A: The Australian Government has extended the temporary MBS telehealth items introduced on 13 March 2020 in response to the COVID-19 pandemic to 31 March 2021 on the recommendation of the Australian Health Protection Principal Committee, but with these changes which take effect from 1 October 2020:
• GPs and Other Medical Practitioners (OMPs) providing COVID-19 telehealth services are no longer required to bulk-bill their patients.
• Temporary MBS COVID-19 bulk-billing incentive items 10981 (for GPs) and 10982 (for OMPs) cease.
• The temporary doubling of fees for MBS bulk billing incentive items 10990, 10991, 10992, 64990, 64991, 74990 and 74991 also cease.
• Bulk-billed GP and OMP services provided using the MBS telehealth items are eligible for MBS incentive payments when provided to Commonwealth concession card holders and children under 16 years of age.
It remains a legislative requirement under the Health Insurance (Section 3C General Medical Services - COVID-19 Telehealth and Telephone Attendances) Determination 2020 that GPs and other medical practitioners working in general practice only perform a telehealth or telephone service where they have an existing relationship with the patient, in order to bill the consultation to Medicare under this Determination. Private billing arrangements can still be made for telehealth consultations with appropriate informed financial consent. These changes do not apply to specialists and other healthcare providers. Telehealth items that were available prior to COVID-19 also remain unaffected by these changes and can continue to be billed where appropriate.
An existing relationship with a patient is defined as:
• The medical practitioner who performs the service has provided a “personal attendance” or face-to-face service to the patient in the last 12 months. The Determination does not specify where the personal attendance has to occur, so in our view this may be either in the medical practice, aged care facility or at a home visit; or
• The medical practitioner who performs the service is located at a medical practice, and the patient has had a face-to-face service arranged by that practice in the last 12 months. This can be a service performed by another doctor located at the practice, or a service performed by another health professional located at the practice (such as a practice nurse or Aboriginal and Torres Strait Islander health worker); or
• The medical practitioner who performs the service is a participant in the Approved Medical Deputising Service (AMDS) program, and the Approved Medical Deputising Service provider (AMDS provider) that engages the medical practitioner has a formal agreement with a medical practice that has provided at least one face-to-face service to the patient in the last 12 months.
The requirement to have had a face-to face consultation in the last 12 months does not apply to:
• children under the age of 12 months
• people experiencing homelessness (see below)
• people located in a COVID-19 impacted area (see below)
• people receiving an urgent after-hours service (in unsociable hours)
• people who receive the service from a medical practitioner located at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service.
A person is considered homeless if their current living arrangement:
(a) is in a dwelling that is inadequate; or
(b) has no tenure, or if their initial tenure is short and not extendable; or
(c) does not allow them to have control of, and access to space for social relations.
Telehealth consultations can still be conducted and billed to Medicare with a person who is in a “COVID-19 impacted area”. This means a patient who, at the time of accessing the telehealth service, has had their “… movement restricted within the State or Territory, by a State or Territory public health requirement applying to the patient’s location”. The Determination doesn’t specify what constitutes a “public health requirement”. We have clarified with the Department of Health that the exemption covers the areas subject to specific restrictions such as Melbourne and Mitchell Shire, but also exempts:
“Patients that test positive for COVID-19 and/or are subject to quarantine or other social restrictions on the basis State and Territory health authorities”.
This will potentially cover a range of patients who have had their movement restricted by state or territory public health orders or public health guidelines on self-isolation. Examples of this, based on the NSW and Victorian laws, are:
• People who live in Melbourne and the Mitchell Shire subject to restrictions on their movement.
• People diagnosed with COVID-19 who are subject to self-isolation orders such as the Public Health (COVID-19 Self-Isolation) Order (No 2) 2020 (NSW) under the Public Health Act 2010 (NSW) which directs that a person diagnosed with COVID-19 must self-isolate in their residence or other suitable location until medically cleared and comply with the COVID-19 self-isolation guidelines.
• People returning from overseas who are subject to quarantine orders such as the Public Health (COVID-19 Quarantine) Order 2020 (NSW).
• People travelling across borders within Australia who are also subject to local quarantine orders. Public Health (COVID-19 Border Control) Order 2020 (NSW) requires, for example, people from Victoria to self-isolate under certain circumstances when they arrive in NSW.
It is also likely to cover patients who have been required (by government or public health guidelines) to self-isolate pending test results or because they are suspected cases or close contacts of confirmed cases.
However, patients living in areas that are not restricted by government lockdown orders and who are not suspected of having COVID-19, will not be able to access telehealth services simply because of their fears of contracting COVID-19 in the community if they do not also fulfil the criteria of having had a personal attendance with the particular GP or that was arranged by the particular GP’s practice in the past 12 months.
If these issues are unclear, you may wish to document that you have given consideration as to whether a patient has had their movement restricted within a state or territory in the patient’s medical record.
Some common scenarios* include:
Q: I saw patient X at practice A 10 months ago. Can I provide a telehealth consultation (THC) for him from practice B?
A: Yes, as patient X has had a personal attendance with you in the past 12 months.
Q: Patient X attended practice A 10 months ago and saw another GP, but I wasn’t working at practice A at that time. Can I now provide patient X with a THC?
A: Yes, as patient X has had a personal attendance with a GP at practice A within the last 12 months.
Q: I have had regular THCs with patient X over the past four months since the pandemic started, developing a good clinical relationship, but I have not yet seen the patient in person and the patient has never attended my practice in person in the past. Can I continue to provide THCs?
A: No, patient X needs to see you in person before you can continue to provide and bill Medicare for any THCs. Alternatively, patient X will need to arrange a THC with a doctor at their former practice if they attended there in person within the last 12 months.
Q: I saw patient X in her home/nursing home in March but otherwise we have had THCs due to her vulnerability to COVID-19. Can I continue with the THCs?
A: Yes, you have had a personal attendance with patient X in the past 12 months.
Q: Patient X is a new patient. She is unwell and doesn’t want to come into the clinic for fear of contracting COVID-19 as her husband is immunocompromised. She doesn’t live in a ‘hotspot’. I am unable to do a home visit. Can I see her via a THC given her anxiety and medical condition?
A: These reasons do not fall within the exemptions listed in the Determination. The patient will need to come and see you face-to-face or attend the hospital or contact her old practice to see if they will do a THC if she can’t get in to see you. You have the option of doing a THC and privately billing the patient with informed financial consent.
*These scenarios are based on the assumption that the consultations are not covered by the telehealth items applicable to GPs prior to COVID-19.
• Health Insurance (Section 3C General Medical Services – COVID-19 Telehealth and Telephone GP Attendances) Amendment (Patient’s Usual Medical Practitioner) Determination 2020.
• MBS changes:
• factsheet on telehealth items
• factsheet for GPs
• RACGP website
• View the Department of Health’s COVID-19 Telehealth Items Guide.