1
Name of Determination \[see Note 1\]
1 Name of Determination [see Note 1]
This Determination is the Health Insurance (Allied Health Services) Determination 2009.
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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
This Determination lists which allied health services attract Medicare benefits, sets the provider qualifications and a Medicare register, fixes the benefit amounts, and imposes referral, minimum-duration, written-report and annual‑cap rules for many items. It treats eligible allied health services as both professional and medical services for Medicare purposes (s5) and prevents claiming a Medicare item where private health insurance was paid (s9). It affects patients receiving referred allied care, the referring medical practitioners who authorise access, Medicare Australia (registering providers) and allied health providers who must meet credentials and compliance rules.
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Direct links to the current provisions in Health Insurance (Allied Health Services) Determination 2009 (No. 2).
1 Name of Determination [see Note 1]
This Determination is the Health Insurance (Allied Health Services) Determination 2009.
2 Commencement
This Determination commences on 1 November 2009
3 Revocation
The Health Insurance (Allied Health Services) Determination 2009 is revoked.
4 Interpretation
(1) In this Determination:
Act means the Health Insurance Act 1973.
allied health professional, for the provision of an allied health service, means a person:
(a) who meets the qualification requirements set out in Schedule 1 for the provision of the service; and
(b) whose name is entered in the register, kept by the Medicare Australia CEO, of allied health professionals who are qualified to provide a service of that kind.
allied health service means a health service of a kind prescribed by regulation 3A of the Health Insurance Regulations 1975 that is specified in an item in Schedule 2.
course of treatment means:
(a) for psychological therapy and focussed psychological strategies — up to 6 services provided, on referral by a medical practitioner, by any of the following persons:
(i) an eligible clinical psychologist;
(ii) an eligible psychologist;
(iii) an eligible occupational therapist;
(iv) an eligible social worker; and
(b) for pervasive developmental disorder services — up to 10 services provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:
(i) an eligible psychologist;
(ii) an eligible speech pathologist;
(iii) an eligible occupational therapist.
eligible Aboriginal health worker means a person who is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service.
eligible audiologist means a person who is an allied health professional in relation to the provision of an audiology health service.
eligible chiropractor means a person who is an allied health professional in relation to the provision of a chiropractic health service.
eligible clinical psychologist means a person who is an allied health professional in relation to the provision of a psychological therapy health service.
eligible diabetes educator means a person who is an allied health professional in relation to the provision of a diabetes education health service.
eligible dietitian means a person who is an allied health professional in relation to the provision of a dietetics health service.
eligible exercise physiologist means a person who is an allied health professional in relation to the provision of an exercise physiology service.
eligible mental health nurse means a person who is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service.
eligible mental health worker means a person who is an allied health professional in relation to the provision of a mental health service.
eligible occupational therapist means a person who is an allied health professional in relation to the provision of one or both of the following:
(b) an occupational therapy health service.
eligible osteopath means a person who is an allied health professional in relation to the provision of an osteopathy health service.
eligible physiotherapist means a person who is an allied health professional in relation to the provision of a physiotherapy health service.
eligible podiatrist means a person who is an allied health professional in relation to the provision of a podiatry health service.
eligible psychologist means a person who is an allied health professional in relation to the provision of one or more of the following:
(b) a non‑directive pregnancy support counselling health service;
(c) a psychology health service.
eligible social worker means a person who is an allied health professional in relation to the provision of one or both of the following:
(b) a non‑directive pregnancy support counselling health service.
eligible speech pathologist means a person who is an allied health professional in relation to the provision of a speech pathology health service.
focussed psychological strategies means any of the following mental health care management strategies, each of which has been derived from evidence‑ based psychological therapies:
(a) psycho‑education;
(b) cognitive‑behavioural therapy that involves cognitive or behavioural interventions;
(c) relaxation strategies;
(d) skills training;
(e) interpersonal therapy;
(f) narrative therapy (for Aboriginal and Torres Strait Islander people).
GP Management Plan, for a patient, means a GP management plan to which item 721 or 732 of the General Medical Services Table applies.
GP Mental Health Treatment Plan, for a patient, means a GP Mental Health Treatment Plan for the patient to which item 2710 of the General Medical Services Table applies.
multidisciplinary care plan, for a patient, means a multidisciplinary care plan to which item 731 of the General Medical Services Table applies.
National Law means:
(a) for a State or Territory other than Western Australia - the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modifications) as a law of the State or Territory; and
(b) for Western Australia – the legislation enacted by the Health Practitioner Regulation National Law (WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.
non‑directive pregnancy support counselling has the meaning given in subsection (2).
OT Australia means the national body of the Australian Association of Occupational Therapists.
PDD treatment and management plan, for a patient, means a plan for the treatment and management of the patient’s pervasive developmental disorder to which item 135 or 289 of the General Medical Services Table applies.
Psychology Board of Australia means that body established under section 31 of the National Law.
relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations under that Act.
Team Care Arrangements means GP coordination of the development of team care arrangements for the patient to which item 723 or item 732 of the General Medical Services Table applies.
Note The following terms are defined in subsection 3 (1) of the Act:
Note: dental practitioner
Note: general medical services table
Note: medical practitioner
Note: Medicare Australia CEO
Note: professional service.
(2) A reference in this Determination to non‑directive pregnancy support counselling is a reference to counselling provided to a woman by a health professional in which:
(a) information and issues relating to pregnancy are discussed; but
(b) the health professional does not impose his or her views or values about what the woman should or should not do in relation to the pregnancy.
5 Treatment of allied health services
An allied health service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) specified for the service a fee in relation to each State, being the fee specified in the item in Schedule 2 relating to the service.
Note For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.
6 Limitation on certain items
(1) For any particular patient, an item mentioned in subsection (2) applies in a calendar year only if the service described in the item is:
(a) one of the first 12 relevant services provided to the patient in the calendar year; or
(b) if exceptional circumstances exist in relation to the patient — one of the first 18 relevant services provided to the patient in the calendar year.
(2) The items are items 80000, 80005, 80010, 80015, 80100, 80105, 80110, 80115, 80125, 80130, 80135, 80140, 80150, 80155, 80160 and 80165 in Schedule 2.
(3) In this section:
exceptional circumstances exist in relation to a patient if:
(a) the patient has, in a calendar year, received at least 12 relevant services; and
(b) the patient’s referring medical practitioner is satisfied that there has been a significant change in the patient’s clinical condition or care circumstances which necessitates a further referral for a service described in an item mentioned in paragraph (a) of the definition of relevant service.
relevant service means a service:
(a) to which any of items 2721 to 2727 of the General Medical Services Table, or items 80000 to 80015, 80100 to 80115, 80125 to 80140, or 80150 to 80165 in Schedule 2, apply; or
(b) to which the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care Program applies.
7 Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services
(1) This section applies to items 80000 to 80170 in Schedule 2.
(2) The referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 293 to 370 of the General Medical Services Table e apply.
(3) The referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 133 of the General Medical Services Table apply.
(4) The referral by a specialist in the practice of his or her field of psychiatry or paediatrics must be a referral for a service to which any of items 104 to 109 of the General Medical Services Table apply.
8 Referrals by psychiatrists and paediatricians for pervasive developmental disorder services
(1) This section applies to items 82000 to 82025 in Schedule 2.
(2) For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 296 to 370 (except item 359) of the General Medical Services Table apply.
(3) For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 131 of the General Medical Services Table apply.
(4) For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which item 289 of the General Medical Services Table applies.
(5) If a child has previously been provided with a service mentioned in item 289, a consultant physician specialising in the practice of his or her field of psychiatry may only refer the child for a service to which any of items 296 to 370 (excepting item 359) of the General Medical Services Table apply.
(6) For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which item 135 of the General Medical Services Table applies.
(7) If a child has previously been provided with a service mentioned in item 135, a consultant physician specialising in the practice of his or her field of paediatrics may only refer the child for a service to which any of items 110 to 131 of the General Medical Services Table apply.
9 Effect of election to claim private health insurance for an allied health service
An item in Schedule 2 applies to an allied health service only if a private health insurance benefit has not been claimed for the service.
Schedule 1 Qualification requirements for allied health professionals
(section 4)
| 1 | Aboriginal and Torres Strait Islander health serviceA person is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service if:(a) for a person who provides an Aboriginal and Torres Strait Islander health service in a State or Territory other than the Northern Territory — the person has been awarded a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a registered training organisation that meets the training standards set by the Australian National Training Authority’s Australian Quality Training Framework; or(b) for a person who provides an Aboriginal and Torres Strait Islander health service in the Northern Territory — the person is registered under the Health Practitioners Act (NT). |
|---|---|
| 2 | Audiology health serviceA person is an allied health professional in relation to the provision of an audiology health service if the person is:(a) a Full Member of the Audiological Society of Australia and the holder of a Certificate of Clinical Practice issued by that Society; or(b) an Ordinary Member — Audiologist, or a Fellow Audiologist, of the Australian College of Audiology. |
| 3 | Chiropractic health serviceA person is an allied health professional in relation to the provision of a chiropractic health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 4 | Diabetes education health serviceA person is an allied health professional in relation to the provision of a diabetes education health service if the person is credentialled by the Australian Diabetes Educators Association as a ‘Credentialled Diabetes Educator’. |
| 5 | Dietetics health serviceA person is an allied health professional in relation to the provision of a dietetics health service if the person is accredited by the Dietitians Association of Australia as an ‘Accredited Practising Dietitian’. |
| 6 | Exercise physiology health serviceA person is an allied health professional in relation to the provision of an exercise physiology health service if the person is accredited by the Australian Association for Exercise and Sports Science as an ‘Accredited Exercise Physiologist’. |
| 7 | Focussed psychological strategies health serviceA person is an allied health professional in relation to the provision of a focussed psychological strategies health service if the person meets one of the following requirements:(a) the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided;(b) the person is a member of the Australian Association of Social Workers (AASW) and certified by AASW as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008;(c) the person:(i) is a Full‑time Member, or a Part‑time Member, of OT Australia; and(ii) is, for a person who provides a focussed psychological strategies health service in Queensland, Western Australia, South Australia or the Northern Territory, registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and(iii) has a minimum of 2 years experience in mental health; and(iv) has given an undertaking to OT Australia to observe the standards set out in the document published by OT Australia titled ‘Australian Competency Standards for Occupational Therapists in Mental Health’, as in force on 1 November 2006. |
| 8 | Mental health serviceA person is an allied health professional in relation to the provision of a mental health service if the person meets one of the following requirements:(a) the person meets the requirements specified for an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service;(b) the person is a credentialled mental health nurse, as certified by the Australian College of Mental Health Nurses;(c) the person is:(i) for a person who provides a mental health service in New South Wales, Victoria, Tasmania or the Australian Capital Territory — a Full‑time Member, or a Part‑time Member, of OT Australia; and(ii) for a person who is an occupational therapist and provides a mental health service in Queensland, Western Australia, South Australia or the Northern Territory — registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided;(d) the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; |
| (e) the person is:(i) a Member of the Australian Association of Social Workers; and(ii) certified by that Association as meeting the standards for mental health set out in the document published by that Association titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008. | |
| 9 | Non‑directive pregnancy support counselling health serviceA person is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service if the person meets one of the following requirements:(a) the person is certified by the Australian College of Mental Health Nurses:(i) as a credentialled mental health nurse; and(ii) as appropriately trained in non‑directive pregnancy counselling;(b) the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided and is certified by the Australian Psychological Society as appropriately trained in non-directive pregnancy counselling;(c) the person is:(i) a member of the Australian Association of Social Workers (AASW); and(ii) certified by AASW either as meeting the standards for mental health set out in the document published by that Association titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008 or as an accredited social worker; and(iii) certified by AASW as appropriately trained in non‑directive pregnancy counselling.For this health service, a person is appropriately trained in non‑directive pregnancy counselling if the person has undergone training based on the key criteria contained in the document published by the Department titled ‘Key criteria for non‑directive pregnancy counselling training provided to GPs and allied health professionals in relation to the Medicare non‑directive pregnancy support counselling items’, as in force on 1 November 2006. |
| 10 | Occupational therapy health serviceA person is an allied health professional in relation to the provision of an occupational therapy health service if the person is:(a) for a person who provides an occupational therapy health service in New South Wales, Victoria, Tasmania or the Australian Capital Territory — a Full‑time Member, or a Part‑time Member, of OT Australia; and(b) for a person who provides an occupational therapy health service in Queensland, Western Australia, South Australia or the Northern Territory — registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 11 | Osteopathy health serviceA person is an allied health professional in relation to the provision of an osteopathy health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 12 | Physiotherapy health serviceA person is an allied health professional in relation to the provision of a physiotherapy health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 13 | Podiatry health serviceA person is an allied health professional in relation to the provision of a podiatry health service if the person is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 14 | Psychological therapy health serviceA person is an allied health professional in relation to the provision of a psychological therapy health service if the person:(a) is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and(b) either:(i) is a member of the College of Clinical Psychologists of the Australian Psychological Society (APS): or(ii) has been assessed by the APS as meeting the requirements for membership of that College and continues to meet those requirements; or(iii) is endorsed by the Psychology Board of Australia to practice in clinical psychology. |
| 15 | Psychology health serviceA person is an allied health professional in relation to the provision of a psychology health service if the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided. |
| 16 | Speech pathology health serviceA person is an allied health professional in relation to the provision of a speech pathology health service if the person is:(a) for a person who provides a speech pathology health service in a State or Territory other than Queensland — a Practising Member of Speech Pathology Australia; and(b) for a person who provides a speech pathology health service in Queensland — registered as a person who may provide that kind of service under the applicable law in force in Queensland. |
Schedule 2 Allied health services
(section 6)
Part 1 Services and fees — general
| Item | Service | Fee ($) |
|---|---|---|
| 10950 | Aboriginal and Torres Strait Islander health service provided to a person by an eligible Aboriginal health worker if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible Aboriginal health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible Aboriginal health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | 58.85 |
| 10951 | Diabetes education health service provided to a person by an eligible diabetes educator if:(a) the service is provided to a person who has:(i) a chronic condition; and | 58.85 |
| (ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and | ||
| (c) the person is referred to the eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | ||
| 10952 | Audiology health service provided to a person by an eligible audiologist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and (c) the person is referred to the eligible audiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and | 58.85 |
| (e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and | ||
| (g) after the service, the eligible audiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or | ||
| (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | ||
| 10953 | Exercise physiology health service provided to a person by an eligible exercise physiologist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | 58.85 |
| 10954 | Dietetics health service provided to a person by an eligible dietitian if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and | 58.85 |
| (c) the person is referred to the eligible dietitian by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | ||
| 10956 | Mental health service provided to a person by an eligible mental health worker if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and | 58.85 |
| (c) the person is referred to the eligible mental health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and | ||
| (g) after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | ||
| 10958 | Occupational therapy health service provided to a person by an eligible occupational therapist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible occupational therapist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or | 58.85 |
| (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | ||
| 10960 | Physiotherapy health service provided to a person by an eligible physiotherapist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible physiotherapist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | 58.85 |
| 10962 | Podiatry health service provided to a person by an eligible podiatrist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and | 58.85 |
| (b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible podiatrist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and | ||
| (g) after the service, the eligible podiatrist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | ||
| 10964 | Chiropractic health service provided to a person by an eligible chiropractor if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible chiropractor by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible chiropractor gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or | 58.85 |
| (ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | ||
| 10966 | Osteopathy health service provided to a person by an eligible osteopath if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible osteopath by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible osteopath gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | 58.85 |
| 10968 | Psychology health service provided to a person by an eligible psychologist if:(a) the service is provided to a person who has:(i) a chronic condition; and | 58.85 |
| (ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible psychologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and(e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible psychologist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or(ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 | ||
| 10970 | Speech pathology health service provided to a person by an eligible speech pathologist if:(a) the service is provided to a person who has:(i) a chronic condition; and(ii) complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person’s medical practitioner has contributed to a multidisciplinary care plan; and(b) the service is recommended in the person’s Team Care Arrangements or multidisciplinary care plan as part of the management of the person’s chronic condition and complex care needs; and(c) the person is referred to the eligible speech pathologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and(d) the person is not an admitted patient of a hospital; and | 58.85 |
| (e) the service is provided to the person individually and in person; and(f) the service is of at least 20 minutes duration; and(g) after the service, the eligible speech pathologist gives a written report to the referring medical practitioner mentioned in paragraph (c):(i) if the service is the only service under the referral — in relation to that service; or | ||
| (ii) if the service is the first or last service under the referral — in relation to that service; or(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of — in relation to those matters;to a maximum of 5 services (including any services to which this item or any other item in Part 1 of this Schedule applies) in a calendar yearThis item is subject to section 9 |
Part 2 Services and fees — psychological therapy and focussed psychological strategies
| Item | Service | Fee ($) |
|---|---|---|
| 80000 | Psychological therapy health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and(c) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and(d) the service is at least 30 minutes but less than 50 minutes durationThis item is subject to sections 7, 8 and 9 | 94.30 |
| 80005 | Psychological therapy health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist in accordance with the requirements of item 80000This item is subject to sections 6, 7 and 9 | 117.85 |
| 80010 | Psychological therapy health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 138.40 |
| (c) on the completion of the course of treatment, the eligible clinical psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and(d) the service is at least 50 minutes durationThis item is subject to sections 6, 7 and 9 | ||
| 80015 | Psychological therapy health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible clinical psychologist in accordance with the requirements of item 80010This item is subject to sections 6, 7 and 9 | 161.95 |
| 80020 | Psychological therapy health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible clinical psychologist if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided in person; and(b) the service is at least 60 minutes duration;to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar yearThis item is subject to sections 7 and 9 | 35.15 |
| 80100 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 66.80 |
| (c) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and | ||
| (d) the service is at least 20 minutes but less than 50 minutes durationThis item is subject to sections 6, 7 and 9 | ||
| 80105 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist in accordance with the requirements of item 80100This item is subject to sections 6, 7 and 9 | 90.85 |
| 80110 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and(c) on the completion of the course of treatment, the eligible psychologist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and(d) the service is at least 50 minutes durationThis item is subject to sections 6, 7 and 9 | 94.30 |
| 80115 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible psychologist in accordance with the requirements of item 80110This item is subject to sections 6, 7 and 9 | 118.40 |
| 80120 | Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible psychologist if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided in person; and | 24.05 |
| (b) the service is at least 60 minutes duration;to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar yearThis item is subject to sections 7 and 9 | ||
| 80125 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and(c) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and(d) the service is at least 20 minutes but less than 50 minutes durationThis item is subject to sections 6, 7 and 9 | 58.85 |
| 80130 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist in accordance with the requirements of item 80125This item is subject to sections 6, 7 and 9 | 82.85 |
| 80135 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 83.10 |
| (c) on the completion of the course of treatment, the eligible occupational therapist gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and(d) the service is at least 50 minutes durationThis item is subject to sections 6, 7 and 9 | ||
| 80140 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible occupational therapist in accordance with the requirements of item 80135This item is subject to sections 6, 7 and 9 | 107.10 |
| 80145 | Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible occupational therapist if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided in person; and(b) the service is at least 60 minutes duration;to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar yearThis item is subject to sections 7 and 9 | 21.10 |
| 80150 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and | 58.85 |
| (c) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and | ||
| (d) the service is at least 20 minutes but less than 50 minutes durationThis item is subject to sections 6, 7 and 9 | ||
| 80155 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker in accordance with the requirements of item 80150This item is subject to sections 6, 7 and 9 | 82.85 |
| 80160 | Focussed psychological strategies health service provided to a person in consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and(aa) the service is provided to the person individually and in person; and(b) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and(c) on the completion of the course of treatment, the eligible social worker gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management of the person’s condition; and(d) the service is at least 50 minutes durationThis item is subject to sections 6, 7 and 9 | 83.10 |
| 80165 | Focussed psychological strategies health service provided to a person at a place other than consulting rooms (but not as an admitted patient of a hospital) by an eligible social worker in accordance with the requirements of item 80160This item is subject to sections 6, 7 and 9 | 107.10 |
| 80170 | Focussed psychological strategies health service provided to a person as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible social worker if:(a) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan or as part of a psychiatrist assessment and management plan; or(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and | 21.10 |
| (aa) the service is provided in person; and | ||
| (b) the service is at least 60 minutes duration;to a maximum of 12 services (including services to which items 80120, 80145 and 80170 apply) in a calendar yearThis item is subject to sections 7 and 9 |
Part 3 Services and fees — pregnancy support counselling
| Item | Service | Fee ($) |
|---|---|---|
| 81000 | Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible psychologist if:(a) the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and(b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and(ba) the service is provided to the woman individually and in person; and(c) the eligible psychologist does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and(d) the service is at least 30 minutes duration;to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancyThe service may be used to address any pregnancy related issues for which non‑directive counselling is appropriateThis item is subject to section 9[* in the General Medical Services Table] | 69.15 |
| 81005 | Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible social worker if:(a) the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and(b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and(ba) the service is provided to the woman individually and in person; and(c) the eligible social worker does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and(d) the service is at least 30 minutes duration;to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancyThe service may be used to address any pregnancy related issues for which non‑directive counselling is appropriateThis item is subject to section 9[* in the General Medical Services Table] | 69.15 |
| 81010 | Non‑directive pregnancy support counselling health service provided to a woman (but not as an admitted patient of a hospital) by an eligible mental health nurse if:(a) the woman is concerned about a current pregnancy or a pregnancy that occurred in the 12 months preceding the provision of the first service; and(b) the woman is referred by a medical practitioner who is not a specialist or consultant physician; and(ba) the service is provided to the woman individually and in person; and(c) the eligible mental health nurse does not have a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination; and(d) the service is at least 30 minutes duration;to a maximum of 3 services (including services to which items 81000, 81005, 81010 and 4001* apply) for each pregnancyThe service may be used to address any pregnancy related issues for which non‑directive counselling is appropriateThis item is subject to section 9[* in the General Medical Services Table] | 69.15 |
Part 4 Services and fees — group services
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Health Insurance (Allied Health Services) Determination 2009 (No. 2)
as amended
made under subsection 3C (1) of the
Health Insurance Act 1973
This compilation was prepared on 13 July 2010
taking into account amendments up to Health Insurance (Allied Health Services) Amendment Determination 2010 (No. 2)
Prepared by the Office of Legislative Drafting and Publishing,
Attorney‑General’s Department, Canberra
Contents
1 Name of Determination [see Note 1]
2 Commencement
3 Revocation
4 Interpretation
5 Treatment of allied health services
6 Limitation on certain items
7 Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services
8 Referrals by psychiatrists and paediatricians for pervasive developmental disorder services
9 Effect of election to claim private health insurance for an allied health service
Schedule 1 Qualification requirements for allied health professionals
Schedule 2 Allied health services
Part 1 Services and fees — general
Part 2 Services and fees — psychological therapy and focussed psychological strategies
Part 3 Services and fees — pregnancy support counselling
Part 4 Services and fees — group services
Division 4.1 Diabetes education services
Division 4.2 Exercise physiology services
Division 4.3 Dietetics services
Part 5 Services and fees — pervasive developmental disorder
Part 6 Services and fees — Aboriginal and Torres Strait Islander services
Notes
1 Name of Determination [see Note 1]
This Determination is the Health Insurance (Allied Health Services) Determination 2009.
2 Commencement
This Determination commences on 1 November 2009
3 Revocation
The Health Insurance (Allied Health Services) Determination 2009 is revoked.
4 Interpretation
(1) In this Determination:
Act means the Health Insurance Act 1973.
allied health professional, for the provision of an allied health service, means a person:
(a) who meets the qualification requirements set out in Schedule 1 for the provision of the service; and
(b) whose name is entered in the register, kept by the Medicare Australia CEO, of allied health professionals who are qualified to provide a service of that kind.
allied health service means a health service of a kind prescribed by regulation 3A of the Health Insurance Regulations 1975 that is specified in an item in Schedule 2.
course of treatment means:
(a) for psychological therapy and focussed psychological strategies — up to 6 services provided, on referral by a medical practitioner, by any of the following persons:
(i) an eligible clinical psychologist;
(ii) an eligible psychologist;
(iii) an eligible occupational therapist;
(iv) an eligible social worker; and
(b) for pervasive developmental disorder services — up to 10 services provided, on referral by a consultant physician specialising in the practice of his or her field of psychiatry or paediatrics, by any of the following persons:
(i) an eligible psychologist;
(ii) an eligible speech pathologist;
(iii) an eligible occupational therapist.
eligible Aboriginal health worker means a person who is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service.
eligible audiologist means a person who is an allied health professional in relation to the provision of an audiology health service.
eligible chiropractor means a person who is an allied health professional in relation to the provision of a chiropractic health service.
eligible clinical psychologist means a person who is an allied health professional in relation to the provision of a psychological therapy health service.
eligible diabetes educator means a person who is an allied health professional in relation to the provision of a diabetes education health service.
eligible dietitian means a person who is an allied health professional in relation to the provision of a dietetics health service.
eligible exercise physiologist means a person who is an allied health professional in relation to the provision of an exercise physiology service.
eligible mental health nurse means a person who is an allied health professional in relation to the provision of a non‑directive pregnancy support counselling health service.
eligible mental health worker means a person who is an allied health professional in relation to the provision of a mental health service.
eligible occupational therapist means a person who is an allied health professional in relation to the provision of one or both of the following:
(a) a focussed psychological strategies health service;
(b) an occupational therapy health service.
eligible osteopath means a person who is an allied health professional in relation to the provision of an osteopathy health service.
eligible physiotherapist means a person who is an allied health professional in relation to the provision of a physiotherapy health service.
eligible podiatrist means a person who is an allied health professional in relation to the provision of a podiatry health service.
eligible psychologist means a person who is an allied health professional in relation to the provision of one or more of the following:
(a) a focussed psychological strategies health service;
(b) a non‑directive pregnancy support counselling health service;
(c) a psychology health service.
eligible social worker means a person who is an allied health professional in relation to the provision of one or both of the following:
(a) a focussed psychological strategies health service;
(b) a non‑directive pregnancy support counselling health service.
eligible speech pathologist means a person who is an allied health professional in relation to the provision of a speech pathology health service.
focussed psychological strategies means any of the following mental health care management strategies, each of which has been derived from evidence‑ based psychological therapies:
(a) psycho‑education;
(b) cognitive‑behavioural therapy that involves cognitive or behavioural interventions;
(c) relaxation strategies;
(d) skills training;
(e) interpersonal therapy;
(f) narrative therapy (for Aboriginal and Torres Strait Islander people).
GP Management Plan, for a patient, means a GP management plan to which item 721 or 732 of the General Medical Services Table applies.
GP Mental Health Treatment Plan, for a patient, means a GP Mental Health Treatment Plan for the patient to which item 2710 of the General Medical Services Table applies.
multidisciplinary care plan, for a patient, means a multidisciplinary care plan to which item 731 of the General Medical Services Table applies.
National Law means:
(a) for a State or Territory other than Western Australia - the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modifications) as a law of the State or Territory; and
(b) for Western Australia – the legislation enacted by the Health Practitioner Regulation National Law (WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.
non‑directive pregnancy support counselling has the meaning given in subsection (2).
OT Australia means the national body of the Australian Association of Occupational Therapists.
PDD treatment and management plan, for a patient, means a plan for the treatment and management of the patient’s pervasive developmental disorder to which item 135 or 289 of the General Medical Services Table applies.
Psychology Board of Australia means that body established under section 31 of the National Law.
relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations under that Act.
Team Care Arrangements means GP coordination of the development of team care arrangements for the patient to which item 723 or item 732 of the General Medical Services Table applies.
Note The following terms are defined in subsection 3 (1) of the Act:
Note: dental practitioner
Note: general medical services table
Note: medical practitioner
Note: Medicare Australia CEO
Note: professional service.
(2) A reference in this Determination to non‑directive pregnancy support counselling is a reference to counselling provided to a woman by a health professional in which:
(a) information and issues relating to pregnancy are discussed; but
(b) the health professional does not impose his or her views or values about what the woman should or should not do in relation to the pregnancy.
5 Treatment of allied health services
An allied health service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) specified for the service a fee in relation to each State, being the fee specified in the item in Schedule 2 relating to the service.
Note For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.
6 Limitation on certain items
(1) For any particular patient, an item mentioned in subsection (2) applies in a calendar year only if the service described in the item is:
(a) one of the first 12 relevant services provided to the patient in the calendar year; or
(b) if exceptional circumstances exist in relation to the patient — one of the first 18 relevant services provided to the patient in the calendar year.
(2) The items are items 80000, 80005, 80010, 80015, 80100, 80105, 80110, 80115, 80125, 80130, 80135, 80140, 80150, 80155, 80160 and 80165 in Schedule 2.
(3) In this section:
exceptional circumstances exist in relation to a patient if:
(a) the patient has, in a calendar year, received at least 12 relevant services; and
(b) the patient’s referring medical practitioner is satisfied that there has been a significant change in the patient’s clinical condition or care circumstances which necessitates a further referral for a service described in an item mentioned in paragraph (a) of the definition of relevant service.
relevant service means a service:
(a) to which any of items 2721 to 2727 of the General Medical Services Table, or items 80000 to 80015, 80100 to 80115, 80125 to 80140, or 80150 to 80165 in Schedule 2, apply; or
(b) to which the Access to Allied Psychological Services component of the Better Outcomes in Mental Health Care Program applies.
7 Referrals by psychiatrists and paediatricians for psychological therapy and focussed psychological strategies health services
(1) This section applies to items 80000 to 80170 in Schedule 2.
(2) The referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 293 to 370 of the General Medical Services Table e apply.
(3) The referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 133 of the General Medical Services Table apply.
(4) The referral by a specialist in the practice of his or her field of psychiatry or paediatrics must be a referral for a service to which any of items 104 to 109 of the General Medical Services Table apply.
8 Referrals by psychiatrists and paediatricians for pervasive developmental disorder services
(1) This section applies to items 82000 to 82025 in Schedule 2.
(2) For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which any of items 296 to 370 (except item 359) of the General Medical Services Table apply.
(3) For items 82000 to 82010, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which any of items 110 to 131 of the General Medical Services Table apply.
(4) For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of psychiatry must be a referral for a service to which item 289 of the General Medical Services Table applies.
(5) If a child has previously been provided with a service mentioned in item 289, a consultant physician specialising in the practice of his or her field of psychiatry may only refer the child for a service to which any of items 296 to 370 (excepting item 359) of the General Medical Services Table apply.
(6) For items 82015 to 82025, the referral by a consultant physician specialising in the practice of his or her field of paediatrics must be a referral for a service to which item 135 of the General Medical Services Table applies.
(7) If a child has previously been provided with a service mentioned in item 135, a consultant physician specialising in the practice of his or her field of paediatrics may only refer the child for a service to which any of items 110 to 131 of the General Medical Services Table apply.
9 Effect of election to claim private health insurance for an allied health service
An item in Schedule 2 applies to an allied health service only if a private health insurance benefit has not been claimed for the service.
Schedule 1 Qualification requirements for allied health professionals
(section 4)
| 1 | Aboriginal and Torres Strait Islander health serviceA person is an allied health professional in relation to the provision of an Aboriginal and Torres Strait Islander health service if:(a) for a person who provides an Aboriginal and Torres Strait Islander health service in a State or Territory other than the Northern Territory — the person has been awarded a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a registered training organisation that meets the training standards set by the Australian National Training Authority’s Australian Quality Training Framework; or(b) for a person who provides an Aboriginal and Torres Strait Islander health service in the Northern Territory — the person is registered under the Health Practitioners Act (NT). |
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