Stay up to date with our latest COVID-19 updates here

Novel COVID-19

Update 20 January 2022

MIGA’s COVID-19 medico-legal and insurance Q&A covers the latest pandemic developments for our members and clients.

Categories include:


Contact MIGA for advice or assistance
We encourage you to contact :
  • MIGA's Legal Service team it you need advice about how to manage COVID-19 medico-legal issues in your practice (1800 839 280 / claims@miga.com.au / contact form), or
  • MIGA's Client Services Officers if you have any questions about your insurance cover (1800 777 156 / miga@miga.com.au / contact form)
You can also use MIGA's contact form here.
 

Insurance cover for COVID-19 vaccinations

Note - the answers in this section only apply to MIGA policies issued to doctors, Eligible Midwives and healthcare businesses which are current as at the date of publication.  Your individual cover is subject to the terms and conditions of your policy with MIGA and your chosen category of practice.  If you are a doctor whose practice entity employs other doctors, eligible midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover administration of COVID-19 vaccinations.
  • Am I covered for services related to COVID-19 vaccinations including administering the vaccines? New 1 Feb 2021

    Yes.
    • You are covered with MIGA for claims and inquiries arising from COVID-19 vaccination services you provide
    • We cover you for healthcare services provided within your category of insurance/scope of practice or healthcare business that is consistent with with your qualifications, training, experience or the healthcare services provided by your practice/business
    • You should ensure you comply with all relevant requirements and guidelines - see Q&A - What do I need to do if I’m involved in the COVID-19 vaccination program?
    • If you are being asked to undertake, or are considering undertaking, a new or different role that may be outside your scope of practice and have any concerns around your medical indemnity insurance or any medico-legal implications, please contact us for assistance.  We’ll help to make sure that your cover is appropriate for what you are doing and guide you on potential medico-legal issues involved.
    • You should let us know as soon as possible if you become aware of any claim or potential claim arising from administering the vaccines.
  • Do I need to let MIGA know that I plan to be involved in the administration of the COVID-19 vaccines? New 1 Feb 2021

    No. 
    • Unless you are in a category of insurance that does not include cover for private practice
    • If you are considering entering into any agreement (with governments, healthcare providers or otherwise) to be involved in COVID-19 vaccination services, you should contact MIGA prior to signing any agreement to ensure that you are not assuming any responsibilities for which we are not able to provide cover
    • We can also help you understand any insurance and medico-legal implications of any agreement.
  • Am I covered if I am working outside of my usual scope of practice to administer COVID-19 vaccines? New 1 Feb 2021

    Yes, if it is permitted by your Ahpra registration, you have appropriate qualifications, training and experience and you are in the appropriate category of insurance with MIGA.
    • You should only provide healthcare you are appropriately qualified and trained for and have sufficient experience to provide
    • Ahpra has provided the following information about medical practitioners moving into new roles in responding to the COVID-19 pandemic
    • If the work you are planning to undertake is outside of your usual area of practice, you should ensure you will meet your regulatory obligations with Ahpra
    • We recommend you take the following steps before starting your new work:
      • Ensure your Ahpra registration does not restrict or prevent you from engaging in the new scope of practice
      • Be comfortable that you have the necessary skills, training and experience to provide the level of care expected, and your hospital, practice or other workplace agrees
      • Ensure your proposed practice is consistent with your hospital/facility credentialing
      • Confirm with your hospital, practice or other workplace (preferably in writing) that you will have the benefit of any indemnity you are normally entitled to as an employee or contractor (e.g. as a visiting medical officer for public patients) 
      • Ensure you do not use a specialist title unless you have the appropriate qualifications – for more information see Ahpra’s guide on health titles
      • Contact MIGA to ensure you have the right category of insurance cover with us. 
  • Will my policy provide cover if my employees administer the vaccine and there is a complaint or claim? New 1 Feb 2021

    Yes

    • You are covered for your own vicarious liability as an employer but remember that you should ensure that your employees are working under your supervision and within the scope of their duties and responsibilities as you have agreed with them.
    • If you are:
      • a doctor, remember that your policy covers some but not all kinds of employees for claims made directly against them - refer to the important note at the top of this update regarding employees who need their own insurance
      • a midwife, remember that your policy covers you personally and not any employees
      • a healthcare company, remember that your policy only covers your employed doctors if the relevant optional extension is included in your Schedule.
  • If I'm asked to administer vaccines to public patients in a public hospital, am I covered for this New 1 Feb 2021

    Generally, No
    • If you are employed in a public hospital (including if you are a medical student) you will generally be indemnified by the hospital for work you undertake
    • If you are insured as a Hospital Doctor with MIGA, cover is generally only for legal expenses for inquires and investigations for which you are not otherwise indemnified or insured and for some limited private practice you may undertake outside your public practice employment
    • If you work in the public health system and plan to undertake work in the private system to administer the COVID-19 vaccines, contact us to check the extent to which you may be covered for private work under your category of insurance
    • If in doubt, please check with your hospital’s administration to clarify your indemnity situation or call MIGA to clarify your position.
  • Is my practice or healthcare business covered by MIGA's Healthcare Policy if it contracts to be part of the COVID-19 vaccination program? New 1 Feb 2021

    Yes.

    • MIGA’s Healthcare Policy for entities will cover the business and its employees (excluding doctors and other who bill on their own right) for claims and inquiries arising from their involvement in the vaccination program
    • This is provided it is within their usual scope of practice/specified business and it is subject to them complying with all relevant requirements and guidelines (see Q&A - What do I need to do if I’m involved in the COVID-19 vaccination program?).
    • Employed medical practitioners are not covered by the policy (unless MIGA has agreed to this) and will need to be covered under an individual practitioner policy with MIGA.
  • If I am asked to sign a contract for COVID-19 vaccine administration, what should I do? New 1 Feb 2021

    If you are considering entering into any agreement (with governments, healthcare providers or otherwise) to be involved in COVID-19 vaccination services, you should contact MIGA prior to signing any agreement to ensure that you are not assuming any responsibilities we are not able to provide cover for, and to understand what insurance and medico-legal implications there may be. 

    Contracts may impose obligations on you that you would not otherwise have, or they may ask you to give up rights that you would otherwise have.  Your insurance does not cover you for these changes to your rights and responsibilities unless we first agree in writing to cover you.

  • What do I need to do if I'm involved in the COVID-19 vaccination program? New 1 Feb 2021

    It is extremely important that you are familiar with and follow all guidelines provided by the manufacturers, distributors, Federal and State Governments and your professional college/association.  Be aware these guidelines may be updated regularly as circumstances change and new information becomes available.

    MIGA is working closely with Australian Governments and professional groups on the COVID-19 vaccine program and will provide further information on guidelines and other information on this website once released. 

COVID-19 vaccinations - medico-legal Q&As

Note - the answers in this section only apply to MIGA policies issued to doctors, Eligible Midwives and healthcare businesses.

COVID-19 vaccination - availability and eligibility

  • Which COVID-19 vaccines are available? Updated 12 January 2022

    The TGA has:
    • Provisionally approved the Pfizer / BioNTech mRNA vaccine ‘Comirnaty 
      • For use as a primary vaccination in those aged 5 or over
      • For use as a booster vaccination for those aged 18 years and over
    • Provisionally approved the University of Oxford / AstraZeneca ‘VAXZEVRIA’ viral vector vaccine as a primary vaccination for those aged 18 and over
    • Provisionally approved of the Moderna mRNA vaccine Spikevax (Elasomeran) for use as a:
      • Primary vaccination in those aged 12 and over
      • Booster vaccination for those aged 18 years and over
    • Is evaluating the Moderna vaccine for use in those aged 6 to 11 years.

    Although the TGA has provisionally approved the one dose vaccine as a primary vaccination for ages 18 and over, it is not included in Australia’s COVID-19 vaccination program and is not available here. 

    Information on other vaccines under consideration by the TGA, but not approved for use in Australia, is available here.
  • When are people eligible for primary doses of COVID-19 vaccines? Updated 12 January 2022

    Across the country:

    • All those aged 12 and over are now eligible for Pfizer and Moderna vaccination
    • All those aged 5 to 11 years are eligible for Pfizer vaccination
    • AstraZeneca vaccination is available to anyone aged 18 years and over. For more information on using this vaccination, particularly for those under 60 years of age, see Q&A:
      • What are the recommended age groups for the AstraZeneca vaccine?
      • What steps should I take in considering whether a patient under 60 years of age should receive the AstraZeneca vaccine? 
    ATAGI has also provided recommendations on a thrid primary dose of COVID-19 vaccination for patients with servere immunocomprimise and it is now available for use in those groups. 
  • When are people eligible for booster doses of COVID-19 vaccine? Updated 20 January 2022

    Anyone aged over 18 who has received their primary COVID-19 vaccinations 6 months ago or more is now eligible for booster vaccination.  From 31 January 2021, the interval between primary and booster vaccination will be reduced to 3 months across the country.  From 21 January 2022, boosters will be available 3 months after primary vaccination in NSW and Victorian state clinics for those aged 18 or over. 

    ATAGI recommends:

    • Pfizer or Moderna vaccine as a booster dose for those aged 18 and over who completed their primary COVID-19 vaccination course 5 or more months ago, irrespective of primary COVID-19 vaccination used
    • Timely receipt of a booster dose is particularly important for people with increased exposure risk (e.g. occupational risk or outbreak areas) or who have risk factors for severe disease.

    ATAGI has also indicated that AstraZeneca is not preferred as a booster, but can be used for those who received it as their primary vaccination and:
    • Have no contraindications or precautions for use, or
    • If a significant adverse reaction occurred after use of Pfizer or Moderna contraindicating further use of those vaccines. 
     
    RANZCOG has a statement on booster vaccines for those trying to conceive, who are pregnant or who are breastfeeding. 
  • Who can be involved in delivery of COVID-19 vaccines? Updated 12 January 2022

    Ability to supervise, authorise and administer COVID-19 vaccinations is based on:

    • Having necessary training and experience to provide immunisation
    • Completing the Commonwealth Government’s online COVID-19 vaccination training program
      • Separate training is required for those administering Pfizer vaccination to those aged 5 to 11 years
      • There may also be other required / suggested training in individual states and territories, particularly for new immunisers or those working in state immunisation clinics / hospitals – see for example Victoria, Queensland and WA
    • Being an authorised immunisation provider in your state / territory.

    Authorised immunisation providers generally include doctors, nurse practitioners and registered nurses. 

    For COVID-19 vaccination Medicare billing, activities associated with individual items can only be undertaken by suitably qualified and registered health practitioners working within their scope of practice and who have undertaken required COVID-19 vaccination training.  A range of Q&A below deal with Medicare billing requirements. 
     
  • What proof do I need from a patient of COVID-19 vaccine eligibility? Updated 20 December 2021

    The Australian Government has indicated that proof of vaccination age eligibility can be based on all standard forms of identification, including drivers license or passport), which should be noted in the clinical record.

    You also need to check the patient hasn’t already received a COVID-19 vaccine elsewhere.  If in doubt, information on this may be accessible via the Australian Immunisation Register, Clinician Vaccine Integrated Platform, a patients state / territory QR code check in app or a patient’s My Health Record (via the new immunisation view).

    Eligibility does not need to be confirmed again for the second vaccination if the first one is already on the Australian Immunisation Register. 

    Prior to booster vaccination, you should check when the patient received their primary COVID-19 vaccine doses on the Australian Immunisation Register to ensure eligibility for booster vaccine (generally 5 months or more post second dose).

COVID-19 vaccination - assessment, precautions / contraindications and informed consent

COVID-19 vaccination - post-vaccine observation, reporting and second doses

COVID-19 vaccination - Medicare and billing

  • How does Medicare fund COVID-19 vaccination? Updated 20 December 2021

    Medicare COVID-19 vaccine suitability assessment bulk billing only item numbers incorporating bulk billing incentives are available for:

    • GPs (including other medical practitioners working in general practice who are not RACGP or ACRRM fellows) and other medical practitioners (specialist medical practitioners and consultant physicians working in a general practice setting who are not vocationally registered GPs)
    • Urban and rural settings – a general practice’s Modified Monash location can be identified via DoctorConnect
    • After hours services (based on usual non-urgent MBS after-hours periods)
    • Certain attendances at a residential aged care / residential disability facility or person’s home to provide COVID-19 vaccination, including for vaccinating facility staff members and patients unable to attend the doctor’s practice.
    • There are also COVID-19 Vaccine Incentive Payments for practices enrolled in the Practice Incentives Program who provide both a first and second MBS vaccine assessment service to a patient.
    From 23 December 2021, an MBS booster incentive is available for doctors undertaking vaccine suitability assessments.
  • When can I bill Medicare COVID-19 vaccination items? Updated 20 December 2021

    These items are only available for use in GP clinics selected to participate in the Australian Government COVID-19 vaccine roll-out.  They cannot be used by other doctors or practices for assessment of vaccine suitability. They are not used in Commonwealth GP vaccination clinics, Aboriginal Controlled Community Health Services or state / territory immunisation clinics.

    The standard assessment items can be billed at each vaccination appointment, so long as the item requirements are met.  This means they can be used for both primary and booster doses of a vaccine. The first dose has a separate item, and the same item applies to second and booster doses.
     
    The in-depth assessment items can only be billed once for each patient in association with one of the standard assessment items.

    The existing items are billed in the name of the supervising GP (or other doctor working in general practice), who must be present at the location where the assessment is being undertaken and accept “full responsibility” for the service. 

    Activities associated with each item can be undertaken by a GP, other doctors working in general practice, registered nurse or other suitably qualified registered health practitioner working within their scope of practice who have undertaken required COVID-19 vaccination training.  For more information on who can undertake COVD-19 vaccination generally, see Q&A Who can be involved in delivery of COVID-19 vaccines?

    If a patient chooses not to go ahead with vaccination following assessment, the relevant MBS item can still be billed if its requirements are met.  If a patient decides not to receive a COVID-19 vaccination, but later chooses to receive it, the relevant standard assessment item numbers can still be billed at each consultation.

  • What other information should I be familiar with when using the Medicare COVID-19 vaccination items? Updated 1 December 2021

    You should be familiar with the following MBS COVID-19 vaccination and follow their requirements strictly:

  • What limits are there on COVID-19 vaccination billing? Updated 5 January 2022

    For GP clinics delivering COVID-19 vaccinations;
    • The only permissible COVID-19 vaccination billing are via the MBS COVID-19 vaccine suitability assessment (standard and in-depth) items bulk billed.  
    • No claiming is permitted, such as,  additional MBS items for pre-vaccination assessments or time spent administering a vaccination following use of the suitability assessment items
    • As is the case for bulk billing generally, there should be no charges associated with COVID-19 vaccination, such as new patient registration or consumables charges.
  • Does Medicare require the claiming doctor to see the patient personally? Updated 5 January 2022

    It depends on which type of item is being claimed. 

    For the in-depth COVID-19 vaccination patient assessment items for patients aged 50 and over, a personal attendance of at least 10 minutes is required, involving:

    • In-depth clinical advice on the individual risks and benefits of vaccination
    • One of both of the following, where clinically relevant
      • A detailed patient history
      • Complex examination and management. 

    For other COVID-19 vaccination assessment items:
    • The claiming doctor is not required to see or assess the patient in person in order to claim those items
    • A claiming doctor will need to be on-site during vaccination (telehealth availability is insufficient) and take ‘full’ responsibility for other team members (e.g. registered nurses) assessing patients and delivering vaccinations to them
    • Doctors need to be available to see COVID-19 vaccination patients as clinically appropriate
    • There are no limitations on doctors seeing patients for COVID-19 vaccination. 


    From 1 January 2022, new MBS items (93600 & 93661) have been introduced allowing qualified health professionals to provide vaccine suitability assessment services provided in a patient's home (including aged / disability care facility) without a doctor being on-site at the patient's home.

    If you are not seeing the patients yourself for vaccination you should ensure:

    • Only appropriately qualified staff are managing the patients – see Q&A - 'Who can be involved in delivery of COVID-19 vaccines?' 
    • You have appropriate processes in place for triage, assessment and observation
    • Any issues requiring attention of a doctor are referred promptly to you as clinically appropriate.  Depending on individual circumstances, this might include patients with suspected contraindications, certain precautions or who have complex or many questions about vaccination. 
  • What assessment requirements are there to bill a Medicare COVID-19 vaccination assessment item number? Updated 25 June 2021

    The MBS COVID-19 standard vaccine assessment items include the following requirements:

    • A face-to-face attendance on the patient by a GP or other suitably qualified and registered health practitioner
    • Scope for a short patient history and limited examination / management where clinically relevant – this may include where the patient has a possible contraindication or precaution to vaccination
    • The vaccine needs to be immediately available to administer to a suitable patient
    • Post-vaccination observation is required in line with professional requirements.

    The in-depth assessment items for those aged 50 and over require:
    • Personal attendance of at least 10 minutes on the patient by the claiming doctor
    • In-depth clinical advice on the individual risks and benefits of vaccination
    • One of both of the following, where clinically relevant:
      • A detailed patient history
      • Complex examination and management. 
  • What are the Medicare COVID-19 vaccination assessment item record-keeping requirements? New 26 Feb 2021

    The MBS COVID-19 vaccination assessment record-keeping requirements include:

    • Completion at time of service or as soon as practicable afterwards
    • Clearly identifying the name of the patient
    • Reasons for the patient’s attendance
    • Outcomes of the consultation, including whether or not the patient received a COVID-19 vaccine
    • Contain a separate entry for each attendance by the patient for the vaccination suitability assessment service and the date(s) on which the service was provided
    • Record the patient’s consent to receive the vaccine
    • Provide clinical information adequate to explain the service
    • Be sufficiently comprehensible that another GP, relying on the record, can effectively undertake the patient’s ongoing care as it relates to COVID-19 vaccinations.

    In addition, the Commonwealth Health Department recommends recording the time of service for any after hours billing.
  • Does the Medicare 80/20 rule apply to COVID-19 vaccination items? New 1 April 2021

    No - Medicare COVID-19 vaccination items are exempted from the ‘80/20’ rule (the Medicare “prescribed pattern of service”), triggering a compliance process and Professional Services Review referral.

  • Can I still bill the Medicare COVID-19 vaccination assessment items if a patient chooses not to receive the vaccination? New 26 Feb 2021

    Yes. If a patient is assessed as not being suitable or doesn’t want to go ahead with vaccination, the MBS items can still be billed if the item requirements are met.

    If a patient needs more than two assessment services, only one PIP incentive payment can be paid. 

    The Commonwealth Health Department has indicated there shouldn’t be more than one claim on the same day (eg patient decides against vaccine, then changes their mind) unless there are exceptional circumstances which need to be detailed in the patient’s records.

  • Can I see a patient for other medical issues at the same time as COVID-19 vaccination and use my usual billing practices for those other issues? Updated 3 August 2021

    For standard COVID-19 vaccine assessment items, this is permitted where there is a clinical need to provide care for the other medical issue and there is no ‘cross-over’ between the COVID-19 MBS assessment item and the other MBS item/s being claimed.

    The in-depth assessment items can only be claimed together with a standard assessment item and a flag-fall item (where relevant). 

    The Commonwealth Health Department indicates:

    • Standard MBS multiple same-day attendance rules apply for co-claiming including
      • The other GP service must be unrelated to the vaccine assessment item
      • The subsequent attendances are not a continuation of the initial or earlier attendances.
    • Before billing, there is a need for informed financial consent for the patient so they understand there is no cost with the Covid vaccine component, and understands how the other service is billed – this should be recorded in the patient records
    • There should be no triage or screening for COVID-19 vaccination using existing MBS items before an MBS vaccination suitability assessment
    • No items can be claimed for time spent administering a vaccine following assessment
    • If a patient suffers a significant adverse reaction to a COVID-19 vaccine, the provider can bill another MBS item in order to provide appropriate treatment – this would include systematic reactions such as syncopal episodes, severe allergic reactions (e.g. anaphylaxis) and a strong, adverse mental / emotional reaction to vaccination – these additional services should be bulk-billed
    • COVID-19 vaccination assessment items cannot be co-claimed with certain other bulk billing incentive items.

    See the Department’s detailed fact sheet for more information, which includes a range of scenarios involving co-claiming.
  • What if a non-Medicare eligible patient presents for vaccination at an approved GP clinic? Updated 25 June 2021

    Non-Medicare eligible patients cannot be ‘privately’ billed. 

    Non-Medicare eligible patients should be referred to a GP respiratory clinic or state / territory immunisation clinic. 

  • If I am delivering COVID-19 vaccinations to patients at a location different to my practice, what is the billing location for Medicare purposes? New 5 March 2021

    Like other Medicare items, COVID-19 vaccine assessment items are billed from the practice location, not the location where the vaccine is delivered if it is different to the practice location.

    For example, if your practice is located in a Modified Monash 1 area, and you deliver the vaccine to a patient at a Modified Monash 2 area location, you would bill the relevant COVID-19 vaccine assessment item for Modified Monash 1 area

  • I / my practice is not providing COVID-19 vaccinations, but I am advising my patient on whether they should receive a vaccination. Can I bill Medicare? Updated 3 August 2021

    Relevant non-COVID-19 vaccine assessment items may be used by GPs and other specialists who are not part of the Australian Government COVID-19 vaccine roll-out and who are advising their patients about COVID-19 vaccinations, so long as the individual requirements of the MBS item number in question are met.

    There is no indication that such advice cannot be provided to the patient either face-to-face or via telehealth.

    The specific COVID-19 vaccination assessment items cannot be used by those who are not part of the COVID-19 vaccine roll-out program.

  • My patient has experienced an adverse reaction to COVID-19 vaccination. What can I bill? New 20 August 2021

    The Commonwealth Health Department indicates that if a patient suffers a significant adverse reaction to a COVID-19 vaccine, the provider can bill another MBS item in order to provide appropriate treatment.  This includes systematic reactions such as syncopal episodes, severe allergic reactions (e.g. anaphylaxis) and a strong, adverse mental / emotional reaction to vaccination.  Additional services should be bulk-billed.

COVID-19 vaccination - advertising, certificates, mandatory vaccination and workplace issues

  • Can I advertise COVID-19 vaccination to my patients or post about it on social media? Updated 20 December 2021

    Yes, you can advertise / promote COVID-19 vaccination to your patients and the community, within limits set out below.  This includes on physical signage, websites and social media.

    The TGA and Ahpra have issued a joint statement explaining the need for promotion of COVID-19 vaccinations to comply with both TGA and Health Practitioner Regulation National Law requirements. 


    TGA requirements
    Although advertising vaccinations and prescriptions medications is generally not permitted, the TGA has made an exception for approved COVID-19 vaccines and provided detailed guidance on this issue, including examples.

    What the TGA considers acceptable advertising of COVID-19 vaccines includes:

    • Using material developed by Australian Governments (federal, state and territory) – for example the Commonwealth Government communication kit and posters
    • Self-developed materials which are consistent with Australian Government messaging,

    You cannot add / include any of the following in Government materials / to self-developed materials:
    • Tradename, sponsor name and/or active ingredient of the specific vaccine, except that Commonwealth Government materials or self-developed materials from approved COVID-19 vaccination providers referring to the type of vaccine being offered at the practice can be used
    • Statements to the effect that COVID-19 vaccines cannot cause harm or have no side-effects
    • Statements comparing COVID-19 vaccines, or comparing those vaccines with other treatments
    • Any statement regarding COVID-19 vaccines which is false or misleading.

    According to the TGA ‘factual and balanced’ information about COVID-19 vaccines is unlikely to be considered advertising and subject to its restrictions.  Examples it has given include:
    • Technical information relating to how the vaccines were developed and manufactured
    • Statements a clinic or pharmacy does not have stock of a particular vaccine
    • Sharing scientific reports from reputable sources (like the World Health Organization) about vaccination, without including promotional material or language
    • Re-tweeting or sharing valuable newsworthy information from reputable sources about the COVID-19 vaccines
    • Presenting comprehensive information that doesn't emphasise the benefits over, for example, the risks and limitations.


    In addition, usual preclusions on health professionals endorsing a medicine do not apply to TGA approved COVID-19 vaccinations.


    National Boards / Ahpra requirements
    Healthcare advertising, including social media, is also regulated by the National Boards / Ahpra, who have an advertising hub providing information and resources, including advertising and social media guidelines.

    For COVID-19 vaccination, the National Boards / Ahpra have indicated:

    • Accurate” information and advice should be provided about COVID-19 vaccination - including in social media and advertising
    • Health practitioners must also ensure that up to date and reputable sources of information are accessed to support the provision of advice and information about COVID-19 vaccines
    • Any promotion of anti-vaccination statements or health advice which contradicts the best available scientific evidence or seeks to actively undermine the national immunisation campaign (including via social media) is not supported by National Boards and may be in breach of the codes of conduct and subject to investigation and possible regulatory action”.

    Social media considerations
    The TGA has indicated that:
    Provided the posts and the articles themselves do not constitute advertising [see Q&A Can I advertise COVID-19 vaccination to my patients or post about it on social media?] … there is no issue with posting links to the articles on social media.

    Where written in a scientific context, the medical journal articles reporting on clinical trials and studies related to COVID-19 vaccines are unlikely to be considered advertising – especially where they are comprehensive and report not just on the study outcomes but also any adverse events identified and any limitations of the study itself.

    However, care needs to be taken in the phrasing of a social media post for the article to ensure it is not considered advertising – for example, a ‘Brand X COVID-19 vaccine shows superior efficacy to Brand Y vaccine in new clinical trial’ would be promotional; ‘outcomes of clinical trial assessing efficacy of Brand X and Brand Y COVID-19 vaccines’ would not.

    The National Boards / Ahpra proactively monitor advertising and social media, and may take action even if no notification / complaint has been made to them.  If you receive communications from Ahpra about your advertising / social media, contact MIGA’s lawyers. 


    Offering incentives for vaccination
    Any person / organisation can offer valuable incentives (case or other rewards) to people who have been fully vaccinated under the Commonwealth Government’s COVID-19 vaccine roll-out as follows:
    • They can only be made to people who have been fully vaccinated (ie completed their course of Pfizer or AstraZeneca vaccination)
    • The offer must include a statement to the effect that vaccination must be undertaken on the advice of a health practitioner
    • They cannot include alcohol, tobacco or medicines (other than listed medicines)
    • Offers can only be more COVID-19 vaccinations generically, not a particular brand or type of vaccination
    • Any offer must be made to all eligible people who have been vaccinated – for example it cannot be made only to those people vaccinated after the date of the offer – it must also apply retrospectively. 

    Doctors and other registered health practitioners are subject to National Board / Ahpra regulation in offering incentives, particularly the need to clearly state the terms and conditions of any gift, discount or other inducement.  Be careful to ensure that any incentives do not encourage what could be considered to directly or indirectly encourage the “indiscriminate or unnecessary use” of health services provided by doctors or other practitioners.

    Other resources
    MIGA also provides an overview of your advertising obligations generally, including recent changes. 
  • My patient seeks a certificate exempting them from COVID-19 vaccination. What should I do? Updated 5 January 2022

    Requests for ‘exemption certificates’ might be based on compelling medical contraindications or personal choice.

    It is requests for certificates based on personal choice only, not based on clear clinical grounds, that are generally precluded and are more likely to cause concern to professional regulators, governments and other bodies about doctors issuing them.  For example, the Medical Council of NSW has indicated that “A Covid-19 vaccination exemption is strictly limited and must be related to a health contraindication for which evidence is required to ensure a doctor is satisfied and can appropriately sign an exemption”.

    In providing any certificate or other letter for a patient declining COVID-19 vaccine, you should:
    • Be aware of any state / territory requirements for vaccination exemption documentation – for example each of NSW, VictoriaWA, Tasmania and the ACT have specific forms to use (for more information on healthcare worker exemption, see relevant state / territory Q&A on mandatory vaccination requirements below)
    • Be up-to-date with current requirements and guidance on COVID-19 vaccinations exemptions:
      • ATAGI guidance on temporary medical exemptions for COVID-19 vaccines – ATAGI indicates that “COVID-19 vaccines have been demonstrated to be safety and effective and as such are recommended for all Australians from 12 years of age. There are very few situations where a vaccine is contraindicated and as such, medical exemption is expected to be rarely required
      • Scope for vaccine exemption vary by state and territory – see
        • Q&A below on mandatory vaccine requirements for healthcare workers in different states and territories – these detail the circumstances in which exemption would be permitted for these healthcare workers – similar limitations will generally apply to vaccine mandates for other workers in the relevant state or territory
        • State / territory specific guidance – eg from the Medical Council of NSWVictorian Health Department and Queensland Health.
    • Limit your certificate / letter to clinical issues within your expertise:
      • In Victoria, certificates for vaccine exemption will only be considered if provided by doctors from certain specialties – see Q&A What are the Victorian healthcare worker mandatory COVID-19 vaccination requirements? 
      • In Queensland, exemptions to certain new vaccination requirements for a range of workers can only be given by certain GPs (RACGP or ACRRM fellows, or vocationally registered with Medicare as a GP), GP registrars on approved 3GA placements, paediatricians, public health physicians, infectious diseases physicians or clinical immunologists
    • Undertake an appropriate clinical assessment of the patient’s reasons for requesting exemption, such as detailed history-taking, physical examination or further testing / assessment as required
    • Consider seeking specialist immunisation service advice, or colleague / specialist opinions as appropriate
    • Avoiding being perceived to support patient decisions which are not based on clinical grounds (e.g. not based on recognised contraindications)
    • Being aware that some exemptions are only justified on a temporary, not permanent, basis
    • Consider providing your patient with further information on COVID-19 vaccination from appropriate sources, or arranging appropriate specialist referral to discuss their concerns
    • Be aware that there is no requirement for you to provide a certificate / letter if you do not feel comfortable in doing so. 

    The Melbourne Vaccine Education Centre provides a Discussion guide for medical exemptions.

    The Medical Board / Ahpra have indicated:
    • Doctors who provide inappropriate exemption certificates will be investigated
    • Although considering each case on its individual facts, an investigation could lead to restrictions on registration, including ability to provide exemptions, managed COVID-19 patients
    • Where there is significant continuing risk or if it is in the public interest, a doctor could be suspended. 

    For further information on medical certificates generally, see Q&A A patient wants a medical clearance certificate for COVID-19.  Can I give this?
     
  • What are the NSW healthcare worker mandatory COVID-19 vaccination requirements? Updated 20 January 2022

    Foreshadowed booster requirements
    Mandatory COVID-19 booster requirements for all healthcare workers have been foreshadowed by the NSW Government.  

    Extension to all healthcare workers from 31 January 2022
    All clinical and support staff in community settings (i.e. including GP and other specialist practices) will need to have received at least one dose of a COVID-19 vaccination by 31 January 2022, and at least 2 doses by 28 February 2022, to continue working in healthcare.

    An exemption has been issued permitting non-vaccinated healthcare workers in community settings to continue providing telehealth – they must have no physical contact with patients and provide telehealth from a place where no-one accesses healthcare on-site (i.e. a doctor’s home).

    Hospitals and day surgeries
    Healthcare workers working for or in a NSW Health entity (e.g. public hospital), private hospital or day procedure centre are unable to work in healthcare unless they have received at least 2 doses of a COVID-19 vaccine.  This includes employees, contractors, visiting medical officers, visiting practitioners, volunteers and students undertaking clinical placements


    Workers can be required to give evidence of their vaccination status to their employer / facility where they work.

    Employers, entities contracting workers or providing healthcare facilities, and those supervising students are required to take “all reasonable steps” to ensure workers comply with this requirement.

    Exemptions for medical contraindications and emergencies
    The vaccination requirements do not apply to:
    • Healthcare workers unable to be vaccinated due to a medical contraindication – they will need to provide a medical contraindication certificate to their employer / contracting entity / facility where they work
    • Health practitioners responding to emergencies.  


    Working in aged care facilities
    Healthcare practitioners and students cannot enter aged care facilities unless they have received at least 2 doses of COVID-19 vaccination.

    The vaccination requirements do not apply to:
    • Healthcare workers unable to be vaccinated due to a medical contraindication – they will need to provide a medical contraindication certificate to their employer / contracting entity / facility where they work – exemptions are limited to ATAGI criteria
    • Health practitioners responding to medical emergencies.

    Invalidated medical contraindication certificates
    If a person is exempted from mandatory health and aged care worker vaccination requirements based on a certificated issued by a doctor who subsequently has a condtition placed on their registration relating to their ability to issue medical certificates, that person must:
    • immediately cease work
    • Provide a new medical contraindication certificate from a different doctor to their employer / facility before returning to work.
  • What are the Victorian healthcare worker mandatory COVID-19 vaccination requirements? Updated 12 January 2022

    New booster requirements

    • All healthcare workers are required to have a COVID-19 booster dose.
    • If fully vaccinated on or before 12 September 2021, they must receive their booster by 12 February 2022.
    • For workers fully vaccinated after 12 September 2021, they must receive their booster by 29 March 2022.  


    Existing vaccination requirements for all healthcare worker
    Mandatory COVID-19 vaccination requirements for healthcare professionals, students and administrative / support staff apply across hospital and community settings (including GP and other specialist practices).


    Employers / facilities must:
    • Collect and record COVID-19 vaccine booking / status information from workers if working at the facility as soon as reasonably practicable
    • Take all reasonable steps to ensure unvaccinated workers don’t enter or remain on the facility for the purposes of work unless:
      • They have an Australian Immunisation Register immunisation medical exception form from specific doctors - this includes GPs (vocationally registered, RACGP or ACRRM fellows), GP registrars (on approved 3GA training placements), general, public health or infectious diseases physicians, clinical immunologists, physicians and paediatricians - certifying they have they cannot receive COVID-19 vaccination due to:
        • a medical contraindication – this is defined as any of:
          • anaphylaxis after a previous COVID-19 vaccine dose, or to any component of the vaccine, including polysorbate or polyethylene glycol
          • in relation to AstraZeneca, either a history of capillary leak syndrome or thrombosis with thrombocytopenia occurring after a previous dose
          • in relation to Pfizer or Moderna myocarditis or pericarditis attributed to a previous dose of either vaccine
          • occurrence of any other serious adverse event that has been:
            • attributed to a previous dose of a COVID-19 vaccine by an experienced immunisation provider or medical specialist (and not attributed to any another identifiable cause); and
            • reported to State adverse event programs and/or the TGA
          • an acute medical illness (including COVID-19)
      • It is an emergency situation or critical, unforeseeable need to provide urgent care – in those situations PPE including at least surgical mask and face shield is required
    • Disclose these new requirements to their staff as soon as reasonably practicable
    • If it is reasonably practicable for a healthcare worker who is not fully vaccinated and does not hold a valid exemption to vaccination, the facility cannot permit them to work on-site and they will need to work from home. 
  • What are the Queensland healthcare worker mandatory COVID-19 vaccination requirements? Updated 5 January 2022

    All workers in a healthcare setting (public or private, hospital or community) must be fully vaccinated against COVID-19 and provide evidence of it to their employer / facility as soon as practicable. 

    Employers and facilities are required to take all reasonable steps to ensure workers do not attend a healthcare setting for work unless an exception applies (see below) and keep records of worker vaccination status and exemption evidence.

    Exceptions include:

    • Medical contraindication
      • Contraindications are only those recognised in ATAGI guidance or notified to the Australian Immunisation Register by a medical practitioner and recorded on their Immunisation History Statement
      • These workers must provide a medical certificate from a medical practitioner and their Australian Immunisation Record, specifying the medical contraindication and its period (if temporary)
      • Employers / facilities must assess the risks to the worker, other staff, patients and other visitors, determines that the worker is unable to work outside the healthcare setting (i.e. from home or an office)
      • In healthcare settings the unvaccinated worker must:
        • Comply with the Safe Work Australia National guide for safe workplaces and other COVID-19 guidance provided by Safe Work Australia for the healthcare setting
        • Undergo a daily COVID-19 PCR test result whilst working, and provide the result to the worker’s health facility as soon as reasonably practicable after it is received (employers / facilities must keep evidence of these results)
        • Wear PPE as required under an established PPE guideline (e.g. Queensland Health guidelines), or
        • As an alternative to this for workers under existing mandatory vaccination requirements, comply with existing requirements for unvaccinated workers.
    • Active participants in Phase 3 or 4 COVID-19 vaccine trials:
      • The worker must provide a medical certificate from a doctor associated with the trial confirming they are participating in a Phase 3 or 4 trial and they have received at least one active dose of the trial vaccine
      • Employers / facilities must assess the risks to the worker, other staff, patients and other visitors and determines that the worker may continue to work on site at the facility
      • The worker must notify the employer / facility as soon as reasonably practicable after completing the trial
      • This exception ceases once the trial vaccine becomes TGA approved, recognised or rejected for use. 
    • Responding to emergencies, but must comply with PPE requirements for the health setting and report the entry to the facility as soon as reasonably practicable
    • Short-term critical workforce shortages in certain circumstances, with appropriate PPE and negative COVID-19 PCR test  prior to starting each shift (with results provided to employer / facility as soon as reasonably practicable after receipt).  
  • What are the South Australian healthcare worker mandatory COVID-19 vaccination requirements? Updated 5 January 2022

    All South Australian healthcare workers must have received at least 1 dose of COVID-19 vaccination and have a booking for a second dose within the ATAGI recommended interval for the vaccine used

    ​The SA Government has also foreshadowed requiring healthcare workers to receive a booster vaccination within 2 weeks of becoming eligible for one..

    There is an exception for those with a medical certificate from a doctor certifying a permanent or temporary exemption based on ATAGI guidelines to either TGA-approved COVID-19 vaccines, or ATAGI preferred vaccine, specifying the nature of the exemption. Further exceptions include those who:
    • Have an appointment to be assessed by a medical specialist, or who have commenced such an assessment, to determine whether they are eligible for vaccine exemption based on ATAGI guidelines
    • Are currently taking part in a COVID-19 vaccine trial and receipt of a TGA approved vaccine would impact trial validity.

    Persons seeking an exemption must also:
  • What are the WA healthcare worker mandatory COVID-19 vaccination requirements? Updated 5 January 2022

    Healthcare workers must be fully vaccinated against COVID-19 to work across all healthcare, aged care and quaratine centre settings.

    From 5 February 2022 booster vaccination requirments will apply for healthcare workers, namely

    • if already eligible for a booster, it must have been received to continue working
    • if not yet eligible for a booster, it must be administered within a month of becoming eligible to continue working.
    Employers / facilities have obligations to collect records of worker vaccination status.

    Exemptions based on medical grounds must be obtained using the relevant Australian Immunisation Register form, completed by a doctor and submitted to the Register for assessment.  Temporary exemption applications (not required for medical exemptions) can be made to the WA Chief Health Officer at COVIDVaccinationExemption@health.wa.gov.au.
     
  • What are the Tasmanian healthcare worker mandatory COVID-19 vaccination requirements? Updated 5 January 2022

    A person employed or engaged by medical or health facilities (which includes hospital and community health care services, both public and private), aged care or quarantine facilities (or undertaking clinical placements / work experience at any of them) is not permitted to enter those facilities for work purposes, or provide healthcare services generally, unless they have:

    • Received their first dose of a COVID-19 vaccine and made a booking for their second dose as soon as reasonably possible, or
    • Made a booking for the first dose and receives all necessary doses as soon as reasonably possible. 

    Workers are excused from vaccination if they have a completed vaccine exemption form from a doctor certifying they have a medical contraindication precluding vaccination, or if they are providing healthcare in an emergency situation. If any of those exceptions apply, a fitted face covering must be work at all times when providing healthcare (unless they have a medical certificate from a doctor indicating they have a health condition or disability making a fitted face covering unsuitable). 
  • What are the NT healthcare worker mandatory COVID-19 vaccination requirements? Updated 5 January 2022

    Healthcare workers

    The NT Government has introduced a mandatory vaccination regime that essentially requires all healthcare professionals providing face-to-face care and other workers having direct contact with people to be vaccinated against COVID-19, across both public and private hospital and community / clinic settings.

    A healthcare worker providing face-to-face care to, or who is likely in their work to come into contact with any of the disabled, the elderly, those posing a risk of COVID-19 infection or other persons vulnerable to COVID-19 (as defined below) and who has not been fully vaccinated against COVID-19 cannot attend their workplace.

    Healthcare facilities have obligations to ensure their workers follow these vaccination requirements and keep a register of how this has been verified. 

    Workers with either of the following certificates are exempted from these requirements:
    • A medical certificate from a doctor indicating that they have a contraindication to all approved COVID-19 vaccines based on ATAGI guidance, or
    • A certificate issued by the Commonwealth Government indicating they have a contraindication to all approved COVID-19 vaccines.

    In addition, the mandatory vaccine requirements do not prevent a worker is working at a place where they are:
    • Not likely to come into contact with a vulnerable person (defined as under 12 years of age, unable to be vaccinated due to a contraindication to all approved COVID-19 vaccines, an Aboriginal person or a person at risk of severe illness from COVID-19, such as being on immune suppressive therapy after an organ transplant or having chronic kidney, heart, liver or lung disease – more information is available here), and
    • Not likely to come into contact with a person or thing that poses a risk of infection with COVID-19, and
    • Not likely to be exposed to a high risk of infection with COVID-19.

    Generally providing telehealth from a worker’s home would be an example of where this exemption would apply.  It would generally not apply to any workers providing face-to-face care / having direct contact with people as the public health direction indicates that hospitals and clinics are places where people are likely to come into contact with people posing a risk of COVID-19 infection.

    The NT Government has foreshadowed requiring third COVID-19 vaccine doses for healthcare workers once medical advice is “definite”.


    Working in aged care facilities

    In Northern Territory, by public health direction employees or contractors of aged care facilities are required to be fully vaccinated against COVID-19 and provide evidence of this to the facility.
  • What are the ACT healthcare worker mandatory COVID-19 vaccination requirements? Updated 20 December 2021

    By public health direction all staff in ACT public or private hospitals (including day hospitals) are required to be fully vaccinated against COVID-19. 

    Registered health practitioners providing healthcare at aged care facilities are required to be fully vaccinated against COVID-19. 

    Medical exemptions are available in accordance with the ACT COVID-19 vaccine exemption policy, using a COVID-19 Vaccine Medical Contraindication or Temporary Exemption Form.

  • What recommendations are there on COVID-19 vaccinations and surgery? Updated 12 January 2022

    RACS provides a range of updated recommendations around COVID-19 vaccination and surgery, including:
    • Ascertaining COVID-19 vaccination status prior to surgery
    • Urgent and emergency procedures should occur irrespective of vaccination status
    • Where possible, patients should be fully vaccinated before elective surgery, with most recent dose being at least 14 days before surgery
    • Following surgery, wait at least 2 weeks prior to vaccination – for major procedures patients should also have returned to normal activity levels, or their condition stablished, before vaccination.

    Clinical Excellence Queensland has also released COVID care principles for surgical patients.  

     

Insurance cover for other COVID-19 matters

Note - the answers in this section only apply to MIGA policies issued to doctors, Eligible Midwives and healthcare businesses about their insurance cover in relation to COVID-19.
  • Am I covered for treating COVID-19 patients? Updated 12 November 2021

    Yes. Claims and inquiries arising from services provided to patients who are, may be or are suspected of being infected with COVID-19 are covered by MIGA’s insurance policies. *

    We cover you for healthcare services provided within your insurance category / scope of practice or healthcare business irrespective of the patient’s condition.

    If you are being asked to undertake, or are considering undertaking, a new or different role that may be outside your scope of practice and have any concerns around your medical indemnity insurance or any medico-legal implications, please contact us for assistance. We’ll help to make sure that your cover is appropriate for what you are doing and to guide you on potential medico-legal issues involved.


    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, Eligible Midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.

  • Am I covered for providing telehealth? Updated 6 Aug 2020

    Yes. Claims arising from healthcare services provided to patients in Australia via telehealth consultations are covered by MIGA’s insurance policies *

    Within your scope of practice, our policies do not place limitations on how you provide your care.

    Telehealth is a well-recognised way of providing care in a wide variety of situations and can include consultations via a wide range of video platforms and telephone.

    You need to ensure that you conduct telehealth in accordance with applicable professional guidelines - see our various Q&A on telehealth.

    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, Eligible Midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.

  • Am I covered if I am unknowingly infected and I infect patients resulting in a claim? Updated 17 Jul 2020

    Yes. Claims arising from healthcare services provided whilst you are infected with COVID-19 are covered by MIGA’s insurance policies *

    Your policy requires you to ensure that you take adequate precautions to prevent the transmission of a virus, bacteria or disease, which means that the steps that you take to prevent transmission must be accepted as competent practice by your peers.

    This would mean that you follow professional obligations for infection control, keep up to date with the potential signs and symptoms of COVID-19, know when to be tested (including the criteria for healthcare worker testing) and follow government requirements for quarantine and isolation (e.g. following travel overseas or to a COVID-19 hotspot, close contact with a confirmed COVID-19 case etc.)

    We recommend that you keep up to date with advice and other information on these issues from Commonwealth Department of Health’s COVID-19 advice for the health sector, your local health department and professional college / association (a range of relevant links are provided on MIGA’s COVID-19 web resources.

    If in doubt about any of these issues, seek advice from your local public health unit.

    If you are aware you are infected or suspect you may be, you should notify your hospital / health service, immediately cease practice, follow public health and other medical advice and complete the necessary isolation period before returning to practice.  

    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, Eligible Midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.

  • Am I covered if I change my scope of practice? Updated 1 May 2020

    Yes, if you need to change your scope of practice you are covered provided it is permitted by your Ahpra registration and you are in the appropriate category of cover with us.*
     
    We recommend you take the following steps before starting your new work:
    • Ensure your Ahpra registration does not prevent you from the new scope of practice - the Medical Board has confirmed that doctors with general and specialist registrations are not restricted in their scope of practice because they have specialist registration
    • Be comfortable that you have the necessary skills, training and experience to provide the level of care expected, and your hospital, practice or other workplace agrees (see below Q&A ‘What if am asked to work outside my usual scope of practice to help my hospital deal with COVID-19 cases?’ for further guidance)
    • Confirm with your hospital, practice or other workplace (preferably in writing) that you will have the benefit of any insurance cover you are normally entitled to as an employee or contractor (e.g. as a visiting medical officer for public patients) 
    • Contact MIGA to ensure you have the right category of insurance cover with us. 

     

    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, Eligible Midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.

  • How might restrictions on healthcare in a COVID-19 hotspot affect my cover? New 6 Aug 2020

    Public health directions may restrict healthcare which may be provided, particularly in a COVID-19 hotspot - see Q&A on healthcare restrictions.  

    We are conscious that this is an extremely challenging time for our members and clients, and that there is potential scope for uncertainty in individual situations.  

    It is important that you take reasonable steps to ensure you only provide healthcare in accordance with applicable public health directions, and regulatory, workplace and peak body guidance.   

    Through our Q&As, we endeavor to provide you with available information around these issues.   

    When in doubt, you should liaise with your local health department, public health unit, relevant peak body and workplace as appropriate.  If you remain in doubt, contact MIGA legal services.  

    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, eligible midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.


    * Your individual cover is subject to your chosen category of practice and the terms and conditions of your policy with MIGA.  If you are a doctor whose practice entity employs other doctors, Eligible Midwives or others who bill in their own name, you must ensure that they have their own insurance arrangements in place to cover any disease that they might carry and transmit to others in your practice.

Healthcare restrictions

  • What healthcare restrictions / requirements are in place in New South Wales? Updated 12 January 2022

    Fitted face masks must be worn when providing or creeiving healthcare indoors unless specific exceptions apply.


    Outside hospital settings (where they apply to staff and non-patient visitors where there is not already an electronic entry recording system), QR check in requirements no longer apply. 

    If a worker contracts COVID-19 in the workplace, SafeWork NSW must be notified.

    Non-urgent elective surgery at public and private hospitals and day procedure centres has been suspended until mid-February 2022.  

    Where possible, the NSW Government requests people work from home.
  • What healthcare restrictions / requirements are in place in Victoria? Updated 20 January 2022

    Fitted face masks must be worn when providing or receiving healthcare indoors, unless specific exceptions apply.  Masks are required now for all persons from age 8 and over.  

    Non-urgent elective surgery is suspended at public and private hospitals and day procedure centres in metropolitan Melbourne and major regional centres. Restrictions on IVF procedures have since been removed.

    Ongoing Victorian healthcare requirements include:
    • Businesses must continue to have a COVID Safe Plan, which must cover appropriate level of personal protective equipment to be worn and response to suspected / confirmed COVID-19 cases – the Government offers a free, confidential review of plans to ensure they meet current COVIDSafe requirements – this can be obtained via covidsafeplanreview@djpr.vic.gov.au
    • A workplace attendance register of all persons at the premises for longer than 15 minutes is required where confidentiality obligations do not apply (ie it is not required to be kept for patients) – outside of a hospital / day surgery setting, use of the Victorian Government QR code service is now required
    • Certain surveillance testing requirements for thos involved in direct care of COVID-19 patients and thos in high risk hospitals
    • For any COVID-19 cases amongst staff, notify both WorkSafe Victoria and the Victorian Health Department, which has further information on notification and other necessary responses, including isolation, risk assessment and management.
    Where possible, the Victorian Government requests people work from home.
  • What healthcare restrictions / requirements are in place in Queensland? Updated 12 January 2022

    Masks are required in healthcare settings unless a valid exception applies. 

    QR Check-in and density requirments do not apply to healthcare.

    Non-urgent elective surgery is suspended at Queensland public hospitals until 1 March 2021, but this will remain under review.  

    The Queensland Government has also urged employers to return to work from home arrangements where possible.

    Aged care
    • Health care workers who wear appropriate PPE (in accordance with the Residential Aged Care Facility and Disability Accommodation PPE Guidance) and follow recommended infection control precautions are not considered ‘known contacts’ of confirmed COVID-19 cases for the purposes of entry to a residential aged care facility
    • In all facilities, must remain at least 1.5 m away from other person where possible, and limit contact with other persons at the facility
    • All visitors to aged care facilities must check in using the Check in Qld app.
  • What healthcare restrictions / requirements are in place in South AustraliaUpdated 5 January 2022

    Masks

    Masks are required for face-to-face heatlhcare , subject to vaild exceptions.  They are not required for hospital / day surgery inpatients.  They are also recommended for use in workplaces, including non-public facing healthcare facilities .

    Elective surgery restrictions

    From 4 January 2022 elective surgery restrcition apply, limiting surgery in public and private hospitals and day procedure centres to:
    • Emergency  surgery and procedures undertaken for conditions where failing to do so expediently and safely will lead to loss of life/limb or permanent disability
    • Non-emergency but urgent surgery and procedures for conditions where a patient would come to harm were surgery to be delayed, including:
      • Category 1 surgery (as defined in the National Guidelines)
      • Category 2 surgery (as defined in the National Guidelines) which is consdered by the treating doctor to be urgent where a clinical rist assessment and / or peer review indicates a need to proceed
      • Where clinical evidence supports an increased risk of loss of life or permanent disability should surgery or a procedure be sidnificantly delayed.  Some examples of the types of procedures which may be permitted, subject to the urgency criteria above, include endoscopy, bronoscopy, interventional radiology and cardiology)
    • Procedures undertaken in a community setting using local anaesthetic within the doctor's scope of practice, including procedures undertaken by dermatologists and plactic surgeons
    • Cosmetic procedures in a community setting (ie. not required to be performed in a hospital or day procedure centre)
    • Surgical termination of pregnancy
    • Dental procedures and surgical treatments, where the risk of disease transmission is managable and PPE stock is safely available.

    Other face-to-face healthcare requirements

    For face-to-face care South Australian healthcare providers must:
    • Have a completed COVID Safe Plan – once completed and lodged you will receive a unique QR code for patients and visitors to use for your premises 
    • Use an approved contact tracing system (including COVIDSAfeCheckIn via the mySA GOV app) to capture the contact details of patients and other visitors
    • Use “best endeavours” to ensure contact details are recorded
    • Use a paper recording log if a patient or visitor lacks a smartphone – these should be kept for 28 days then disposed of securely
    • Ensure total number of persons in ‘public’ (i.e. patient accessible areas) areas of your premises (excluding staff members and anyone else providing healthcare), and within a single room or other enclosed area, does not exceed 1 person per 2 sq m 
    • Use best endeavours to keep a distance of 1.5m between people, unless required for healthcare (e.g. physical examination).

    The SA Government also encourages working from home where possible.

  • What healthcare restrictions / requirements are in place in Western AustraliaUpdated 20 January 2022

    Fitted face masks must be worn when providing or receiving healthcare indoors in the Perth, Peel and South West regions, subject to specific exceptions.

    Western Australia public and private hospitals are required to collect contact information from visitors (patients are excluded from this requirement), but this requirement does not extend to community healthcare settings.  However use of QR Check-in is encouraged.

    In aged care facitlities across Western Australia, healthcare must be provided by telehealth, or by attending an external facility, where reasonably practicable or in the residents' best interests.
  • What healthcare restrictions / requirements are in place in the ACT? Updated 12 January 2022

    Fitted face masks must worn when providing or receiving healthcare indoors, subject to valid exemptions.  

    Requirements for COVID-19 safety plans, density limits and collecting visitor information (via QR code or otherwise) do not apply to healthcare.

    Non-urgent elective surgery has ceased for 6 to 8 weeks in certain public hospital settings.  

    The ACT Government also encourages working from home where possible.

  • What healthcare restrictions / requirements are in place in the Northern TerritoryUpdated 24 September 2021

    Fitted face masks must be worn when providing healthcare indoors where a distance of 1.5m cannot be maintained, subject to specific exceptions.

    Healthcare providers must:
    • Lodge a COVID-19 safety plan online and review it 6 monthly
    • Appoint a COVID-19 safety supervisor
    • Collect contact information (including time of entry) from visitors using the Territory Check In app
    • Provide hand sanitiser or handwashing facilities
    • Conspicuously display signage encouraging people to consider COVID-19 safety principles and practices.

    More information is available here.
  • What healthcare restrictions / requirements are in place in Tasmania? Updated 5 January 2022

    Unless a valid exemption applies, masks are required to be worn

    • When providing or receiving healthcare
    • By unvaccinated healthcare workers unless a valid exemption applies – see Q&A What are the Tasmanian healthcare worker mandatory COVID-19 vaccination requirements?
    QR Check-in is required for private community heatlhcare settings.  COVID-19 Safety Plans are also required.

    Density limits do not apply to healthcare. 

Protecting yourself, your colleagues and your patients

  • Can I make COVID-19 vaccination a requirement for seeing patients face-to-face? Updated 5 January 2022

    Requiring patients to be fully vaccinated against COVID-19 as a condition of a face-to-face consultation could be open to criticism from medico-legal, professional, ethical and discrimination perspectives unless there are clear and compelling justifications for it in specific circumstances. 
      
    In MIGA’s view, such requirements could only ever be contemplated as a last resort, where there is no other reasonable option to protect yourself, staff and patients (see below for more information on this) and there are significant numbers of COVID-19 cases in the community. 

    Such situations are likely to be rare, e.g. where a certain worker is particularly vulnerable to the effects of COVID-19 infection due to a serious underlying condition.  Even then, it would be difficult to justify extending a preclusion on seeing unvaccinated patients face-to-face to other doctors and staff in the same practice who aren’t as vulnerable.    

    MIGA recommends thoroughly exploring whether the options detailed below are sufficient to protect yourself, your colleagues / staff and other patients, seeking public health / specialist advice as needed, before considering mandatory vaccination requirements for face-to-face care:

    • Strongly encouraging vaccination
    • Exploring with individual patients their reluctance to be vaccinated
    • Increased COVID Safe measures for non-vaccinated patients, such as triaging, enhanced PPE, use of different, appropriate practice areas apart from other staff and patients (particularly those at higher risk from COVID-19), outdoor consultations (where clinically appropriate) hygiene measures, physical distancing and air filtration / purification
    • Pre-consultation triaging for use of telehealth where clinically appropriate
    • Pre-consultation COVID-19 testing (subject to reasonable and ready availability)
    • Limiting face-to-face consultations with unvaccinated persons to clinical issues which cannot be dealt with via telehealth
    • For staff at higher risk of COVID-19 infection, whether they can be kept separate to unvaccinated patients and those patients be seen by those at lesser risk. 

    Consider seeking public health / other specialist advice if uncertain about the extent to which these more straightforward approaches for seeing unvaccinated patients face-to-face where necessary would provide sufficient protection for yourself, your colleagues / staff and your patients. 

    In the rare situation where these steps are insufficient to protect staff and patients,  a wide range of issues need to be considered before imposing mandatory vaccination requirements for face-to-face care, including:
    • Current ATAGI, public health and peak body advice
    • Extent of COVID-19 case numbers in the local community
    • Vulnerability of individual staff and particular patient groups
    • Why other measures such as staff vaccination, PPE, COVID-19 testing, telehealth triaging, hygiene measures and physical distancing are inadequate reduce transmission risk sufficiently
    • Why mandatory vaccination for patients is necessary if exposed workers are not required to be ‘furloughed’ or isolate if they are vaccinated and using certain PPE – see Q&A What should I do if I / practice staff have been exposed to COVID-19? 
    • What to do when use of telehealth would be clinically inappropriate
    • Practical limits on whether you are able to see patients outside your practice, such as in the car park – such as need for physical examination, privacy, access to devices and records, patient privacy etc
    • Access to care – including other local healthcare options and continuity of care for non-vaccinated patients when face-to-face care is needed
    • Whether the current volume of COVID-19 cases in the community would make it difficult to provide necessary face-to-face care in  your broader community if mandatory vaccination requirments were introduced by your practice
    • Discrimination law (generally there are exemptions under discrimination law for things reasonably necessary to protect individuals or public health)
    • Appropriate exceptions (e.g. emergencies and medical contraindications).
    Ahpra and the National Boards have issued 'Facilitating access to care in a COVID-19 environment: Guidance for health practitioners'
  • Can I ask my patients and staff about their COVID-19 vaccination status? New 22 November 2021

    It is generally appropriate to ask patients about the COVID-19 vaccination status where there are COVID-19 patients in the community, given its relevance to the safety of you, your colleagues / staff and other patients.

    In many situations, you will be collecting staff vaccination status as part of mandatory vaccination requirements in certain states and territories.

    If you decide to ask your patients and / or staff about COVID-19 vaccination status, MIGA recommends:
    • Explaining the reasons why you are taking such steps
    • Exploring the concerns of the patient / staff member
    • If they remain reluctant to provide the information, consider whether there are other ways to ensure protection of other patients and staff without pressing for the information. 
  • Can I ask my patients to wear masks when attending our practice? Updated 20 January 2022

    MIGA considers it is reasonable for you to request patients to wear a face mask when attending your practice, subject to any medical or other valid reasons, where:
    • Face masks are required by public health direction or advised by authorities / peak bodies:
      • see  above Q&A - on healthcare requirements / restrictions across the country
      • AHPPC advises that "voluntary wearing of face masks offers protection to individuals agains transmission even when not mandated... when there is community transmission, individuals may choose to furtehr protect themselves and others by wearing well-fitted mace masks in certain circumstances in community settings.  Wearing a mask is not dependent on whether an individual is vaccinated or mandated by public health orders.... These circumstances include... visiting hospitals and healthcare settings..."
      • The Commonwealth Health Department has recommended wearing masks in indoor public spaces, which includes healthcare settings
    • There are high risks / significant levels of community transmission
    • Patients are unvaccinated
    • You, your colleagues or your staff are vulnerable to COVID-19.

    If you are asking patients to wear masks in your practice, it would be appropriate to have stocks available for those patients who do not have one. 
     
    Where a patient is reluctant to wear a face mask, you should consider:
    • Whether there is an appropriate alternative way to provide care to your patient, eg via telehealth where clinically appropriate – see Q&A below on telehealth
    • Whether staff COVID-19 vaccination and appropriate PPE would sufficiently reduce the risk
    • How to ensure necessary continuity of care for your patient.

    The Australian Human Rights Commission provides information on whether requiring people to wear masks would constitute discrimination.  Adapted for the healthcare context, it indicates:
    • A strict rule preventing patients without face masks from accessing healthcare at your practice, even patients who are lawfully exempt from public health requirements and cannot wear masks for medical reasons, could constitute unlawful discrimination
    • The onus would be on you to show a strict rule is reasonable in the circumstances, which may include:
      • Scope of public health directions and exemptions
      • Urgency of healthcare being sought
      • Risks of transmission in your practice, e.g. scope for physical distancing
      • How long the patient would remain in the practice
      • Whether there are other patients / staff who are most vulnerable to severe COVID-19
      • Government, regulator and peak body advice on medical and work health and safety risks
      • Whether you can provide healthcare in another way (e.g. via telehealth)
      • Local incidence, severity and distribution of COVID-19
      • Alternative methods for reducing risk without strict mask wearing requirements, such as testing regimes, physical distancing or PPE.
    • You are also required to make “reasonable adjustments” for people with disability, which are those which do not impose an “unjustifiable hardship” on your business – this might include providing healthcare without need for a mask at certain times / with certain providers or telehealth
    • You may be able to use the ‘infectious disease’ exemption to justify strict mask wearing requirements if “reasonably necessary”, but it is unlikely to be enough that a mask requirement is “merely helpful, desirable or convenient in protecting public health”.
  • My patient seeks an exemption to a requirement to wear a mask - What can I do? Updated 23 July 2021

    You may be approached by your patients to provide a certificate or written support for them not wearing a mask.

    Context of the request

    Usually requests for exemptions come in the context of public health directions requiring the wearing of masks. Those directions detail circumstances where people are exempted from wearing a mask.  Generally this includes a physical or mental health condition or disability that makes wearing a mask unsuitable.  More information on current mask requirements is in the Q&A above on healthcare restrictions.

    If an employer has asked your patient to wear a mask, it is important to explore the reasons for the employer’s request with the patient.

    In New South Wales if a person seeks exemption from wearing a mask on grounds of physical or mental health conditions or disability, they must have:
    • A medical certificate or other written evidence signed by a registered health practitioner or registered NDIS provider confirming they have the physical or mental health condition or disability, and that it makes wearing a fitted face covering unsuitable; or
    • A statutory declaration from them confirming they have the physical or mental health condition or disability, and that it makes wearing a fitted face covering unsuitable.


    Assessing requests for mask exemptions

    You can only provide an opinion within the limits of your expertise, and which you feel comfortable and confident in expressing from a clinical perspective. 

    In assessing requests for mask exemptions, consider:
    • Whether the patient’s individual circumstances (risks to them / others from not wearing a mask) and broader public health imperatives outweigh any clinical issues for them in wearing a mask.  
    • Exploring with the patient alternative options to a mask exemption, such as working from home, minimising time they are required to be wearing a mask, or whether certain masks / face coverings are more acceptable to the patient than others  
    • Seeking specialist advice and / or liaising with your local public health unit as appropriate.

    Unless the patient clearly warrants an exemption consider advising them about the public health benefits of using masks, particularly if they work in higher risk settings (such as health or aged care).

    It is appropriate to decline the patient’s request for a mask exemption if you do not feel their condition or disability justifies an exclusion from wearing a mask on clinical grounds, when balanced against public health imperatives and risks the patient may face or pose to others from not wearing a mask.

    In some circumstances, it may be appropriate to offer to provide the patient with a certificate / letter stating that they have a certain medical condition or disability if you don’t feel comfortable in saying they should be exempted from wearing a mask.
  • Can I ask my patients to undergo a COVID-19 test prior to undergoing surgery or seeing them face-to-face? Updated 5 January 2022

    Requirements for pre-consultation COVID-19 testing may be reasonably used in circumstances of local cases / community transmission of COVID-19, or for seeing unvaccinated patients, where COVID_19 testing (whether through PCR or rapid antigen testing) is readily available.

    If considering whether to require patients to have a COVID-19 test before they undergo surgery or attend your practice the following factors are relevant:
    • Current state / territory public health directions for testing – see Q&A on healthcare restrictions for current healthcare worker testing requirements
    • Government and peak body advice – see for example RACS elective surgery recommendations
    • Approaches taken by local public hospitals
    • Whether you practice in an area with a significant outbreak / large numbers of cases
    • Whether they have recently suffered from COVID-19 symptoms
    • Vulnerability of other patients and staff
    • Local PCR testing capacity, including ability to obtain a result before coming to your practice
    • Patient's ability to access rapid antigen testing (if permitted where you are)
    • Extent to which other protection measures, such as PPE and hygiene measures are likely to reduce the risk of COVID-19 transmission.

    If a patient / staff member is reluctant to undergo testing, testing is difficult to obtain or a result is delayed, MIGA recommends exploring with the patient / staff member whether there are ways to ensure appropriate protection of other patients / staff without a current test result.  As relevant this may include whether attending the practice / surgery can be delayed until this has taken place, or whether a consultation via telehealth is clinically appropriate.
  • What requirements are there for rapid antigen testing? Updated 20 January 2022

    Rapid antigen test results which are positive for COVID-19 must be reported in NSW, Victoria, Queensland, South AustraliaTasmania, ACT and the Northern Territory.

    Previous restrictions on use of rapid antigen testing in Queensland and Western Australia have now been lifted.  
    The TGA provides information about rapid antigen testing, guidance and checklist for business and details of approved testing kits.  

    Information is also available about their use in NSW, including living evidence tables, and Victoria.
  • What should I do if I / practice staff have been exposed to COVID-19? Updated 20 January 2022

    The Commonwealth Health Department has issued Permissions and Restrictions for Workers in Healthcare Settings – Interim Guidance .  It provides a framework for assessment and management of both low and high risk COVID-19 case contacts.

    States and territories have their own requirements and guidance for COVID-19 exposures in healthcare, including New South Wales, VictoriaQueensland and South Australia.

    In some states there can be certain exemptions available for healthcare workers from close contact isolation requirements in order to attend work, including New South Wales and Victoria

    If uncertain about an appropriate response in particular circumstances, contact your local public health unit.  
  • What services are there to support the profession during this time? Updated 20 December 2021

    It is important that you seek any professional and personal support you need. 

    MIGA’s Doctors’ Health website provides a range of resources and links.

    Doctors can access Doctors’ Health Services 24/7 helplines across Australia to help you find the support you need, which include:
    • Drs4Drs Support Service - crisis support as well as non-urgent mental health support, provided by psychologists, social workers and counsellors – 1300 374 377 or www.Drs4Drs.com.au
    • State and territory doctors’ health services – individual - contact details are here.  

    Midwives can access Nurse & Midwife Support, a 24/7 telephone and online service – contact details are here.
     
    Other resources and support include: The Black Dog Institute TEN – The Essential Network app for healthcare workers and further COVID-19 resources here.

Managing COVID-19 in the community

Telehealth and Medicare requirements

  • When can I use telehealth? Updated 20 December 2021

    Telehealth is appropriate to use where:
    • You have a reliable, secure telehealth system
    • You can provide the same level of care and advice you can in a face-to-face consultation
    • You have appropriate arrangements to see the patient face-to-face if necessary.  

    Telehealth can still be used if it does not qualify for a Medicare item where clinically appropriate to do so. 
    Your fees for this should be disclosed to the patient prior to consultation.
     
    For telehealth guidance see:
  • What platforms can I use for telehealth? Updated 3 September 2021

    A range of commonly used video platforms and landline / mobile telephone services can be suitable for telehealth.  
     
    Be aware free versions of telehealth platforms may not meet privacy and security requirements. 
     
    To assist in choosing suitable video conferencing platforms, the Australian Digital Health Agency provides:
    Telehealth video conference platform interpreting is available via TIS National
  • What are the changes to Medicare Telehealth from January 2022? Updated 20 January 2022

    The Commonwealth Government has announced population wide telehealth under Medicare will continue permanently for GPs and other specialists.

    Although certain longer MBS telephone items were initially removed, a range of telephone items have since been restored until 30 June 2022, including longer GP telephone items (Level C) and items for specialists to provide telehealth to hospital inpatients when their doctor cannot see them because of isolation / quarantine restrictions.  These items are available across the country.

    Changes include:
    • Unrestricted access to MBS telehealth services for patients subject to COVID-19 public health orders requiring isolation / quarantine, without need for an established clinical relationship with their general practice
    • Patients in COVID-19 hotspot areas not subject to isolation / quarantine requirements must have an established clinical relationship with their general practice to access MBS telehealth, unless an exemption applies – see Q&A Can I only use Medicare COVID-19 telehealth items for existing patients? 
    • Face-to-face item for GPs caring for COVID positive patients in the community now extends to patients that have tested positive through a rapid antigen test.

    For specialists outside general practice a range of pre-pandemic telehealth items have been removed. Medicare has released a list of telehealth items, both permanent and temporary, for these specialists.  

    A new 30/20 rule for GP and consultant physician telephone services (ie non-video services) will not commence until at least 1 July 2022.  Breach of this rule, precluding 30 or more telephone attendances on each of 12 or more days during a 12 month period, leads to a Professional Services Review referral.

    From 1 July 2022 the existing 80/20 rule applies to all GP consultation times, whether face-to-face or telehealth 

    More information on the changes, including continuing item numbers, is available here.
  • When can I use Medicare telehealth items? Updated 5 January 2022

    The current items extend to all Medicare eligible Australians, so long as the requirements for individual item numbers are met. 
     
    Both you and your patient must be in Australia to use Medicare telehealth items (as is the case for Medicare items generally). 
    You do not need to be within your regular practice to provide telehealth.  It can be provided from home. 
    You should use your provider number for your primary practice location. 
     
    Your Medicare provider number should only be used for telehealth consultations you undertake yourself.  
    It cannot be used by other practitioners you work with for their consultations. 
     
    For each service / consultation, the full requirements of a telehealth item must be met.  They cannot be used solely for triaging.   
     
    In determining whether telehealth is appropriate, Medicare requires the practitioner must:
    • Have the capacity to provide the full service through this means safely and in accordance with professional standards; and
    • Be satisfied that it is clinically appropriate to provide the service to the patient; and
    • Maintain a visual and audio link (or audio only for telephone) with the patient; and
    • Be satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy – see Q&A What platforms can I use for telehealth? 
    • Only use telephone if video cannot be used.
     
    Online chat, messaging and email cannot be used for Medicare telehealth items.
     
    Before using the new items, you should familarise yourself with the requirements for telehealth use generally and each individual item.   This is very important.  This includes:
    • Obtaining informed financial consent before providing telehealth where you are not bulk-billing (the AMA’s Informed Consent guide is here)
    • Documentation – there are the same record-keeping requirements as for face-to-face consultations – this includes referrals where required
    • Assignment of benefit:
      • For the new telehealth items only, documentation in clinical notes of a patient’s agreement to assign their benefit as full payment for the service is sufficient
      • Other options include posting the completed assignment of benefit form to the patient for their signature and return, or email agreement between the practitioner and patient
      • The agreement can be provided by a patient’s carer or family member if the patient is unable to provide it
      • The Department of Health has indicated it does not intend to undertake compliance activities “directly focused on whether the assignment of benefit process aligned with the usual requirements”, but may investigate potentially fraudulent claims by seeking to verify that the service was provided to a patient
    • Multiple attendances on the same day (co-claiming is precluded) – see Q&A What if I see a patient via telehealth and then need to see them face-to-face?.
     
    The Department of Health provides an email service for questions around COVID-19 MBS items –AskMBS@health.gov.au.  It has also provided advisories for GPs, physicians and other specialists covering both telehealth and broader MBS claiming questions. 
     
    The Commonwealth Health Department has released the following Medicare telehealth guidance:
    COVID-19 telehealth item news – detailing changes to the items as made.
  • Can I only use Medicare COVID-19 telehealth items for existing patients? Updated 20 January 2022

    Subject to a range of exceptions (see below), GPs and other doctors working in general practice can only claim COVID-19 telehealth items if they have an existing and continuous relationship with a patient. Similar restrictions have not been imposed on specialists or other healthcare providers.
     
    An existing and continuous relationship involves the patient having seen the same doctor or another medical or health practitioner (including a practice nurse) at the same practice face-to-face in the last 12 months. The requirement applies to each and every telehealth claim. For example if this requirement was met for past telehealth claims, but you have not now since the patient face-to-face for more than 12 months, you cannot claim MBS COVID-19 telehealth items. 
     
    There are a number of exceptions, which are:
    • Patients isolating / quarantined under COVID-19 movement restrictions imposed by state or territory public health requirements
    • Children under 12 months of age
    • Homeless patients – this includes people who live in an inadequate dwelling, have no tenure or a short and non-extendable tenure, or live somewhere where they do not have control of, and access to, space for social relations
    • Patients receiving an urgent after-hours (unsociable hours) service
    • Doctors located at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service
    • Doctors participating in the Approved Medical Deputising Service (AMDS) program if the AMDS provider has a formal agreement in place with a medical practice to provide services to its patients, and that practice has provided, or arranged, at least one personal attendance for the patient in the past 12 months.
    • Patients accessing specific MBS items for:
      • Blood borne viruses, sexual or reproductive health consultations
      • Pregnancy counselling services
      • Mental health services
      • Nicotine and smoking cessation counselling.
  • What if I see a patient via telehealth and then need to see them face-to-face? Updated 10 Sept 2020

    For use of Medicare telehealth items, the Commonwealth Health Department has indicated:

    • You need to have the capacity to see the patient face-to-face if required, wherever possible, or otherwise scope to arrange prompt care as required, whether through colleagues at your practice / hospital or other frameworks you have put in place before providing telehealth services
    • If a subsequent attendance on the same day does constitute a continuation of an earlier attendance, the sessions together are considered a single attendance for benefit purposes.
    • If you cannot meet the requirements of a telehealth item without a subsequent face-to-face consultation, you cannot bill Medicare until you have provided a complete MBS service - this could be through billing either a telehealth item or a face-to-face item, whichever took the longer, so long as the individual item requirements are met – you cannot bill both items
    • If two components of a single service are provided by different practitioners, each should bill the appropriate item number fo rhte individual service they provided
    • The new telehealth items are stand-alone items – they cannot be co-claimed with existing face to-face or existing telehealth items - in addition, you cannot claim a telehealth item and a chronic desease management plan item on the same day
    • Multiple Medicare items could only be claimed on the same day by the same practitioner if subsequent attendances are not a continuation of initial or earlier attendances – if you bill multiple items you should state the time of each attendance on the account, and also include in the clinical records time of each service, how each item descriptor was met and explain why they are separate services.

    More information is available here (Provider FAQs). 

    For telehealth that is not Medicare billable, you should ensure that you have the necessary arrangements in place to provide continuity of care within appropriate timeframes for patients who you initially consult with via telehealth, but subsequently need to see face-to-face, where you cannot do this yourself. 
     
  • Are there any bulk billing requirements for COVID-19 telehealth items? Updated 16 Nov 2020

    Practitioners can choose whether to bulk bill or use their regular billing practices.   .
     
    COVID-19 telehealth services provided by GPs and other doctors in general practice are eligible for MBS incentive payments when provided as bulk billed services to Commonwealth concession card holders and children under 16 years of age. 
     
    Rural bulk billing incentives are only payable to practitioners in areas classified as regional, rural and remote under the Modified Monash Model (MMM) classification system (MMM 2 – 7 locations).  Practitioners in metropolitan (MMM 1) areas receive the standard bulk billing incentive payment.
     
    Further information on eligibility and claiming rules is available here (Bulk-billing incentives – FAQs).
     
    Where bulk billing is not being used, the Commonwealth Health Department advises providers should ensure “informed financial consent is obtained prior to the provision of the service”.  Informed financial consent includes details relating to fees, including any out-of-pocket expenses.  The AMA’s Informed Consent guide is here
     
    There can be no non-rebatable deposits charged which are then put towards later consultations.  Fees charged for this (and any MBS service) can only be for the service which is being claimed for.  It cannot include fees for another service.

    More information is available here.

     
  • Can I use telehealth for patients in aged care facilities? Updated 9 Sept 2020

    Yes, the Medicare telehealth items can be used for patients in aged care facilities, subject to individual item number requirements and whether it is clinically appropriate to use telehealth for the patient in question.

    The patient must be present when receiving the telehealth service.  The items cannot be used for consultations with family or care providers without the patient being present.

    Where a patient lacks capacity, their substitute decision-maker (guardian, power of attorney, close relative as relevant) can be involved, whether with the patient or linked in from another location via video or telephone.  MIGA’s resource on Substitute consent provides more information on who should be involved in these situations.  

     

Electronic prescribing

  • Can I use digital image / image-based prescribing? Updated 5 January 2022

    Until 31 March 2021 digital image / image-based prescribing can be used for PBS prescriptions across the country where electronic prescribing or other prescribing methods (such as a handwritten prescription) cannot be used.

    Image-based prescription means:
    • You can create a paper prescription, signed in writing or via valid digital signature
    • A clear digital copy of the entire prescription is sent electronically to the patient’s pharmacy
    • You retain the original prescription for two years. 

    It is important to be aware of specific restrictions on image-based prescribing in different states and territories, including what medications it can be used for and record-keeping requirements. 

    The Commonwealth Department of Health provides a guide for prescribers and an overview of state and territory rules.  Further information is also available for South Australia, NSW, Victoria, QueenslandWATasmania and ACT.
  • What does electronic prescribing involve? Updated 5 January 2022

    Token model 
     
    The Token model is a unique QR barcode (token) is sent via app, SMS or email to a patient. 
     
    Patients can send the token / take it in to a pharmacy of their choice for dispensing.
     
    One token is used for each medication.  Once scanned at a pharmacy, it cannot be reused.  Pharmacies sent a new token to the patient for each repeat. 
     
    If your patient requests, you can send the token to someone else caring for them, such as a family member.  It can only be sent to one mobile number or email address by you. 
     
    You should confirm token receipt before the end of the consultation.  If it was not received / sent to the wrong location, cancel the prescription and generate a new token. 

    Active Script List model   
     
    An ASL contains a patient’s active prescriptions which can be dispensed by a pharmacy. 
     
    Patients need to register for an ASL and must provide consent for you to access and view their ASL. 
     
    This model will eliminate the need for a token, and is meant to be particularly helpful for patients on multiple medications.  
     
    You cannot provide both an electronic prescription and a paper or digital image prescription to a patient.
     
    Electronic prescribing use is not mandatory.  You can continue to use paper (across the country) instead of these new methods. Both you and your patients may find it easier and quicker to use. It also reduces the risk of lost prescriptions. 
     
    More information on the Token and ASL models, including timing for roll-out, is available here
     
    The Commonwealth Health Department has prepared policies on both privacy (including a specific framework for the initial active script list rollout), and security and access, obligations for healthcare providers using electronic prescribing.
     
    The Australian Digital Health Agency provides a free online electronic prescription course, focusing on the Token model. 
     
    The RACGP has also released electronic prescribing resources.

Registration, pandemic sub-register and training issues

  • What if I am working outside my usual scope of practice? Updated 16 Nov 2020

    We are conscious that a range of our members are undertaking a broader range of work in helping to respond to the challenges of COVID-19. 
     
    The Medical Board indicates:

    • Individual doctors, as well as organisations who engage them, will need to make decisions about scope of practice
    • Decisions should prioritise patient safety and take into account your qualifications, training, experience and transferability of their skills to deliver safe care
    • Consider the conditions in which you will be working, including facilities and access to supervision and training
    • The Board does not prescribe what individual doctors can and cannot do – these are decisions for you and your hospital, practice or other workplace, prioritising patient safety.

     
    We recognise practitioners are often equipped to work across a number of specialties or fields of practice. 

    You should:

    • Make sure your Ahpra registration does not restrict or preclude new or broader work
      • The Medical Board has confirmed that doctors with general and specialist registration are not restricted in their scope of practice because they have specialist registration
      • If your registration does restrict you (e.g. you are limited to certain fields of practice)you would have to apply to Ahpra for changes to your registration before commencing work
    • Consider whether you have the necessary skills, training and experience to provide the level of care expected in the new context
    • Contact MIGA to ensure you have the right insurance category for your new work
    • Ensure you do not incorrectly represent your qualifications, training and experience – the Medical Board has confirmed working in a different scope of practice does not permit you to use a title for which you do not have specialist registration  See Ahpra and the National Boards guidance on Titles in health advertising – Getting it right.   


    If you have concerns about being able to work in a new area, you should raise them with senior colleagues, your hospital or health service.

  • I have returned / am considering a return to practice as part of Ahpra's pandemic sub-register. Are there limitations on what I can and cannot do? Updated 24 September 2021

    Ahpra has separate 2020 and 2021 pandemic sub-registers, which cover:

    • 2020 sub-register - for doctors, nurses and midwives who if they wish can practice until 5 April 2022 in any area supporting the COVID-19 response – this includes (but is not limited to)
      • Vaccination rollout – administering COVID-19 vaccines, handling and storage activities, dosing and administering the vaccine and/or helping with this, and/or safety and surveillance monitoring following vaccination
      • Clinical and non-clinical roles directly related to the COVID-19 response
      • Employment and practice as part of a surge workforce or temporary backfill positions due to outbreak management or quarantining of other health workers.
    • 2021 sub-register -  for doctors, nurses, midwives and a range of other registered professions who if they wish can practice until 21 September 2022 to the full scope of their registration, subject to any restrictions, notations or conditions.


    Ahpra has provided information for practitioners and employers on the sub-registers.  

    Ahpra indicates “Only those who are properly qualified, competent and suitable should be on the sub-registers. Practitioners who are in a high-risk category for COVID-19 should only work in a safe practice environment”.  

    It is expected that those practising under the pandemic sub-register will exercise their professional judgement and work within their level of competence to ensure they have the necessary knowledge and skills to provide appropriate and safe care.  For more information, see Q&A What if am working outside my usual scope of practice?  

    Whilst on the sub-register, and similarly to your practising peers, you are required to follow your profession’s code of practice (doctors or midwifery) and work within your scope of practice.  Midwifery scope of practice is defined in the Nursing and Midwifery Board’s Midwife Standards for Practice.

  • I have only returned to work in the public sector. Do I need cover from MIGA? New 3 Apr 2020

    Doctors employed in the public hospital system will usually have cover for civil damages claims from their employer, but this does not normally include cover for legal expense or assistance with responding to other issues, such as professional disciplinary matters (i.e. a Medical Board / Ahpra notification) or workplace disputes.  Assistance available in relation to coronial investigations and inquests may also be limited.
     
    Before starting work, you should confirm the nature and extent of your insurance cover or indemnity with your hospital or health service.  We recommend you consider insurance cover from MIGA for matters for which you are not covered.

  • If I return to private practice will I lose eligibility for Commonwealth Government run-off cover scheme? Updated 20 January 2022

    A special exemption has been agreed to allow doctors and midwives to return to private practice and not lose their eligibility for the Commonwealth’s run-off cover scheme (ROCS) until 17 March 2022, and is likely to be extended further.

    If you continue in private practice after that time, the special ROCS exemption will no longer apply and you will need to obtain run-off cover for past practice at your own expense. 

    Practitioners returning to public practice only do not lose ROCS eligibility.

  • I have ceased practice and am not currently working, do I still have to have insurance? Doctors and Midwives Updated 22 Apr 2020

    Yes, under your registration requirements as a doctor or a midwife, you must maintain run-off cover for matters that would otherwise be uncovered arising from your previous practice.

    If you cease practice, your Policy with MIGA can be amended to run-off cover only, to cover you for claims that may still be made against you that arise from your prior practice.

    If you change your policy to run-off, you will need to notify us prior to returning to practice to arrange ongoing insurance cover.

Insurance policies are issued by Medical Insurance Australia Pty Ltd (AFSL 255906).  MIGA has not taken into account your personal objectives or situation.  Before you make any decisions about our policies, please review the relevant Product Disclosure Statement (which can be found here) and consider your own needs.
Information on this site does not constitute legal or professional advice. If you have questions, or need advice please contact us for assistance.