Health Fund Rebate Changes from 1 July 2009

HypnosisAustralia, May 2009

By Dr Tracie O'Keefe DCH, Clinical Hypnotherapist, Psychotherapist & Counsellor
Editorial Director of HypnosisAustralia Online.

The changes to health fund compliance for rebated health service fees reach their final stage on 1 July this year. The recognition criteria for natural therapy providers will be upgraded in order to meet standards set out in section 10 of the Private Health Insurance (Accreditation) Rules 2008, laid down by federal government for the health funds. This means from 1 July hypnotherapists will need to meet the following criteria to be considered as a service provider by the health funds:

Hypnotherapists need to belong to a professional association that meets particular recognition criteria. This may be determined by statute but may also differ slightly from health fund to health fund. All associations need to be aware of the requirements from each health fund with regard to their professional standards.

Each association will need to demonstrate that its members have met a standard of training/education set out and available to health fund inspections. Standards of course will be determined by minimum hours of training, continual education and possible continuous professional supervision. Eventually when the federal government, through COAG, decides minimum standards for non-government-registered healthcare professions they will all be in line with what might be expected by health funds. In the meantime many associations will be unable to meet these standards and although their members will still legally be able to practise hypnotherapy they will miss out on their clients being able to claim back health fund rebates.

Practitioners will need to hold current professional indemnity insurance along with public and product liability insurance to a minimum of $1 million for services supplied to health funds member/clients.

Practitioners must hold a senior first aid certificate (or equivalent)

Comply with any particular terms laid down by each health fund.

Although the due date of change is 1 July many health funds will require new practitioners registering to meet that standard before the due date. Previously when rules changed for health fund rebates, practitioners who were registered with the health funds before the changes were often allowed to remain registered. This situation may be different this time as the health fund will be legally liable to check that associations are only putting forward practitioners who are meeting the set standards. If health funds are paying out rebates to practitioners who do not meet these standards, they themselves will now be in breach of the government rules and liable for sanction.

Associations will also be responsible for informing health funds of any changes to the practitioner's practice so they will need to ensure that members are not tardy in reporting such changes to them.

If practitioners already belong to associations that are meeting those standards, they do not need to do anything, but if their association is not meeting those standards, they stand to lose their eligibility with the health funds.

There are still some practitioners who get rebates paid for their clients by health funds that are not members of recognised associations and their eligibility will cease at the due date. They will need to join an eligible association before the due date to retain their eligibility.

There are health funds that will pay out to members/clients for hypnotherapy services but many will not nor will any law now or in the future will force them to do so. It is the individual policy with the health fund that the client has that determines whether hypnotherapy is included in their policy. Some older policies may include hypnotherapy but the health fund may not allow that in more recent policies or vice versa. Some health funds will only pay out for hypnotherapy on top rate cover policies under what is generally termed as "extras".

The responsibility for health fund eligibility rebates lies with three parties: the client, the association and the practitioner. It is up to practitioners to ensure their associations are on top of the rule changes. Ultimately, however, it is up to the client to ensure that their practitioner is eligible under the rebate changes and that their policy covers them. Many clients are often deeply confused about what their policy covers and often think they are covered when they are not. Therapists need to emphasise to their clients their responsibility to check their cover if they intend to claim rebates.

In this article we have of course covered the services of hypnotherapists, but the same will apply to counsellors, psychotherapists, and counselling naturopaths who use hypnosis as a sub-modality. The changes will not affect psychologists, psychiatrists, medical hypnotists or dentists, who are generally fully covered with health funds through their primary discipline associations.

©HypnosisAustralia, May 2009