MONDAY, 6 APRIL 2020
Telehealth
New – BUPA
As of today (6 April, 2020), Accredited Exercise Physiologists can deliver telehealth exercise physiology consultations for BUPA members. Current item numbers should be used for the present until you receive a formal communication from ESSA early next week confirming the distinct new item numbers. BUPA has prepared Guidelines for Telehealth Consultations for Practitioners - please read these Guidelines before delivering services to BUPA members.
New – ReturntoWork SA – Initial Consultations
On the 26 March 2020, ReturntoWork SA advised ESSA that new exercise physiology telehealth fee items had been introduced in response to the COVID-19 health emergency. These telehealth items were initially only for existing ReturntoWork SA clients.
ESSA welcomed the introduction of telehealth items however flagged serious concerns relating to the absence of telehealth items for initial consultations. We addressed these concerns in a briefing paper submitted to ReturntoWork SA.
Following the briefing paper, ReturntoWork SA introduced Telehealth/telephone initial exercise physiology assessment telehealth fee item (EPTE9) for workers who are unable to attend an appointment because they have been impacted by COVID-19.
ReturntoWork SA has advised it may take a few days for this to be visible in its system for invoice processing, but AEPs can start seeing new clients requiring an initial assessment via telehealth effective immediately.
Informed Consent - Code of Conduct
Informed consent is an ongoing process that covers service options, service purpose, risks and benefits, and client rights and responsibilities. Consent is usually a combination of verbal and written approval and continues across the life of services.
In addition to these standard considerations for consent, telehealth services should also address:
• telehealth specific risk management strategies for privacy, security and emergencies - this includes steps that you as the practitioner provide, as well as what steps the client should take to protect their privacy;
• how the service will run including technology requirements and what will happen in the service;
• outcomes expected - these considerations should be addressed with the client before delivering the service, and you should check in with the client regularly.
MBS
From 6 April 2020, it is a legislative requirement that the new telehealth services must be bulk billed for Commonwealth concession card holders, children under 16 years old and patients who are more vulnerable to COVID-19.
Health providers may apply their usual billing practices to the telehealth items for patients who do not fit the above criteria after such time as Services Australia is able to process co-payments.
Bulk billing for telehealth under MBS remains enforceable until Services Australia is able to process co-payments. ESSA has no timeline for this. It is expected to be weeks away given the demand on Services Australia through Department of Social Services.
Providers are expected to obtain informed financial consent from patients prior to providing the service, providing details regarding their fees, including any out-of-pocket costs.
Health Fund Fact Sheet - Updated 6 April 2020 for Telehealth
For patients to receive a rebate from their Private Health Insurer, the patient’s cover must include exercise physiology services and the treatment must aim to prevent, delay or ameliorate a chronic disease or injury. Insurers do not pay a benefit for general fitness programs.
ESSA is monitoring Private Health Insurers daily and will advise members of further acceptance of telehealth. Furthermore, we continue to advocates for AEP telehealth item codes for insurers who have not yet adapted telehealth.
# N for AEP telehealth = the provider has telehealth for other Allied Health Professions.
-# = No information available yet confirming telehealth for any Allied Health Professions.
All receipts should include providers details (including name, practice address, contact details), business details (business name, ABN), member details (name, address), service details (receipt number, date of service, explanation of the type of service, item code). The following codes developed by ESSA, in conjunction with HICAPS and Private Healthcare Australia:
This information is of a general nature only and is current at the date of publication. It is no substitute for professional or medical advice. ESSA accepts no legal liability for any loss or damage suffered as a result of any information provided in this publication. ESSA recommends that you carefully consider the accuracy, currency, completeness and relevance of the information in this publication, and make your own inquiries and seek appropriate professional advice specific to your particular purposes and circumstances (including the provision of medical advice to your patients) before relying on it.
Workers’ Compensation Schemes supporting AEP service delivery via Telehealth – Updated 6 April 2020
NSW State Insurance Regulatory Authority (SIRA)
The Fees Order 2020 - Accredited Exercise Physiology No 2 outlines that Telehealth services means delivery of consultations via video or telephone. Consultations would be inclusive of any electronic communication to support the delivery of the treatment service. Accredited Exercise Physiologists must consider the appropriateness of this mode of service delivery for each worker on a case-by-case basis. Telehealth services require pre-approval from the insurer and must be consented to by all parties – the worker, Accredited Exercise Physiologist and insurer.
QLD Workcover
The Exercise Physiology Table of Costs July 2019 already supports telehealth as a method of service delivery. Exercise Physiology telehealth services are restricted to video consultations only and requires prior approval from WorkCover Queensland.
ReturntoWork SA
Temporary COVID-19 Allied Health Practitioner fee items have been introduced. Exercise physiology guidance outlines telehealth/telephone individual sessions are available for workers with an existing claim that are unable to attend an appointment because they have been impacted by COVID-19. Review, planning, education, instruction, supervision and upgrade of prescribed functional and work-related exercise activities. Maximum of 10 sessions, up to a maximum of 1 hour per session. An Exercise Physiology Management Plan is required on commencement of this service. On 3 April, 2020 ReturntoWork SA introduced Telehealth/telephone initial exercise physiology assessment telehealth fee item (EPTE9) for workers who are unable to attend an appointment because they have been impacted by COVID-19. See additional information above
Worksafe Victoria
New Item Codes for Exercise Physiology have been introduced. These items codes are temporary measure and will be reviewed regularly. It is expected that telehealth services are provided when clinically appropriate and should not replace face-to-face consultations unless there is a need.
Workcover WA
The use of telehealth services is encouraged for consultations where direct patient contact and examination is not essential. As there are no specific Workcover WA service codes for telehealth, medical and allied health providers should use the relevant service codes that apply to consultations generally. The fees for these services should also be applied.
State Insurance Regulatory Authority (SIRA) update – AEPs and Certificates of Capacity/Fitness
ESSA advocated to SIRA in March 2020 that AEPs were the most appropriate allied health professionals to be included in any legislative amendments enabling a second or subsequent Certificate of Capacity/Fitness as part of the NSW Government’s COVID-19 emergency plan.
SIRA confirmed with ESSA today (6 April, 2020) that allied health providers cannot currently submit a Certificate of Capacity because the legislative amendment allows for a second or subsequent Certificate of Capacity/Fitness provided by a claimant to the insurer be a certificate that complies with the requirements prescribed by the Motor Accident Guidelines (MAGs) and the Workers’ Compensation Regulations. SIRA is currently updating the MAGs and the Regulations to enact this amendment and will advise ESSA once the updates are confirmed. Therefore, at present only a medical practitioner can issue a Certificate of Capacity.
The NSW Government laws passed included an amendment to the Workers Compensation Act 1987 to allow a follow up Certificate of Capacity to be completed by “a relevant Allied Health provider”.
ESSA will advise members on more details as once more is known.
Public Health and Emergency Declaration Orders
All ESSA accredited professionals and members are bound by ESSA's Code of Professional Conduct and Ethical Practice, which outlines professional practice expectations.
Section 2 of the Code 'Compliance with the Law' states:
2.1 Exercise and sports science professionals shall make themselves aware of any laws, legislation, regulations and other professional policies relevant to their practice settings.
This include compliance with requirements such as public health orders and emergency declaration orders. Failure to abide by the Code, including failure to abide by the COVID-19 orders and other external legal/industry requirements may lead to disciplinary action by ESSA.
ESSA professionals are expected to review the Code regularly and consider their practices to ensure compliance.
Stay at home rules
A reminder to follow the stay at home rules, particularly for those living in the states which have the toughest rules:
VIC - 'Stay at home' and 'Restricted activities' directions - frequently asked questions
NSW - What you can and can't do, where you can go and what is open, closed or restricted
QLD - Home confinement, movement and gatherings for Queenslanders
Healthcare Hours - Supermarket Access
Emergency Services and Healthcare Workers can now do their groceries 7.00am and 8.00am every Tuesday and Thursday at Coles and Woolworths.
AEPs will need to be wearing their uniforms, carrying their work ID, or their ESSA certificate to access stores when they open at 7.00am.
Movement Across State Borders
For those for AEPs who may work on a fly-in fly-out basis, you are permitted to cross jurisdictional borders despite borders being closed, especially those working in critical services or rural and remote areas.
Easter Holidays
Social distancing is slowing the spread of the virus in Australia. These measures are saving lives and livelihoods. The National Cabinet reminds Australians that social distancing must continue at Easter and agreed that Australians should stay at home this Easter and not undertake unnecessary holiday travel.
NBN Co News
The NBN increased capacity is still holding up. It has measured usage at peak times there is still capacity remaining.
It is aware that with further lockdowns, more demand may be placed on the network from telehealth but it will monitor this and adjust as necessary.
From GP and Allied Health perspectives, it is monitoring the increased demand on telehealth services. It is anticipating a launch of further support for these health professionals in the next few days. Stay tuned for an announcement.
Health businesses and education are priorities for service delivery and support.
A face-to-face platform is being developed to allow better access to customer support. More news on this shortly.
If any member experiences NBN issues, pass on your concerns to Caroline Robertson ([email protected]) so Carline can sent them to the NBN for feedback/support.
A package is also being developed to help people of lower SES access the NBN if they do not already for financial reasons. This may apply to some of your clients.
Department of Health: Update for primary care workers (including allied health) health on 2nd April, 2020:
The recording of the webinar, hosted by Deputy Chief Medical Officer, Professor Michael Kidd AM, specifically for Allied Health practitioners from the Department of Health is now available here.
Advanced Payment - National Disability Insurance Scheme (NDIS)
The NDIA has introduced a number of measures to support NDIS Service providers during the COVID-19 pandemic including advanced payments for registered providers. It is important to note that if registered providers did not opt out of the advanced payment, they will be required to repay the debt to the NDIA (in accordance with section 182 of the NDIS Act).
The NDIA has indicated that is cannot advise on the start date for repayments. The NDIA will wait until the pandemic crisis is over and there is a healthy economic environment before seeking repayments. At this stage, the NDIA has indicated that 100% of future claims will be used to offset repayments until the debt has been cleared. For example, an AEP claiming for one individual one-hour session of $166.99 (GST incl) will be required to offset the entire amount of $166.99 (GST incl). An AEP delivering 10 individual sessions in one day will have 100% of all individual sessions offset against the debt.
ESSA will be seeking adjustments to the repayment schedule to ensure that providers are not having their income reduced to zero when the repayment process begins. However, we cannot be certain that we will be successful with that so providers should take the advance payment on the basis that they could manage under the circumstances of having no income once the repayments are due.
Registered providers that have missed the opt out date and have automatically received the advance payment in their accounts, can make an immediate repayment to the NDIA, if they chose, by contacting the NDIA National Contact Centre and asking for an invoice to be issued for the repayment.
Tenancies
ACT - Residential tenancy relief
The rebate will be equal to 50 per cent of the rent reduction, capped at $1,300 per quarter (around $100 per week), for up to six months. This will provide rental relief to impacted tenants of up to $200 per week. Households would be able to defer rates for 12 months if they have incomes below $160,000 and have had a 25 per cent reduction in income, and landlords would get tax relief if they agree to lower rents by at least 25 per cent. More information is here.
QLD - COVID-19 Rental Grant
The COVID-19 Rental Grant is a one-off payment of up to 4 weeks rent (maximum of $2,000) available to those affected by the COVID-19 pandemic who do not have access to other financial assistance. The grant is paid directly to your lessor.
Before you apply
You must have had a conversation with your lessor and be able to provide evidence that the lessor has declined all attempts for you to make a payment arrangement.
Eligibility
Applicants must meet the following criteria:
• you live in Queensland
• you have, or will shortly have, a bond registered with the Residential Tenancies Authority
• you are an Australian citizen, permanent resident, or have a temporary or permanent protection visa or possess a bridging visa
• you do not have more than $10,000 in cash and savings
• you can provide evidence of attempts to negotiate a payment plan with your lessor
• you have lost your job and have applied to Centrelink for income support
• you are waiting for your application with Centrelink to be approved.
More information here.
Commercial Tenancies
National Cabinet made further progress last Friday, 3 April, 2020 on the issue of commercial tenancies. It agreed that a mandatory code of conduct guided by certain principles will be developed and subsequently legislated by State and Territory Governments to apply for tenancies where the tenant is eligible for the Commonwealth Government’s JobKeeper assistance and is a small- or medium-sized enterprise (less than $50 million turnover).
The principles that guide the code will be:
a. Where it can, rent should continue to be paid, and where there is financial distress as a result of COVID-19 (for example, the tenant is eligible for assistance through the JobKeeper program), tenants and landlords should negotiate a mutually agreed outcome
b. There will be a proportionality to rent reductions based on the decline in turnover to ensure that the burden is shared between landlords and tenants
c. There will be a prohibition on termination of leases for non-payment of rent (lockouts and eviction)
d. There will be a freeze on rent increases (except for turnover leases)
e. There will be a prohibition on penalties for tenants who stop trading or reduce opening hours
f. There will be a prohibition on landlords passing land tax to tenants (if not already legislated)
g. There will be a prohibition on landlords charging interest on unpaid rent
h. There will be a prohibition on landlords from making a claim to a bank guarantee or security deposit for non-payment of rent
i. Ensure that any legislative barriers or administrative hurdles to lease extensions are removed (so that a tenant and landlord could agree a rent waiver in return for a lease extension)
For landlords and tenants who sign up to the code of conduct, States and Territories have agreed to look at providing the equivalent of at least a three-month land tax waiver and three-month land tax deferral on application for eligible landowners, with jurisdictions to continue to monitor the situation. Landlords must pass on the benefits of such moves to the tenants. In cases where parties have signed to the code of conduct, the ability for tenants to terminate leases as mentioned in the National Cabinet Statement on 29 March, 2020 will not apply. Mediation will be provided as needed through existing State and Territory mechanisms.
The proposed code of conduct will be discussed at the next meeting of the National Cabinet tomorrow (Tuesday 7 April, 2020).
Business Development
Article: “Tips to keep your business going during the COVID-19 pandemic” by WA Small Business Development Corporation (WA Government), published 30 March 2020 provides a checklist with 12 tips to help guide you during the pandemic.
Other Ways to Reduce Your Operating Costs
HICAPS
Allied Health Professions Australia (AHPA) has advised ESSA that HICAPS has announced it is waiving merchant terminal rental fees for three months, from 1 April to 30 June 2020, for all customers.
Other transaction fees and charges will remain the same.
For more information about this announcement and customer support for businesses impacted by COVID-19, click here. Information and updates on telehealth items from HICAPS during the COVID-19 health crisis is available here.
Mobile Phone Fees Reduced for Health-care Workers
Optus is waiving mobile access fees for three months, while Vodafone is offering a two-month credit to registered health-care workers. The criteria to access these benefits includes giving the companies an Australian Health Practitioner Regulation Agency (Ahpra) registration number. ESSA is working on this.
Coronavirus: How to manage your credit card
Information from finder.com.au about hardship, credit limit increases, cash advances and other details during the coronavirus pandemic available here.
Mental Health
Article: “The psychology of isolation” written by Associate Professor Terry Bowles, University of Melbourne and Associate Professor Janet Scull, Monash University. Published in Pursuit, 4 April 2020.