Dear Doctors and Health Care Workers
Following on from our bulletin earlier today, the new Determination is now on the Commonwealth Law Register and commences tomorrow, 30 March 2020. Here is the link https://www.legislation.gov.au/Details/F2020L00342
The changes focus mostly on Primary Health Care, bringing little relief for specialists. However, further changes are expected during this coming week and Stage 5 is described as focussing on specialists per this comment in the press release:
“The Government will continue to work on a further expansion of non-GP specialist telehealth under stage 5 in collaboration with the profession.”
Rather than trying to summarise everything, what follows is a high-level overview of the changes that commence tomorrow. Whilst the changes are of course welcome, they are not as comprehensive as we know you might have liked and provide no relief at all for specialists. But hang in there.
So please flood us with questions. We felt the below summary would be the best way of helping you to start interpreting the changes as they apply to the specifics of your practice setting and are committed to answering your questions every day for as long as is necessary.
1. Are inpatient services included in the Stage 4 changes?
No. All COVID MBS items remain restricted exclusively to non-admitted patients.
2. Is forced bulk billing still in place?
Yes. But note previous bulletins concerning the legalities around this.
Somewhat confusingly, the changes commencing tomorrow provide a doubling of the bulk bill incentive items to encourage the bulk billing of non-referred services. So, do the services have to be bulk billed or not? Why incentivise bulk billing if it is mandatory? This adds confusion to an already vexed issue unfortunately. More on this during the week.
To charge your usual fees, the message here is that you need to continue to see your patients face to face.
3. Are the rebates 100% or still 85% of the schedule fee?
Still 85%. To make them 100% would require a bigger legislative change involving a parliamentary process.
4. Has anything changed in regards previous advice about DB4 forms, keeping adequate and contemporaneous records, using video over phone where possible, privacy and security, and all the basics we have covered in the last 2 weeks?
No. Everything remains the same. The only changes are expansions of actual item numbers and the inclusion of new health workers. Here are the allied health workers now able to avail COVID MBS items:
“(a) an eligible Aboriginal health worker;
(b) an eligible Aboriginal and Torres Strait Islander health practitioner;
(c) an eligible diabetes educator;
(d) an eligible audiologist;
(e) an eligible dietitian;
(f) an eligible mental health worker;
(g) an eligible occupational therapist;
(h) an eligible exercise physiologist;
(i) an eligible physiotherapist;
(j) an eligible podiatrist;
(k) an eligible chiropractor;
(l) an eligible osteopath;
(m) an eligible psychologist; or
(n) an eligible speech pathologist.”
5. Are items 132, 133 included in the changes?
No. Nothing for physicians. Only item 110 and 116 equivalents, which were already in place. There have been no changes and none are expected till Stage 5.
6. Are the services only able to be provided to Vulnerable Patients or by Vulnerable Practitioners as was the case last week?
No. This is a significant and welcome change. The former Determination has been completely repealed by the new Determination in force from tomorrow, and all definitions of ‘health practitioner at risk of COVID’ and ‘patient at risk of COVID’ have been removed.
So, you can now provide these services to all patients whether they are at risk of COVID or not and whether you are at risk or not. But the services themselves remain limited, certainly for specialists.
7. Anything available for group therapy?
No. The new Determination specifically states the following in the General provisions:
“8 Application of items – general
(5) An item in a Schedule only applies to a service that is an attendance by a single health professional on a single patient.”
More generally, there have been many items added for Mental Health, Chronic Disease Care Plans and Aboriginal and Torres Strait Islander Health Services.
So, let the questions roll in. We are at the ready to help you make sense of all of this.
Margaret and the Synapse team.