EXPLANATORY STATEMENT
Health Insurance Amendment (90 Day Pay Doctor Cheque Scheme) Act 2008
Proclamation
Subsection 2(1) the Health Insurance Amendment (90 Day Pay Doctor Cheque Scheme) Act 2008 (the Act) provides that Schedule 1 to the Act commences on a day to be fixed by Proclamation. However, if any of the provisions of Schedule 1 do not commence within 12 months from the day on which the Act received the Royal Assent, they commence on the first day after the end of that period. The Act received Royal Assent on 25 June 2008.
The purpose of the Proclamation is to fix 1 November 2008 as the day which Schedule 1 to the Act commences.
Schedule 1 to the Act amends section 20 of the Health Insurance Act 1973 (the HIA) to allow specialists and consultant physicians access to the 90 Day Pay Doctor Cheque Scheme (the Scheme) where the original claim for the Medicare benefit is submitted electronically to Medicare Australia.
A person is entitled to a Medicare benefit on presentation of a paid account for a professional service under the HIA. However, when the patient is unable to pay the full amount of the account upfront, the patient may lodge an unpaid account with Medicare Australia and may request that a cheque for the amount of the Medicare benefit be drawn by Medicare Australia in favour of the medical practitioner who rendered the professional service. This cheque is sent to the patient, who is then responsible for presenting the cheque to the doctor along with any additional co-payment that may be required. This cheque is known as a ‘pay doctor via claimant cheque’.
In cases where the patient fails to present the cheque for payment within 90 days, the cheque is cancelled and Medicare Australia pays the general practitioner (GP) directly, via electronic funds transfer. The Scheme was introduced in 2001 to protect doctors from non-payment as a result of patients not forwarding the cheques and is currently only available to GPs.
Schedule 1 to the amending Act allows specialists and consultant physicians access to the Scheme on the condition that the original claim for the Medicare benefit is submitted to Medicare Australia electronically in the manner prescribed by the regulations.
A separate Minute recommends that amendments be made to the Health Insurance Regulations 1975 relating to the Scheme.
The amendments were made in response to repeated requests from the broader medical profession to extend the 90 Day Pay Doctor Cheque Scheme (the Scheme) to include specialists and consultant physicians. The industry has welcomed this beneficial measure which allows these medical practitioners to adopt the Scheme if they choose to take up electronic claiming. Medicare Australia undertook consultation through focus groups with pathology peak bodies, (such as Australian Association of Pathology Practices and the Royal College of Pathologist of Australia), and the Australian Medical Association, to address technical issues around payment methods for the relevant professional bodies affected. The Reserve Bank of Australia was also consulted as part of this process. The Department of Health and Ageing consulted with Medicare Australia on policy matters and the date of commencement of the amendment to ensure that the arrangements around the payment system were ready before the commencement of the Scheme.
The Proclamation is a legislative instrument for the purposed of the Legislative Instruments Act 2003.
Overview
The Health Insurance Amendment (90 Day Pay Doctor Cheque Scheme) Act 2008 was enacted to address a specific gap in the Health Insurance Act 1973, by expanding the scope of the 90 Day Pay Doctor Cheque Scheme to include specialists and consultant physicians, provided the initial claim for the Medicare benefit is submitted electronically to Medicare Australia. This amendment responds to repeated requests from the broader medical profession to extend the scheme, which was previously only available to general practitioners. The objective of the Act, which was passed by the Australian Parliament and received Royal Assent on 25 June 2008, is to ensure that specialists and consultant physicians can also protect themselves from non-payment by patients who do not forward cheques within 90 days. The changes are intended to be implemented through a Proclamation, which sets the commencement date of the amendments as 1 November 2008, ensuring that the necessary arrangements for the expanded scheme are in place.
Scope and Application
The Health Insurance Amendment (90 Day Pay Doctor Cheque Scheme) Act 2008 applies to specialists and consultant physicians by extending their access to the 90 Day Pay Doctor Cheque Scheme, previously exclusive to general practitioners. This legislative amendment allows these medical practitioners to benefit from the financial protection provided by the scheme, contingent on their submission of the original Medicare benefit claims electronically. The Act is of national jurisdiction within Australia and is designed to enhance the financial security of medical practitioners by ensuring timely payments for services rendered under the Health Insurance Act 1973. The scheme, which was introduced in 2001, allows patients to present a paid account for a professional service and request a cheque for the Medicare benefit amount if they cannot pay the full amount upfront. The cheque, known as a 'pay doctor via claimant cheque', must be presented to the doctor within 90 days; otherwise, it is cancelled and Medicare Australia pays the practitioner directly. The Act’s provisions will commence on 1 November 2008, as per the Proclamation, and it is complemented by amendments to the Health Insurance Regulations 1975, ensuring that the technical and operational aspects of the scheme are well-coordinated and effectively implemented.
Key Provisions
The Health Insurance Amendment (90 Day Pay Doctor Cheque Scheme) Act 2008 (the Act) amends the Health Insurance Act 1973 (the HIA) by extending the 90 Day Pay Doctor Cheque Scheme to include specialists and consultant physicians, provided that the original claim for the Medicare benefit is submitted electronically to Medicare Australia. This legislative change was made in response to repeated requests from the medical community to broaden the scheme, which previously only applied to general practitioners. The scheme is designed to protect medical practitioners from non-payment when patients fail to present the cheque within 90 days.
Under section 20 of the HIA, as amended by Schedule 1 of the Act, medical practitioners who choose to submit their claims electronically are eligible for the 90 Day Pay Doctor Cheque Scheme. This means that if a patient is unable to pay the full amount of a medical bill upfront, they can lodge an unpaid account with Medicare Australia. A cheque for the Medicare benefit amount is then issued to the patient, who presents it to the doctor, along with any required co-payment. If the patient fails to present the cheque within 90 days, it is cancelled, and Medicare Australia directly pays the doctor via electronic funds transfer. This scheme ensures that medical practitioners are not left unpaid due to patient inaction, thus providing financial security.
The Act imposes certain obligations on the parties involved, primarily requiring medical practitioners who wish to participate in the scheme to submit their claims electronically as prescribed by the regulations. This electronic submission is a prerequisite for eligibility under the amended scheme. Additionally, patients who opt for the cheque payment method must ensure that the cheque is presented to the doctor within the stipulated 90-day period to avoid cancellation. Failure to adhere to these requirements may result in the practitioner not being compensated through the scheme.
Failure to comply with the provisions of the Act can lead to various consequences. For instance, medical practitioners who do not submit their claims electronically as required will not be eligible for the 90 Day Pay Doctor Cheque Scheme, potentially leaving them vulnerable to non-payment if patients do not pay upfront. Patients who fail to present the cheque within 90 days will result in the cheque being cancelled, and the payment will be made directly to the practitioner, which could inconvenience both parties. While the Act does not specify criminal penalties, it does imply that non-compliance with the scheme's requirements can have financial and administrative repercussions for both medical practitioners and patients.