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 applies.\n\n3 Subsection 4(1) (definition of Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018)\n\nAfter the definition of Health Care Homes Program, insert:\n\nHealth Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 means the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 as originally made.\n\n4 Subsection 4(1) (definition of multidisciplinary care plan)\n\nRepeal the definition, substitute:\n\n> multidisciplinary care plan, for a patient, means a multidisciplinary care plan to which item 729 and 731 of the general medical services table or item 231 and 232 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 applies.\n\n5 Subsection 4(1) (definition of Team Care Arrangements)\n\nRepeal the definition, substitute:\n\n> Team Care Arrangements means GP coordination of the development of team care arrangements for the patient to which item 723 or 732 of the general medical services table or item 230 or 233 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 applies.\n\n6 Subsection 6(4)\n\nRepeal the subsection, substitute:\n\n(4) In this section, relevant service means a service to which any of items 2721 to 2727 of the general medical services table, item 283, 285, 286 or 287 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018, or items 80000 to 80015, 80100 to 80115, 80125 to 80140, or 80150 to 80165 in Schedule 2, apply.\n\n7 Paragraph 6B(4)(b)\n\nRepeal the paragraph, substitute:\n\n(b) personal individual service means a service mentioned in any of items 2721 to 2727 of the general medical services table, item 283, 285, 286 or 287 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018, or items 80000, 80005, 80010, 80015, 80100, 80105, 80110, 80115, 80125, 80130, 80135, 80140, 80150, 80155, 80160 and 80165 in Schedule 2.\n\n8 Schedule 2, Part 3, items 81000, 81005 and 81010\n\nRepeal the text after the end of paragraph (d), substitute:\n\nto a maximum of 3 services (including services to which items 81000, 81005, 81010, 4001\\* and 792\\*\\* apply) for each pregnancy.\n\nThe service may be used to address any pregnancy related issues for which non‑directive counselling is appropriate\n\nThis item is subject to section 9\n\n\\[\\* in the general medical services table\\]\n\n\\[\\*\\* in the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018\\]\n\n9 Schedule 1, paragraph 7(b) and subparagraphs 8(e)(ii) and 9(c)(ii)\n\nOmit “titled ‘Practice Standards for Mental Health Social Workers’, as inforce on 8 November 2008” (wherever occurring), substitute “titled ‘Practice Standards for Mental Health Social Workers 2014’ as in force on 25 September 2014”.\n\n  \nSchedule 2 Transitional provisions\n\n1 Certificates issued relating to practice standards for mental health social workers\n\nIf:\n\n(a) as of the commencement of this Determination, a person has been certified by the Australian Association of Social Workers (AASW), as meeting the standards for mental health set out in the document published by the AASW titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008; and\n\n(b) the certification has not been revoked,\n\nfor the purposes of paragraph 7(b) and subparagraphs 8(e)(ii) and 9(c)(ii) of Schedule 1 of the Health Insurance (Allied Health Services) Determination 2014, the person is taken to be certified as meeting the standards for mental health set out in the document published by the AASW titled ‘Practice Standards for Mental Health Social Workers’ as in force on 25 September 2014.","sortOrder":3}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"The Determination extends the set of Medicare items that count for various GP and allied‑health plan constructs by expressly including items from the ‘Other Medical Practitioner’ Determination, so services tied to those items are treated equivalently to existing general medical services (Schedule 1, items 1–7). It also narrows/clarifies the pregnancy counselling cap (Schedule 1, item 8) and updates the professional standard reference for mental‑health social workers while deeming existing AASW certificates to meet the new citation for specified purposes (Schedule 1, item 9; Schedule 2, item 1)."},"complexity_factors":["Multiple cross-references to item numbers across two Determinations (Health Insurance (Allied Health Services) Determination 2014 and Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018) increase administrative mapping complexity (Schedule 1, items 1–7).","Definition replacements change which items are treated as applying to GP Management Plans, GP Mental Health Treatment Plans, multidisciplinary care plans and Team Care Arrangements (Schedule 1, items 1–5).","Amendments to which services are ‘relevant’ and which are ‘personal individual services’ require updates to claim and compliance processes (Schedule 1, items 6–7).","Change to pregnancy counselling items limits services per pregnancy and links those items with items in other schedules/tables, affecting counting and billing (Schedule 1, item 8).","Updating the referenced AASW practice standards alters the qualifying standard for mental‑health social workers and requires practitioners and administrators to confirm certification alignment (Schedule 1, item 9).","Transitional deeming provision preserves prior AASW certifications under the new standard for specified purposes, but creates a one-off recognition rule administrators must apply (Schedule 2, item 1).","Commencement dependency on the Other Medical Practitioner Determination means timing and operational effect hinge on another instrument coming into force (clause 2)."],"plain_english_summary":"Updates the Allied Health Services Determination so specified Medicare items created for “other medical practitioners” count for GP management plans, mental‑health treatment plans, multidisciplinary care plans and Team Care Arrangements. It also clarifies which allied‑health items are “relevant”, caps pregnancy‑related non‑directive counselling at three services per pregnancy, and replaces the cited AASW mental‑health practice standards (with transitional recognition of earlier AASW certifications). Affects GPs, other medical practitioners, allied health providers, mental‑health social workers and patients using Medicare plans."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a straightforward consequential amendment to implement the 'Other Medical Practitioner' scheme across allied health services. It does not expand beyond the original intent of enabling non-GP medical practitioners to refer patients for allied health services under Medicare."},"complexity_factors":["Heavy reliance on cross-references to external instruments (Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 and the general medical services table)","Numerous specific item numbers (721, 732, 229, 233, etc.) that require external lookup to understand","Amendment structure requires reading alongside the 2014 Determination to understand full context","Transitional provision creates a legal fiction (deeming 2008 certifications as 2014 certifications)","Multiple defined terms being amended simultaneously"],"plain_english_summary":"This bill lets Medicare rebates for allied health (e.g., physio, psychology, dietetics) be triggered by care plans and service items created under a new \"Other Medical Practitioner\" scheme as well as by GPs, and folds those item numbers into pregnancy counselling limits. It also updates the reference date for mental health social worker practice standards to 2014 while preserving existing certifications.\n\nIt expands patient access to subsidised allied health services and affects allied health providers and mental health social workers."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-allied-health-services-amendment-other-medical-practitioner-determination-2018","history":"/api/acts/health-insurance-allied-health-services-amendment-other-medical-practitioner-determination-2018/history","analysis":"/api/acts/health-insurance-allied-health-services-amendment-other-medical-practitioner-determination-2018/analysis","conflicts":"/api/acts/health-insurance-allied-health-services-amendment-other-medical-practitioner-determination-2018/conflicts","importantCases":"/api/acts/health-insurance-allied-health-services-amendment-other-medical-practitioner-determination-2018/important-cases","documents":"/api/acts/health-insurance-allied-health-services-amendment-other-medical-practitioner-determination-2018/documents"}}