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Category 8 - MISCELLANEOUS SERVICES
81345 - Additional Information
CHIROPRACTIC HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible chiropractor if:
- a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; or
the person’s shared care plan identifies the need for follow-up allied health services; and
(b) the person is referred to the eligible chiropractor by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c) the person is not an admitted patient of a hospital; and
(d) the service is provided to the person individually and in person; and
(e) the service is of at least 20 minutes duration; and
(f) after the service, the eligible chiropractor gives a written report to the referring medical practitioner mentioned in paragraph (b):
(i) if the service is the only service under the referral - in relation to that service; or
(ii) if the service is the first or the last service under the referral - in relation to the service; or
(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably be expected to be informed of - in relation to those matters
- to a maximum of five services (including services to which items 81300 to 81360, 93048, 93061, 93546 to 93558 and 93579 to 93593 inclusive apply) in a calendar year
Fee: $65.85 Benefit: 85% = $56.00
(See para MN.11.1 of explanatory notes to this Category)
Category 8 - MISCELLANEOUS SERVICES
Follow-up Allied Health Services for people of Aboriginal or Torres Strait Islander descent (Items 81300 to 81360)
A person who is of Aboriginal or Torres Strait Islander descent may be referred by their GP for follow-up allied health services under items 81300 to 81360 when the GP has undertaken a health assessment or a Health Care Home shared care plan and identified a need for follow-up allied health services.
These items are similar to the individual allied health items (items 10950 to 10970) available to patients who have a chronic or terminal medical condition and complex care needs and have a GP Management Plan and Team Care Arrangements or a Health Care Home shared care plan prepared by their GP. However items 81300 to 81360 provide an alternative referral pathway for Aboriginal or Torres Strait Islander people to access allied health services. If a patient meets the eligibility criteria for individual allied health services under the Chronic Disease Management items or the Health Care Home shared care plan and for follow-up allied health services, they can access both sets of services and are eligible for up to ten allied health services under Medicare per calendar year.
A practice nurse/Aboriginal and Torres Strait Islander health practitioner item (10987) is also available for Indigenous Australians who have received a health check. This item enables Aboriginal or Torres Strait Islander people to receive follow-up services from a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a GP. More detail on this item is provided at explanatory note M.12.4 of the Medicare Benefits Schedule.
Eligible Allied Health Services
The following allied health professionals are eligible to provide services under these items:
- Aboriginal and Torres Strait Islander health practitioners
- Aboriginal Health Workers
- Diabetes Educators
- Exercise Physiologists
- Mental Health Workers
- Occupational Therapists
- Speech Pathologists
Publicly funded services
Items 81300 to 81360 do not apply for services that are provided by any Commonwealth or state or territory government funded services or provided to an admitted patient of a hospital. However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or state/territory government health clinic, items 81300 to 81360 can be claimed for services provided by eligible allied health professionals salaried by, or contracted to, the service or health clinic. All requirements of the relevant item must be met, including registration of the allied health professional with the Department of Human Services. Medicare services provided under a subsection 19(2) exemption must be bulk billed (i.e. the Medicare rebate is accepted as full payment for services).
Number of services per year
Medicare benefits are available for up to five follow-up allied health services per eligible patient, per calendar year. The five allied health services can be made up of one type of service (e.g. five physiotherapy services) or a combination of different types of services (e.g. one dietetic, two podiatry and two physiotherapy services).
The annual limit of five allied health services per patient under items 81300 to 81360 is in addition to the individual allied health services for patients with a chronic or terminal medical condition and complex care needs (items 10950 to 10970).
Checking patient eligibility for items 81300 to 81360
If there is any doubt about a patient's eligibility, the Department of Human Services will be able to confirm the number of allied health services already claimed by the patient during the calendar year. Allied health professionals can call the Department of Human Services on 132 150 and patients can call the Department of Human Services on 132 011 or alternatively the Indigenous Access Line for the Department of Human Services on 1800 556 955.
Service length and type
Services provided by eligible allied health professionals under these items must meet the specific requirements set out in the item descriptors. These requirements include that:
- the service is of at least 20 minutes duration;
- the service is provided to the person individually (i.e. not as part of a group service) and in person (i.e. the allied health professional must personally attend the patient);
- the person is not an admitted patient of a hospital;
- the allied health professional must provide a written report to the GP; and
- if the patient has private health insurance, he/she cannot use their private health insurance ancillary cover to 'top up' the Medicare rebate paid for these services.
Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to 'top up' the Medicare rebate paid for the services.
Reporting back to the GP
Where an allied health professional provides a single service to the patient under a referral, the allied health professional must provide a written report back to the referring GP after that service.
Where an allied health professional provides multiple services to the same patient under a referral, the allied health professional must provide a written report back to the referring GP after the first and last service, or more often if clinically necessary. Written reports should include:
- any investigations, tests, and/or assessments carried out on the patient;
- any treatment provided; and
- future management of the patient's condition or problem.
Allied health professionals are required to retain the referral form 24 months.
Out-of-pocket expenses and Medicare safety net
Allied health professionals can determine their own fees for the professional service, except where the service is provided under a subsection 19(2) exemption. Charges in excess of the Medicare benefit for the allied health items are the responsibility of the patient. However, such out-of-pocket costs will count toward the Medicare safety net for that patient. Allied health services in excess of five in a calendar year will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the patient for such services.
For Medicare benefits to be payable, the patient must be referred to an eligible allied health professional by their GP using a referral form that has been issued by the Australian Government Department of Health or a form that contains all the components of this form.
The form issued by the department is available at the MBS Primary Care Items information page (click on the link for follow-up allied health services).
GPs are encouraged to attach a copy of the relevant part of the patient's care plan to the referral form.
GPs may use one referral form to refer patients for single or multiple services of the same service type (e.g. five dietetic services). If referring a patient for single or multiple services of different service types (e.g. two dietetic services and three podiatry services), a separate referral form will be needed for each service type.
The patient will need to present the referral form to the allied health professional at the first consultation, unless the GP has previously provided it directly to the allied health professional.
Allied health professionals are required to retain the referral form for 2 years from the date the service was rendered (for the Department of Human Services auditing purposes). A copy of the referral form is not required to accompany Medicare claims, and allied health professionals do not need to attach a signed copy of the form to patients' itemised accounts/receipts or assignment of benefit forms.
Completed forms do not have to be sent to the Department of Health.
Health Care Home shared care plan
A Health Care Home shared care plan means a written plan that is prepared for a patient enrolled at a Health Care Home trial site; is prepared by a medical practitioner (including a general practitioner but not including a specialist or consultant physician) who is leading the patient's care at the Health Care Home trial site; and includes: an outline of the patient's agreed current and long-term goals; the person or people responsible for each activity; arrangements to review the plan by a day mentioned in the plan; and if authorised by the patient, arrangements for the transfer of information between the medical practitioner and other health care providers supporting patient care about the patient's condition or conditions and treatment.
A referral is valid for the stated number of services. If all services are not used during the calendar year in which the patient was referred, the unused services can be used in the next calendar year. However, those services will be counted as part of the five rebates for allied health services available to the patient during that calendar year.
When patients have used all of their referred services they will need to obtain a new referral from their GP.
Allied health Professional Eligibility
Items 81300 to 81360 can only be claimed for services provided by eligible allied health professionals who are registered with the Department of Human Services. Allied health professionals already registered with Medicare (e.g. for items 10950 to 10970) do not need to register again to claim these items.
Specific eligibility requirements for allied health professionals providing services under these items are:
Aboriginal and Torres Strait Islander health practitioners must be registered with the Aboriginal and Torres Strait Islander Health Practice Board of Australia. Aboriginal and Torres Strait Islander health practitioners may use any of the titles authorised by the Aboriginal and Torres Strait Islander Health Practice Board: Aboriginal health practitioners; Aboriginal and Torres Strait Islander health practitioners; or Torres Strait Islander health practitioners.
Aboriginal health workers in a State or Territory other than the Northern Territory must have been awarded either:
a. a Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care (or an equivalent or higher qualification) by a registered training organisation; or
b. a Certificate III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a registered training organisation before 1 July 2012.
Note: Where individuals consider their qualification to be equivalent to or higher than the qualifications listed above, they will need to contact a registered training organisation in their State or Territory to have the qualification assessed as such before they can register with the Department of Human Services. In the Northern Territory, a practitioner must be registered with the Aboriginal and Torres Strait Islander Health Practice Board of Australia.
Audiologists must be either a 'Full Member' of the Audiological Society of Australia Inc (ASA), who holds a 'Certificate of Clinical Practice' issued by the ASA; or an 'Ordinary Member - Audiologist' or 'Fellow Audiologist' of the Australian College of Audiology (ACAud).
Chiropractors must be registered with the Chiropractic Board of Australia.
Diabetes educators must be a Credentialled Diabetes Educator (CDE) as credentialled by the Australian Diabetes Educators Association (ADEA).
Dietitians must be an 'Accredited Practising Dietitian' as recognised by the Dietitians Association of Australia (DAA).
Exercise physiologists must be an 'Accredited Exercise Physiologist' as accredited by Exercise and Sports Science Australia (ESSA).
Mental health workers can include services provided by members of five different allied health professional groups. 'Mental health workers' are drawn from the following:
- mental health nurses;
- occupational therapists;
- social workers;
- Aboriginal and Torres Strait Islander health practitioners; and
- Aboriginal health workers.
Psychologists, occupational therapists, Aboriginal and Torres Strait Islander health practitioners and Aboriginal health workers are eligible in separate categories for these items.
Mental health nurses must be a credentialled mental health nurse, as certified by the Australian College of Mental Health Nurses.
Mental health nurses who were registered in the ACT or Tasmania prior to the introduction of the National Registration and Accreditation Scheme (NRAS) on 1 July 2010, will have until 31 December 2010 to be certified by the Australian College of Mental Health Nurses.
Social workers must be a 'Member' of the Australian Association of Social Workers (AASW); and be certified by AASW as meeting the standards for mental health set out in the document published by AASW titled 'Practice Standards for Mental Health Social Workers' as in force on 8 November 2008.
Occupational therapists must be registered with the Occupational Therapy Board of Australia.
Osteopaths must be registered with the Osteopathy Board of Australia.
Physiotherapists must be registered with the Physiotherapy Board of Australia.
Podiatrists must be registered with the Podiatry Board of Australia.
Psychologists must hold general registration in the health profession of psychology under the applicable law in force in the State or Territory in which the service is provided.
Speech pathologists must be a 'Practising Member' of Speech Pathology Australia.
Registering with the Department of Human Services
Provider registration forms may be obtained from the Department of Human Services on 132 150 or by visiting the Department of Human Services website and then searching for "allied health application".
Further information about these items, including a fact sheet and the referral form, is available on the Department of Health's MBS Primary Care Items information page. For providers, information is also available from the Department of Human Services provider inquiry line on 132 150. The Indigenous Access Line for the Department of Human Services on 1800 556 955 is also a useful source of information.
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change