Health Insurance Amendment Regulations 1999 (No. 4) 1999 No. 176
EXPLANATORY STATEMENT
STATUTORY RULES 1999 No. 176
Issued by the Authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance Amendment Regulations 1999 (No. 4)
Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations for the purposes of the Act.
The Act provides, in part, for the payment of medicare benefits for professional services rendered by medical practitioners and for certain professional services rendered by dental practitioners and optometrists.
Section 4AA of the Act provides that regulations may prescribe a table of diagnostic imaging services. The Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations 1998 prescribe such a table.
Section 9 of the Act provides that medicare benefits shall be calculated by reference to the fees for medical services (including diagnostic imaging services) set out in the table which includes the Diagnostic Imaging Services Table (the Table).
On 1 March 1999, a number of new computed tomography items were introduced to the Table. Essentially, the new items enabled a differentiation in payment on the basis of the age of the imaging equipment (capital sensitive items) with the new items being introduced to cover services on older machines.
Subsection 16B(1) of the Act provides in part that medicare benefits are not payable for an R-type diagnostic imagine, service rendered by the providing practitioner unless the service was requested in writing by a medical practitioner, a dental practitioner, a chiropractor, a physiotherapist or a podiatrist. An R-type service is a service identified with the symbol (R) and comprise the majority of services in the Table.
Subsection 16B(2) of the Act provides that regulations may prescribe R-type diagnostic imaging services specified in regulations that may be requested by a dental practitioner.
Regulation 10 of the Health Insurance Regulations specifies R-type items that may be requested by practitioners who are registered or licensed under relevant State or Territory laws as dental practitioners. Dental practitioners are divided into. dental practitioners., dental practitioners approved by the Minister under paragraph (b) of the definition of a professional service in subsection 3(1) of the Act (that is oral and maxillofacial specialists), and. prosthodontists.
Item 1A of the Regulations amends Regulation 10 of the Health Insurance Regulations by adding seven Medicare Benefits Schedule item numbers (56250, 56256, 565541, 56547, 57041, 57047 and 57345) which oral and maxillofacial surgeons can request. These items are capital sensitive versions of Computed Tomography items that oral and maxillofacial surgeons were previously eligible to request, prior to the amendments to the Table that commenced on 1 March 1999, and consequently it is appropriate that they continue to be eligible to claim for these services.
Item 2 of the Regulations amends Regulation 10 of the Health Insurance Regulations by omitting Medicare Benefits Schedule item 56019 from those items which prosthodontists can request. Item 56019 has been deleted from the Medicare Benefits Schedule as it is no longer clinically relevant, and consequently it is no longer possible for this item to be requested.
There are no objections to the proposals by the relevant organisations.
The Regulations commenced 1 September 1999.
Overview
The Health Insurance Amendment Regulations 1999 (No. 4) were enacted to amend the Health Insurance Regulations and were issued under the authority of the Minister for Health and Aged Care. These regulations aim to address discrepancies in the payment of medicare benefits for diagnostic imaging services by updating the list of services that can be requested by certain healthcare practitioners, specifically oral and maxillofacial surgeons and prosthodontists. The changes were implemented to align with the introduction of new computed tomography items and to remove outdated services that are no longer clinically relevant. The objective of these amendments is to ensure that the services covered by the Health Insurance Act 1973 accurately reflect current clinical practices and equipment capabilities, thereby maintaining the integrity of the medicare system. The regulations came into effect on 1 September 1999.
Scope and Application
The Health Insurance Amendment Regulations 1999 (No. 4) applies to entities and individuals involved in the provision and administration of health insurance services within Australia. Specifically, the regulations pertain to medical practitioners, dental practitioners, and other authorised health professionals who provide diagnostic imaging services as part of their professional duties. These services are governed by the Health Insurance Act 1973, which outlines the payment of medicare benefits for various health services. The Regulations introduce amendments to the Health Insurance Regulations to update the list of diagnostic imaging services that certain dental practitioners can request, ensuring that the services align with current clinical practices and equipment capabilities. These regulations extend across the Commonwealth of Australia, affecting all states and territories uniformly. The Regulations do not introduce any new exclusions or thresholds beyond what is already stipulated in the Act, but they do clarify and update the list of eligible services based on the latest diagnostic imaging services table. The applicability of the Regulations can be further extended or modified through subordinate instruments as needed to keep pace with technological advancements and clinical standards.
Key Provisions
The main operative sections of the Health Insurance Amendment Regulations 1999 (No. 4) include sections that make amendments to the existing Health Insurance Regulations. Specifically, Section 133 of the Health Insurance Act 1973 allows the Governor-General to make regulations for the purposes of the Act, and the Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations 1998 prescribe a table of diagnostic imaging services. Regulation 10 of the Health Insurance Regulations is amended to specify which R-type diagnostic imaging services can be requested by certain practitioners, including oral and maxillofacial specialists and prosthodontists.
These Regulations impose certain obligations and requirements on the parties they govern. For example, Subsection 16B(1) of the Act stipulates that medicare benefits are not payable for an R-type diagnostic imaging service unless it is requested in writing by a medical practitioner, a dental practitioner, a chiropractor, a physiotherapist or a podiatrist. Additionally, Subsection 16B(2) of the Act allows for regulations to prescribe which R-type diagnostic imaging services can be requested by dental practitioners. Regulation 10 of the Health Insurance Regulations specifies the R-type items that may be requested by practitioners who are registered or licensed under relevant State or Territory laws as dental practitioners.
The Regulations also outline certain offences, penalties, or consequences for breach. However, the Explanatory Statement does not provide specific details regarding any potential penalties or consequences. It is important to note that any breach of the Act or Regulations could result in civil or criminal consequences, as determined by the courts.
Overall, the Health Insurance Amendment Regulations 1999 (No. 4) provide important clarification and updates to the existing regulations governing the payment of medicare benefits for diagnostic imaging services. By amending Regulation 10 of the Health Insurance Regulations, the Regulations ensure that oral and maxillofacial surgeons can continue to claim for certain services, while also removing an item that is no longer clinically relevant.