Health Insurance Amendment Regulations 1999 (No. 3) 1999 No. 157
EXPLANATORY STATEMENT
STATUTORY RULES 1999 NO. 157
Issued by authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance Amendment Regulations 1999 (No. 3)
The Health Insurance Act 1973 ("the Act") provides for payments by way of Medicare benefits and payments for hospital services.
Section 133 of the Act provides that the Governor-General may make regulations for the purposes of the Act.
Sections 4 and 4AA of the Act provide that regulations may prescribe a table of medical services and a table of diagnostic imaging services (the tables). The Health Insurance (1998-99 General Medical Services Table) Regulations and the Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1998 currently prescribe such tables.
The Regulations:
(1) Include the speciality of Oral and Maxillofacial Surgery under Schedule 4 of the Health Insurance Regulations. The recognised specialty is prescribed as a Fellowship of the Royal Australasian College of Dental Surgeons (Oral and Maxillofacial Surgery);
(2) Correct anomalies between the item numbers which appear in the Health Insurance Regulations 1975 with those appearing in the Health Insurance (1998-99 General Medical Services Table) Regulations 1998 and the Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1998; and
(3) Provide that referrals for specialist services are valid from the date of the first service given in accordance with the referral.
Regulations 1 and 2 set out the name and commencement date of the Regulations.
Regulation 3 provides for amendments to the Regulations as set out in Schedule 1.
Schedule 1
Items 1 to 5 make minor machinery amendments to ensure that the references to items in the Health Insurance Regulations correctly refer to items in the tables. This is to reflect recent changes to the tables where new items have been added and superfluous items have been removed from the tables.
Item 6 clarifies that referrals given for a fixed period under paragraph 31(1)(a) become valid for that period after the service is given in accordance with the referral. This is similar to referrals given under paragraph 31(1)(c) of the Health Insurance Regulations which provides that where a referral period is not specified, the referral is valid for 12 months after the first service is given in accordance with the referral.
Item 7 prescribes an administering body and qualification for the new specialty of Oral and Maxillofacial Surgery.
The Regulations commenced on Gazettal.
Overview
The Health Insurance Amendment Regulations 1999 (No. 3) were enacted to address discrepancies and to introduce specific amendments to the existing Health Insurance Regulations under the Health Insurance Act 1973. The Minister for Health and Aged Care issued these regulations to ensure that the tables of medical and diagnostic imaging services align correctly and to incorporate the specialty of Oral and Maxillofacial Surgery into the recognised specialties. This regulatory action aimed to rectify inconsistencies between the Health Insurance Regulations 1975 and the more recent Health Insurance (1998-99 General Medical Services Table) Regulations and Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations. Additionally, the regulations clarify the validity period for referrals for specialist services, ensuring that these referrals are effective from the date of the first service given in accordance with the referral, thus providing certainty and consistency in the application of these regulations.
Scope and Application
The Health Insurance Amendment Regulations 1999 (No. 3) pertain to the Health Insurance Act 1973, which governs payments for Medicare benefits and hospital services in Australia. These regulations apply to all entities involved in the provision and administration of health insurance, including medical practitioners, patients, and health insurers. They also apply to the recognised specialty of Oral and Maxillofacial Surgery, as prescribed by a Fellowship of the Royal Australasian College of Dental Surgeons (Oral and Maxillofacial Surgery). The regulations correct discrepancies between item numbers in the Health Insurance Regulations 1975 and the updated tables of medical services and diagnostic imaging services. Furthermore, they establish that referrals for specialist services are valid from the date of the first service given in accordance with the referral. The geographic reach of these regulations is national, applying across all states and territories in Australia. The regulations amend the existing Health Insurance Regulations to incorporate these changes and ensure that the correct references to items in the updated tables are used. The regulations commenced on the date of their gazette.
Key Provisions
The Health Insurance Amendment Regulations 1999 (No. 3) introduce several key provisions under the Health Insurance Act 1973. Firstly, they include the specialty of Oral and Maxillofacial Surgery under Schedule 4 of the Health Insurance Regulations (Reg 1). This specialty is recognised as a Fellowship of the Royal Australasian College of Dental Surgeons (Oral and Maxillofacial Surgery) (Reg 1). Secondly, the Regulations correct inconsistencies between the item numbers in the Health Insurance Regulations 1975 and those in the Health Insurance (1998-99 General Medical Services Table) Regulations 1998 and the Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1998 (Reg 2). Lastly, they clarify that referrals for specialist services are valid from the date of the first service given in accordance with the referral (Reg 3).
These Regulations impose specific obligations on the parties involved. Firstly, healthcare providers must now recognise Oral and Maxillofacial Surgery as a valid specialty for Medicare benefits and payments. Secondly, they must ensure that their billing and record-keeping practices align with the corrected item numbers in the prescribed tables. Additionally, healthcare providers must follow the new referral validity rules, ensuring that referrals for specialist services are correctly dated and managed according to the regulations.
Failure to comply with these Regulations can lead to civil or criminal consequences. For instance, healthcare providers who do not recognise the new specialty or who incorrectly bill for services may face penalties under the Health Insurance Act 1973. Additionally, those who do not adhere to the corrected item numbers or the new referral rules may also face penalties. The specific penalties are not detailed in the Explanatory Statement, but they generally include fines and potential legal action for non-compliance with Medicare regulations.