Health Insurance (Allied Health and Dental
Services) Amendment Determination 2007
(No. 1)
Health Insurance Act 1973
I, MEGAN MORRIS, First Assistant Secretary, Medical Benefits Division,
Department of Health and Ageing, make this Determination under subsection 3C (1)
of the Health Insurance Act 1973.
Dated 10 April 2007
MEGAN MORRIS
First Assistant Secretary, Medical Benefits Division, Department of Health and
Ageing
1
Name of Determination
This Determination is the Health Insurance (Allied Health and Dental
Services) Amendment Determination 2007 (No. 1).
2
Commencement
This Determination commences on 1 May 2007.
3
Amendment of Health Insurance (Allied Health and Dental
Services) Determination 2006
Schedule 1 amends the Health Insurance (Allied Health and Dental
Services) Determination 2006.
0702544A-070328Z
Schedule 1
Amendments
Schedule 1
Amendments
(section 3)
[1]
Subsection 4 (1), after definition of allied health service
insert
course of treatment, for psychological therapy and focussed psychological
strategies, means up to 6 services provided by an allied mental health
professional (on referral from an eligible medical practitioner).
[2]
Subsection 4 (1), definition of focussed psychological
strategies, paragraph (e)
omit
therapy.
insert
therapy;
[3]
Subsection 4 (1), definition of focussed psychological
strategies, after paragraph (e)
insert
(f) narrative therapy (for Aboriginal and Torres Strait Islander people).
[4]
Subsection 4 (1), after definition of focussed psychological
strategies
insert
GP management plan, for a patient, means a GP management plan to
which item 721 or 725 of the general medical services table applies.
[5]
Subsection 4 (1), after definition of GP Mental Health Care Plan
insert
multidisciplinary care plan, for a patient, means a multidisciplinary care
plan to which item 731 of the general medical services table applies.
2
Health Insurance (Allied Health and Dental Services) Amendment
Determination 2007 (No. 1)
Amendments
[6]
Schedule 1
Subsection 8 (3)
omit
items 104
insert
items 110
[7]
After subsection 8 (3)
insert
(4) The referral by a specialist in the practice of his or her field of psychiatry or
paediatrics must be a referral to which any of items 104 to 109 of the
general medical services table applies.
[8]
Schedule 1, subparagraph 8 (b) (ii)
omit
and New Zealand
[9]
Schedule 1, paragraph 9 (a)
omit
and New Zealand
[10]
Schedule 2, Part 1, items 10950 to 10970, paragraphs (a) and (b)
substitute
(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 an EPC plan;
and
(b) the service is recommended in the person’s EPC plan as part
of the management of the person’s chronic condition and
complex care needs; and
[11]
Schedule 2, Part 2, items 80000, 80010, 80100, 80110, 80125,
80135, 80150 and 80160, paragraph (b)
substitute
(b) at the completion of a course of treatment, the referring
medical practitioner reviews the need for a further course of
treatment; and
Health Insurance (Allied Health and Dental Services) Amendment
Determination 2007 (No. 1)
3
Schedule 1
[12]
Amendments
Schedule 2, after Part 3
insert
Part 4
Services and fees — group services
Division 4.1 Diabetes education services
Item
Service
81100
Diabetes education health service provided to a person by an
eligible diabetes educator for assessing the person’s suitability for
group services for the management of type 2 diabetes, including
taking a comprehensive patient history, identifying an appropriate
group services program based on the patient’s needs and preparing
the person for the group services, if:
(a) the person has type 2 diabetes; and
(b) the person is being managed by a medical practitioner
(including a general practitioner, but not a specialist or
consultant physician) under a GP management plan 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
(c) the person is referred to an eligible diabetes educator by the
medical practitioner using a referral form that has been
issued by the Department of Health and Ageing, or a referral
form that substantially complies with 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 45 minutes duration; and
(g) after the service, the eligible diabetes educator gives a
written report to the referring medical practitioner mentioned
in paragraph (c); and
(h) for a service for which a private health insurance benefit is
payable, the person has elected to claim the medicare benefit
for the service and not the private health insurance benefit —
payable once in a calendar year for this or any other assessment for
group services item (including services in items 81100, 81110 and
81120)
4
Health Insurance (Allied Health and Dental Services) Amendment
Determination 2007 (No. 1)
Fee ($)
70.55
Amendments
Item
Service
81105
Diabetes education health service provided to a person by an
eligible diabetes educator, as a group service for the management
of type 2 diabetes, if:
(a) the person has been assessed as suitable for a type 2 diabetes
group service under assessment item 81100, 81110 or 81120;
and
(b) the service is provided to a person who is part of a group of
between 2 and 12 patients; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to a person involving the personal
attendance by an eligible diabetes educator; and
(e) the service is of at least 60 minutes duration; and
(f) after the last service in the group services program provided
to the person under item 81105, 81115 or 81125, the eligible
diabetes educator prepares, or contributes to, a written report
to be provided to the referring medical practitioner; and
(g) an attendance record for the group is maintained by the
eligible diabetes educator; and
(h) for a service for which a private health insurance benefit is
payable, the person has elected to claim the medicare benefit
for the service and not the private health insurance benefit —
Schedule 1
Fee ($)
17.60
to a maximum of 8 group services in a calendar year (including
services in items 81105, 81115 and 81125)
Health Insurance (Allied Health and Dental Services) Amendment
Determination 2007 (No. 1)
5
Schedule 1
Amendments
Division 4.2 Exercise physiology services
Item
Service
81110
Exercise physiology health service provided to a person by an
eligible exercise physiologist for assessing the person’s suitability
for group services for the management of type 2 diabetes,
including taking a comprehensive patient history, identifying an
appropriate group services program based on the patient’s needs
and preparing the person for the group services, if:
(a) the person has type 2 diabetes; and
(b) the person is being managed by a medical practitioner
(including a general practitioner, but not a specialist or
consultant physician) under a GP management plan 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
(c) the person is referred to an eligible exercise physiologist by
the medical practitioner using a referral form that has been
issued by the Department of Health and Ageing, or a referral
form that substantially complies with 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 45 minutes duration; and
(g) after the service, the eligible exercise physiologist gives a
written report to the referring medical practitioner mentioned
in paragraph (c); and
(h) for a service for which a private health insurance benefit is
payable, the person has elected to claim the medicare benefit
for the service and not the private health insurance benefit —
payable once in a calendar year for this or any other assessment for
group services item (including services in items 81100, 81110 and
81120)
6
Health Insurance (Allied Health and Dental Services) Amendment
Determination 2007 (No. 1)
Fee ($)
70.55
Amendments
Item
Service
81115
Exercise physiology health service provided to a person by an
eligible exercise physiologist, as a group service for the
management of type 2 diabetes, if:
(a) the person has been assessed as suitable for a type 2 diabetes
group service under assessment item 81100, 81110 or 81120;
and
(b) the service is provided to a person who is part of a group of
between 2 and 12 patients; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to a person involving the personal
attendance by an eligible exercise physiologist; and
(e) the service is of at least 60 minutes duration; and
(f) after the last service in the group services program provided
to the person under item 81105, 81115 or 81125, the eligible
exercise physiologist prepares, or contributes to, a written
report to be provided to the referring medical practitioner;
and
(g) an attendance record for the group is maintained by the
eligible exercise physiologist; and
(h) for a service for which a private health insurance benefit is
payable, the person has elected to claim the medicare benefit
for the service and not the private health insurance benefit —
Schedule 1
Fee ($)
17.60
to a maximum of 8 group services in a calendar year (including
services in items 81105, 81115 and 81125)
Health Insurance (Allied Health and Dental Services) Amendment
Determination 2007 (No. 1)
7
Schedule 1
Amendments
Division 4.3 Dietetics services
Item
Service
81120
Dietetics health service provided to a person by an eligible dietitian
for assessing the person’s suitability for group services for the
management of type 2 diabetes, including taking a comprehensive
patient history, identifying an appropriate group services program
based on the patient’s needs and preparing the person for the group
services, if:
(a) the person has type 2 diabetes; and
(b) the person is being managed by a medical practitioner
(including a general practitioner, but not a specialist or
consultant physician) under a GP management plan 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
(c) the person is referred to an eligible dietitian by the medical
practitioner using a referral form that has been issued by the
Department of Health and Ageing, or a referral form that
substantially complies with 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 45 minutes duration; and
(g) after the service, the eligible dietitian gives a written report
to the referring medical practitioner mentioned in
paragraph (c); and
(h) for a service for which a private health insurance benefit is
payable, the person has elected to claim the medicare benefit
for the service and not the private health insurance benefit —
payable once in a calendar year for this or any other assessment for
group services item (including services in items 81100, 81110 and
81120)
8
Health Insurance (Allied Health and Dental Services) Amendment
Determination 2007 (No. 1)
Fee ($)
70.55
Amendments
Item
Service
81125
Dietetics health service provided to a person by an eligible
dietitian, as a group service for the management of type 2 diabetes,
if:
(a) the person has been assessed as suitable for a type 2 diabetes
group service under assessment item 81100, 81110 or 81120;
and
(b) the service is provided to a person who is part of a group of
between 2 and 12 patients; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to a person involving the personal
attendance by an eligible dietitian; and
(e) the service is of at least 60 minutes duration; and
(f) after the last service in the group services program provided
to the person under item 81105, 81115 or 81125, the eligible
dietitian prepares, or contributes to, a written report to be
provided to the referring medical practitioner; and
(g) an attendance record for the group is maintained by the
eligible dietitian; and
(h) for a service for which a private health insurance benefit is
payable, the person has elected to claim the medicare benefit
for the service and not the private health insurance benefit —
Schedule 1
Fee ($)
17.60
to a maximum of 8 group services in a calendar year (including
services to which items 81105, 81115 and 81125 apply)
[13]
Schedule 3, items 10975, 10976 and 10977, paragraphs (a) and
(b)
substitute
(a) the service is provided to a person whose dental condition is
exacerbating a chronic condition being managed by a
medical practitioner (including a general practitioner, but not
a specialist or consultant physician) under an EPC plan; and
(b) the service is recommended in the person’s EPC plan as part
of the management of the person’s chronic condition and
complex care needs; and
[14]
Further amendments — specialist
Subparagraphs (a) (ii) and (iii) of the following items of Part 2 of
Schedule 2 are amended by omitting ‘a consultant’ and inserting ‘a
specialist or consultant’:
80000
80125
80010
80135
80020
80145
80100
80150
80110
80160
Health Insurance (Allied Health and Dental Services) Amendment
Determination 2007 (No. 1)
80120
80170
9
Schedule 1
[15]
Amendments
Further amendments — day-hospital facility
(1) The following items of Schedule 2 are amended by omitting ‘or
day-hospital facility’:
10950
10958
10970
80100
80130
80160
10951
10960
80000
80105
80135
80165
10952
10962
80005
80110
80140
80170
10953
10964
80010
80115
80145
81000
10954
10966
80015
80120
80150
81005
10956
10968
80020
80125
80155
81010
(2) The following items of Schedule 3 are amended by omitting ‘or
day-hospital facility’:
10975
10
10976
10977
Health Insurance (Allied Health and Dental Services) Amendment
Determination 2007 (No. 1)