HCF

The Private Health Insurance Fund HCF has advised OTA of the following:

The COVID-19 pandemic is causing unprecedented changes to many of our lives. The reality is that during this period of restricted activities patients need solutions that empower them to seek appropriate treatment for their circumstances and make the most of their health benefits.

Your professional association provided a case for telehealth service provision during this time, and taking this into account, we are relaxing the requirement for one to one consultations to be delivered in person. 

HCF members will be able to claim for one-to-one consultations via telehealth as well as face to face from your members who are HCF recognised providers. This exception will be temporary – applying to services delivered between 30 March and 30 June 2020 (with the latter date subject to further review during the period). 

WHAT HEALTH PROVIDERS NEED TO KNOW

The specific item numbers which are eligible for an HCF telehealth benefit are listed on the HCF Provider Telehealth Claim Form. This can be found HERE.  

Telehealth is not a defined term, and so we ask that health care providers conducting their consultation by telehealth, to complete and sign the telehealth claim form and attach it to their invoice so HCF members can claim. 

HCF members can claim for telehealth services using the HCF photo app.

Bupa

OTA has received Telehealth Guidelines from BUPA to guide your telehealth practice. The private health funds are all independent entities, advised by but not beholden to, Private Healthcare Australia (PHA). OTA has in recent days liaised with AHPA, PHA and individual health funds, outlining those aspects of occupational therapy that can be effectively delivered by Telehealth. We will advise OTA members of each private health fund’s position as we are advised. View the Guidelines here. 

Latest Update
Private Healthcare Australia has introduced a new set of Telehealth items which Bupa will be adopting. It is important that practitioners make the switch to using these new codes to denote Telehealth consultations as this will allow retrospective examination of utilisation data to inform us as to how we might proceed with discussions regarding Telehealth services in the future.

Current Item	New Telehealth Item
100	601 Individual Initial/Referred Assessment by teleconsultation
200	602 Individual Subsequent Treatment by teleconsultation

HBF

Update as at 25 November
Temporary telehealth benefits due to end 31 December 2020 have recently been extended to 30 June 2021.

Accounts must include the following information 

• Telehealth item number H601 or H602 or H603  (refer to hbf.com.au/telehealth for item numbers)
• Delivery method 
• Duration 

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HBF have approved some initial Item numbers for use via Telehealth

H601	Individual Initial Assessment Telehealth	At least 45 minutes via video
H602	Individual Subsequent Treatment Telehealth	At least 30 minutes via video
H602 *new*	Individual Subsequent Treatment Telehealth	20-30 minutes via video

Telehealth benefits will be temporarily available on services certain occupational therapy treatments. It’s important to remember that benefits towards telehealth treatments are available only on a selection of specific treatments within each service category.

*HBF introduced a new temporary item number to allow claiming for subsequent Occupational Therapy treatments provided via telehealth with a duration of 20 - 30 minutes. Although the new item number was introduced on 11 May 2020, if a service was provided on or after 1 April 2020, and the treatment meets all eligibility criteria,  HBF will pay a benefit.

Account requirements

In addition to account requirements outlined in the HBF Approved Provider Terms & Conditions, the account must clearly indicate:

• Required Delivery Method – i.e. phone call or video conference
• Treatment start and end times (e.g. 1pm to 1.30pm)
• Duration (e.g. 30 minutes)

HBF staff and systems will be utilising the following item numbers and descriptions.

For more information visit the HBF website: https://www.hbf.com.au/members/useful-articles/telehealth-treatments

HICAPS

Telehealth Item Number Guide for Occupational Therapists

ITEM NUMBER	FULL DESCRIPTION	ABBREVIATED DESCRIPTION
601	Individual Initial/Referred Assessment by teleconsultation	IND INT ASMENT TC
602	Individual Subsequent Treatment by teleconsultation	IND SUB ASMENT TC

nib

Private health insurer, nib health funds, has announced that in light of COVID-19 it will fund individual telehealth occupational therapy services from 6 April until 30 June 2020, at which time it will be reviewed to ensure it meets the needs of their membership and, if required, extended.

The following services are eligible for funding.

Occupational Therapy

Item Code 601 Individual Initial/Referred Assessment by teleconsultation	INDIVID INIT ASSESS T/C
HiCaps code 602 Individual Subsequent Treatment by teleconsultation	INDIVID SUB TRMT T/C

• Occupational therapists are expected to adhere to the standards/code of conduct of OTA  and any specific telehealth guidance and training including, but not limited to, these requirements:
  • Ensure that telehealth services are delivered with the adequate security, privacy and consent in place.
  • Adequate assessment is undertaken to ensure that services are only delivered via telehealth where it is safe and effective.
  • AHPRA’s published guidelines in relation to telehealth that are also observed. These can be accessed here
• Service providers need to work with nib members, their patients, to ensure their presenting symptoms can be safely and effectively managed via a telehealth mode of delivery.
• Service providers must ensure that they are working within their competency to deliver safe and effective care via telehealth.
• nib members are eligible to receive benefits for telehealth where they are covered for the face to face service on their policy.
• Normal fund rules and provider terms and conditions apply.
• Individual consultations only are covered.

Medibank and ahm

Latest Update: 10 August, 2020
Medibank is extending the ability for customers to claim for telehealth consultations for occupational therapy (as well as psychology, physiotherapy, dietetics, podiatry, exercise physiology and speech therapy) until further notice. Read more here.

Medibank and ahm have recently announced that eligible customers with extras cover will be able to claim for selected services where telehealth can be delivered effectively as an alternative to a face-to-face consultation.

These services include physiotherapy, dietetics, occupational therapy, podiatry, exercise physiology, and speech therapy. This follows the introduction of psychology telehealth on 30 March 2020. Both Medibank and ahm will pay benefits towards individual (one-on-one) telehealth consultations for services by 14 April 2020 through to 30 September 2020. Some conditions apply.

Cover is available for eligible Medibank and ahm members, who have an extras product that includes cover for the occupational therapy where*:

• The patients is undergoing an existing course of treatment or has been a patient of the clinic/health professional in the past six months, (as preference for efficacy supported by telehealth outcomes
• For new patients, consultations will remain available but preference for GP or treating specialist to provide recommendation for treatment options where possible

Note, the clinician should use their clinical reasoning to determine if the patient is clinically appropriate to receive the service via telehealth. The clinician must work within their scope of practice and the service should be undertaken in accordance with Occupational Therapy Australia’s telehealth policy and guidelines.

* Normal waiting periods and annual limits apply to telehealth consultations.

New Item numbers and Submitting Claims

Medibank members can submit claims through usual channels including My Medibank and the MyMedibank app. When they login to My Medibank, there will be a message on that page providing directions on how to make these claims.

ahm members can submit claims through channels including online, ahm app or email.

Please note, telehealth claims will not be able to be submitted via electronic claiming channels (HICAPS and Healthpoint).

Medibank and ahm will accept the following new telehealth item numbers and descriptions. These telehealth item numbers are available for all Medibank and ahm recognised providers, not just our Medibank Members’ Choice providers.

The benefits paid towards these telehealth consultations the same as the equivalent face-to-face consultation

Modality	New code	New description	Established /Equivalent code	Established /Equivalent description
Occupational Therapy	601	Individual Initial/Referred Assessment by teleconsultation	100	initial Individual assessment
Occupational Therapy	602	Individual Subsequent Treatment by teleconsultation	200	individual assessment/Treatment

With regard to the recent announcement here is the link to the Medibank newsroom.

https://www.medibank.com.au/livebetter/newsroom/post/medibank-and-ahm-boost-access-to-telehealth-during-covid-19-pandemic

Further information for providers can be found here.

Police Health and Emergency Services Health

The following Telehealth benefits for Occupational Therapy have been introduced by Police Health and Emergency Services Health, effective from 1 April 2020 in response to the COVID-19 pandemic.

Services for Telehealth Individual Initial Assessment and telehealth Individual Subsequent Treatment  have been approved for benefits within these health funds.

The rules around Telehealth claims for Occupational Therapy are reasonably straightforward:

Telehealth services are applicable where:

• The patient is undergoing an existing course of treatment, and has seen the physiotherapist providing the telehealth consultation over the past 6 months, or
• For new patients, the telehealth service has been recommended by their general Practitioner, relevant medical specialist or continuation of care in a health management or hospital discharge plan, and
• The service is delivered using audio and visual communication (such as Zoom, Skype or Facetime), and
• The service is undertaken in accordance with the Occupational Therapy Scope of Practice Framework.
• Services are provided from 1 April 2020 to 30 September 2020.

For services meeting the above criteria, an account issued to the member, appropriately itemised and including a notation for telehealth or video consultation will be sufficient for member benefit purposes.

The Funds note the possible introduction of telehealth services within HICAPS, but advise that Police Health and Emergency Services Health membership cards will not be enabled for Key Entry of the card number and as such all claims will need to be submitted by the member.

Defence Health

Defence Health is recognising occupational therapy telehealth consultations (effective from 13 March 2020). This is an important benefit available for ongoing therapy as well as newly referred clients. The information can now be found on this document.

State/Territory Based Compensable Schemes

State Insurance Regulatory Authority (SIRA) NSW

In the current environment of the COVID-19 virus, SIRA supports the use of telehealth services delivered by Occupational Therapists (OT) where it is appropriate and reasonably necessary for an OT to deliver that service via telehealth.

Practitioners must consider the appropriateness of this mode of service delivery for each worker on a case-by-case basis. Practitioners are responsible for delivering telehealth services in accordance with the principles of professional conduct and the relevant professional and practice guidelines to ensure that all care is taken to ensure the safety, appropriateness and effectiveness of the service.

Please note all Telehealth services require pre-approval from the insurer and must be consented to by all parties – the worker, practitioner and insurer.

There are no Fees Orders for Occupational Therapists, however for services delivered by a non SIRA approved practitioner that are similar in nature to that of a SIRA approved practitioner (eg hand therapy by an occupational therapist is similar service delivered by a physiotherapist) it is recommended the relevant gazetted Physiotherapy Fees Order  be used as a guide for the cost of services.

NIISQ (National Injury Insurance Scheme Queensland)

NIISQ Agency aim to ensure that treatment, care and support for NIISQ participants continues to be provided with no, or minimal, disruption.

• NIISQ Agency will fund the provision of necessary and reasonable treatment, care and support services via tele-health and these will be assessed on a case-by-case basis
• Service providers can continue to provide quotes for their services, based on the services that are required for each individual participant. Refer to the NDIS Price Guide to benchmark fees for services.
• There is a delay finalising re-registration for those who sought registration as case management service providers – current registration status will be maintained through any delay
• For more information visit the NIISQ Agency Covid-19 webpage

Workcover Qld

Workcover Queensland supports telehealth as a method of delivery.

Telehealth services are only related to video consultations. Phone consultations are not covered under the current Table of Costs.

The following should be considered prior to delivering the service:

• Providers must consider the appropriateness of this mode of service delivery for each worker on a case-bycase basis i.e. the principles and considerations of good clinical care continue to be essential in telehealth services.
• Providers are responsible for delivering telehealth services in accordance with the principles of professional conduct and the relevant professional and practice guidelines to ensure that all care is taken to ensure the privacy, confidentiality, safety, appropriateness and effectiveness of the service.
• As with any consultation, it is important to provide sufficient information to enable workers to make informed decisions regarding their care.
• All telehealth services require prior approval from the insurer and must be consented to by all parties – the worker, provider and insurer.

For billing purposes, telehealth services do not have specific item codes and should be invoiced in line with the current item codes and descriptors in each Table of Costs. “Telehealth” must be noted in the comments section on any invoice submitted to the insurer when this service has been utilised.

ReturnToWorkSA

ReturnToWorkSA has created two new occupational therapy telehealth fee items in response to the COVID-19 health emergency. Some points to highlight regarding the new fees are: these fees are available to workers with an existing claim, an Occupational Therapy Management Plan is required and there is a maximum of 10 sessions. These new fees are available to download here.

TAC

Latest Update 14 September 2020
The TAC is grateful for the dedicated work of health providers during these challenging times. In response to COVID-19 the TAC introduced temporary funding of telehealth services to ensure its clients can still access the treatments and services they need related to their transport accident. The TAC has now announced it will extend funding temporary telehealth services previously scheduled to end on 30 September until further notice, giving clients the ongoing convenience and flexibility of accessing health services from home.

Telehealth services enable you to use video conferencing to deliver health services to a TAC client. Telephone consultations may be used if videoconferencing is not available. TAC telehealth rates allow you to be paid at your equivalent TAC face-to-face rate when telehealth services are delivered to TAC clients. Provider guidelines for the delivery of telehealth can be found on the TAC website.

Previous Update:
After significant lobbying from OTA, TAC is now implementing telehealth item codes for occupational therapists, GPs and other allied health services. The new rates will allow you to be paid at your current TAC face-to-face rate when you deliver telehealth services to TAC clients. These arrangements will remain in place until 30 September 2020 to ensure TAC clients can continue to access essential treatments and services during these challenging times. Telehealth invoices can be backdated to 13 March 2020.

Telehealth items have now been added to LanternPay allowing you to invoice us online and get next business day payments. Go to lanternpay.com/providers to sign in or register, or visit tac.vic.gov.au/lanternpay for more information.

Worksafe VIC

WorkSafe Victoria is introducing temporary measures to support the continuation of essential health services for injured workers. WorkSafe will introduce temporary item codes to allow occupational therapists to deliver services via telehealth. Learn more here

Workcover WA

To help minimise social contact, WorkCover WA is allowing allied health telehealth consultations using the relevant service code (and fees) that apply to consultations generally. Learn more on the WorkCover WA website