Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) REGULATIONS 2002 2002 NO. 244

EXPLANATORY STATEMENT

STATUTORY RULES 2002 No. 244

Issued by the Authority of the Minister for Health and Ageing

Health Insurance Act 1973

Health Insurance (General Medical Services Table) Regulations 2002

Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations prescribing matters for the purposes of the Act.

The Act provides for payments of Medicare benefits in respect of professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services, including diagnostic imaging services, set out in prescribed Tables.

Subsection 4(1) of the Act provides that the regulations may prescribe a table of medical services (other than diagnostic imaging services and pathology services) that sets out items of medical services, the amount of fees applicable in respect of each item and rules for interpretation of the table. Subsection 4(2) provides that, unless sooner repealed, regulations made under Section 4 cease to be in force and are taken to be repealed on the day next following the 15th sitting day of the House of Representatives, after the expiration of a period of 12 months commencing on the day on which the regulations are notified in the Gazette.

The purpose of the Regulations is to repeal the Health Insurance (General Medical Services Table) Regulations 2001 and to prescribe a table of medical services for the 12 month period commencing on 1 November 2002, which sets out the items of medical services which are eligible for Medicare benefits, the amount of fees applicable in respect of each item and rules for interpretation of the table.

The new table replaces the table contained in the Health Insurance (General Medical Services Table) Regulations 2001.

The Regulations contain the following changes made as part of the ongoing management of the General Medical Services Table:

•       a 2.5% increase in Schedule fees will apply to all items in Group A1 (General Practitioner attendances) and equivalent attendance items such as items in Group A18 relating to the taking of a cervical smear, and treatment for asthma and diabetes;

•       no increase in the Schedule Fees for items in Group A2 (other non-referred attendances), Group A6 (group therapy), item 173 in Group A7 (acupuncture), Group A19 (PIP incentive payments, other non-referred);

•       a 2.5% increase will apply to all other items in the General Medical Services Table; and

•       a decrease in the unit fee for anaesthetic items from $17.15 to $16.50 will apply to achieve cost-neutrality under the Relative Value Guide (RVG) for Anaesthesia which was introduced on 1 November 2001.

The Regulations also incorporate changes to items in the table resulting from ongoing reviews by the Medicare Benefits Consultative Committee. These reviews are designed to ensure that the table reflects current medical practice and encourages best practice.

The changes to the General Medical Services Table include:

•       a range of new items for telepsychiatry, which is defined as a psychiatric service delivered by electronic transmission in rural and remote areas;

•       new items specifically for case conferencing by psychiatrists;

•       new breast surgery items for the Advanced Breast Biopsy Instrumentation procedure;

•       new items in relation to emergency medicine attendances;

•       items relating to the 3 Step Mental Health Process, previously included in a Ministerial Determination made under Section 3C of the Act have been incorporated;

•       new items for the delivery of Focussed Psychological Strategies;

•       a number of items have been amended, for example, urology item 11918 has been split into two items, 11917 and 11918 to define the types of procedures being performed, and vascular surgery items 32504, 32507, 32508, 32511, 32514 and 32517 have had their descriptions improved for clarification purposes; and

•       obsolete services, for example, Ear, Nose and Throat items 41602 and 41605, have been deleted.

Details of the Regulations are set out in the Attachment.

The Regulations commence on 1 November 2002.

ATTACHMENT

DETAILS OF THE HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) REGULATIONS 2002

Regulation 1 provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Regulations 2002.

Regulation 2 provides for the Regulations to commence on 1 November 2002.

Regulation 3 provides for the repeal of the Health Insurance (General Medical Services Table) Regulations 2001.

Regulation 4 provides definitions for the purposes of the Regulations.

Regulation 5 prescribes the new Table of general medical services and rules of interpretation as set out in Schedule 1.

The General Medical Services Table is redrafted each year commencing on the first of November. The redraft takes the form of duplicating all rules and services that have not been changed or amended from the previous Regulations. Listed below are the amendments (including new items) that have been agreed to by the Minister for Health and Ageing relating to reviews undertaken by the Department with the medical profession.

Schedule 1 - Table of General Medical Services

Part 2 - Rules of Interpretation

Rules 2 to 24 have been renumbered to allow existing Rule 1A to be renumbered as Rule 2. Because Rule 25 has been deleted as explained in this Attachment, the numbering of Rules 26 to 55 remains the same. Existing Rule 55A has been renumbered as Rule 56, and existing rules that follow have been renumbered as required. New Rules 68 to 74 have been inserted as explained in this Attachment. All future references to amended rules take the new numbers.

Subrule 6 (1) has been amended to include new emergency medicine attendance items 501 to 536 and new 3 Step Mental Health Process and Focussed Psychological Strategies items 2704 to 2727 in the range of items for the meaning of 'professional attendance'.

Rules 10 and 11 have been expanded by adding a new subrule (4) in each case to take into account that in relation to specific items 353 to 358 a telepsychiatry consultation is taken to be a personal attendance by the medical practitioner on the patient.

Existing Rule 25 has been deleted, as it has become obsolete following the introduction of the Relative Value Guide (RVG) for Anaesthesia.

Rule 56 (previously 55A) has been amended by clarifying and renumbering the requirements of subrule (2) to convey that:

•       measurement of HbA1c must be done at least once every year;

•       weight and height must be measured and BMI calculated at the initial visit as part of the initial patient assessment, but for subsequent visits only weight needs to be measured at least once every six months;

•       blood pressure must be measured at least once every six months; and

•       microalbuminuria must be tested at least once every year.

Other requirements have been renumbered accordingly.

Rule 57 has been amended following recent revision of the table of the National Asthma Council's (NAC) recommended Asthma 3+ Visit Plan, by re-ordering and renumbering the requirements of subrule (2) to:

•       emphasise that documented diagnosis and documented assessment of severity occurs at the outset;

•       ensure that the two recalls specified are planned at a consultation that is part of the 3+ Visit Plan; and

•       offer an alternative method of providing an asthma action plan where a patient is unable to use a written plan.

Other requirements have been renumbered accordingly.

A new Rule 68 has been inserted entitled 'Restriction of Telepsychiatry consultations to rural and remote areas' to specify that use of new telepsychiatry items 353 to 358 applies only to consultations provided in designated areas.

A new Rule 69 has been inserted entitled 'Meaning of recognised emergency department and problem focussed history' in the new Group A21 items for emergency physician attendances to:

•       specify that the emergency department of a private hospital in which the services are rendered must be licensed to operate under the relevant State or Territory law; and

•       define 'problem focussed history' as a history focussing on the medical condition of the patient that necessitates the patient presenting for emergency attention.

A new Rule 70 has been inserted entitled 'Prolonged attendances by emergency physicians' to define the requirements of an attendance for emergency evaluation of a critically ill patient with an immediately life threatening problem in relation to items 519 to 536.

A new Rule 71 has been inserted entitled 'Application of Subgroup 4 of Group A18 and Subgroup 4 of Group A19' which outlines for the 3 Step Mental Health Process:

•       the registration, training and skills requirements of practitioners;

•       the frequency at which services may be provided; and

•       the procedures which must be followed to meet the minimum requirements of the process.

The terms 'mental health disorder', 'outcome measurement tool' and 'written mental health plan' are also defined in relation to these sub-groups of items.

A new Rule 72 entitled 'Focussed Psychological Strategies' has been inserted, stating that items in Group A20 apply only to services that are clinically indicated under the 3 Step Mental Health Process and outlines:

•       the registration, training and skills requirements of practitioners;

•       the requirement that the services may only be provided in a general practice that participates in the Practice Incentives Program or is an accredited general practice that is not participating in the Program;

•       the frequency at which services may be provided; and

•       the description of the strategies derived from evidence-based psychological therapies which may be provided.

The term 'general practice' is also defined in relation to this group of items.

A new Rule 73 has been inserted to clarify that the meaning of a 'qualified surgeon' in items 31539 and 31545 relates to written advice from the Royal Australasian College of Surgeons that the person meets the skills requirements for providing services in relation to the items.

A new Rule 74 has been inserted to clarify that the meaning of a 'qualified radiologist' in item 31542 relates to written advice from the Royal Australian and New Zealand College of Radiologists that the person meets the skills requirements for providing services in relation to the item.

In addition to the above amendments, minor drafting changes to rules have been made for correction and clarification.

Part 3 - Services and Fees

Reviews of the services in the Table undertaken since November 2001 relate to case conferencing by consultant psychiatrists, telepsychiatry, emergency medicine, asthma and diabetes (rule changes only), mental health, ophthalmology, urology, anaesthesia, breast surgery, vascular surgery, cardiovascular conditions, ear, nose and throat surgery and neurosurgery.

Case Conferencing by Consultant Psychiatrists

A new range of case conferencing items (855, 857, 858, 861, 864 and 866) specifically for psychiatrists has been introduced with a requirement for three formal care providers instead of four as with existing case conferencing items for consultant physicians.

Telepsychiatry

Ten new telepsychiatry items (353, 355, 356, 357, 358, 364, 366, 367, 369, 370) has been introduced for referred consultations via telepsychiatry for assessment, diagnosis and treatment for patients located in rural and remote areas and appropriate cross-referencing to existing consultant psychiatrist attendance items 300 to 319 is included.

Emergency Medicine

Five new items (501, 503, 507, 511, 515) have been included for emergency physicians practising in private emergency medicine departments. The new items are content based and align with emergency medicine practice in terms of complexity of care.

A further range of items (519, 520, 530, 532, 534, 536) has been introduced for emergency physicians for prolonged attendances in the treatment of critical conditions. The new items allow emergency physicians to attend to a number of critical patients concurrently.

Mental Health

A new Subgroup 4 for items relating to the 3 Step Mental Health Process has been included under Group A18 GP Attendance Associated with PIP Incentive Payments. New items 2574 - 2578 have been introduced in this Subgroup to outline the requirements for completion of the 3 Step Mental Health Process by a general practitioner, before PIP payments can be claimed.

A new Subgroup 4 for items relating to the 3 Step Mental Health Process has also been included under Group A19 Other Non-referred Attendances Associated with PIP Incentive Payments. New items 2704 - 2708 have been introduced in this Subgroup to outline the requirements for completion of the 3 Step Mental Health Process when the practitioner is a medical practitioner practising in general practice, not being a general practitioner, specialist or consultant physician, before PIP payments can be claimed.

A new Group A20 for items relating to Focussed Psychological Strategies has been included and four new items numbered 2721 - 2727 have been inserted covering the requirements for delivery of Focussed Psychological Strategies by both general practitioners and other medical practitioners practising in general practice, not being specialists or consultant physicians.

Ophthalmology

Items 11240 - 11243 have been amended by inserting the word 'unidimensional' after 'ultrasonic echography of' to correct a previous omission.

Item 42809 has been amended by adding the words 'not being a service associated with photodynamic therapy with verteporfin' at the end of the descriptor. This amendment introduces restrictions on existing items being inappropriately used for Photodynamic therapy.

Urology

Item 11918 has been split into a new item 11917 and a modified item 11918 to more clearly define the types of diagnostic imaging services which are being performed.

Item 11918 has been amended by substituting 'contrast micturating cystourethrography' for 'imaging' in line 1, and substituting 'including all associated imaging by any approach' for 'including all imaging associated with cystemotography' in line 5. The list of items referred to at the end of the descriptor has been amended to include reference to the new item 11917.

Items 37203 - 37208 have been amended to include a reference to two new items, 37201 and 37202, approved under a Ministerial Determination under Section 3C of the Act to implement the Minister's decision to accept a Medical Services Advisory Committee recommendation for transurethral needle ablation of the prostate. Items 37203 and 37207 have been amended by including '37201, 37202,' in the sequence of numbers at the end of their descriptors. Items 37206 and 37208 have been amended by including '37201' in the sequence of numbers at the end of their descriptors.

Anaesthesia

Item 11600 has been amended by adding the words 'and where not performed in association with the administration of anaesthesia' immediately after 'item 13876 applies'. The reference to '(Anaes)' has been removed.

Item 11601 has been deleted because it is now redundant.

Items 16515 - 16573 in Group T4 - Obstetrics have been amended to include '(Anaes.)' at the end of their descriptors. This amendment corrects a previous omission when the Relative Value Guide (RVG) was introduced, and will facilitate the claiming of benefits for anaesthesia in association with these services.

Items 18216, 18219, 18230, 18232, 18233, 18234, 18236, 18242, 18262, 18280, 18284, 18286, 18288, 18290, 18292, 18294, 18296 and 18298 in Group T7 - Regional or Field Nerve Blocks have been amended to include '(Anaes.)' at the end of their descriptors, to facilitate the claiming of benefits for anaesthesia in association with these services.

Two new items numbered 18226 and 18227 have been introduced to cover obstetric epidurals provided in the after hours period .

Relative Value Guide for Anaesthesia (RVG)

The fees for all items (20100 - 25205) in Group T10 - Relative Value Guide for Anaesthesia have been amended because the unit fee for RVG services has been reduced from $17.15 to $16.50 to maintain cost neutrality, in accordance with the Anaesthetic Agreement between the Australian Society of Anaesthetists, the Australian Medical Association, the Rural Doctors Association of Australia and the Commonwealth.

Two new items 20799 and 20886 have been introduced for upper and lower percutaneous abdominal procedures because the RVG does not currently cover anaesthesia in relation to these procedures.

Item 20855 has been amended to include the words 'or hysterectomy within 24 hours of delivery' at the end of the descriptor, because the RVG does not currently cover anaesthesia in relation to hysterectomy within 24 hours of delivery.

Breast Surgery

Items in Sub-Group 1 of Group T8 Surgical Operations have been re-numbered to allow space for three new Advanced Breast Biopsy Instrumentation (ABBI) items numbered 31539, 31542 and 31545 which cover the radiological and surgical components of the ABBI procedure.

Re-numbered item 31530 has been amended by adding the words 'not being a service associated with a service to which item 31539, 31545 or 31548 applies' to the end of the descriptor to prevent its use in association with the ABBI procedure.

Re-numbered item 31536 has been amended by adding the words 'not being a service associated with a service to which item 31539, 31542 or 31545 applies' to the end of the descriptor to prevent its use in association with the ABBI procedure.

Re-numbered item 31548 has been amended by adding the words 'not being a service associated with a service to which item 31530, 31539 or 31545 applies' to the end of the descriptor to prevent its use in association with the ABBI procedure.

Vascular Surgery

Minor amendments have been made to several vascular surgery items to clarify the original intent of the items.

Items 32504 and 32507 have been amended by adding 'in relation to the same leg' to the end of the descriptor.

Items 32508 and 32511 have been amended by adding 'on the same leg, for the first time' in lines 4/5 of the descriptor.

Items 32514 and 32517 have been amended by adding 'on the same leg' after 'saphenous vein' in line 1 of each of the items.

Item 33806 has been amended to add 'including the infusion of thrombolytic or other agents' immediately after 'thrombectomy' in line 1, to clarify that the infusion of such agents, where necessary, is already covered by the item.

Items 35317, 35319, 35320 and 35321 have been amended by adding the words 'and not being a service associated with photodynamic therapy with verteporfin' at the end of their descriptors. This amendment introduces restrictions on existing items being inappropriately used for Photodynamic therapy.

Cardiovascular Conditions

Three new items 38498, 38501 and 38504 have been inserted for Off-Pump Coronary Artery Bypass (OPCAB) and Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) surgery procedures using either vein grafts, single arterial grafts or two or more arterial grafts.

Item 38497 has been amended by adding the words 'with cardiopulmonary bypass' after 'Coronary artery bypass' in line 1, and 'not being a service associated with a service to which item 38498, 38500, 38501, 38503 or 38504 applies' at the end of the descriptor.

Item 38500 has been amended by adding the words 'with cardiopulmonary bypass' after 'Coronary artery bypass' in line 1, and 'not being a service associated with a service to which item 38497, 38498, 38501, 38503 or 38504 applies' at the end of the descriptor.

Item 38503 has been amended by adding the words 'with cardiopulmonary bypass' after 'Coronary artery bypass' in line 1, and 'not being a service associated with a service to which item 38497, 38498, 38500, 38501, or 38504 applies' at the end of the descriptor.

This will exclude the use of the items when an off-pump procedure is performed and cardio-pulmonary bypass is not required. Off-pump procedures will now be covered by the new items 38498, 38501 and 38504.

Ear, Nose and Throat Surgery

Items 41602 and 41605 relating to fenestration operation and venous graft to fenestration cavity have been deleted because they are now obsolete.

Neurosurgery

Items 39134 and 40801 have been amended by adding 'not being a service associated with deep brain stimulation for Parkinson's Disease' at the end of their descriptors to prevent use of these items for the deep brain stimulation procedure (DBS), instead of the appropriate DBS items 40850 - 40862 which are approved under a Ministerial Determination under Section 3C of the Act.

Miscellaneous Diagnostic Procedures

Item 13915 has been amended by adding the words 'not being a service associated with photodynamic therapy with verteporfin' at the end of the descriptor. This amendment introduces restrictions on existing items being inappropriately used for Photodynamic therapy.

In addition to the above amendments, minor drafting changes to items have been made for correction and clarification.


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