EXPLANATORY STATEMENT

Select Legislative Instrument 2009 No. 136

Health Insurance Act 1973

Health Insurance (General Medical Services Table) Amendment Regulations 2009 (No. 2)

Health Insurance Amendment Regulations 2009 (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.

Part II of the Act provides for the payment of Medicare benefits for professional services rendered to eligible persons.  Section 9 of the Act provides that Medicare benefits are calculated by reference to the fees for medical services set out in prescribed tables.

Subsection 4(1) of the Act provides that the regulations may prescribe a table of medical services (other than diagnostic imaging services and pathology services) which sets out items of medical services, the amount of fees applicable for each item, and rules for interpreting the table.  The Health Insurance (General Medical Services Table) Regulations 2008 (GMST Regulations) currently prescribe such a table.

The Regulations amend the GMST Regulations to introduce 4 new items and amend the descriptors for 13 items, to either clarify the intent of underlying policy or to ensure that the items reflect current medical practice.

Schedule 6 to the Health Insurance Regulations 1975 lists services for which the Medicare benefit is 100% of the Schedule fee. The Regulations also amend this Schedule to include one of the new items being inserted into the GMST Regulations.  This item covers a service provided by a practice nurse or registered Aboriginal health worker, on behalf of a general practitioner, for an Indigenous person who has received a health assessment which is being added to the GMST Regulations.

Details of the Regulations are set out in the Attachment.

The Australian Medical Association and Medicare Australia were consulted on all changes to the MBS.  Consultation was not required for the four new items added to the GMST Regulations as they were originally made by ministerial determination and appropriate consultation was undertaken at that time.  This level of consultation undertaken for the remaining changes to the MBS was deemed sufficient because the changes are minor or mechanical in nature, and will have no impact on service volumes. 

The Act specifies no conditions which need to be met before the power to make the Regulations is exercised. 

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

The Regulations commence on 1 July 2009.

   Authority: Subsection 133(1) of the

     Health Insurance Act 1973

ATTACHMENT

DETAILS OF THE HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2009 (No. 2)

Regulation 1 – Name of Regulations

This regulation provides that the title of the Regulations is the Health Insurance (General Medical Services Table) Amendment Regulations 2009 (No. 2).

Regulation 2 - Commencement

This regulation provides for the Regulations to commence on 1 July 2009.

Regulation 3 – Amendment of the Health Insurance (General Medical Services Table) Regulations 2008

This regulation provides that Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2008.

Schedule 1 - Amendments

Rules of interpretation

Item [1]

Subrule 3(1)

This item amends the definition of practice nurse to make it consistent with subsection 19(2) of the Health Insurance Act 1973.

Item [2]

Subrule 13(3)

This item amends a list of primary care items by including new item 11823 described at item [17] below.

Items [3] to [8]

Rule 55 heading and subrules 55(1), 55(2), 55(3), 55(4), paragraph 55(6)(b) and rules 56 and 57.

These items amends the heading and rules governing items 2710 and 2712 to more accurately express their policy intent, by substituting mental health treatment plan for mental health care plan, which emphasises the need for treatment rather than maintenance.

Item [9]

Subrule 62(2)

This item effects a consequential amendment from the amendment to item 12533 by item [18].

Item [10]

Rule 72 heading

This item renames the Group to more accurately describe the nature of the included items. 

Item [11]

Subrule 72(1)

This item corrects a reference for the definition of practice nurse.

Services and Fees

Item [12]

This item renames the current Subgroup heading to more accurately describe the nature of the included items. 

Item [13]

This item amends the descriptors for items 2710 and 2712 to clarify their policy intent.

Item [14]

This item renames a current heading to more accurately describe the nature of the included items, and introduces item 10987 which was originally made by a ministerial determination.  (Item 10987 constitutes a follow up service to a maximum of five services per patient in a calendar year, provided by a practice nurse or registered Aboriginal health worker, on behalf of a GP, for an Indigenous person who has received a health assessment).

Items [15] and [16]

These items rename their respective Groups to more accurately describe the nature of the included items. 

Item [17]

This item introduces new item 11823 which was originally made by a ministerial determination.  (Item 11823 - capsule endoscopy to conduct small bowel surveillance of a patient diagnosed with Peutz-Jehgers syndrome).

Item [18]

This amendment limits item 12533 to services provided by a medical practitioner and is a consequential amendment to the introduction into the Pathology Services Table of item 66900 which mirrors item 12533 but is claimed by providers other than medical practitioners.

Item [19]

This item amends the descriptors for items 22055 and 22065 to 22075, to clarify the policy intent that they be not claimed by a practitioner if that practitioner also provides anaesthesia. 

Items [20] and [21]

These items amend the descriptors for items 30168, 30171, 30684 and 30686 to reflect current clinical practice.

Item [22]

This item introduces new items 32220 and 32221 which were originally made by a ministerial determination.  (Item 32220 – Insertion of an artificial bowel sphincter for severe faecal incontinence in the treatment of a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed).  ( Item 32221 – Removal or revision of an artificial bowel sphincter (with or without replacement) for sever faecal incontinence in the treatment of a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed). 

Item [23]

This item amends the descriptors for 45557 and 45558 to reflect current clinical practice.

DETAILS OF THE HEALTH INSURANCE AMENDMENT REGULATIONS 2009 (NO. 1)

Regulation 1 – Name of Regulations

This regulation provides that the title of the Regulations is the Health Insurance Amendment Regulations 2009 (No. 1).

Regulation 2 - Commencement

This regulation provides for the Regulations to commence on 1 July 2009.

Regulation 3 – Amendment of the Health insurance Regulations 1975

This regulation provides that Schedule 1 amends the Health Insurance Regulations 1975.

Schedule 1 - Amendment

Item [1]

Schedule 6

This item amends the list of services for which medicare benefit is 100% of the Schedule fee, to include new item 10987. (Item 10987 constitutes a follow up service to a maximum of five services per patient in a calendar year, provided by a practice nurse or registered Aboriginal health worker, on behalf of a GP, for an Indigenous person who has received a health assessment).