{"id":"F2023L00350","name":"Health Insurance (Professional Services Review – Allied Health, Primary Health Care and Others) Determination 2023","slug":"health-insurance-professional-services-review-allied-health-primary-health-care-and-others-determina","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441785,"registerId":"F2023L00350-fast-fetch-1775956995402","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Health Insurance (Professional Services Review – Allied Health, Primary Health Care and Others) Determination 2023","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![Commonwealth Coat of Arms of Australia](image.001.jpeg)\n\n \n\nHealth Insurance (Professional Services Review – Allied Health, Primary Health Care and Others) Determination 2023\n\nI, Mark Butler, Minister for Health and Aged Care, make the following determination.\n\nDated 21 March 2023  \n\nMark Butler\n\nMinister for Health and Aged Care\n\n \n\nContents\n\n1  Name\n\n2  Commencement\n\n3  Authority\n\n4  Repeal\n\n5  Interpretation\n\n6  Practitioners\n\n7  Professions\n\n8  Savings provisions\n\nSchedule 1 – Health professionals determined to be practitioners\n\nSchedule 2 – Vocations determined to be professions\n\n \n\n1  Name \n\n  This instrument is the Health Insurance (Professional Services Review – Allied Health, Primary Health Care and Others) Determination 2023.\n\n2  Commencement\n\n(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.\n\n \n\n- Commencement information\n- Column 1 Column 2 Column 3\n- Provisions Commencement Date/Details\n- 1. The whole of this instrument 1 April 2023 1 April 2023\n\n\nNote: This table relates only to the provisions of this instrument as originally made.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.\n\n(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.\n\n3  Authority\n\n  This instrument is made under subsection 81(1A) of the Health Insurance Act 1973.\n\n4  Repeal\n\n  The Health Insurance (Professional Services Review – Allied Health and Others) Determination 2012 is repealed.\n\n5  Interpretation  \n\n(1)      In this instrument:\n\n \n\nAboriginal and Torres Strait Islander health practitioner means a person who is registered under the National Law in the Aboriginal and Torres Strait Islander health practice profession.\n\n \n\nNote: a person registered in the Aboriginal and Torres Strait Islander health practice profession may use the following titles:\n\n- Aboriginal and Torres Strait Islander health practitioner;\n- Aboriginal health practitioner;\n- Torres Strait Islander health practitioner.\n\n\n \n\nAboriginal health worker means a person in a State or Territory other than the Northern Territory, who has been either:\n\n(a)           awarded a Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care (or an equivalent or higher qualification) by a registered training organisation; or\n\n(b)           awarded a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a registered training organisation before 1 July 2012.\n\n \n\nAct means the Health Insurance Act 1973.\n\n \n\nAudiologist means a person who is:\n\n(a)           a Full Member of Audiology Australia and is certified as an ‘Audiology Australia Accredited Audiologist’; or\n\n(b)           an Ordinary Member—Audiologist, or a Fellow Audiologist, of the Australian College of Audiology.\n\n \n\nDiabetes educator means a person who is credentialled by the Australian Diabetes Educators Association as a ‘Credentialled Diabetes Educator’.\n\n \n\nDietitian means a person who is accredited by the Dietitians Association of Australia as an ‘Accredited Practising Dietitian’.\n\n \n\nExercise physiologist means a person who is accredited by Exercise and Sports Science Australia as an ‘Accredited Exercise Physiologist’.\n\n \n\nMental health nurse means a person who is a ‘Credentialed Mental Health Nurse’, as certified by the Australian College of Mental Health Nurses.\n\n \n\nOccupational therapist means a person who is registered under the National Law in the occupational therapy profession.\n\n \n\nOrthoptist means a person who is:\n\n(a)           registered with the Australian Orthoptic Board; and\n\n(b)           a member of Orthoptics Australia.\n\n \n\nPsychologist means a person who is registered under the National Law in the psychology profession.\n\n \n\nSocial worker means a person who is a member of the Australian Association of Social Workers.\n\n \n\nSpeech pathologist means a person who is a practising member of Speech Pathology Australia.\n\n \n\nNote: The following term is defined in subsection 3(1) of the Act:\n\n- National Law.\n\n\n6  Practitioners\n\n  For the purposes of paragraph 81(1A)(a) of the Act, a health professional listed in Schedule 1 is a practitioner.\n\n7  Professions\n\n  For the purposes of paragraph 81(1A)(b) of the Act, a vocation listed in Schedule 2 is a profession.\n\n8  Savings provisions \n\n  Despite the repeal of the Health Insurance (Professional Services Review - Allied Health and Others) Determination 2012, that instrument continues to apply to a practitioner in relation to a request made under subsection 86(1) of the Act before 1 April 2023 as if the repeal had not happened.\n\n \n\n \n\nSchedule 1 – Health professionals determined to be practitioners\n\n \n\n \n\n| Item | Practitioners |\n| --- | --- |\n| 1 | Aboriginal and Torres Strait Islander health practitioners |\n| 2 | Aboriginal health workers |\n| 3 | Audiologists |\n| 4 | Diabetes educators |\n| 5 | Dietitians |\n| 6 | Exercise physiologists |\n| 7 | Mental health nurses |\n| 8 | Occupational therapists |\n| 9 | Orthoptists |\n| 10 | Psychologists |\n| 11 | Social workers |\n| 12 | Speech pathologists |\n\n\n \n\n \n\nSchedule 2 – Vocations determined to be professions\n\n \n\n \n\n| Item | Professions |\n| --- | --- |\n| 1 | Aboriginal and Torres Strait Islander health practice |\n| 2 | Aboriginal health worker services |\n| 3 | Audiology |\n| 4 | Diabetes education |\n| 5 | Dietetics |\n| 6 | Exercise physiology |\n| 7 | Mental health nursing |\n| 8 | Occupational therapy |\n| 9 | Orthoptic health services |\n| 10 | Psychology |\n| 11 | Social work |\n| 12 | Speech pathology |\n\n\n \n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":2,"scope_assessment":{"changed":false,"description":"The legislation maintains its original narrow purpose: specifying which allied health professionals fall under the Professional Services Review scheme. It updates the 2012 list to reflect current professional titles and qualifications but does not expand the scheme's fundamental scope or purpose."},"complexity_factors":["Short instrument: only 8 sections plus 2 schedules","Minimal cross-referencing: only references to section 81(1A) of the Health Insurance Act 1973 and the National Law","Straightforward definitions: 12 defined terms in section 5, mostly requiring simple membership/registration checks","No conditional logic or nested exceptions: the rules are direct 'means' definitions without 'if/then' complexity","Tabular schedules: simple lookup tables listing practitioners and professions with no additional conditions","Single savings provision (section 8) with clear temporal cutoff (pre-1 April 2023 requests)"],"plain_english_summary":"This instrument clarifies and expands which non‑medical health practitioners the Professional Services Review (PSR) can investigate for improper Medicare claims or substandard care, by specifying covered allied health vocations and the required qualifications or memberships. It replaces an older 2012 list, preserves any reviews begun before 1 April 2023, and thus strengthens Medicare integrity and patient safeguards for commonly used allied and primary care services."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"The instrument repeals the 2012 Determination and re‑establishes which health professionals and vocations fall within PSR coverage, thereby altering the controlling instrument (sec 4). A savings provision preserves the 2012 instrument’s effect for PSR requests made before 1 April 2023, so ongoing cases remain subject to the prior instrument while future cases follow this Determination (secs 2, 4, 8)."},"complexity_factors":["Direct cross‑reference to the Health Insurance Act 1973 (power under subsection 81(1A)) creates dependency on PSR scheme rules (sec 3).","Definitions refer to external registration, accreditation or membership standards (e.g. National Law registration; professional bodies and credentials) which requires verification by administrators (sec 5).","Primary effect is declaratory: Schedules 1 and 2 list practitioners and professions, so application is largely mechanical (Schedules 1 & 2).","Repeal of the 2012 Determination with a savings provision preserves treatment of pre‑existing PSR requests, adding limited transitional complexity (secs 4, 8).","Fixed commencement date (1 April 2023) reduces phased implementation ambiguity but requires agencies and practitioners to move by that date (sec 2).","Limited substantive rule‑making or discretion in the text — interaction complexity arises mainly from how PSR enforcement and Medicare billing rules apply in practice (secs 6–7)."],"plain_english_summary":"This Determination names which allied‑health and primary‑health workers are treated as \"practitioners\" and which vocations are treated as \"professions\" for the Professional Services Review under the Health Insurance Act 1973. It replaces a 2012 instrument and takes effect from 1 April 2023. Being listed brings those workers and services within Medicare claim review processes, changing who faces compliance costs, legal risk and administrative oversight under the PSR scheme."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-professional-services-review-allied-health-primary-health-care-and-others-determina","history":"/api/acts/health-insurance-professional-services-review-allied-health-primary-health-care-and-others-determina/history","analysis":"/api/acts/health-insurance-professional-services-review-allied-health-primary-health-care-and-others-determina/analysis","conflicts":"/api/acts/health-insurance-professional-services-review-allied-health-primary-health-care-and-others-determina/conflicts","importantCases":"/api/acts/health-insurance-professional-services-review-allied-health-primary-health-care-and-others-determina/important-cases","documents":"/api/acts/health-insurance-professional-services-review-allied-health-primary-health-care-and-others-determina/documents"}}