Health Insurance (1994-1995) General Medical Services Table Regulations (Amendment) 1995 No. 160
EXPLANATORY STATEMENT
STATUTORY RULES 1995 No. 160
Issued by authority of the Minister for Human Services and Health
Health Insurance Act 1973
Health Insurance (1994-1995) General Medical Services Table Regulations (Amendment)
The Health Insurance Act 1973 (the Act) provides for payments by way of medicare benefits, payments for hospital services and payments for matters concerning related committees and tribunals.
Section 133 of 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 (the table), (other than diagnostic imaging services and pathology services). The Health Insurance (General Medical Services Table) Regulations, Statutory Rules 1994 No. 362 currently 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.
The Regulations amend the current table of general medical services by introducing new services (e.g., C14 urea breath testing - subregulation 47; partial tracheostomy - subregulation 4.57), deleting obsolete services (e.g., limb lengthening procedures - subregulation 4.60) and amending the descriptions and/or fees of other services. They also introduce 2 new rules of interpretation of the table and amend existing rules to add clarification and to take account of changes to items in the table.
Changes to the table resulted from ongoing reviews by the Medicare Benefits Consultative Committee designed to ensure that the table reflects current medical practice.
Details of the Regulations are set out in the Attachment.
The regulations come into effect on 1 July 1995.
Attachment
Details of the Regulations are as follow:
Regulation 1 provided for the Regulations to commence on 1 July 1995.
Regulation 2 provided that the General Medical Services Table be amended as set out in the Regulations.
Subregulation 3.1 amended subrule 1 (1) of the rules of interpretation by inserting a definition of "closed reduction" and "open reduction" for the purposes of items in the table containing these expressions.
Subregulations 3.2 and 3.3 amended subrule 1(4) of the rules of interpretation to clarify factors "n1" and "n2" in the formula relating to a combined anaesthetic unit value included in the description of an item.
Subregulations 3.4 to 3.7 amended rule 21 of the rules of interpretation to:
(a) include in subrule 21 (1) a definition of "appropriate law" for the purposes of this rule;
(b) replace "75000" with "75001" in subparagraph 21(1)(b)(5) and subrule 21(2) as a consequence of the deletion of item 75000 from the table; and
(c) provide that accredited oral and maxillo-facial surgeons, as defined in rule 22, may render services to which items 75009 to 75023 apply.
Subregulation 3.8 omitted rule 32. The meanings of "closed reduction" and "open reduction" previously contained in this rule were transferred to subrule 1(1).
Subregulation 3.9 introduced 2 new rules of interpretation as follow:
(a) Rule 38 specified the fee for new item 16633 which is a "derived" fee equal to 50 percent of the fee for any of the services covered by items 16600 to 16627 where the service relates to a second or subsequent foetus in a multiple pregnancy.
(b) Rule 39 specified the fee for new item 51312 which is a "derived" fee equal 20 percent of the fee for any operation covered by items 16609 to 16615 or 16333.
Subregulations 4.1 to 4.4 amended the descriptions of services in the table covering diagnostic neurology investigations to exclude the use of these items for computerised analysis of electroencephalograms and evoked potential recordings using "neurometrics" in the treatment of "attention deficit disorders". The relevant professional medical bodies had advised that such investigations are not of proven clinical value and therefore should not attract Medicare benefits.
Subregulation 4.5 introduced a new item into the table to cover "tilt table" testing in the diagnosis of syncope.
Subregulations 4.6, 4.8, 4.9, 4.13 to 4.23, 4.25 and 4.43 introduced new services into the table which were previously covered by Ministerial Determination under section 3C of the Health Insurance Act. Section 3C allows the Minister to determine an item and fee for services not listed in the table. This facility is generally used in respect of medical services which have not attained the status of mainstream medical practice and which often need to be revised promptly to correct anomalies to descriptions or fees. These services are transferred to the table when appropriate.
Subregulation 4.7 introduced a new item into the table to cover C14 urea breath testing for the diagnosis of H-pylori bacteria which will result in a decrease in the utilisation of endoscopies.
Subregulations 4.10, 4.11, 4.29, 4.30 and 4.65 amended obstetric and gynaecological services in the table in respect of ultrasound guided procedures to reflect current practice aimed at improved perinatal outcomes.
Subregulations 4.12, 4.58 and 4.59 corrected a number of minor anomalies in the table arising from the previous major review of anaesthesia.
Subregulation 4.24 amended items in the table relating to circumcision to reflect Government policy that this procedure should be restricted to males.
Subregulation 4.26 corrected a minor anomaly in item 32138 in the table covering haemorrhoidectomy.
Subregulations 4.27 and 4.28 made minor amendments to vascular surgery services in the table pending a forthcoming major review of these services.
Subregulations 4.31 to 4.40 amended a number of urology services in the table relating to laser surgery, in light of changes in medical practice.
Subregulations 4.41 and 4.42 provided services in the table to cover cardio-electrophysiological studies undertaken by surgeons.
Subregulations 4.44 to 4.56 amended neurosurgery services in respect of skull base surgery and spinal disorders surgery, in light of changes in medical practice.
Subregulation 4.57 introduced an item into the table to cover a new procedure for partial tracheostomy.
Subregulations 4.60 to 4.62 restructured services in the table relating to paediatric orthopaedic surgery to reflect current medical practice, involving the inclusion of a significant number of new procedures.
Subregulations 4.63 and 4.64 amended the items covering assistance at operation to preclude assistants' fees being claimed for upper and lower gastrointestinal endoscopies.
Subregulations 4.66 to 4.74 amended items in the table relating to orthodontic and oral surgery services in. the treatment of cleft lip and cleft palate conditions following a review of these services to more appropriately reflect current practice.