EXPLANATORY STATEMENT
Select Legislative Instrument 2007 No. 98
Subject: Health Insurance Act 1973
Health Insurance Amendment Regulations 2007 (No. 3)
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 Act provides for payments of Medicare benefits in respect of professional services rendered to eligible persons. Section 19AA provides that a Medicare benefit is not payable in respect of a professional service, if the person who rendered the service first became a medical practitioner on or after 1 November 1996 and was not, within the meaning of the Act, a “specialist”, a “consultant physician”, a “general practitioner”, a person registered under section 3GA of the Act, or a person (not being an Australian citizen or permanent resident) covered by an exemption under subsection 19AB(3). Section 19AA was introduced in 1996 with the aim of ensuring that the long term medical workforce in Australia is of a high quality and to assist in dealing with workforce distribution problems.
Section 3GA of the Act provides for the registration of certain medical practitioners in approved placements as recorded in the Register of Approved Placements that is maintained by Medicare Australia. In particular, paragraph 3GA (5) (a) requires the entry of a practitioner's name on the Register of Approved Placements where the practitioner applies and a body specified in the regulations gives written notice to the Medicare Australia CEO that the applicant is enrolled in, or undertaking, a course or program of a kind specified in the regulations, together with the duration and location of the applicant’s course or program. For the purposes of paragraph 3GA(5)(a), the relevant bodies and courses are specified in Schedule 5 to the Health Insurance Regulations 1975 (the Principal Regulations).
Entry of a medical practitioner's name in the Register of Approved Placements allows the payment of Medicare benefits for professional services rendered by the practitioner where section 19AA of the Act otherwise prevents the payment of Medicare benefits in respect of the practitioner's services.
The Health Insurance Amendment Regulations 2007 (No. 3) amend Part 2 of Schedule 5 of the Principal Regulations to include a new item identifying the Remote Vocational Training Scheme Limited as a specified body and the Remote Vocational Training Scheme (the Program) as the corresponding specified program for the purposes of section 3GA of the Act. This is necessary to reinstate the entitlement of the Program participants to access the higher A1 Medicare rebate for relevant services, made unavailable as a result of the recent change in governance of the Program, as detailed below.
The Program provides vocational training, almost entirely by distance education for medical practitioners working in remote areas and solo doctor towns. Prior to the change in governance, the Program was administered by a governance group consisting of members of the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM).
Prior to the change in governance, participants in the Program were able to provide services in respect of which Medicare benefits may be payable according to section 19AA of the Act, as participants in the Program could be registered as undertaking an approved placement under section 3GA of the Act by virtue of the Program being approved by the RACGP as a part of the RACGP Training Program (which is specified in Item 2 of Part 2 of Schedule 5 of the Principal Regulations).
As of 1 May 2007 the management of the Program ceased to be under the auspices of the RACGP and ACRRM, and was assumed by a newly incorporated entity, the ‘Remote Vocational Training Scheme Limited’. As a result, the Program is no longer to be approved by the RACGP as a part of the RACGP Training Program, and participants in the Program are no longer entitled to provide services for which Medicare benefits are payable according to section 19AA of the Act.
The Regulations are required to once again permit participants in the Program to become registered as participants in an approved placement under section 3GA of the Act.
Consultation for these amendments included the Australian Medical Association, relevant professional medical craft groups and Medicare Australia. Relevant professional medical craft groups consulted included the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners.
The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised.
The Regulations commence on 1 May 2007.
Overview
The Health Insurance Amendment Regulations 2007 (No. 3) were enacted to address the specific issue of medical practitioners participating in the Remote Vocational Training Scheme (Program) losing their eligibility for higher Medicare rebates due to a change in the Program's governance. The Health Insurance Act 1973 (the Act) governs payments of Medicare benefits for professional services rendered to eligible persons, with certain conditions outlined in section 19AA that exclude practitioners who became medical practitioners after 1 November 1996 unless they are registered under specific provisions or hold certain titles. The Program, which provides vocational training primarily through distance education for medical practitioners in remote areas, was previously administered by the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM), allowing its participants to be registered under section 3GA of the Act and thereby qualify for Medicare benefits. However, following a change in governance to the Remote Vocational Training Scheme Limited as of 1 May 2007, participants in the Program lost this eligibility. These Regulations aim to reinstate the entitlement of Program participants to access higher Medicare rebates by specifying the new entity and program in the Register of Approved Placements, thus ensuring continued qualification for Medicare benefits under the Act.
Scope and Application
The Health Insurance Amendment Regulations 2007 (No. 3) pertains to the Health Insurance Act 1973, which governs the payment of Medicare benefits for professional services rendered to eligible persons. The Act applies to medical practitioners and other health professionals who provide services eligible for Medicare rebates, ensuring a high-quality medical workforce and addressing distribution issues. The Act’s provisions are applicable nationally across Australia, with regulations that may extend or restrict application through subordinate instruments, such as the Health Insurance Regulations 1975. The recent amendments focus on reinstating the eligibility of participants in the Remote Vocational Training Scheme for higher Medicare rebates, following a change in the scheme’s governance from the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine to the Remote Vocational Training Scheme Limited. This change inadvertently made the participants ineligible for Medicare benefits under section 19AA of the Act. The Regulations amend the Principal Regulations to recognise the new governance entity and program, thus restoring the participants’ eligibility for higher Medicare rebates.
Key Provisions
The Health Insurance Amendment Regulations 2007 (No. 3) (the Regulations) amend the Principal Regulations to allow the Remote Vocational Training Scheme Limited to be recognised as a body under section 3GA of the Health Insurance Act 1973 (the Act). This amendment addresses the transition in the management of the Remote Vocational Training Scheme (the Program) from the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine to the Remote Vocational Training Scheme Limited. This change in governance had previously resulted in the participants in the Program no longer being eligible for Medicare benefits for services rendered under section 19AA of the Act (subsection 133(1)).
Under the Act, specific bodies are required to provide written notice to the Chief Executive Officer of Medicare Australia, confirming that a practitioner is enrolled in, or undertaking, a specified course or program. The amendment includes the Remote Vocational Training Scheme Limited as a recognised body and the Remote Vocational Training Scheme as a specified program. This allows participants in the Program to be registered under section 3GA, thereby reinstating their eligibility for Medicare benefits for services provided. This amendment is necessary to ensure continuity of vocational training for medical practitioners in remote areas and solo doctor towns, which was disrupted by the change in governance.
The Regulations impose specific obligations on the Remote Vocational Training Scheme Limited and the participants in the Program. The Remote Vocational Training Scheme Limited must ensure that it provides written notice to the Chief Executive Officer of Medicare Australia for each participant enrolled in the Program, detailing the participant’s enrolment, the duration, and the location of the Program. Participants, in turn, must ensure that they are enrolled in the Program as recognised by the Regulations and must provide any necessary information to the Remote Vocational Training Scheme Limited to facilitate their registration under section 3GA of the Act.
Failure to comply with the requirements set out in the Regulations could result in the participants in the Program not being eligible for Medicare benefits for services rendered, as stipulated in section 19AA of the Act. While the Act does not explicitly state penalties for non-compliance, the consequences could include financial losses for the participants and potential administrative issues for Medicare Australia. The Remote Vocational Training Scheme Limited and the participants are expected to adhere to the stipulated procedures to avoid any such adverse outcomes.