Health Insurance (1991-1992 General Medical Services Table) Regulations
(Amendment) 1992 No. 191
EXPLANATORY STATEMENT
STATUTORY RULES 1992 No. 191
Issued by the authority of the Minister for Health, Housing and Community Services
Health Insurance Act 1973
Health Insurance (1991-1992 General Medical Services Table) Regulations (Amendment)
Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations for the purposes of the Act.
Section 4 of the Act provides that the regulations may prescribe a table of medical services (other than pathology services) in accordance with the form of table set out in Schedule 1 and that, upon commencement of a regulation prescribing a table of medical service, the prescribed table has effect as if it were set out in Schedule 1 in place of the table in that Schedule. The Health Insurance (General Medical Services Table) Regulations prescribe such a table.
Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for general medical services set out in the table of general medical services (the table) in Schedule 1 of the Act.
The Regulations amended the Health Insurance (General Medical Services Table) Regulations by altering the table of general medical services and the rules of interpretation of the table, substituting three new optometrical items in the table for the existing optometrical item 10901. This amendment made rule 8 in the existing rules of interpretation redundant and consequently it is omitted.
Discussions were held between the Department of Health, Housing and Community Services, the Royal Australian College of Ophthalmologists (RACO) and the Australian Optometrical Association (AOA) because of concerns held by RACO that Rule 8 which related to item 10901 allowed optometrists to treat medical conditions. Item 10901 had been introduced into the table effective from 1 December 1991. Both RACO and the AOA have agreed to the changes.
The new items further improve monitoring by the Health Insurance Commission of the incidence of optometrists claiming a comprehensive consultation within 24 months of a previous initial or comprehensive consultation, so that any abuse can be detected.
The Regulations are to commence on 1 July 1992.
Overview
The Health Insurance (1991-1992 General Medical Services Table) Regulations (Amendment) 1992 No. 191, enacted under the authority of the Minister for Health, Housing and Community Services, amend the Health Insurance (General Medical Services Table) Regulations to address specific concerns raised by the Royal Australian College of Ophthalmologists (RACO) regarding the scope of optometrical services covered by Medicare. These regulations respond to the need for greater clarity and control over the types of medical conditions that optometrists can treat under Medicare, ensuring that these services are appropriately monitored to prevent any misuse. By substituting three new optometrical items for the existing item 10901 and removing the redundant Rule 8, the amendment aims to better align the services provided with the intended scope of optometry under Medicare. The changes were agreed upon by both RACO and the Australian Optometrical Association (AOA), and the regulations are set to commence on 1 July 1992.
Scope and Application
The Health Insurance (1991-1992 General Medical Services Table) Regulations (Amendment) 1992 No. 191 applies to the general medical services listed in the Health Insurance Act 1973, specifically altering the table of general medical services to incorporate new optometrical items while removing the previously existing item 10901. These amendments follow consultations between the Department of Health, Housing and Community Services, the Royal Australian College of Ophthalmologists, and the Australian Optometrical Association, addressing concerns about the scope of services that could be provided under the old item. The regulations are intended to enhance oversight and prevent potential misuse by ensuring that optometrists' services are correctly monitored and billed under Medicare. The amendments are to take effect from 1 July 1992, and they illustrate the ongoing process of updating medical services to better align with professional standards and practices.
Key Provisions
The main operative sections of these Regulations are Sections 1 and 3. Section 1 provides that the Regulations will amend the Health Insurance (General Medical Services Table) Regulations by altering the table of general medical services and the rules of interpretation, while Section 3 provides that the Regulations will commence on 1 July 1992. The Regulations specifically address the table of general medical services (Section 2) and the associated rules of interpretation (Section 4). These changes include substituting three new optometrical items in the table for the existing optometrical item 10901 and omitting rule 8 in the existing rules of interpretation, which became redundant with the amendment.
These Regulations impose obligations on the parties involved, particularly on optometrists and the Health Insurance Commission. Optometrists must now adhere to the new items in the table of general medical services, which are designed to prevent the treatment of medical conditions outside their scope of practice. This change aims to ensure that optometrists provide services that are within their professional boundaries. The Health Insurance Commission, on the other hand, has the responsibility to monitor the implementation of these changes and to ensure that any abuse of the system, such as claiming a comprehensive consultation within an inappropriate timeframe, is detected and addressed.
Breaches of these Regulations may lead to civil or criminal consequences. While specific penalties are not detailed in the Explanatory Statement, the Health Insurance Act 1973 provides a framework for penalties related to non-compliance. Generally, penalties for breaches under the Act can include fines and other civil penalties, as well as potential criminal charges in cases of serious or repeated breaches. The maximum penalties would be determined in accordance with the relevant sections of the Act and any associated regulations. It is important for all parties to comply with these Regulations to avoid any legal repercussions.