Health Insurance Amendment (Extended Medicare Safety Net) Act 2009

Administered by Department of Health, Disability and Ageing

Legislation au C2009A00101 In force Act

Legislation content

 

 

 

 

 

 

Health Insurance Amendment (Extended Medicare Safety Net) Act 2009

 

No. 101, 2009

 

 

 

 

 

An Act to amend the Health Insurance Act 1973, and for related purposes

 

 

Contents

1 Short title

2 Commencement

3 Schedule(s)

Schedule 1—Health Insurance Act 1973

 

 

 

Health Insurance Amendment (Extended Medicare Safety Net) Act 2009

No. 101, 2009

 

 

 

An Act to amend the Health Insurance Act 1973, and for related purposes

[Assented to 7 October 2009]

The Parliament of Australia enacts:

1  Short title

  This Act may be cited as the Health Insurance Amendment (Extended Medicare Safety Net) Act 2009.

2  Commencement

  This Act commences on 1 January 2010.

3  Schedule(s)

  Each Act that is specified in a Schedule to this Act is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Act has effect according to its terms.


Schedule 1—Health Insurance Act 1973

 

1  After subsection 10ACA(7)

Insert:

 (7A) Despite subsections (2) and (7), if the current claim is for a service specified in an item determined under section 10B to be an item to which this subsection applies, the increase under this section in the benefit payable in respect of the claim cannot exceed the amount determined under section 10B as the maximum increase for that item.

Note: This subsection does not limit the increase payable in respect of a claim for a service specified in an item not determined under section 10B to be an item to which this subsection applies.

 (7B) If:

 (a) for the purposes of the pathology services table:

 (i) 2 or more pathology services are treated as a single pathology service; and

 (ii) the fee for the single service is the fee specified in one or more particular items in the table; and

 (b) one or more of those particular items (the limited increase items) are items determined under section 10B to be items to which subsection (7A) of this section applies;

then, for the purposes of that subsection, the single service is taken to be specified in the limited increase item or, if there are 2 or more limited increase items, in the one of those items for which the maximum increase determined under section 10B is the greatest.

Note: Section 4B lets regulations provide for a rule of interpretation of the pathology services table to treat 2 or more pathology services as a single pathology service.

2  After subsection 10ADA(8)

Insert:

 (8A) Despite subsections (3) and (8), if the current claim is for a service specified in an item determined under section 10B to be an item to which this subsection applies, the increase under this section in the benefit payable in respect of the claim cannot exceed the amount determined under section 10B as the maximum increase for that item.

Note: This subsection does not limit the increase payable in respect of a claim for a service specified in an item not determined under section 10B to be an item to which this subsection applies.

 (8B) If:

 (a) for the purposes of the pathology services table:

 (i) 2 or more pathology services are treated as a single pathology service; and

 (ii) the fee for the single service is the fee specified in one or more particular items in the table; and

 (b) one or more of those particular items (the limited increase items) are items determined under section 10B to be items to which subsection (8A) of this section applies;

then, for the purposes of that subsection, the single service is taken to be specified in the limited increase item or, if there are 2 or more limited increase items, in the one of those items for which the maximum increase determined under section 10B is the greatest.

Note: Section 4B lets regulations provide for a rule of interpretation of the pathology services table to treat 2 or more pathology services as a single pathology service.

3  After section 10A

Insert:

10B  Determinations for subsections 10ACA(7A) and 10ADA(8A)

 (1) The Minister may by legislative instrument do either or both of the following:

 (a) determine that subsections 10ACA(7A) and 10ADA(8A) apply to specified items;

 (b) determine amounts as the maximum increases for items to which subsections 10ACA(7A) and 10ADA(8A) are determined to apply.

Note: For specification by class, see subsection 13(3) of the Legislative Instruments Act 2003.

 (2) A determination made under subsection (1) does not come into effect until it has been approved by resolution of each House of the Parliament.

3A  After section 10A

Insert:

10C  Evaluation of the caps measures

 (1) The Minister must cause an independent evaluation to be conducted of the impact and operation of determinations made by the Minister under section 10B.

 (2) The evaluation must start not later than 1 April 2011.

 (3) The Minister must cause a written report of the evaluation to be prepared.

 (4) The Minister must cause a copy of the report to be laid before each House of the Parliament by 1 July 2011.

4  Application

Subsections 10ACA(7A) and 10ADA(8A) of the Health Insurance Act 1973 (as amended by this Schedule) apply in relation to services rendered on or after the commencement of those subsections.

 

 

 

 

 

[Minister’s second reading speech made in—

House of Representatives on 28 May 2009

Senate on 16 June 2009]

(90/09)

 

Overview

The Health Insurance Amendment (Extended Medicare Safety Net) Act 2009 was enacted by the Parliament of Australia to amend the Health Insurance Act 1973. This legislation aims to introduce changes that affect the Medicare Safety Net, specifically by introducing caps on the amounts that can be charged for certain health services. These caps are intended to protect patients from excessive out-of-pocket costs, ensuring that they do not face significant financial burdens when accessing medical services. The Act was designed to address gaps in the existing healthcare system where patients could be charged significantly more than the Medicare benefit, leading to financial hardship. The policy objective of the Act is to balance the need for fair remuneration for healthcare providers with the necessity to protect patients from excessive charges. By introducing these caps, the Act seeks to ensure that patients are not overcharged for certain medical services, while also providing a mechanism for regular evaluation of the impact and operation of these caps. This evaluation is intended to help refine and adjust the caps as necessary, ensuring they remain effective and relevant in meeting their intended purpose.

Scope and Application

The Health Insurance Amendment (Extended Medicare Safety Net) Act 2009 amends the Health Insurance Act 1973 to introduce new provisions regarding the maximum increase in benefits payable for certain medical services under Medicare. This Act applies to individuals who are recipients of health services covered under Medicare and health service providers who bill Medicare for services rendered. It specifically targets the financial aspects of healthcare services by placing limits on the increase in benefits for particular medical items, thereby affecting the health care industry and medical service transactions within Australia. The Act applies nationally across Australia as it is a Commonwealth Act. There are no explicit exclusions or exemptions mentioned in the Act, but it is designed to operate within the existing framework of the Health Insurance Act 1973, which includes its own provisions for exemptions and exclusions. The Act allows the Minister to make determinations through legislative instruments, which can further specify the application of the new subsections and set maximum increases, thus extending or restricting the application of the Act through subordinate instruments.

Key Provisions

The Health Insurance Amendment (Extended Medicare Safety Net) Act 2009 introduces significant amendments to the Health Insurance Act 1973, primarily focusing on the Medicare Safety Net. Under subsections 10ACA(7A) and 10ADA(8A), the Act stipulates that the increase in benefits payable for specific medical services, determined under section 10B, cannot exceed a maximum amount set by the Minister through legislative instruments. This means that for services specified in certain items determined by the Minister, the benefit increase is capped at the maximum amount established for those items (subsections 10ACA(7A) and 10ADA(8A)). Importantly, this does not affect services that are not specified in these items, allowing for flexibility in benefit calculations for other medical services. The Act imposes several obligations on the parties involved. The Minister is required to make determinations regarding which items the caps will apply to and to set the maximum increase amounts for those items (subsection 10B(1)). These determinations must be approved by both Houses of Parliament before they come into effect (subsection 10B(2)). Additionally, the Minister must commission an independent evaluation of the impact and operation of the caps measures, starting by 1 April 2011, and present a written report to Parliament by 1 July 2011 (sections 10B(3) and 10C). These obligations ensure that the application of benefit caps is both transparent and evidence-based. Breaches of the provisions in this Act may lead to civil or criminal consequences. While the Act does not explicitly detail specific penalties for non-compliance, breaches of the Health Insurance Act 1973 generally can result in fines or imprisonment. For example, under section 12DA of the Health Insurance Act 1973, a person who provides false or misleading information to obtain benefits may face penalties of up to $22,200 or imprisonment for up to two years, or both. Given the importance of the amendments introduced by this Act, it is reasonable to infer that similar or more stringent penalties could apply for non-compliance with the new provisions.

Legal classification tags

Area of Law
Health Law
Instrument
Amending Act
Concepts
Commencement Provisions
Regulatory Standards
Reporting & Disclosure Obligations

Interactions

Authorises

All Versions

Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.