Health Insurance (Allied Health Services) Amendment (Eating Disorders) Determination 2019

 

I, Elizabeth Dowd, delegate of the Minister for Health, make the following determination.

Dated       9 October 2019   

Elizabeth Dowd

Assistant Secretary

MBS Policy and Specialist Services Branch

Medical Benefits Division

Health Financing Group

Department of Health

 

 

 

 

Contents

  

1  Name  

2  Commencement 

3  Authority  

4  Schedules  

Schedule 1— Amendments commencing 1 November 2019

Schedule 2— Amendments commencing 1 January 2020


1  Name

  This instrument is the Health Insurance (Allied Health Services) Amendment (Eating Disorders) Determination 2019.

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

1.  Sections 1 to 4 and anything in this instrument not elsewhere covered by this table

The day after the instrument is registered.

 

2. Schedule 1

1 November 2019.

 

3. Schedule 2

1 January 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 Note: This table relates only to the provisions of this instrument as originally made.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  Schedules

 

Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

 


Schedule 1— Amendments commencing 1 November 2019

 

 

Health Insurance (Allied Health Services) Determination 2014

 

1  Subsection 4(1) (after the definition of disability treatment and management plan)

Insert:

eating disorder dietetic treatment service means a service to which any of items 10954, 82350 and 82351 applies.

eating disorder psychological treatment service has the same meaning as in the Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019. 

eating disorder treatment and management plan has the same meaning as in the Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019.

 

2  Subsection 4(1) (after the definition of eligible osteopath)

Insert:

eligible patient has the same meaning as in the Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019. 

 

3  After section 6A

Insert:

6AA  Limitations on eating disorders items

(1) For an item in Subgroup 2 of Part 8 of Schedule 2, an eating disorder psychological treatment service must involve the provision of any of the following mental health care management strategies:

(a)          family based treatment (including whole family, parent based therapy, parent only or separated therapy)

(b)         adolescent focused therapy;

(c)          cognitive behavioural therapy;

(d)         cognitive behavioural therapy-anorexia nervosa;

(e)          cognitive behavioural therapy for bulimia nervosa and binge-eating disorder;

(f)          specialist supportive clinical management;

(g)         maudsley model of anorexia treatment in adults;

(h)         interpersonal therapy for bulimia nervosa and binge-eating disorder;

(i)           dialectical behavioural therapy for bulimia nervosa and binge-eating disorder;

(j)           focal psychodynamic therapy.

(2) An item in Subgroup 2 of Part 8 of Schedule 2 does not apply to:

(a)          a service which:

(i)                     is provided to a patient who, in 12 month period from the provision of an eating disorder treatment and management plan, has already been provided with 10 eating disorder psychological treatment services; and

(ii)                   is provided before a medical practitioner has conducted a patient review (the first review) of the eating disorder treatment and management plan and recorded in the patient’s records the medical practitioner’s recommendation that the patient have additional eating disorder psychological treatment services in the same 12 month period; and

(b)         a service which:

(i)                     is provided to a patient who, in 12 month period from the provision of an eating disorder treatment and management plan, has already been provided with 20 eating disorder psychological treatment services; and

(ii)                   is provided before a medical practitioner in general practice (not including a specialist or consultant physician) has conducted a patient review (the second review) of the eating disorder treatment and management plan and recorded in the patient’s records the medical practitioner in general practice’s recommendation that the patient have additional eating disorder psychological treatment services in the same 12 month period; and

(iii)                 is provided before a consultant physician practising in the specialty of psychiatry or paediatrics has conducted a patient review (the third review) of the eating disorder treatment and management plan and recorded in the patient’s records the consultant physician’s recommendation that the patient have additional eating disorder psychological treatment services in the same 12 month period; and

(c)          a service which:

(i)                     is provided to a patient who, in 12 month period from the provision of an eating disorder treatment and management plan, has already been provided with 30 eating disorder psychological treatment services; and

(ii)                   is provided before a medical practitioner has conducted a patient review (the fourth review) of the eating disorder treatment and management plan and recorded in the patient’s records the medical practitioner’s recommendation that the patient have additional eating disorder psychological treatment services in the same 12 month period.

(3) For any particular patient, an item in Subgroup 2 of Part 8 in Schedule 2 does not apply if the patient has had 40 eating disorder psychological treatment services in a 12 month period commencing from the provision of an eating disorder treatment and management plan.

(4) For any particular patient, an item in Subgroup 1 of Part 8 in Schedule 2  does not apply if the patient has had 20 eating disorder dietetic treatment services in a 12 month period commencing from the provision of an eating disorder treatment and management plan.

(5) An item in Part 8 in Schedule 2 does not apply if the patient’s eating disorder treatment and management plan has expired under subsection 7(3) of the Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019.

(6)  For the purpose of this subsection:

patient review means a service to which an item in Subgroup 3 of the Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019 applies.

6AB    Reporting requirement for eating disorders items

(1)         For an item in Part 8 of Schedule 2, the relevant allied health professional must provide the referring medical practitioner with a written report on assessments carried out, treatment provided and recommendations for future management of the patient’s condition at required intervals.

(2)    A report under subsection (1) is to be provided:

(a)          after the first service;

(b)          as clinically required following subsequent services; and

(c)          after the final service.

6AC  Limitation on certain individual telehealth items

 (1) This section applies to items 82351, 82353, 82356, 82359, 82361, 82364, 82367, 82369, 82372, 82375, 82377, 82380 and 82383.

 (2) An item mentioned in subsection (1) does not apply to a service if the patient or the allied health professional has travelled to a place to satisfy the requirement that the patient be a distance of at least 15 km by road from the allied health professional.

 

4  After section 8A

Insert:

8B  Referrals by medical practitioners for eating disorder allied health treatment services

 (1) This section applies to items in Part 8 of Schedule 2.

 (2) For any particular patient, an item in Part 8 of Schedule 2 does not apply unless the patient has been referred by:

(a)          a general practitioner or medical practitioner who issued the referral as part of a service to which an item in Subgroup 1 of the Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019 applies; or

(b)          a consultant physician in the specialty of psychiatry or paediatrics
who issued the referral as part of a service to which an item in Subgroup 2 of the Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019 applies; or

(c)          a medical practitioner who issued the referral as part of a service to which an item in Subgroup 3 of the Health Insurance (Section 3C General Medical Services – Eating Disorders Treatment Plan and Psychological Treatment Services) Determination 2019 applies.

 

5  Part 1 of Schedule 2 (column 2 of item 10954)

 Omit references to “eligible dietician” (wherever occurring) and substitute with “eligible dietitian”.

 

6  Part 4 of Schedule 2 (column 2 of items 81120 and 81125)

 Omit references to “eligible dietician” (wherever occurring) and substitute with “eligible dietitian”.

 

7  Part 6 of Schedule 2 (column 2 of item 81320)

 Omit references to “eligible dietician” (wherever occurring) and substitute with “eligible dietitian”.

 

8  After Part 7

Insert:

 

Part 8 – Services and Fees – eating disorders services

 

Group M16 – Eating disorders services

 

Subgroup 1 – Eating disorders dietitian services

 

Item

Service

Fee ($)

82350

Dietetics health service provided to an eligible patient by an eligible dietitian if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is of at least 20 minutes in duration.    

63.25

82351

Dietetics health service provided to an eligible patient by an eligible dietitian if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually; and

(d)    the attendance is by video conference; and

(e)     the patient is located within a telehealth eligible area; and

(f)     the patient is, at the time of the attendance, at least 15 kilometres by road from the dietitian; and

(g)    the service is of at least 20 minutes duration.  

63.25

Subgroup 2  – Eating disorder psychological treatment services provided by eligible clinical psychologists

 

82352

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible clinical psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 30 minutes but less than 50 minutes in duration.    

101.35

82353

Eating disorder psychological treatment service provided to an eligible patient by an eligible clinical psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually; and

(d)    the attendance is by video conference; and

(e)     the patient is located within a telehealth eligible area; and

(f)     the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(g)    the service is at least 30 minutes but less than 50 minutes in duration.

101.35

82354

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible clinical psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 30 minutes but less than 50 minutes in duration.    

126.65

82355

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible clinical psychologist if:

(a)       the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 50 minutes in duration.

148.80

82356

Eating disorder psychological treatment service provided to an eligible patient by an eligible clinical psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually; and

(d)    attendance is by video conference; and

(e)     the patient is located within a telehealth eligible area; and

(f)     the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(g)    the service is at least 50 minutes in duration.

148.80

82357

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible clinical psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 50 minutes in duration.

174.10

82358

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible clinical psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided in person; and

(d)    the service is at least 60 minutes in duration.

37.80

82359

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible clinical psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the attendance is by video conference; and

(d)    the patient is located within a telehealth eligible area; and

(e)     the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(f)     the service is at least 60 minutes in duration.

37.80

Subgroup 3

Eating disorder psychological treatment services provided by eligible psychologists

 

82360

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 20 minutes but less than 50 minutes in duration.

71.80

82361

Eating disorder psychological treatment service provided to an eligible patient by an eligible psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually; and

(d)    the attendance is by video conference; and

(e)     the patient is located within a telehealth eligible area; and

(f)     the patient is, at the time of the attendance, at least 15 kilometres by road from the psychologist; and

(g)    the service is at least 20 minutes but less than 50 minutes in duration.

71.80

82362

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 20 minutes but less than 50 minutes in duration.

97.70

82363

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 50 minutes in duration.   

101.35

82364

Eating disorder psychological treatment service provided to an eligible patient by an eligible psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually; and

(d)    the attendance is by video conference; and

(e)     the patient is located within a telehealth eligible area; and

(f)     the patient is, at the time of the attendance, at least 15 kilometres by road from the psychologist; and

(g)    the service is at least 50 minutes in duration. 

101.35

82365

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 50 minutes in duration.

127.30

82366

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided in person; and

(d)    the service is at least 60 minutes in duration.

25.85

82367

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible psychologist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the attendance is by video conference; and

(d)    the patient is located within a telehealth eligible area; and

(e)     the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(f)     the service is at least 60 minutes in duration.

25.85

Subgroup 4

Eating disorder psychological treatment services provided by eligible occupational therapists

 

82368

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible occupational therapist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 20 minutes but less than 50 minutes in duration.

63.25

82369

Eating disorder psychological treatment service provided to an eligible patient by an eligible occupational therapist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually; and

(d)    the attendance is by video conference; and

(e)     the patient is located within a telehealth eligible area; and

(f)     the patient is, at the time of the attendance, at least 15 kilometres by road from the psychologist; and

(g)    the service is at least 20 minutes but less than 50 minutes in duration.

63.25

82370

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible occupational therapist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 20 minutes but less than 50 minutes in duration.

89.10

82371

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible occupational therapist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 50 minutes in duration.

89.35

82372

Eating disorder psychological treatment service provided to an eligible patient by an eligible occupational therapist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually; and

(d)    the attendance is by video conference; and

(e)     the patient is located within a telehealth eligible area; and

(f)     the patient is, at the time of the attendance, at least 15 kilometres by road from the psychologist; and

(g)    the service is at least 50 minutes in duration.

89.35

82373

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible occupational therapist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 50 minutes in duration.

115.15

82374

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible occupational therapist if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided in person; and

(d)    the service is at least 60 minutes in duration

22.70

82375

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients by an eligible occupational therapist if:

(a)    the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)    the attendance is by video conference; and

(d)    the patient is located within a telehealth eligible area; and

(e)    the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(f)     the service is at least 60 minutes in duration.

22.70

Subgroup 5

Eating disorder psychological treatment services provided by eligible social workers

 

82376

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible social worker if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 20 minutes but less than 50 minutes in duration.

63.25

82377

Eating disorder psychological treatment service provided to an eligible patient by an eligible social worker if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually; and

(d)    the attendance is by video conference; and

(e)     the patient is located within a telehealth eligible area; and

(f)     the patient is, at the time of the attendance, at least 15 kilometres by road from the psychologist; and

(g)    the service is at least 20 minutes but less than 50 minutes in duration.

63.25

82378

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible social worker if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 20 minutes but less than 50 minutes in duration.

89.10

82379

Eating disorder psychological treatment service provided to an eligible patient in consulting rooms by an eligible social worker if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 50 minutes in duration. 

89.35

82380

Eating disorder psychological treatment service provided to an eligible patient by an eligible social worker if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually; and

(d)    the attendance is by video conference; and

(e)     the patient is located within a telehealth eligible area; and

(f)     the patient is, at the time of the attendance, at least 15 kilometres by road from the psychologist; and

(g)    the service is at least 50 minutes in duration.

89.35

82381

Eating disorder psychological treatment service provided to an eligible patient at a place other than consulting rooms by an eligible social worker if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided to the patient individually and in person; and

(d)    the service is at least 50 minutes in duration. 

115.15

82382

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible social worker if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the service is provided in person; and

(d)    the service is at least 60 minutes in duration.

22.70

82383

Eating disorder psychological treatment service provided to an eligible patient as part of a group of 6 to 10 patients (but not as an admitted patient of a hospital) by an eligible social worker if:

(a)     the service is recommended in the patient’s eating disorder treatment and management plan; and

(b)    the patient is not an admitted patient of a hospital; and

(c)     the attendance is by video conference; and

(d)    the patient is located within a telehealth eligible area; and

(e)     the patient is, at the time of the attendance, at least 15 kilometres by road from the clinical psychologist; and

(f)     the service is at least 60 minutes in duration.

22.70

 


Schedule 2— Amendments commencing 1 January 2020

 

 

Health Insurance (Allied Health Services) Determination 2014

 

1  Subsection 6D(2)

Repeal the subsection, and substitute:

(2) In this section:

(a)           ASGS means the July 2016 edition of the Australian Statistical Geography Standard, published by the Australian Bureau of Statistics, as existing on 1 January 2020;

(b)          Modified Monash area 2 means areas categorised as ASGS-RA 2 or ASGS-RA 3 under the ASGS that are in, or within 20 kilometres road distance of, a town with population >50,000; and

(c)           Modified Monash area 3 means areas categorised as ASGS-RA 2 or ASGS-RA 3 under the ASGS that are not in Modified Monash area 2 and are in, or within 15 kilometres road distance of, a town with population between 15,001 and 50,000.

Note 1:  The ASGS can be viewed on the Australian Bureau of Statistics’ website (https://www.abs.gov.au).

Note 2:  The Modified Monash Model is a geographical classification system developed by the Department for categorising metropolitan, regional, rural and remote locations according to both geographical remoteness and population size, based on population data published by the Australian Bureau of Statistics.

Maps of the Modified Monash Model areas and the Department’s remoteness classification can be viewed at www.doctorconnect.gov.au.