Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE AMENDMENT REGULATIONS 2010 (NO. 1) (SLI NO 230 OF 2010)

EXPLANATORY STATEMENT

 

Select Legislative Instrument 2010 No. 230

 

Health Insurance Act 1973

 

Health Insurance Amendment Regulations 2010 (No. 1)

 

Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides, in part, that the Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.

 

The Regulations are part of the implementation of the Health Legislation Amendment (Midwives and Nurse Practitioners) Act 2010 (the Amendment Act) which commenced on the Royal Assent on 12 April 2010. The Act provides for new arrangements to enhance and expand the role of midwives and nurse practitioners, allowing them to take a greater role in providing quality health care.

 

The Amendment Act also amends both the Act and the National Health Act 1953 to enable nurse practitioners and appropriately qualified and experienced midwives to request appropriate diagnostic imaging and pathology services for which Medicare benefits may be paid. It allows these health professionals to be authorised as Pharmaceutical Benefits Scheme (PBS) prescribers to be able to prescribe certain medicines under the PBS. Secondary legislation also provides for such matters as the creation of new Medicare items and referrals under the Medicare Benefits Schedule (MBS).

 

Access to MBS services and PBS subsidised medicines will be available to patients of appropriately qualified and experienced midwives and nurse practitioners from

1 November 2010.

 

The purpose of the Regulations is to amend the Health Insurance Regulations 1975 (the Principal Regulations) to allow participating midwives and nurse practitioners to render services for which Medicare benefits are payable in line with changes made to the Act by the Amendment Act.

 

The Regulations amend the Principal Regulations to give effect to new MBS arrangements that are consistent with the Act (as amended by the Amendment Act) by:

 

 

Details of the Regulations are set out in the Attachment.

 

Consultation regarding implementation of the arrangements for access by patients to midwife and nurse practitioner Medicare services and PBS prescribing occurred via advisory groups established to advise on specific issues and technical aspects. The advisory groups included practitioners from relevant medical and health professions, with experience in midwifery, nursing, general practice, obstetrics, and representatives from registration bodies, state and territory health services, regional and remote health services, Indigenous populations, and consumers. Advice included advice on Medicare and PBS eligibility, collaborative arrangements with medical professionals, authorisation as PBS prescribers, and medicines suitable for PBS prescribing.

 

The Act specifies no conditions that need to be satisfied before the power to make the Regulations may be exercised.

 

The regulations 1 to 3 and the Schedule 1 which contain the provisions relating to eligible midwife and collaborative arrangements commence on the later of 1 July 2010 or the day following registration. Schedule 1 commences prior to 1 November 2010 to assist Medicare Australia to issue provider numbers to prepare for patient access to the new Medicare services on 1 November 2010. Schedule 2, which contains the provisions that support the creation of new Medicare items, details the particulars required on accounts and receipts and facilitates the referral and requesting arrangements for eligible midwives and nurse practitioners, commences on 1 November 2010.

 

The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

 


ATTACHMENT

 

Details of the Health Insurance Amendment Regulations 2010 (No. 1)

 

Regulation 1 – Name of Regulations

 

This regulation provides that the title of the Regulations is the Health Insurance Amendment Regulations 2010 (No. 1).

 

Regulation 2 – Commencement

 

This regulation provides for regulations 1 to 3 and Schedule 1 to commence on the later of

1 July 2010 or the day following registration, and for Schedule 2 to commence on

1 November 2010.

 

Regulation 3 – Amendment of Health Insurance Regulations 1975

 

This regulation provides that the Health Insurance Regulations 1975 (the Principal Regulations) are amended as set out in Schedules 1 and 2.

 

Schedule 1 – Amendments commencing on 1 July 2010

 

Item [1] – Regulation 2, after definition of approved collection centre

 

This item inserts a new definition in regulation 2 of the Principal Regulations for the term ‘collaborative arrangement’. This definition provides that a ‘collaborative arrangement’ is a collaborative arrangement mentioned in new regulations 2C or 2F.

 

Item [2] – Regulation 2, after definition of Medical Board

 

This item inserts the following new definitions within regulation 2 of the Principal Regulations:

 

‘National Law’ means the Health Practitioner Regulation Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld);

 

‘Nursing and Midwifery Board’ means the Nursing and Midwifery Board of Australia established under section 31 of the National Law;

 

‘obstetrician’ means a medical practitioner who is a specialist in the specialty of obstetrics and gynaecology (however described);

 

‘obstetric specified medical practitioner’ means a medical practitioner mentioned in paragraphs 2B(1)(a) or (b);

 

‘paediatrician’ means a medical practitioner who is a specialist in the speciality of paediatrics and child health (however described).

 

 

 

Item [3] – Regulation 2, after definition of servicing provider

 

This item inserts a new definition of ‘specified medical practitioner’, being a medical practitioner mentioned in new regulation 2B for a participating midwife, and a medical practitioner mentioned in new regulation 2F for a participating nurse practitioner.

 

Item [4] – Regulation 2, after definition of treatment provider

This item inserts a new definition of ‘usual general practitioner’ being, for a patient, a medical practitioner nominated by the patient.

 

Item [5] – Regulation 2, note

 

This item substitutes the existing note at the end of regulation 2 listing terms used in the Principal Regulations that are defined in the Act with a new note that adds more terms to the same list.

 

Item [6] – After regulation 2A

 

Subsection 3(1) of the Act defines ‘participating midwife’ as an eligible midwife, so far as the eligible midwife render a service in a collaborative arrangement of a kind or kinds specified in the regulations with one or more medical practitioners of a kind or kinds specified in the regulations. To be an eligible midwife, a person must be registered or authorised (however described) as a midwife under state or territory law and must satisfy the requirements in the new regulation 14A (see item [7] below).

 

Subsection 3(1) of the Act defines ‘participating nurse practitioner’ as an eligible nurse practitioner, so far as the eligible nurse practitioner in a collaborative arrangement of a kind or kinds specified in the regulations with one or more medical practitioners of a kind or kinds specified in the regulations. To be an eligible nurse practitioner, a person must be registered or authorised (however described) as a nurse practitioner under state or territory law.

 

This item inserts new regulations 2B to 2H into the Principal Regulations. New regulations 2B to 2H specify the kinds of collaborative arrangements that an eligible midwife and an eligible nurse practitioner must participate in when rendering a service, with the kinds of specified medical practitioners, in order to satisfy the definitions of ‘participating midwife’ and ‘participating nurse practitioner’ in subsection 3(1) of the Act.

 

Regulation 2B Specified medical practitioners

 

The definition of ‘participating midwife’ in subsection 3(1) of the Act requires an eligible midwife to render a service in a collaborative arrangement of a kind or kinds specified in the regulations, with one or more medical practitioners of a kind or kinds specified in the regulations (emphasis added).

 

Subregulation 2B(1) specifies the kinds of medical practitioners with whom an eligible midwife may render a service in a collaborative arrangement, for the purpose of the definition of participating midwife. The kinds of medical practitioners specified are: an obstetrician; a medical practitioner who provides obstetric services; and a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative arrangement.

 

The kinds of medical practitioners specified in paragraphs 2B(1)(a) and (b) provide obstetric services and are defined in regulation 2 (as amended by item [2] above) as ‘obstetric specified medical practitioners’.

 

Paragraph 2B(1)(c) allows a hospital to nominate a medical practitioner (such as the head of obstetrics or the director of medical services) to be in a collaborative arrangement with a midwife.

 

Although there is no requirement for the medical practitioner specified in paragraph 2B(1)(c) to have an obstetric background, an obstetric specified medical practitioner be required for consultation and transfer of patient care as part of the collaborative arrangement (see subregulation 2C(2) below).

 

The definition of ‘participating nurse practitioner’ in subsection 3(1) of the Act requires an eligible nurse practitioner to provide nurse practitioner treatment in a collaborative arrangement of a kind of kinds specified in the regulations, with one or more medical practitioners of kind or kinds specified in the regulations (emphasis added).

 

Subregulation 2B(2) specifies that all kinds of medical practitioners are specified medical practitioners for the purposes of the definition of participating nurse practitioner.

 

Subregulation 2B(3) provides that in regulation 2B, ‘hospital authority’ has the meaning given by subsection 84(1) of the National Health Act 1953.

 

Regulation 2C Collaborative arrangements – participating midwives

 

The definition of ‘participating midwife’ in subsection 3(1) of the Act requires an eligible midwife to render a service in a collaborative arrangement of a kind or kinds specified in the regulations, with one or more medical practitioners of a kind or kinds specified in the regulations (emphasis added).

 

Subregulation 2C(1) specifies the kinds of collaborative arrangements for the purposes of the definition of participating midwife.

 

Midwife employed or engaged by a medical practice

 

Paragraph 2C(1)(a) provides for a kind of collaborative arrangement where the eligible midwife is employed or engaged by one or more obstetric specified medical practitioners or by an entity that employs or engages one or more obstetric specified medical practitioners. The reference to ‘employs or engages’ covers both employees and contractors. This covers an eligible midwife who is employed or engaged by a medical practice so long as that medical practice employs or engages at least one obstetric specified medical practitioner.

 

Paragraph 2C(1)(b) provides that an eligible midwife is in a collaborative arrangement if a specified medical practitioner refers a patient in writing to the midwife for midwifery treatment.

 

The two kinds of collaborative arrangement specified at paragraphs 2C(1)(c) and (d) are described in more detail in the item-by-item description for regulations 2D and 2E, respectively.

 

Subregulation 2C(2) provides that each kind of collaborative arrangement specified in subregulation 2C(1) must provide for: consultation between the midwife and an obstetric specified medical practitioner; referral of patients to a specified medical practitioner; and transfer of a patient’s care to an obstetric specified medical practitioner.

 

Subregulation 2C(2) ensures that all kinds of collaborative arrangement must deal with the issues of how collaboration is to occur regarding consultation, referral and transfer.

 

Subregulation 2C(3) provides that a collaborative arrangement of a kind specified in paragraph 2C(1)(a), (b) or (c) may apply to more than one patient. Subregulation 2C(3) does not provide that a collaborative arrangement of a kind specified in paragraph 2C(1)(d) (mentioned in regulation 2E) could apply to more than one patient. The kind of collaborative arrangement mentioned in regulation 2E (midwife’s written records) contains elements which must be patient specific, so a separate collaborative arrangement must exist for each patient.

 

However, subregulation 2C(4) provides that the acknowledgement from a specified medical practitioner mentioned in paragraph 2E(1)(c) may apply to more than one patient. This has the effect that, although the kind of collaborative arrangement mentioned in regulation 2E (midwife’s written records) is specific to a patient, a midwife can obtain an acknowledgement from a specified medical practitioner that he or she will collaborative with the midwife for more than one of the midwife’s patients. This means that the midwife does not have to obtain a separate acknowledgement for every patient.

 

Regulation 2D Agreement between eligible midwife and 1 or more specified medical practitioners

 

Subregulation 2D(1) provides that an agreement may be made between an eligible midwife and one or more specified medical practitioners. This agreement is a kind of collaborative arrangement for the purposes of the definition of participating midwife in subsection 3(1) of the Act (see paragraph 2C(1)(c) above).

 

Subregulation 2D(2) provide that the agreement must be in writing and signed by the eligible midwife and each specified medical practitioner who is a party to the agreement.

 

Regulation 2E Arrangement – midwife’s written records

 

Subregulation 2E(1) provides for a kind of collaborative arrangement where an eligible midwife must record certain specified information regarding a patient in the midwife’s written records. This is a kind of collaborative arrangement for the purposes of the definition of participating midwife in subsection 3(1) of the Act (see paragraph 2C(1)(d)).

 

Paragraph 2E(1)(a) requires the midwife to record the name of at least one specified medical practitioner who the midwife is, or will be, collaborating with in the patient’s care (the ‘named medical practitioner’).

 

Paragraph 2E(1)(b) requires the midwife to record that he or she has informed the patient that he or she will be providing services in a collaborative arrangement.

 

Paragraph 2E(1)(c) requires the midwife to record an acknowledgement by the named medical practitioner that he or she will be collaborating in the patient’s care.

 

Paragraph 2E(1)(d) requires the midwife to record plans for the circumstances in which the midwife will consult with an obstetric specified medical practitioner, refer the patient to a specified medical practitioner, and transfer the patient to an obstetric specified medical practitioner.

 

Subregulation 2E(2) provides that the midwife must also record the matters referred to in paragraphs 2E(2)(a) to (g) in the midwife’s written records. These matters must be recorded as the patient’s pregnancy progresses, for the midwife to continue to be rendering services in a collaborative arrangement.

 

Paragraph 2E(2)(a) requires the midwife to record any consultation or other communication between the midwife and an obstetric specified medical practitioner about the patient’s care.

 

Paragraph 2E(2)(b) requires the midwife to record any referral of the patient by the midwife to a specified medical practitioner.

 

Paragraph 2E(2)(c) requires the midwife to record any transfer of the patient’s care by the midwife to an obstetric specified medical practitioner.

 

Paragraph 2E(2)(d) requires the midwife to record an acknowledgement that a named medical practitioner has received, from the midwife, a copy of a hospital booking letter (however described) for the patient.

 

Paragraph 2E(2)(e) requires the midwife to record an acknowledgement that a named medical practitioner has received, from the midwife, a copy of the maternity care plan that the midwife has prepared for the patient.

 

Paragraph 2E(2)(f) requires the midwife to record that the midwife has given the named medical practitioner the results of any diagnostic imaging or pathology services that the midwife has requested for the patient.

 

Paragraph 2E(2)(g) requires the midwife to record that, following the end of the midwife’s care of the patient, the midwife has given a discharge summary (however described) to a named medical practitioner and to the patient’s usual general practitioner.

 

Regulation 2F Collaborative arrangements – participating nurse practitioners

 

The definition of ‘participating nurse practitioner’ in subsection 3(1) of the Act requires an eligible nurse practitioner to render a service in a collaborative arrangement of a kind or kinds specified in the regulations, with one or more medical practitioners of a kind or kinds specified in the regulations (emphasis added).

 

Subregulation 2F(1) specifies the kinds of collaborative arrangements for the purposes of the definition of participating nurse practitioner.

 

Nurse practitioner employed or engaged by a medical practice

 

Paragraph 2F(1)(a) provides for a kind of collaborative arrangement where the eligible nurse practitioner is employed or engaged by one or more specified medical practitioners or by an entity that employs or engages one or more specified medical practitioners. The reference to ‘employs or engages’ covers both employees and contractors. This covers an eligible nurse practitioner who is employed or engaged by a medical practice so long as that medical practice employs or engages at least one medical practitioner.

 

Nurse practitioner receiving patients on referral from a specified medical practitioner

 

Paragraph 2F(1)(b) provides that an eligible nurse practitioner is in a collaborative arrangement if a specified medical practitioner refers a patient in writing to the nurse practitioner for treatment.

 

Signed agreement and nurse practitioner’s written records

 

The two kinds of collaborative arrangement specified at paragraphs 2F(1)(c) and (d) are described in more detail in the item-by-item description for regulations 2G and 2H, respectively.

 

Subregulation 2F(2) provides that each kind of collaborative arrangement specified in subregulation 2F(1) must provide for: consultation between the nurse practitioner and a medical practitioner; referral of patients to a medical practitioner; and transfer of a patient’s care to a medical practitioner.

 

Subregulation 2F(2) ensures that all kinds of collaborative arrangement must deal with the issues of how collaboration is to occur regarding consultation, referral and transfer.

 

Subregulation 2F(3) provides that a collaborative arrangement of a kind specified in paragraph 2F(1)(a), (b) or (c) may apply to more than one patient. Subregulation 2F(3) does not provide that a collaborative arrangement of a kind specified in paragraph 2F(1)(d) (mentioned in regulation 2H) can apply to more than one patient. The kind of collaborative arrangement mentioned in regulation 2H (nurse practitioner’s written records) contain elements which must be patient specific, so a separate collaborative arrangement must exist for each patient.

 

However, subregulation 2F(4) provides that the acknowledgement from a medical practitioner mentioned in paragraph 2H(1)(c) may apply to more than one patient. This has the effect that, although the kind of collaborative arrangement mentioned in regulation 2H (nurse practitioner’s written records) is specific to a patient, a nurse practitioner can obtain an acknowledgement from a medical practitioner that he or she collaborate with the nurse practitioner for more than one of the nurse practitioner’s patients. This means that the nurse practitioner does not have to obtain a separate acknowledgement for every patient.

 


Regulation 2G Agreement between eligible nurse practitioner and 1 or more specified medical practitioners

 

Subregulation 2G(1) provides that an agreement may be made between an eligible nurse practitioners and one or more specified medical practitioners. This agreement is a kind of collaborative arrangement for the purposes of the definition of participating nurse practitioner in subsection 3(1) of the Act (see paragraph 2F(1)(c) above).

 

Subregulation 2G(2) provides that the agreement must be in writing and signed by the eligible nurse practitioner and each specified medical practitioner who is a party to the agreement.

 

Regulation 2H Arrangement – nurse practitioner’s written records

 

Subregulation 2H(1) provides for a kind of collaborative arrangement where an eligible nurse practitioner must record certain specified information regarding a patient in the nurse practitioner’s written records. This is a kind of collaborative arrangement for the purposes of the definition of participating nurse practitioner in subsection 3(1) of the Act (see paragraph 2F(1)(d) above).

 

Paragraph 2H(1)(a) requires the nurse practitioner to record the name of at least one specified medical practitioner who the nurse practitioner is, or will be, collaborating with in the patient’s care (a ‘named medical practitioner’).

 

Paragraph 2H(1)(b) requires the nurse practitioner to record that he or she has informed the patient that he or she will be providing services in a collaborative arrangement.

 

Paragraph 2H(1)(c) requires the nurse practitioner to record an acknowledgement by a named medical practitioner that he or she is collaborating with in the patient’s care.

 

Paragraph 2H(1)(d) requires the nurse practitioner to record plans for the circumstances in which the nurse practitioner consults with a medical practitioner, refers the patient to a medical practitioner, and transfers the patient’s care to a medical practitioner.

 

Paragraph 2H(1)(e) requires the nurse practitioner to record any consultation or other communication between the nurse practitioner and a medical practitioner about the patient’s care.

 

Paragraph 2H(1)(f) requires the nurse practitioner to record any transfer of the patient’s care by the nurse practitioner to a medical practitioner.

 

Paragraph 2H(1)(g) requirs the nurse practitioner to record any referral of the patient by the nurse practitioner to a medical practitioner.

 

Paragraph 2H(1)(h) requires that, if the nurse practitioner gives a copy of a document mentioned in subregulations 2H(2) or (3) to a named medical practitioner – when the copy is given.

 

Paragraph 2H(1)(i) requires that, if the nurse practitioner gives a copy of a document mentioned in subregulations 2H(4) or (5) to the patient’s usual general practitioner – when the copy is given.

 

Subregulation 2H(2) provides that if the nurse practitioner refers the patient to a specialist or consultant physician, or if the nurse practitioner requests diagnostic imaging or pathology services for the patient, the nurse practitioner must give a copy of the referral, or the results of the services, to a named medical practitioner if: the nurse practitioner consults, refers the patient to, or transfers the patient’s care to the named medical practitioner; and the named medical practitioner asks the nurse practitioner for a copy of the referral or results.

 

Subregulation 2H(3) provides that the nurse practitioner must give a named medical practitioner a record of the services provided by the nurse practitioner to the patient if: the nurse practitioner consults, refers the patient to, or transfers the patient’s care to the named medical practitioner; and the named medical practitioner asks the nurse practitioner for the record.

 

Subregulation 2H(4) provides that if the nurse practitioner refers the patient to a specialist or consultant physician, or if the nurse practitioner requests diagnostic imaging or pathology services for the patient, and the patient’s usual medical practitioner is not a named medical practitioner, the nurse practitioner must give a copy of the referral, or the results of the services, to the patient’s usual general practitioner.

 

Subregulation 2H(5) provides that if the patient’s usual general practitioner is not a named medical practitioner, the nurse practitioner must give the patient’s usual general practitioner a record of the services provided by the nurse practitioner to the patient.

 

Subregulation 2H(6) provides that subregulations 7(4) and (5) only apply if the patient consents.

 

Item [7] – After regulation 14

 

This item inserts into the Principal Regulations, a new regulation 14A, which relates to the definition of ‘eligible midwife’ in paragraph 21(1)(b) of the Act.

 

The Act (as amended by the Amendment Act) allows midwives who satisfy the definition of ‘participating midwife’ to render services to patients for which Medicare benefits are payable.

 

The definition of ‘participating midwife’ in subsection 3(1) gives the Minister for Health and Ageing (the Minister) the option to approve a common form of undertaking for eligible midwives under section 21A of the Act. The Minister has not approved a common form of undertaking under section 21A.

 

Thus, a ‘participating midwife’ is defined in section 3(1) as an ‘eligible midwife’ so far as the eligible midwife renders a service in a collaborative arrangement of a kind or kinds specified in the regulations, with one or more medical practitioners of a kind or kinds specified in the regulations. See item [6] above for new regulations providing for collaborative arrangements with a specified medical practitioner for the purposes of the definition of ‘participating midwife’.

 

Subsection 21(1) of the Act provides that ‘eligible midwife’ means a person who is a ‘midwife’ and who meets the additional requirements specified in a regulations made for the purpose of paragraph 21(1)(b). If there are no regulations in force under paragraph 21(1)(b), a person cannot be an ‘eligible midwife’ for the purposes of the Act (subsection 21(2)).

 

A ‘midwife’ is a person who has been registered or authorised (however described) to practise midwifery under state or territory law (subsection 3(1) of the Act).

 

New regulation 14A provides that a person only satisfies the definition of ‘eligible midwife’ for the purposes of the Act if they meet a registration standard for an eligible midwife developed by the Nursing and Midwifery Board of Australia (the Board) for the purpose of section 38(2) of the National Law.

 

The National Law is set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) and is the means of implementing the National Registration and Accreditation Scheme for health professionals.

 

In order to satisfy the requirements in the new regulation 14A, a midwife must demonstrate to Medicare Australia that he or she meets a registration standard for an eligible midwife developed by the Board for the purposes of subsection 38(2) of the National Law. This will be done by the midwife providing evidence that he or she satisfies the Board that he or she has the relevant qualifications and experience required by the registration standard. The Board may notate the Register of Midwives, provide a letter of assessment or other form of evidence once satisfied that the standard has been met.

 

The current registration standard for eligible midwives is made under subsection 38(2) of the National Law and contains requirements relating to a midwife's qualifications and experience. This standard was approved by the Australian Health Workforce Ministerial Council and is publicly available on the Board’s website at: http://www.nursingmidwiferyboard.gov.au/index.php .

 

Schedule 2 – Amendments commencing on 1 November 2010

 

Item [1] – Regulation 2, definition of provider number, paragraph (a)

 

This item omits the phrase ‘an approved pathology practitioner or an optometrist’ from paragraph (a) of the definition of ‘provider number’ in regulation 2 of the Principal Regulations and inserts ‘approved pathology practitioner, optometrist, participating midwife or participating nurse practitioner’. This amendment is made to extend the definition of ‘provider number’ to include numbers allocated by the Medicare Australia Chief Executive Officer to participating midwives and participating nurse practitioners.

 

Item [2] – Regulation 2, definition of referring practitioner, paragraph (c)

 

This item omits ‘dental practitioner.’ from paragraph (c) of the definition of referring practitioner in regulation 2 of the Principal Regulations and inserts ‘dental practitioner’; and provide for the insertion of new paragraphs (d) and (e) into the definition of ‘referring practitioner’ (see item [3] below).

 


Item [3] – Regulation 2, definition of referring practitioner, after paragraph (c)

 

This item inserts new paragraphs (d) and (e) into the definition of ‘referring practitioner’ in regulation 2 of the Principal Regulations in order to extend the definition of ‘referring practitioner’ to include, respectively, participating midwives and participating nurse practitioners.

 

The purpose of this amendment is to allow relevant specialists and consultant physicians to claim a higher (‘specialist’) Medicare rebate for Medicare services, where a higher specialist rebate is applicable, and the patient has been referred by a participating midwife or a participating nurse practitioner.

 

A participating midwife is a ‘referring practitioner’ if the referral arises out of a midwifery service provided by a participating midwife and is to an obstetrician or a paediatrician. A participating nurse practitioner is a ‘referring practitioner’ if the referral arises out of a nurse practitioner service provided by a participating nurse practitioner and is to a specialist or consultant physician.

 

Item [4] – Regulation 2, definition of treatment provider, paragraph (c)

 

This item omits ‘optometrist’ from paragraph (c) of the definition of ‘treatment provider’ in regulation 2 of the Principal Regulations and inserts ‘optometrist; or’ to provide for the insertion of new paragraphs (d) and (e) into the definition of ‘treatment provider’ (see

item [5] below).

 

Item [5] – Regulation 2, definition of treatment provider, after paragraph (c)

 

This item inserts new paragraphs (d) and (e) into the definition of ‘treatment provider’ in regulation 2 of the Principal Regulations in order to extend the definition of ‘treatment provider’ to include, respectively, participating midwives and participating nurse practitioners.

 

Item [6] – Regulation 3A, table, after item 8

 

This item inserts a new item 8A in the table in regulation 3A of the Principal Regulations in order to prescribe ‘midwifery’ services as a kind of health service for the purposes of the definition of ‘health service’ in subsection 3C(8) of the Act.

 

This amendment allows the Minister to determine under subsection 3C(1) of the Act that specified midwifery services shall be treated as if they were professional services and as if they were items in the general medical services table, the pathology services table or the diagnostic imaging services table (as appropriate) for the purposes of the Act and Regulations under the Act. New Medicare items for patients of participating midwives are for creation through a determination under subsection 3C(1) of the Act.

 

Item [7] – Regulation 3A, table, after item 9

 

This item inserts a new item 9A in the table in regulation 3A in order to prescribe ‘nurse practitioner services’ as a kind of health service for the purposes of the definition of ‘health service’ in subsection 3C(8) of the Act.

 

This amendment allows the Minister to determine under subsection 3C(1) that specified nurse practitioner services shall be treated as if they were professional services and as if they were items in the general medical services table, the pathology services table or the diagnostic imaging services table (as appropriate) for the purposes of the Act and regulations under the Act. New Medicare items for patients of participating nurse practitioners are for creation through a determination under subsection 3C(1) of the Act.

 

Item [8] – Regulation 9A

 

This item substitutes a new regulation 9A for the current regulation 9A, which relates to identifying the practitioner who has made a request for pathology services by electronic means. This amendment is made to extend regulation 9A to include requests for pathology services made electronically by participating midwives and participating nurse practitioners, and to make the regulation more reader-friendly.

Item [9] – After subregulation 13(1B)

 

Regulation 13 sets out the particulars that must be recorded in relation to services in order for Medicare benefits to be payable for those services.

 

This item inserts a new subregulation 13(1C) which prescribes certain particulars that must be recorded in order for a Medicare benefit to be payable (assuming all other necessary requirements have been met) in respect of a service provided by a participating midwife or a participating nurse practitioner.

 

Item [10] – After subregulation 13(8)

 

This item inserts new subregulations 13(8A) and 13(8B) which have the combined effect that if a participating midwife or a participating nurse practitioner attends a person more than once on the same day, on each occasion providing a service to that person, the time that each attendance starts is also a prescribed particular that must be recorded in order for Medicare benefits to be payable in respect of each service.

Item [11] – Paragraph 13(9)(a)

 

Subregulation 13(9) prescribes certain particulars that must be recorded in relation to services to which an item in the pathology services table relates.

 

This item omits ‘practitioner’ from paragraph 13(9)(a) and inserts ‘practitioner, participating midwife or participating nurse practitioner’ in order to extend the paragraph to include participating midwives and participating nurse practitioners. This amendment requires certain particulars to be recorded for pathology services requested by a participating midwife or a participating nurse practitioner.

 

Item [12] – Subregulation 13(13)

 

This item substitutes the current subregulation 13(13), which prescribed certain particulars that must be recorded in respect of certain professional services, with new

subregulations 13(13) and 13(13A). This amendment is made to extend the requirement to record these prescribed particulars, where they should apply, in respect of services provided by participating midwives and participating nurse practitioners, and to make the regulation more reader-friendly.

 

Item [13] – Subparagraph 20(2)(c)(i)

 

Regulation 20 relates to records of diagnostic imaging services that must be kept by providing medical practitioners.

 

This item omits ‘a physiotherapist or a podiatrist’ from subparagraph 20(2)(c)(i) and inserts ‘a physiotherapist, a podiatrist, a participating midwife or a participating nurse practitioner’ in order to extend the definition of ‘requesting practitioner’, for the purposes of regulation 20, to include participating midwives and participating nurse practitioners.

 

The effect of this amendment is that providing medical practitioners are required to keep certain records in relation to diagnostic imaging services requested by participating midwives and participating nurse practitioners.

Item [14] – Paragraph 25A(1)(b)

 

This item omits ‘medical practitioner’ from paragraph 25A(1)(b) and inserts ‘medical practitioner or participating midwife’. This amendment is made in order to extend the circumstances where it is an offence for a person mentioned in subsection 128C(2) of the Act to charge a fee or receive any payment or consideration in respect of a obstetric public hospital service provided to a public hospital patient, to include the provision of an ‘obstetric service’ provided by, or on behalf of, a participating midwife. The penalty for this offence is 50 penalty units.

Item [15] – Regulation 25A, example

 

This item omits the phrase ‘by a medical practitioner’ from the example at the end of regulation 25A and insert ‘by a medical practitioner or participating midwife’ in order to extend the example to cover booking fees or requests for payment by a participating midwife or a person acting on behalf of a participating midwife.

Item [16] – Subregulation 29(4A)

 

This item omits each mention of ‘general practitioner’ from subregulation 29(4A) and inserts ‘general practitioner, participating midwife or participating nurse practitioner’.

 

The effect of this amendment is that if the referring practitioner is a specialist or consultant physician, then the referral must be endorsed with the name of the general practitioner, participating midwife or participating nurse practitioner nominated by the patient.

 

The amendment also has the effect that if the patient is unwilling or unable to nominate a general practitioner, participating midwife or participating nurse practitioner, the referral must contain a statement to that effect.

 

 


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