EXPLANATORY STATEMENT
STATUTORY RULES 1990 No. 342
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (1990/91 GENERAL MEDICAL SERVICES TABLE) REGULATIONS
Section 133 of the Health Insurance Act 1973 (the Act) provides in part that the Governor-General may make Regulations for the purposes of the Act.
Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fee for medical services set out in the table of medical services (the table) in Schedule 1 to the Act.
Section 4 of the Act provides, among other things, that the regulations may prescribe a table of medical services (other than pathology services) in accordance with the form of the table set out in Schedule 1, and that upon commencement of a regulation prescribing a table of medical services, the prescribed table has effect as if it were set out in Schedule 1 in the place of the table in that Schedule. The Health Insurance (General Medical Services Table) Regulations prescribe such a table.
It should be noted that the title of these regulations has been altered to more accurately reflect their purpose, which is to replace the table in Schedule 1 to the Act. At the same time, the former method of sequentially numbering regulations (i.e., No 1 to No 54) has been abandoned in favour of the more appropriate reference to the relevant financial year.
By virtue of subsection 4(6) of the Act, the No. 51 Regulations automatically cease to be in force on 7 November 1990, ie. the day next following the fifteenth sitting day of the House of Representatives 12 months after their notification in the Gazette. The 1990/91 Regulations replace the No. 51 Regulations, and incorporate the provisions of the No. 52, No. 53 and No. 54 Regulations which are also due to lapse within the next 12 months. The Minister for Community Services and Health agreed to the various recommendations and amendments set out below, and accordingly the 1990/91 Regulations amend the table of medical services and its rules for interpretation.
The gastroenterology and colo-rectal surgery services in the table have been revised as part of the ongoing review of services to ensure that the items reflect modern medical practice. Agreement has been reached with the Australian Medical Association (AMA) and professional craft groups on revised item descriptions and the inclusion/deletion of new/obsolete services. The Minister approved the revision of these items in the table on 28 August 1990.
Amendments to the table in respect of Items covering oesophageal echocardiography and therapeutic nuclear medicine have been agreed to in association with the AMA and relevant craft groups. The Minister approved these changes on 28 August 1990. A consequential change required as a result of these changes is the deletion of Item 8875.
The Department of Community Services and Health also conducted a further three reviews, in consultation with the AMA and relevant craft groups, of items in the table which were considered to be the subject of inappropriate use. These reviews resulted in improved item descriptors for services related to treatment of skin cancer, impedance audiometry and injections into joints. The Minister also approved these changes on 28 August 1990.
Following discussions with representatives of the Royal Australian College of General Practitioners (RACGP) and the AMA, it is proposed to introduce revised structures and Schedule fees into the table for attendances by general practitioners at hospitals, nursing homes and other institutions, and for services provided after hours. The Minister approved the above proposal on 20 July 1990.
As a result of a lengthy review by the Department of in vitro fertilisation (IVF), a number of specific items have been developed for inclusion in the table to cover assisted reproductive services such as IVF and gamete intra fallopian transfer (GIFT). These items are to be used in respect of assisted reproductive services in lieu of items already included in the table, and will provide benefits for embryology laboratory services and treatment counselling not previously covered. These items are to be included in a new division in Part 6 of the table titled Division 3A.
As part of the Department’s ongoing evaluation of services in the table, a review of radiation oncology items, resulting in revised fees for some services, has been finalised. Agreement has been reached with the Royal Australian College of Radiologists on the revised fees. The previous Minister (Dr Blewett) agreed to these changes on 12 March 1990. However, endorsement of these changes was not received in time for the 1 May 1990 amendment to the table, and it was agreed that implementation should proceed at the next round of amendments.
As announced in the 1990/91 Federal Budget, an increase of 5.5% in fees for all services (excluding optometrical services), with a 7.14% increase for optometrical consultations, will be incorporated in the table. Cabinet approved these increases in fees with effect from 1 November 1990 on 16 July and 4 August 1990.
The general fee increase of 5.5% was a Government decision based on consideration of movements in the Average Award Rates of Pay Index and the Consumer Price Index and taking into account overall economic policy.
The increase of 7.14% for optontetrical items was determined by the Minister taking into account the above considerations and the fact that optometry is a participating scheme in which, in return for being eligible for benefits under Medicare, the optometrists concerned agree to adhere to the Schedule fee.
The regulations include additions to and amendments of the Rules of Interpretation of the Table resulting from the addition of items to the Table and amendments to existing items. An amendment to Rule IS is necessary to include the change to the arrangements for payment of benefits for services by approved dentists contained in Health Amendment Act No. 3 of 1990. Benefits are no longer restricted to services rendered in the operating theatre of a hospital.