Medicare Benefits Schedule - Note MN.13.5

To provide Medicare rebate-able services an eligible midwife must have a collaborative arrangement in place that must provide for consultation, referral or transfer of care as clinical needs dictate, to ensure safe, high quality maternity care.

Under the legislation a collaborative arrangement can be with the following "specified" medical practitioners:

1. an obstetrician;
2. a medical practitioner who provides obstetric services; or
3. a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative arrangement.

The types of practitioners listed 1) and 2) are defined in the Regulations as "obstetric specified medical practitioners".

Collaborative arrangement can be established in the following ways:

1. where the midwife:
   1. is employed or engaged by 1 or more obstetric specified medical practitioners or by an entity that employs or engages 1 or more obstetric specified medical practitioners; or
   2. has an agreement, in writing, with an entity, other than a hospital, that employs or engages one or more obstetric specified medical practitioners, OR
2. receiving patients by referral in writing to the midwife for midwifery treatment from a specified medical practitioner, OR
3. having a signed written agreement with one or more specified medical practitioners, OR
4. having an arrangement with and acknowledged by at least one specified medical practitioner
   1. an arrangement requires that the eligible midwife must record the following in the midwife's written records:-
      1. The name of at least one specified medical practitioner who is, or will be, collaborating with the midwife in the patient's care (a named medical practitioner);
      2. That the midwife has told the patient that the midwife will be providing midwifery services to the patient in collaboration with one or more specified medical practitioners;
      3. Acknowledgement by a named medical practitioner that the practitioner will be collaborating in the patient's care;
      4. Plans for the circumstances in which the midwife will do any of the following:
         1. consult with an obstetric specified medical practitioner;
         2. refer the patient to a specified medical practitioner;
         3. transfer the patient's care to an obstetric specified medical practitioner.
   2. The midwife must also record the following in the midwife's written records:
      1. Any consultation or other communication between the midwife and an obstetric specified medical practitioner about the patient's care;
      2. Any referral of the patient by the midwife to a specified medical practitioner;
      3. Any transfer by the midwife of the patient's care to an obstetric specified medical practitioner;
      4. When the midwife gives a copy of the hospital booking letter for the patient to a named medical practitioner - acknowledgement that the named medical practitioner has received the copy;
      5. When the midwife gives a copy of the patient's maternity care plan prepared by the midwife to a named medical practitioner - acknowledgement that the named medical practitioner has received the copy;
      6. If the midwife requests diagnostic imaging or pathology services for the patient - when the midwife gives the results of the services to a named medical practitioner
      7. That the midwife has given a discharge summary at the end of the midwife's care for the patient to:
         1. a named medical practitioner; and
         2. the patient's usual general practitioner, OR
5. In relation to a hospital, the midwife is:
   1. credentialed to provide midwifery services after successfully completing a formal process to assess the midwife's competence, performance and professional suitability; and
   2. given clinical privileges for a defined scope of clinical practice for the hospital; and
   3. permitted to provide midwifery care to his or her own patients at the hospital.

The legislation requires that collaborative arrangements must be in place at the time the participating midwife provides the service.

1. Being employed or engaged by a medical practice or an entity or having a written agreement with an entity
   An entity may refer to, for example, a community health centre or a medical practice. For a midwife to have a collaborative arrangement in these circumstances, that midwife must be employed or engaged by or have a written agreement with an entity that also employs or engages 1 or more obstetric specified medical practitioners.
   The terms employ or engage covers both employees and contractors. This will cover an eligible midwife who is employed or engaged by a medical practice so long as that medical practice employs or engages at least one obstetrician or medical practitioner that provides obstetric services.
   There must be at least one obstetric specified medical practitioner employed or engaged by the entity each time the midwife renders a service/performs treatment. However, there is no requirement that the consultation, referral or transfer of care must always be to the medical practitioner(s) employed/engaged by the entity.
2. Referral from a medical practitioner
   A participating midwife's patient will be able to access the MBS and PBS if a patient has been referred in writing to the midwife by a specified medical practitioner. The arrangement must provide for consultation, referral and transfer of care should the clinical need arise.
3. Written agreement with a medical practitioner
   A participating midwife's patient will be able to access the MBS and PBS if the nurse practitioner has a written agreement in place with one or more specified medical practitioners. The agreement must be signed by the nurse practitioner and doctor. The arrangement must provide for consultation, referral and transfer of care.
4. Arrangement with, acknowledged by a medical practitioner
   Evidence of 'acknowledgement' by an obstetrician/GP obstetrician for each woman for whom the midwife provides care is a requirement to ensure that the medical practitioner being named understands and accepts the collaborative arrangement.
   The acknowledgement does not have to be obtained on an individual patient basis. This means that, for example, a midwife could obtain an acknowledgement from a specified medical practitioner that he or she will be the collaborating medical practitioner for some or all of the midwife's patients. Arrangements to collaborate could be obtained in a number of ways including signing of documents, email or fax confirmation, or verbal acknowledgement which the midwife documents in their written records.
   The midwife is required to record in written records communications in regard to consultations, referral and transfer of the woman's care with the medical practitioner, including information that has been forwarded to the medical practitioner. The midwife is also required to send a copy of all pathology and diagnostic imaging results to a named medical practitioner and to record in the midwife's written records when this occurs (however, there is no requirement that the midwife consult with a medical practitioner in relation to every test result). The purpose of sharing records with the collaborating medical practitioner is to prevent duplication of services and to ensure continuity of care.
5. Collaborative arrangement with a hospital
   This type of collaborative arrangement applies where an eligible midwife is credentialed for a hospital, having successfully completed a formal assessment of his or her qualifications, skills, experience and professional standing. It is expected that the assessment would involve an appropriately qualified medical practitioner/s. The midwife is also required to have a defined scope of clinical practice at the hospital and be eligible to treat his or her own patients at the hospital. The hospital must employ or engage at least one obstetric specified medical practitioner. It is expected that the hospital will have a formal written agreement with such midwives, addressing consultation, referral and transfer of care, relevant clinical guidelines and locally determined policies.

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