HEALTH FUND REPORT

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ATMS published a Health Insurance Update for members on 29 January 2019. That update provided the most recent information for the major health funds on plans to introduce the health insurance rules that become law on 1 April 2019

The current Coalition Government, at the time of writing, continues to confirm that it will change the Rules for natural medicine treatments in private health insurance. ATMS will continue to champion natural medicine and advocate that this bad decision be changed.

 

Health funds are compelled by these Government reforms to now redesign all policies and benefit schedules, to be ready on 1 April 2019. The health funds acknowledge this is an enormous challenge.

For ATMS members we celebrate those treatments that will continue to be covered and attract potential rebates: Acupuncture; Ayurveda; Chinese herbal medicine; Chiropractic; Remedial Massage; Nutrition and Osteopathy.
 
Each Health Fund will make its own decisions about provider eligibility and treatment rebates. ATMS will continue to work with the funds to manage eligibility, provider registration and maintain accurate lists into 2019 and beyond.
 
For other ATMS members we acknowledge with deep regret that these treatments have been listed by the current Government as no longer to be covered by health insurance from 1 April 2019: Alexander technique; Aromatherapy; Bowen therapy; Buteyko; Feldenkrais; Western Herbalism; Homeopathy; Iridology; Kinesiology; Naturopathy; Pilates; Reflexology; Rolfing; Shiatsu; Tai chi; Yoga

It is with deep regret that despite an active and passionate lobby from natural medicine practitioners, the current government continues to confirm that the Business Rules for health funds will restrict a list of natural therapies from 1 April 2019. From this date onwards, health funds will not be allowed to offer treatment and rebate coverage for the listed therapies.

At the time of writing the listed therapies are:
Alexander technique; aromatherapy; Bowen therapy; Buteyko; Feldenkrais; Western herbalism; homeopathy; iridology; kinesiology; naturopathy; Pilates; reflexology; Rolfing; shiatsu; tai chi; yoga.

It is now inevitable that individual health funds will begin to implement these changes. ATMS will keep members advised as we are told what these changes will be.

The first health fund to make changes is HBF who have advised ATMS they will implement these changes from 1 January 2019, before the government commencement date of 1 April 2019.

Important Health Fund reminders

 

  • BUPA requires $2 million in professional indemnity insurance cover, effective 1 July 2017
  • BUPA has a maximum 4 clinics for all modalities
  • Medibank has a maximum 3 clinics for Remedial Massage members only
  • No online/Skype/email/phone consultations for rebates for all health funds
  • Patient clinic Records: you must write and keep a clinical record of each treatment provided. Each record must be accurate, legible and easily readable by a third party and written in English.

It is a requirement of AHPRA and the Chinese Medicine Board that all (TCM) Traditional Chinese Medicine practitioners hold a minimum of $5 million professional indemnity cover for any single claim.

Please revise your insurance policy to $5million for individual professional indemnity claims as soon as possible and forward a copy of your revised insurance policy to info@atms.com.au as soon as possible.

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The following are valuable reminders of key elements for health insurance provider numbers.

Full details of health fund conditions are available for members here.

  • Gift vouchers or Gift cards are not entitled to health fund rebates;
  • BUPA requires $2 million in professional indemnity insurance cover, effective 1 July 2017;
  • BUPA has a maximum 4 clinics for all modalities;
  • Medibank has a maximum 3 clinics for Remedial Massage members only;
  • ARHG, AHM and Medibank do not recognise mobile treatments, only treatments within a clinic environment is acceptable (professional, clinically appropriate facilities);
  • No online/Skype/email/phone consultations for rebates for all health funds;
  • Always update ATMS with changes to your contact details including email address and mobile number, postal and/or clinic locations;
  • Do not allow your Provider Number(s) to be used by any other person;
  • Patient clinic Records: You must write and keep a clinical record of each treatment provided. Each record must be accurate, legible and easily readable by a third party and written in English. 

Medibank has asked ATMS to clarify for all members the view of Medibank as to whether a gift card or voucher can be used to claim a benefit from Medibank or ahm. Medibank/ahm does not pay benefits for services when the services are fully covered by a third party. Medibank advises that this applies to gift cards and vouchers. Members requiring further information in relation to Medibank rules and policies should refer to the Medibank Member Guide available here. Medibank’s Fund Rules and policies are summarised in the Member Guide. The Member Guide details when benefits are not payable (in this instance refer to p27 of the Guide).

ARHG will no longer recognise mobile Massage and Remedial Therapists and Health Funds have the right to reject the claim for mobile therapy even if the claim is from a recognised provider with ARHG. Only treatment within a clinic environment is accepted by ARHG and mobile treatments will not be eligible for Health Fund Rebates from the participating ARHG Health Funds. 
 

Mobile Therapy does not meet ARHG criteria or Private Health Insurance Legislation regarding Practice Quality.  This also includes any Massage or Remedial treatment provided within a corporate environment. GMHBA, including Frank Health & Budget Direct will no longer be paying benefits on Massage Therapy (Cert IV Qualification).  They will only be accepting a minimum qualification for Remedial Therapists (Diploma of Remedial Therapy).

A new health fund with ARHG, they will only be accepting qualifications for Remedial Therapists (Diploma of Remedial Therapy), Acupuncture, Homoeopathy and Naturopathy.

  • Need to be rubber stamped, a pre-printed receipt book, letterhead or computer generated.
  • Do not allow your Provider Number(s) to be used by any other person
  • Date of the service and name of the patient who received the treatment
  • Address where the service was provided and the contact telephone number

The Australian Health Practitioner Regulation Agency (AHPRA) registration for Acupuncturists, Chinese Herbal Medicine Practitioners, Chiropractors and Osteopaths expires 30 November 2017. If you have not already renewed your AHPRA registration, please renew as soon as possible to avoid removal of health fund provider status and possible late fees.

ATMS requests members to provide a copy of your renewed AHPRA registration to ensure that you remain ATMS accredited for these modalities.

Please email a copy of your registration to info@atms.com.au 

For registration renewal applications received during December, AHPRA may require the annual registration fee plus a late fee. If you have not renewed your registration by 1 January 2018, please note that you will be removed from the AHPRA register and these modalities will be removed from your list of ATMS accredited modalities. If these modalities are your only ATMS accredited modalities, your membership will be downgraded from Accredited to Associate Membership, until you can demonstrate current Practising registration with AHPRA. Your ATMS membership will also be downgraded to Associate if you renew AHPRA registration in the Non-Practising category.

For further information, please contact AHPRA on 1300 419 495 or visit their website www.ahpra.gov.au

ATMS is audited by a number of health funds annually to ensure provider compliance, but to also ensure the Associations’ compliance to the individual health fund contracts.

A small number of members randomly selected by these health funds have unfortunately, either not completed any CPE or have undertaken insufficient activities to meet the required 20 ATMS CPE points for 2016/2017. 

These members have also renewed their ATMS membership declaring completion of the required ATMS CPE points for 2016/2017. Members, who fail a health fund audit, not only risk their own provider status being removed, but also that of every other provider with ATMS.

We therefore ask all members to:

  1. Read and understand the ATMS CPE Policy and the CPE FAQ documents (both available on the ATMS website).
     
  2. Start planning your CPE activities for 2017/2018 now, if you have not already done so.
     
  3. Ensure that the activities you have chosen to do relate to natural medicine, and more specifically for any, and all, modalities in which you have health fund recognition.
     
  4. Aim for more than 20 ATMS CPE points. It’s better to have more, than not enough.
     
  5. Ensure that you fill out the ATMS CPE Record and that you keep sufficient substantiating documentation. Points will not be awarded where the supporting evidence is not sufficient.
     
  6. All CPE Evidence must be in your name. Points will not be awarded where the supporting evidence is in someone else’s name.
     
  7. Ensure that you keep this evidence secure and easily accessible. Some health funds require members to submit their CPE within 24 hours of being audited and will not provide extensions or exemptions for members on holidays, overseas or facing personal hardship.
     

Contact the ATMS Office on 1800 456 855 or by email at info@atms.com.auif you have any questions regarding the ATMS CPE Policy.

TCM Members who completed their studies in a non-English language, please note the IELTS Overall Band 7 requirement to qualify for BUPA recognition.

The ATMS Health Fund Report will advise Accredited Members of specific changes relating to individual health funds Read More

The essential general requirement to be recognised by a health fund is to maintain professional standing as an ATMS Accredited Member Read More

It is worth recapping that ATMS is a ‘professional organisation’ within the meaning of section 10 of the Private Health Insurance (Accreditation) Rules 2011 Read More