Health Insurance (Section 3C Participating Nurse Practitioner and Midwife Services – Attendances and Other Changes) Amendment Determination 2025

I, Louise Riley, delegate of the Minister of Health and Aged Care, make the following determination.

Dated 3 February 2025 

Louise Riley

Contents

1  Name

2  Commencement

3  Authority

4  Schedules

Schedule 1—Nurse Practitioner Amendments

Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Determination 2020

Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021

Schedule 2—Midwife Amendments

Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Determination 2020

Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021

1  Name

  This instrument is the Health Insurance (Section 3C Participating Nurse Practitioner and Midwife Services – Attendances and Other Changes) Amendment Determination 2025.

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.

Note:  This table relates only to the provisions of this instrument as originally made.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

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  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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

Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Determination 2020

1.         Schedule (table, heading, row with “Item” in column 1, “Service” in column 2 and “Fee ($)” in column 3)

Repeal the row, substitute:

1.         Schedule 2 (item 82205, column 2)

After “lasting”, insert “at least 6 minutes and”.

1.         Schedule 2 (after item 82215)

     Insert:

Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021

1.         Schedule 4 (item 91178, column 2)

Omit “Telehealth attendance by a participating nurse practitioner lasting”, substitute “Video attendance by a participating nurse practitioner lasting at least 6 minutes and”.

1.         Schedule 4 (after item 91180)

     Insert:

1.         Schedule 4 (item 91189, column 2)

After “lasting”, insert “at least 6 minutes and”.

Schedule 2—Midwife Amendments

Health Insurance (Section 3C Midwife and Nurse Practitioner Services) Determination 2020

1.    At the end of Part 1

Add:

6B. Meaning of symbol (H)

(1) An item in this instrument including the symbol (H) applies only to a service performed or provided in a hospital.

1.    After subsection 10(5)

Insert:

1.     If a service described in item 82103 is provided on the same day as a service to which item 82100, 82102, 82105, 82110, 91211, 91212, 91218 or 91219 applies, the subsequent item will only apply if it is:
   1.     not a continuation of the first attendance; and
   2.     is clinically relevant and distinct from the first attendance.

1.    Schedule 1 (cell at item 82100, column 2)

Repeal the cell, substitute:

Initial antenatal professional attendance by a participating midwife, lasting at least 60 minutes, including all the following:

(a) taking a detailed patient history;

(b) performing a comprehensive examination;

(c) performing a risk assessment;

(d) based on the risk assessment — arranging referral or transfer of the patient’s care to an obstetrician;

(e) requesting pathology and diagnostic imaging services, when necessary;

Payable only once per pregnancy

1.    Schedule 1 (cell at item 82100, column 3)

Repeal the cell, substitute:

84.70

1.    Schedule 1 (after item 82100)

     Insert:

1.    Schedule 1 (cell at item 82105, column 2)

Omit “lasting up to 40 minutes”, substitute “lasting at least 10 minutes”.

1.    Schedule 1 (cell at item 82110, column 2)

Omit “Long”, substitute “Routine”.

1.    Schedule 1 (cell at item 82110, column 3)

Omit “60.85”, substitute “84.70”.

1.    Schedule 1 (cell at item 82130, column 2)

Omit “lasting up to 40 minutes”, substitute “lasting at least 20 minutes”.

1.    Schedule 1 (cell at item 82135, column 2)

Omit “Long”, substitute “Routine”.

1.    Schedule 1 (cell at item 82135, column 3)

Omit “89.50”, substitute “124.50”.

1.    Schedule 1 (cell at item 82140, column 2)

Repeal the cell, substitute:

Postnatal professional attendance by a participating midwife on a patient, not less than 4 weeks but not more than 8 weeks after birth of a baby, lasting at least 60 minutes, including all of the following:

(a) a comprehensive examination of the patient and baby to ensure normal postnatal recovery;

(b) a labour and birth debrief;

(c) a mental health assessment;

(d) referral of the patient to a primary carer for the ongoing care of the patient and baby

A record of a patient’s decision not to undergo a mental health assessment or accept a referral to a primary carer must be recorded in the patient’s clinical notes.

Payable only once per pregnancy

Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021

1.    Division 4.2 (items 91211, 91212, 91214, 91215)

Repeal and substitute:

1.    Division 4.2 (items 91218, 91219, 91221, 91222)

Repeal and substitute: