Section 1 - Health Insurance (Section 3C General Medical Services – GP and Allied Health COVID-19 Services) Amendment Determination No.1 2020 - Health Insurance (Section 3C General Medical Services – GP and Allied Health COVID-19 Services) Amendment Determination No.1 2020 | Zoe
Health Insurance (Section 3C General Medical Services – GP and Allied Health COVID-19 Services) Amendment Determination No.1 2020
1Health Insurance (Section 3C General Medical Services – GP and Allied Health COVID-19 Services) Amendment Determination No.1 2020
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This instrument is the Health Insurance (Section 3C General Medical Services – GP and Allied Health COVID-19 Services) Amendment Determination No.1 2020.
2. Commencement
(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.
Commencement information
Column 1 Column 2 Column 3
Provisions Commencement Date/Details
The whole of this instrument Immediately after the registration of the Health Insurance (Section 3C General Medical Services – GP and Allied Health COVID-19 Services) Determination 2020.
Note: This table relates only to the provisions of this instrument as originally made.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.
(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.
3. Authority
This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.
4. Definitions
(1) In this instrument:
Act means the Health Insurance Act 1973.
Schedule means a Schedule to this instrument.
Note: The following terms are defined in subsection 3(1) of the Act:
clinically relevant service;
general medical services table;
item;
(2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
Schedule 1 – Amendments to Health Insurance (Section 3C General Medical Services – GP and Allied Health COVID-19 Services) Determination 2020
Within the definition of Patient at risk of COVID-19 of section 5 Definitions
Insert after (c)(v):
or
(d) the person meets the current national triage protocol criteria for suspected COVID-19 infection
2. Omit paragraph 1.1.1 and substitute:
1.1.1 – Application of COVID-19 medical practitioner telehealth services
(1) For items in 91806, 91807 and 91808, “eligible area” has the meaning given by section 4 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018.
(2) For items in Division 1.1, “medical practitioner” has the meaning given by section 4 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018.
(3) Clause 2.22.7 of the general medical services table shall have effect as if items 91818 and 91819 were also specified in that clause.
(4) Clause 1.9.4 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 shall have effect as if items 91820 and 91821 were also specified in that clause.
(5) For items in Subgroups 1 and 2, the rendering practitioner must not perform a service in subgroup 2 if the practitioner and the patient have the capacity to undertake an attendance by telehealth.
(6) For items in Subgroup 1 and 2, the rendering practitioner must have had at least one face to face attendance with the patient in the preceding 12 months if the patient is considered to be more susceptible to the COVID-19.
3. Schedule 1 - Relevant Services
Division 1.2 – Services and Fees – COVID-19 allied health telehealth services
Repeal the table at Subgroup 5 – COVID-19 nurse practitioner telehealth services, substitute:
91178 Telehealth attendance by a participating nurse practitioner lasting less than 20 minutes if: (i) The person is at risk of COVID-19 virus; or (ii) The participating nurse practitioner is a health professional at risk of COVID-19 virus; and (a) The attendance includes any of the following that are clinically relevant: (i) taking a history; (ii) undertaking clinical examination; (iii) arranging any necessary investigation; (iv) implementing a management plan; (v) providing appropriate preventive health care;where the service is bulk-billed. 21.30
91179 Telehealth attendance by a participating nurse practitioner lasting at least 20 minutes if: (a) The attendance is where: (i) The person is at risk of COVID-19 virus; or (ii) The participating nurse practitioner is a health professional at risk of COVID-19 virus; and (b) The attendance includes any of the following that are clinically relevant: (i) taking a history; (ii) undertaking clinical examination; (iii) arranging any necessary investigation; (iv) implementing a management plan; (v) providing appropriate preventive health care;where the service is bulk-billed. 40.40
91180 Telehealth attendance by a participating nurse practitioner lasting at least 40 minutes if: (a) The attendance is where: (i) The person is at risk of COVID-19 virus; or (ii) The participating nurse practitioner is a health professional at risk of COVID-19 virus; and (b) The attendance includes any of the following that are clinically relevant: (i) taking a history; (ii) undertaking clinical examination; (iii) arranging any necessary investigation; (iv) implementing a management plan; (v) providing appropriate preventive health care;where the service is bulk-billed. 59.50
4. After Division 1.2 of Schedule 1
Insert:
Division 1.3 - Services and fees – COVID-19 medical practitioner attendances
1.3.1 Application of COVID-19 medical practitioner phone services
Insert:
(1) For items in the subgroup below, the rendering practitioner must not perform a service in subgroup 10 if the practitioner and the patient have the capacity to undertake an attendance by telehealth.
Group A40 – COVID-19 medical practitioner phone services
91842 Phone attendance for a patient at risk for COVID-19 virus by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if:(a) the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and(b) the service lasts at least 30 minutes, but less than 40 minutes;where the service is bulk-billed 110.85
91843 Phone attendance for a patient at risk for COVID-19 virus by a general practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if:(a) the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and(b) the service lasts at least 40 minutes;where the service is bulk-billed 158.60
91844 Phone attendance for a patient at risk for COVID-19 virus by a medical practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if:(a) the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and(b) the service lasts at least 30 minutes, but less than 40 minutes;where the service is bulk-billed 88.70
91845 Phone attendance for a patient at risk for COVID-19 virus by a medical practitioner, for the purpose of providing focussed psychological strategies for assessed mental disorders if:(a) the practitioner is registered with the Chief Executive Medicare as meeting the credentialing requirements for provision of this service; and(b) the service lasts at least 40 minutes;where the service is bulk-billed 126.90
5. After Division 1.3 of Schedule 1
Insert:
Division 1.4 - Services and fees – Services and fees – COVID-19 allied health phone services
1.4.1 – Application of COVID-19 allied health attendances
(1) For items in Division 1.4, “eligible clinical psychologist”, “eligible psychologist”, “eligible occupational therapist” and “eligible social worker” have the meanings given by section 4 of the Health Insurance (Allied Health Services) Determination 2014.
(2) For items 91181 and 91189, sections 7 and 9 of the Health Insurance (Allied Health Services) Determination 2014 shall have effect as if the items were also specified in those clauses.
(3) For items in subgroups below the rendering practitioner must not perform a service in these subgroups 6, 7, 8, 9 and 10 if the practitioner and the patient have the capacity to undertake an attendance by telehealth.
Group M18 – COVID-19 allied health telehealth services
91181 Psychological therapy health service provided by phone attendance by an eligible clinical psychologist if:(a) the attendance is where:(i) the person is a patient at risk of COVID-19 virus; or(ii) the eligible clinical psychologist is a health professional at risk of COVID-19 virus; and(b) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a shared care 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(c) the service is provided to the person individually; and(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and(e) 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(f) the service is at least 30 minutes but less than 50 minutes duration; where the service is bulk-billed 101.35
91182 Psychological therapy health service provided by phone attendance by an eligible clinical psychologist if:(a) the attendance is where:(i) the person is a patient at risk of COVID-19 virus; or(ii) the eligible clinical psychologist is a health professional at risk of COVID-19 virus; and(b) the person is referred by:(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a shared care 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(c) the service is provided to the person individually; and(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and(e) 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(f) the service is at least 50 minutes duration;where the service is bulk-billed 148.80
| 91183 | Focussed psychological strategies health service provided by phone attendance by an eligible psychologist if:<br>(a) the attendance is where:<br>(i) the person is a patient at risk of COVID-19 virus; or<br>(ii) the eligible psychologist is a health professional at risk of COVID-19 virus; and<br>(b) the person is referred by:<br>(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a shared care plan or as part of a psychiatrist assessment and management plan; or<br>(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br>(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br>(c) the service is provided to the person individually; and<br>(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br>(e) 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<br>(g) the service is at least 20 minutes but less than 50 minutes duration;<br>where the service is bulk-billed | 71.80 |
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| 91184 | Focussed psychological strategies health service provided by phone attendance by an eligible psychologist if:<br>(a) the attendance is where:<br>(i) the person is a patient at risk of COVID-19 virus; or<br>(ii) the eligible psychologist is a health professional at risk of COVID-19 virus; and<br>(b) the person is referred by:<br>(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a shared care plan or as part of a psychiatrist assessment and management plan; or<br>(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br>(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br>(c) the service is provided to the person individually; and<br>(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br>(e) 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<br>(f) the service is at least 50 minutes duration;<br>where the service is bulk-billed | 101.35 |
| 91185 | Focussed psychological strategies health service provided by phone attendance by an eligible occupational therapist if:<br>(a) the attendance is where:<br>(i) the person is a patient at risk of COVID-19 virus; or<br>(ii) the eligible occupational therapist is a health professional at risk of COVID-19 virus; and<br>(a) the person is referred by:<br>(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a shared care plan or as part of a psychiatrist assessment and management plan; or<br>(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br>(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br>(b) the service is provided to the person individually; and<br>(c) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br>(d) 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<br>(e) the service is at least 20 minutes but less than 50 minutes duration<br>where the service is bulk-billed | 63.25 |
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| 91186 | Focussed psychological strategies health service provided by phone attendance by an eligible occupational therapist if:<br>(a) the attendance is where:<br>(i) the person is a patient at risk of COVID-19 virus; or<br>(ii) the eligible occupational therapist is a health professional at risk of COVID-19 virus; and<br>(b) the person is referred by:<br>(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a shared care plan or as part of a psychiatrist assessment and management plan; or<br>(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br>(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br>(c) the service is provided to the person individually; and<br>(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br>(e) 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<br>(f) the service is at least 50 minutes in duration<br>where the service is bulk-billed | 89.35 |
| 91187 | Focussed psychological strategies health service provided by phone attendance by an eligible social worker if:<br>(a) the attendance is where:<br>(i) the person is a patient at risk of COVID-19 virus; or<br>(ii) the eligible social worker is a health professional at risk of COVID-19 virus; and<br>(b) the person is referred by:<br>(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a shared care plan or as part of a psychiatrist assessment and management plan; or<br>(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br>(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br>(b) the service is provided to the person individually; and<br>(c) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br>(d) 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<br>(e) the service is at least 20 minutes but less than 50 minutes duration<br>where the service is bulk-billed | 63.25 |
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| 91188 | Focussed psychological strategies health service provided by phone attendance by an eligible social worker if:<br>(a) the attendance is where:<br>(i) the person is a patient at risk of COVID-19 virus; or<br>(ii) the eligible social worker is a health professional at risk of COVID-19 virus; and<br>(b) the person is referred by:<br>(i) a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a shared care plan or as part of a psychiatrist assessment and management plan; or<br>(ii) a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or<br>(iii) a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and<br>(c) the service is provided to the person individually; and<br>(d) at the completion of a course of treatment, the referring medical practitioner reviews the need for a further course of treatment; and<br>(e) 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<br>(f) the service is at least 50 minutes duration<br>where the service is bulk-billed | 89.35 |
91189 Phone attendance by a participating nurse practitioner lasting less than 20 minutes if: (a) The attendance is where: (i) The person is at risk of COVID-19 virus; or (ii) The participating nurse practitioner is a health professional at risk of COVID-19 virus; and (b) The attendance includes any of the following that are clinically relevant: (i) taking a history; (ii) undertaking clinical examination; (iii) arranging any necessary investigation; (iv) implementing a management plan; (v) providing appropriate preventive health care;where the service is bulk-billed. 21.30
91190 Phone attendance by a participating nurse practitioner lasting at least 20 minutes if: (a) The attendance is where: (i) The person is at risk of COVID-19 virus; or (ii) The participating nurse practitioner is a health professional at risk of COVID-19 virus; and (b) The attendance includes any of the following that are clinically relevant: (i) taking a history; (ii) undertaking clinical examination; (iii) arranging any necessary investigation; (iv) implementing a management plan; (v) providing appropriate preventive health care;where the service is bulk-billed. 40.40
91191 Phone attendance by a participating nurse practitioner lasting at least 40 minutes if: (a) The attendance is where: (i) The person is at risk of COVID-19 virus; or (ii) The participating nurse practitioner is a health professional at risk of COVID-19 virus; and (b) The attendance includes any of the following that are clinically relevant: (i) taking a history; (ii) undertaking clinical examination; (iii) arranging any necessary investigation; (iv) implementing a management plan; (v) providing appropriate preventive health care;where the service is bulk-billed. 59.50