Document ID: chunk:federal_register_of_legislation:F2024C00561:body:0:p8
Version: federal_register_of_legislation:F2024C00561
Segment Type: other
Provision Reference: 
Character Range: 18679–21642

is to provide for the above treatments or services that are eligible for a medicare benefit to come within the definition of hospital‑substitute treatment.
           Note 2: Private health insurers cannot cover, as part of general treatment (including hospital‑substitute treatment) professional services for which medicare benefit is payable, except as provided for in this rule.
           Note 3: Section 126 of the Health Insurance Act 1973 prohibits insurance regarding professional services for which medicare benefit is payable, other than a complying health insurance policy entered into by a private health insurer that covers hospital treatment or hospital‑substitute treatment, or insurance regarding a person who is an eligible person by reason only of being treated as an eligible person under subsection 7 (2) of the Health Insurance Act 1973.

     11. General treatment—excluded treatment
 (1) For paragraph 121‑10 (3) (b) of the Act, the following treatments or classes of treatment are specified:
            (a) treatment which primarily takes the form of sport, recreation or entertainment, other than treatment that is part of a chronic disease management program or a health management program if the programs have been approved by the private health insurer;
            (b) excluded natural therapy treatment.
 (2) In this rule:
health management program means a program that is intended to ameliorate a person's specific health condition or conditions, but does not include treatment that is excluded natural therapy treatment.

     12. Chronic disease management programs
      (1) A chronic disease management program means a program that is intended to:
(a) either:
(i) reduce complications in a person with a diagnosed chronic disease; or
                     Note:  A chronic disease management program that is intended to reduce a patient's complications and is provided in the circumstances mentioned in subsection 121‑5 (1) of the Act is hospital treatment.  If the program is provided other than in the circumstances mentioned in paragraphs 121‑5 (1) (b) and (c), it is general treatment.
(ii) prevent or delay the onset of chronic disease for a person with identified multiple risk factors for chronic disease; and
                     Note:  A chronic disease management program intended to prevent or delay the onset of a chronic disease in a patient can be general treatment only―see paragraph 121‑5 (1) (a) of the Act and paragraph 8 (d) of these Rules in respect of hospital treatment, and paragraph 121‑10 (1) (a) in relation to general treatment intended to prevent a disease.
(b) requires the development of a written plan that:
(i) specifies the allied health service or services, and any other goods and services to be provided; and
(ii) specifies the frequency and duration of the provision of those goods and services; and
(iii) specifies the date for review of the plan; and
(iv) has been provided to the patient