Commonwealth Coat of Arms of Australia

 

Health Insurance (Allied Health Services) Amendment (Group Therapy Services) Determination 2022

I, Travis Haslam, delegate of the Minister for Health and Aged Care, make the following Determination.

Dated  13 October 2022

Travis Haslam

Acting First Assistant Secretary

Medical Benefits Division

Health Resourcing Group

Department of Health and Aged Care

 

 

 

Contents

1 Name...............................................1

2 Commencement.........................................1

3 Authority.............................................1

4 Schedules.............................................1

Schedule 1—Group Therapy Amendments 2

Health Insurance (Allied Health Services) Determination 2014 2

 

1  Name

  This instrument is the Health Insurance (Allied Health Services) Amendment (Group Therapy Services) Determination 2022.

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.  The whole of this instrument

1 November 2022.

 

 Note: This table relates only to the provisions of this instrument as originally made.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  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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— Group Therapy Amendments

Health Insurance (Allied Health Services) Determination 2014

1        Subsection 4(1)

Insert:

admitted patient means a patient who is receiving a service that is provided:

(a)  as part of an episode of hospital treatment; or

(b) as part of an episode of hospital‑substitute treatment in respect of which the person to whom the treatment is provided chooses to receive a benefit from a private health insurer.

2        Subsection 6A(2)

Repeal the subsection, substitute:

(2)  The items are items 80020, 80021, 80022, 80023, 80024, 80025, 80120, 80121, 80122, 80123, 80127, 80128, 80145, 80146, 80147, 80148, 80152, 80153, 80170, 80171, 80172, 80173, 80174 and 80175 in Schedule 2.

3        After subsection 6A(3)

Insert:

(4)  An item listed in subsection (2) may apply to a service where only three patients attend if:

  (a) four patients were due to attend; and

  (b) one of the patients is unable to attend.

4        Subsection 6C(1)

Repeal the subsection, substitute:

(1)  This section applies to items 80021, 80023, 80025, 80121, 80123, 80128, 80146, 80148, 80153, 80171, 80173 and 80175 in Schedule 2.

5        Subsection 6C(4)

Repeal the subsection, substitute:

 (4)  In this section relevant service means a service to which any of items 80020, 80021, 80022, 80023, 80024, 80025, 80120, 80121, 80122, 80123, 80127, 80128, 80145, 80146, 80147, 80148, 80152, 80153, 80170, 80171, 80172, 80173, 80174 and 80175 in Schedule 2, apply.

6        Subsection 7(1)

Omit “80000 to 80171”, substitute “80000 to 80175”.

7        Schedule 2 (items 80020 and 80021, column 2)

Omit “group of 6 to 10”, substitute “group of 4 to 10”.

8        Schedule 2 (after item 80021)

Insert:

80022

Psychological therapy health service provided to a person as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

   (a)  the person is referred for a course of treatment by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the service is provided in person; and

  (c)  the patient is not an admitted patient; and

  (d)  the service is at least 90 minutes duration;

This item is subject to sections 6A, 7 and 9

53.50

80023

Psychological therapy health service provided to a person as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the attendance is by video conference; and

  (c)  the patient is not an admitted patient; 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 90 minutes duration

This item is subject to sections 6C, 7 and 9

53.50

80024

Psychological therapy health service provided to a person as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

   (a)  the person is referred for a course of treatment by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the service is provided in person; and

  (c)  the patient is not an admitted patient; and

  (d)  the service is at least 120 minutes duration;

This item is subject to sections 6A, 7 and 9

72.75

80025

Psychological therapy health service provided to a person as part of a group of 4 to 10 patients by an eligible clinical psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the attendance is by video conference; and

  (c)  the patient is not an admitted patient; 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 120 minutes duration

This item is subject to sections 6C, 7 and 9

72.75

 

9        Schedule 2 (items 80120 and 80121, column 2)

Omit “group of 6 to 10”, substitute “group of 4 to 10”.

10   Schedule 2 (after item 80121)

Insert:

80122

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the service is provided in person; and

  (c)  the patient is not an admitted patient; and

  (d)  the service is at least 90 minutes duration;

This item is subject to sections 6A, 7 and 9

36.65

80123

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 by an eligible psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the attendance is by video conference; and

  (c)  the patient is not an admitted patient; 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 psychologist; and

  (f)  the service is at least 90 minutes duration

This item is subject to sections 6C, 7 and 9

36.65

 

11   Schedule 2 (after item 80126)

Insert:

80127

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the service is provided in person; and

  (c)  the patient is not an admitted patient; and

  (d)  the service is at least 120 minutes duration;

This item is subject to sections 6A, 7 and 9

49.80

80128

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible psychologist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the attendance is by video conference; and

  (c)  the patient is not an admitted patient; 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 psychologist; and

  (f)  the service is at least 120 minutes duration

This item is subject to sections 6C, 7 and 9

49.80

 

12   Schedule 2 (items 80145 and 80146, column 2)

Omit “group of 6 to 10”, substitute “group of 4 to 10”.

13   Schedule 2 (after item 80146)

Insert:

80147

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible occupational therapist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the service is provided in person; and

  (c)  the patient is not an admitted patient; and

  (d)  the service is at least 90 minutes duration;

This item is subject to sections 6A, 7 and 9

32.10

80148

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible occupational therapist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the attendance is by video conference; and

  (c)  the patient is not an admitted patient; 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 occupational therapist; and

  (f)  the service is at least 90 minutes duration

This item is subject to sections 6C, 7 and 9

32.10

 

14   Schedule 2 (after item 80151)

Insert:

80152

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible occupational therapist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the service is provided in person; and

  (c)  the patient is not an admitted patient; and

  (d)  the service is at least 120 minutes duration;

This item is subject to sections 6A, 7 and 9

43.70

80153

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible occupational therapist if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the attendance is by video conference; and

  (c)  the patient is not an admitted patient; 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 occupational therapist; and

  (f)  the service is at least 120 minutes duration

This item is subject to sections 6C, 7 and 9

43.70

 

15   Schedule 2 (items 80170 and 80171, column 2)

Omit “group of 6 to 10”, substitute “group of 4 to 10”.

16   Schedule 2 (item 80171, column 2, paragraph (e))

Omit “eligible social”, substitute “social worker”.

17   Schedule 2 (after item 80171)

Insert:

80172

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible social worker if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the service is provided in person; and

  (c)  the patient is not an admitted patient; and

  (d)  the service is at least 90 minutes duration;

This item is subject to sections 6A, 7 and 9

32.10

80173

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible social worker if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the attendance is by video conference; and

  (c)  the patient is not an admitted patient; 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 social worker; and

  (f)  the service is at least 90 minutes duration

This item is subject to sections 6C, 7 and 9

32.10

80174

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible social worker if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the service is provided in person; and

  (c)  the patient is not an admitted patient; and

  (d)  the service is at least 120 minutes duration;

This item is subject to sections 6A, 7 and 9

43.70

80175

Focussed psychological strategies health service provided to a person as part of a group of 4 to 10 patients by an eligible social worker if:

   (a)  the person is referred by:

         (i)   a medical practitioner, either as part of a GP Mental Health Treatment Plan, or as part of a psychiatrist assessment and management plan; or

        (ii)   a specialist or consultant physician specialising in the practice of his or her field of psychiatry; or

       (iii)   a specialist or consultant physician specialising in the practice of his or her field of paediatrics; and

  (b)  the attendance is by video conference; and

  (c)  the patient is not an admitted patient; 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 social worker; and

  (f)  the service is at least 120 minutes duration

This item is subject to sections 6C, 7 and 9

43.70