EXPLANATORY STATEMENT
Select Legislative Instrument 2012 No. 138
Health Insurance Act 1973
Health Insurance Amendment Regulation 2012 (No. 1)
Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides that the
Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
The Act provides, in part, for payments of medicare benefits in respect of professional services rendered to eligible persons by medical practitioners who are not vocationally registered but are undertaking approved placements in specified workforce programs which will lead to vocational registration. Section 3GA of the Act refers to the approved programs and courses in which a non-vocationally registered medical practitioner can participate in order to be eligible to provide rebateable services. (Section 3GA, section 3GC and section 19AA of the Act are collectively known as Medicare Provider Number Legislation.)
The approved programs and courses referred to in section 3GA of the Act are specified in Part 2 of Schedule 5 of the Health Insurance Regulations 1975 (the Principal Regulations). Recently, the status of several programs and courses in Part 2 of Schedule 5 have changed. The 2010 Review into Medicare Provider Number Legislation recommended that Part 2, Schedule 5 of the Principal Regulations be amended to reflect these changes.
In particular
- the Rural and Remote Area Placement Program (item 2), the Assistance at Operations Program (item 5) and the Metropolitan Workforce Support Program (item 6) be removed from
Part 2, Schedule 5 as they no longer exist; and
- the references to the Pre-vocational General Practice Placements Program being managed by the Royal Australian College of General Practitioners (item 19) or the Australian College of Rural and Remote Medicine (item 1) be removed from Part 2, Schedule 5 as the Program is now wholly managed through General Practice Education and Training Limited.
The amendments to the Principal Regulations remove the above references from Part 2, Schedule 5 and result in an updated list of approved programs under section 3GA of the Act.
The Act specifies no conditions that need to be met before the power to make the regulation may be exercised.
The regulation is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The regulation commences on the day after it is registered.
The consultation for these changes largely took place through the 2010 Review of Medicare Provider Number Legislation, conducted by ARTD Consultants. As part of the Review, ARTD meet with key industry stakeholders during the consultation phase. Sixty-five participants engaged in one on one interviews or group meetings, six organisations provided formal submissions and 37 responses to a semi-structured electronic submission were received.
During the Review, the consultants liaised continually with the Medical Training Review Panel which includes representatives from all state and territory health administrations, recognised specialist medical colleges, medical schools, the Australian Medical Council, and a range of other professional, industrial and stakeholder bodies.
Authority: Subsection 133(1) of the Health Insurance Act 1973
Overview
The Health Insurance Amendment Regulation 2012 (No. 1) was introduced to amend the Health Insurance Regulations 1975, and more specifically to update Part 2 of Schedule 5, which lists approved programs and courses for non-vocationally registered medical practitioners undertaking placements to be eligible for Medicare rebates. The Health Insurance Act 1973 empowers the Governor-General to make regulations that are necessary or convenient for the operation of the Act. This amendment was enacted to address the obsolescence of certain programs and the restructuring of program management. The regulation was developed following recommendations from the 2010 Review of Medicare Provider Number Legislation, which involved extensive consultation with stakeholders including health administrations, medical colleges, and professional bodies. The policy objective of these amendments is to ensure the list of approved programs accurately reflects current practices and program management structures, thereby maintaining the integrity and effectiveness of the Medicare system.
The amendments made by the Health Insurance Amendment Regulation 2012 (No. 1) involve the removal of certain programs and references from the list of approved programs, reflecting their dissolution or changes in management. Specifically, the Rural and Remote Area Placement Program, the Assistance at Operations Program, and the Metropolitan Workforce Support Program were removed as they no longer exist, while references to the Pre-vocational General Practice Placements Program being managed by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine were also removed as the Program is now managed by General Practice Education and Training Limited. These changes ensure that the approved programs listed in the regulations align with the current state of medical training and placement programs in Australia.
Scope and Application
The Health Insurance Amendment Regulation 2012 (No. 1) applies to the Health Insurance Act 1973, which regulates the provision of medical services and the administration of Medicare benefits in Australia. This regulation specifically addresses the eligibility of non-vocationally registered medical practitioners to provide rebateable services under Medicare by updating the list of approved programs in which they can participate to become eligible. These approved programs are necessary for practitioners to gain vocational registration and subsequently be able to render professional services for which Medicare benefits can be claimed by eligible persons. The regulation targets medical practitioners and educational institutions involved in the training and placement of medical professionals in approved programs. It applies across Australia, reflecting the national scope of the Health Insurance Act 1973, and is applicable to all states and territories. There are no specific exclusions or thresholds mentioned within the regulation itself, but the eligibility and benefits are contingent upon the practitioner participating in the programs listed in the Principal Regulations. The regulation updates the list of approved programs in Schedule 5 of the Principal Regulations to reflect changes recommended by the 2010 Review into Medicare Provider Number Legislation, ensuring that the regulatory framework remains current and effective in supporting the healthcare workforce.
Key Provisions
The Health Insurance Amendment Regulation 2012 (No. 1) makes amendments to the Health Insurance Regulations 1975 (the Principal Regulations) to reflect changes in the approved programs for non-vocationally registered medical practitioners to participate in, in order to be eligible to provide rebateable services under section 3GA of the Health Insurance Act 1973 (the Act). The changes include the removal of several programs and courses from Part 2 of Schedule 5 of the Principal Regulations because they no longer exist or have been re-assigned to a new managing body (subsections 5(1) and (2)). These updates ensure that the list of approved programs remains current and accurate.
The regulation imposes specific obligations on the parties governed by it. Medical practitioners who are not vocationally registered must participate in approved programs and courses as specified in Part 2 of Schedule 5 of the Principal Regulations to be eligible for Medicare rebates for services provided to eligible persons. The regulation requires the Principal Regulations to accurately list these programs and courses, and to update them as necessary to reflect changes in program management or availability.
There are no specific offences or penalties outlined in the regulation itself for failing to comply with these requirements. However, any breaches of the Act or the regulations that relate to the provision of rebateable services may result in civil or criminal penalties. For example, section 133A of the Act provides that a person who knowingly makes a false or misleading statement in a claim for a benefit under the Act is guilty of an offence and is liable to a penalty of up to $22,200 for individuals and $111,000 for bodies corporate. Similarly, section 133C of the Act provides that a person who engages in conduct that is fraudulent or dishonest in relation to a claim for a benefit under the Act is guilty of an offence and is liable to a penalty of up to $44,400 for individuals and $222,000 for bodies corporate. These penalties are subject to the discretion of the court and may be higher in certain circumstances.