EXPLANATORY STATEMENT

Select Legislative Instrument 2007 No. 55

Subject: Health Insurance Act 1973

Health Insurance Amendment Regulations 2007 (No. 1)

Health Insurance (General Medical Services Table) Amendment Regulations 2007 (No. 2)

Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides, in part, 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 Council of Australian Governments announced on 14 July 2006 that to attract and retain more general practitioners with procedural skills in rural areas, an alternative pathway to vocational recognition of general practitioners will be created.  This will be achieved through the recognition of the Australian College of Rural and Remote Medicine (ACRRM) as a medical training provider and standards body, subject to ACRRM’s training program being accredited by the Australian Medical Council (AMC).  ACRRM was granted accreditation for its training program on 1 February 2007 which paves the way for this measure to be implemented. 

The  amendments to the Health Insurance Regulations 1975 (the Principal Regulations) allow ACRRM to communicate directly with Medicare Australia on matters relating to the recognition of medical practitioners who have attained fellowship of ACRRM.  The  Regulations give ACRRM the same status as the Royal Australian College of General Practitioners (RACGP) in relation to the training of general practitioners for the purposes of Medicare.  Under the  Regulations, ACRRM will be able to certify that a medical practitioner is eligible for recognition as a general practitioner for the purposes of the Act and related regulations.  The CEO of Medicare Australia will have to make a determination under these provisions within a prescribed time period of receipt of such certification from ACRRM.

The CEO of Medicare Australia will be required to revoke a determination if notified by ACRRM that a medical practitioner has failed to satisfy ACRRM’s minimum requirements for continuing medical education and quality assurance.  The  amendments will require ACRRM to notify Medicare Australia if ACRRM is satisfied that a medical practitioner has not met minimum requirements for continuing medical education and quality assurance.  However, this notification will be effective only if, before notifying Medicare Australia, ACRRM has given the practitioner an opportunity to show why the notice should not be given.  The effect of this amendment will be to ensure that a medical practitioner has been given the opportunity to seek a review of ACRRM’s decision before Medicare Australia is notified.  

The  amendments to the Health Insurance (General Medical Services Table) Regulations 2006 (the GMST Regulations) will include certain practitioners with ACRRM qualifications in the definition of ‘general practitioner’.  This will allow the services provided by practitioners in respect of whom a determination has been made under sub regulation 6DA(2) of the Health Insurance Regulations 1975 to attract Medicare benefits at the higher rate applicable to general practitioners. 

Details of the  Principal Regulations are set out in the Attachment 1.

Details of the  GMST Regulations are set out in Attachment 2.

The Department has consulted the RACGP, ACRRM, the Australian Medical Association, general Practice Education and Training and Medicare Australia.  Further consultation focusing on the integration of the ACRRM’s training program will be undertaken over the next few months.

The Act does not specify any conditions that need to be met before the power to make the  Regulations may be exercised. 

The  Regulations is a legislative instruments for the purposes of the Legislative Instruments Act 2003. 

The  Regulations commence on 1 April 2007.

ATTACHMENT 1

DETAILS OF THE  HEALTH INSURANCE AMENDMENT REGULATIONS 2007 (No. 1)

 Regulation 1

This regulation will provide for the Regulations to be referred to as the Health Insurance Amendment Regulations 2007 (No. 1).

 Regulation 2

This regulation will provide for the Regulations to commence on 1 April 2007.

 Regulation 3

This regulation will provide that Schedule 1 amends the Health Insurance Regulations 1975 (the Principal Regulations).

Schedule 1 – Amendments

Item [1]

This item will amend regulation 2 by inserting a definition of ACRRM before the definition of ’Appeal Committee’. 

Item [2]

This item will insert a new regulation 2A after regulation 2.  Regulation 2A provides that a medical practitioner for whom a determination under new regulation 6DA is in force is specified for the purposes of paragraph (c) of the definition of ‘general practitioner’ in subsection 3(1) of the Act. 

Item [3]

This item inserts a new regulation 6DA into the Principal Regulations that describes the process by which a doctor can be recognised for the purposes of paragraph (c) of the definition of ‘general practitioner’ in section 3 of the Act.   A doctor who wishes to be recognised under this provision will apply to the CEO of Medicare Australia for a determination that the doctor is recognised as meeting the fellowship standards of ACRRM.  The Medicare Australia CEO must make a determination within 14 days of being given written notice by the ACRRM that the doctor is eligible for a determination.  Medicare Australia must notify the doctor in writing noting the day on which the determination will enter into force.

Under new subregulation 6DA(5) the Medicare Australia CEO or an authorised officer as defined in the regulation may give information about determinations in force for particular persons to ACCRM.  The names and addresses of practitioners who are the subject of determinations under this regulation may be made available to the public on request under new subregulation 6DA(6). 

This item also inserts a new regulation 6DB into the Regulations that describes the criteria for eligibility for a determination.    Under subregulation 6DB(1), an applicant who attained fellowship of ACRRM after AMC accredited training was introduced will be eligible for a determination if ACRRM certifies that he or she has completed either the AMC accredited training program in its entirety or has been assessed by ACRRM as having training and experience equivalent to the successful completion of the AMC accredited ACRRM

training. In addition, ACCRM will need to certify that the applicant meets ACRRM’s requirements for continuing medical education and quality assurance.

New subregulation 6DB(2) sets out the criteria for applicants who attained fellowship of ACRRM before AMC accredited training was introduced.  Such applicants are eligible for a determination pursuant to subregulation 6DA(2) if ACRRM certifies that  the applicant has training and experience equivalent to the successful completion of  AMC accredited ACRRM training or that they are a vocationally recognised general practitioner. In addition, ACRRM must certify that the applicant  meets ACRRM’s minimum requirements for continuing medical education and quality assurance.

This item also inserts a new regulation 6DC that provides for the revocation of determinations made pursuant to regulation 6DA.  Medicare Australia must revoke a determination made under regulation 6DA if it receives written notification from ACRRM that the practitioner has not met minimum requirements for continuing medical education and quality assurance.

This regulation requires ACRRM to inform the practitioner about the  notice and to allow 14 days for the doctor to show why the notice should not be made, before notifying Medicare Australia.  Regulation 6DC also requires Medicare Australia to inform the doctor in writing that the determination will be revoked.  The notice must specify the day on which the determination will be revoked. The day of revocation must be at least 14 days after the day the notice was given.  

New regulation 6DC l also requires the Medicare Australia CEO to revoke a determination under regulation 6DA if the medical practitioner requests the Medicare Australia CEO to do so or if the Medicare Australia CEO becomes aware that the person is no longer a medical practitioner.

ATTACHMENT 2

DETAILS OF THE  HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2007 (NO. 2)

 Regulation 1

This Regulation provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table)  Amendment Regulations 2007 (No. 2).

 Regulation 2

This Regulation provides for the Regulations to commence on 1 April 2007.

 Regulation 3

This Regulation provides for Schedule 1 to amend the Health Insurance (General Medical Services Table) Regulations 2006.

Schedule 1- Amendments

Item [1]

This item inserts a new paragraph (ba) into the definition of ‘general practitioner’, after paragraph (b) of sub rule 3(1) to provide that a practitioner, in relation to whom a determination has been made under regulation 6DA of the Health Insurance Regulations 1975 that he or she is recognised as meeting the fellowship standards of the ACRRM, is a general practitioner for the purposes of sub rule 3(1).