TUESDAY, 14 APRIL 2020
Who Must be Bulk Billed under Medicare Telehealth Items?
From Monday 6 April 2020 the Department of Health was able to activate consumer payment channels through Services Australia which means some patients can now claim Medicare rebates and some patients can be privately billed.
The requirement for bulk billing is no longer a requirement for all groups. Patients not regarded as vulnerable can now be privately billed.
As previously notified, 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.
Patients who are regarded as vulnerable are:
• aged at least 70 years old
• indigenous and aged at least 50 years old
• pregnant
• a parent of a child under 12 months
• immune compromised
• have a chronic medical condition that results in increased risk from coronavirus infection.
Accredited Exercise Physiologists (AEPs) are asked to exercise their clinical judgement as to who is regarded as having a chronic medical condition that results in increased risk from coronavirus infection. Allied Health Professions of Australia (AHPA) of which ESSA is a member is seeking further guidance from the Department of Health on the definition of who is vulnerable. We will update you as soon as we receive clarification.
Professional Development Opportunities
a. Learn more about ESSA’s recent Telepractice Policy Statement at our webinar tomorrow, 15 April 2020
What you need to do to ensure a safe and quality digital service:
- privacy and consent obligations
- platform selection
- preparing your client
- preparing yourself
- opportunity for Q & A
Date and time: Wednesday 15 April | 10.00am-11.00am AEST
Cost: This webinar is FREE for ESSA members Please read ESSA’s Telepractice Policy Statement before attending. Eligible for ESSA CPD under Further Education with a completed self-assessment tool.
Click here to register now
b. Webinar: Telehealth Virtual care - Introduction to Telehealth
The lead agency for innovation in clinical care in NSW (the Agency for Clinical Innovation) has established a Telehealth Capability Interest Group (TCIG), a community of practice that aims to share telehealth initiatives and supports clinicians to increase the use of telehealth into their clinical practice.
The TCIG has developed a monthly information series focusing on Telehealth Capability which focuses on enabling the uptake and usage of NSW Government Telehealth Guidelines: Telehealth in Practice.
Date and time: Thursday 16 April | 1.00pm-2.00pm AEST and every third Thursday of each month from 1:00pm - 2:00pm.
Cost: This webinar is FREE.
Access: All clinicians and their managers across the state, government, non-government or private organisations with an interest in telehealth.
Click here to register now
c. Webinar: Lung Foundation Australia COVID-19 in respiratory disease
Experts will provide an update on COVID-19 and what it means for people living with chronic lung disease.
Date and time: Thursday 16th April | 7.30pm-8.30pm AEST
Cost: This webinar is FREE.
Click here to register
Subsidised Short, Online Courses - Higher Education Relief Package
The Australian Government released a package on Sunday 12 April 2020 for higher education institutions to deliver subsidised short, online courses in National Priority areas such as nursing, teaching, health, IT and science.
Australians who have lost their job or are looking to retrain can use their time studying nursing, teaching, counselling, allied health or other areas considered national priorities. The courses will start at the beginning of May and initially will run for six months. More information available here. ESSA will provide more details on this package as they come to hand.
Australian Government Employment Subsidies
JobKeeper Payment
Under the JobKeeper Payment, businesses impacted by the coronavirus will be able to access a subsidy to continue paying their employees. The Government will provide a fortnightly payment of $1,500 per eligible employee from 30 March 2020 until 27 September 2020. More information here. FAQs here.
JobSeeker Payment
This payment is for those seeking financial help if you are between 22 and Age Pension age and looking for work. More information here. FAQs here.
Telehealth Coverage - Private Health Insurance Funds Fact Sheet
- Updated 14 April 2020
For a patient 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.
- * = No information available yet confirming telehealth for any Allied Health Profession.
# N for AEP telehealth = the provider has telehealth for other 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 Health Care Australia:
Item - Number Full Description - Abbreviated Description
102 - Initial Session – once only per course of treatment > 45 min Initial consultation
202 - Standard Consultation 30 – 60 minutes Standard consultation
502 - Group Session 60 minutes (maximum of 8 people)
The information contained in this publication 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.
COVID-10 Restrictions
New South Wales - Public health order expires at 29 June 2020 unless it is revoked earlier. More information here.
Queensland - Chief Health Officer public health direction extended by regulation to 19 May 2020 and may be further extended. More information here.
New - Victoria – Stage 3 restrictions and state of emergency were extended on 12 April 2020 to midnight on May 11, 2020. More information here.
Can I still use my gym for clinical treatment?
Yes, provided your gym is small and meets the general social distancing requirements, namely, space for social distancing of four square metres per person and not more than 10 people attending at the same time. (Refer Advice from Dr Lisa Studdert from the Australian Government Department of Health here.)
How small is a small gym?
In the absence of any guidance from the National Cabinet or the Australian and state/territory governments, ESSA has determined that a small gym should be 140 square metres or less.
Can I still do outdoor classes/personal training/boot camps?
Yes, provided there is only one instructor and you only have one client and social distancing is observed.
Can I film work outs from my gym?
Yes, ESSA received word on Wednesday 8 April, 2020 from the Australian Government that filming workouts is allowed within gyms (of any size) for the purpose of offering remote personal training.
Tenancies and Rent Relief
Commercial Tenancies
The National Cabinet agreed on Tuesday 7 April 2020 that states and territories would implement the mandatory Code of Conduct (the Code), including via legislation or regulation as appropriate, to implement the principles agreed on Friday 3 April. The Code builds on the draft codes submitted by landlord and tenant representative bodies in the commercial property sector.
The purpose of the Code is to impose a set of good faith leasing principles for application to commercial tenancies (including retail, office and industrial) between owners/operators/other landlords and tenants, in circumstances where the tenant is a small-medium sized business (annual turnover of up to $50 million) and is an eligible business for the purpose of the Commonwealth Government’s JobKeeper programme.
National Cabinet agreed that there would be a proportionality to rent reductions based on the tenant’s decline in turnover to ensure that the burden is shared between landlords and tenants. The Code provides a proportionate and measured burden share between the two parties while still allowing tenants and landlords to agree to tailored, bespoke and appropriate temporary arrangements that take account of their particular circumstances.
National Cabinet again noted that it expects Australian and foreign banks along with other financial institutions operating in Australia, to support landlords and tenants with appropriate flexibility as they work to implement the mandatory Code.
The Commonwealth Government is also acting as a model landlord by waiving rents for all its small and medium enterprises and not-for-profit tenants within its owned and leased property across Australia.
The Rent Relief Policy will include a mutual obligation requirement on the small and medium sized enterprises and not-for-profit tenants to continue to engage their employees through the JobKeeper initiative where eligible, and if applicable, provide rent relief to their subtenants.
Waivers of rent must account for 50 per cent at least of the reduction in the rental provided to the tenant during that period while deferrals must be covered over the balance of the lease term and for no less of a period than 12 months. More clear insight is available here on the Code of Conduct from Grant Thornton, a major global accounting organisation.
NSW Tenancies
Further to information in the Communique on 6 April, 2020 on support for Queensland and Australian Capital Territory residential tenants, the NSW Government released a number of measures to assist both commercial and residential tenants yesterday (Monday 13 April, 2020):
· Commercial landlords will be offered a land tax concession if they pass the savings on to tenants through a rent reduction
· An interim 60-day moratorium for new applications to the NSW Civil and Administrative Tribunal for forced evictions over COVID-19-related rent arrears
· Landlords must negotiate rent relief agreements with tenants in financial distress due to COVID-19 by applying the leasing principles in the Code;
· A ban on the termination of a lease for non-payment of rent.
· A freeze in rent increases. More information available here.
Hardship provisions for energy, water and rates
On Thursday 9 April 2020, the National Cabinet agreed to a nationally consistent approach to hardship support across the essential services for households and small businesses.
The Commonwealth is already taking action across the energy and telecommunications sectors to scale-up hardship support provided by those industries.
State and territory governments agreed to adopt similar principles for the essential services within their remit, including water utilities and local governments. They will work with the organisations supplying those services to apply the principles to each sector.
The principles will also ensure accessing support for essential services is as simple and easy as possible. They specify that businesses eligible for the JobKeeper payment will automatically be considered to be under ‘financial stress’ for the purposes of accessing hardship arrangements.
These principles, modelled on the Government’s recently released Statement of Expectations for the energy sector, include:
• Offering flexible payment options to all households and small businesses in financial stress – including small businesses eligible for the JobKeeper Payment;
• Not disconnecting restricting supply/services to those in financial stress;
• Deferring debt recovery proceedings and credit default listing;
• Waiving late fees and interest charges on debt; and
• Minimising planned outages for critical works, and provide as much notice as possible to assist households and businesses during any outage.
Those who can continue to pay their bills need to keep doing so - this is critical to ensuring the ongoing viability of essential services providers.
More information will be available over the coming days from each State and Territory Government COVID-10 website.
Home Office Expenses
On Tuesday 7 April, 2020, the Australian Taxation Office has increased the hourly rate for home office expenses from 52 cents per hour to 80 cents per hour. Using this method only requires you to keep a record of the number of hours worked from home. This shortcut approach can apply from 1 March 2020 until the end of this financial year (30 June, 2020).
There is a second method of claiming a deduction using actual running costs, where a diary of expenses is kept that can be produced if the ATO requests it. Of the two methods, the second method may produce the larger deduction but the record-keeping requirements are much more stringent.
You cannot claim a deduction for items provided by your employer or if you have been reimbursed for the expense. Additional running expenses you can claim include:
· electricity expenses associated with heating, cooling and lighting the area from which you are working and running items you are using for work
· cleaning costs for a dedicated work area
· phone and internet expenses
· computer consumables (for example, printer paper and ink) and stationery
· home office equipment, including computers, printers, phones, furniture and furnishings.
Please talk to your accountant about which method best suits you and/or your business.
Summary from Department of Health (DoH) COVID-19 response update for Allied Health Practitioners - 9 April, 2020
DoH needs in-person care to be continued to be delivered for people with chronic conditions.
Ask these two key questions before treating a patient:
· Consider whether this treatment is absolutely necessary today? A service may only be provided by telehealth where it is safe and clinically appropriate to do so.
· Might this patient have COVID-19? Have in place administrative controls where you or your receptionist asks about symptoms.
Review maps about the density about rates of infection e.g. NSW Health publishes data on hot spots.
Make a risk assessment about whether a patient has COVID-19. Not every respiratory tract infection (e.g. COPD, respiratory failure, acute lung conditions e.g. infection and asthma) is COVID-19 related. If you have concerns, look at guidance from DoH in relation to the need for Personal Protective Equipment (PPE). The need for PPE can depend on where clusters are around the country.
Telehealth bulk billing
DoH needing to update Medicare billing systems through Services Australia.
From Monday 6 April, 2020 DoH was able to activate consumer payment channels through Services Australia which means some patients can now claim Medicare rebates and some patients can be privately billed.
The requirement for bulk billing is no longer a requirement for all groups.
Patients not regarded as vulnerable can now be privately billed.
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. Details on which patients who are regarded as vulnerable is detailed above.
More information on billing for those with a chronic care plan is available on the DoH website and MBS online. DoH is continuing to do work on the telehealth items.
Questions from Webinar
Q. Are all conditions referred under Chronic Disease Management (formerly Enhanced Primary Care or EPC) regarded as chronic conditions and therefore need to be bulk billed?
Bulk billing arrangements under telehealth items include people with chronic conditions where that chronic condition will put someone at increased risk if infected with COVID-19.
It is ultimately a clinical decision as to whether a person has a chronic illness that will put them at increased risk if infected with COVID-19. (Note, more details on this question above).
Q. Is remedial massage allowed?
Remedial massage has different rules in different states. No clear answer was provided but in general, if someone is registered with Ahpra, then he/she should be allowed to offer remedial massage if it is needed as part of treatment.
Q. What are the social distancing requirements in reception areas in a clinical setting?
The density rule is most important rule (ensuring one person per four square metres). Observe social distancing, good cough etiquette, enquire of patients when they make appointments if they have a cough or a temperature.
Q. Are pain management programs allowed in residential aged care
These can still be delivered in person with the requirement that PPE be worn if working in a COVID-19 hot spot.
Will be requirement from 1 May that all people will need to have had flu shots before working in aged care. Planning your contact and interaction with patients is important in managing use of PPE.
Therapies that help keep people mobile and help manage acute or chronic pain problems need to continue.
Q. Do patients need a GP referral to access the telehealth services?
The components of the service in the item descriptors and the requirement for a referral remain the same under telehealth.
There are no changes to referral requirements.
Q. Can patients travel outside the home to receive allied health services?
Yes - provided the services are absolutely necessary.
Q. Can allied health professionals travel for work?
Yes - provided this is done for essential treatments and is done wisely depending on patient’s clinical needs.
Q. How long should be patient be excluded from face-to-face treatment after testing?
3 different criteria – CDNA national series guidelines which let patients know when they can get out of quarantine.
Q. Any need to take the temperature of a patient?
No - on basis of screening, on basis of therapeutic up to individual practitioner.
Not currently recommended apart from those with a respiratory condition.
Q. Can I practice exclusively through telehealth?
Only if it is safe and clinically appropriate to do so. Exclusive delivery through telehealth will not be appropriate for very patient. DoH is encouraging all AHPs to continue to offer face-to-face services.
Q. Should masks be worn?
Make an individual risk assessment about patients and their likelihood of having COVID-19. Information from DoH on PPE here.
New Mental Health resources from Beyond Blue released Thursday 9 April, 2020 (Details below).
Mental Health
Call the Coronavirus Mental Wellbeing Support Service provided by Beyond Blue on 1800 512 348 or join the online forum or check out the information, advice and strategies to help you manage your wellbeing and mental health during this time here.