Health Insurance Amendment Regulations 2010 (No. 2)

Administered by Department of Health, Disability and Ageing

Legislation au F2010L02796 Regulations Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

 

Select Legislative Instrument 2010 No. 260

 

Health Insurance Act 1973

 

Health Insurance (General Medical Services Table) Regulations 2010

 

Health Insurance Amendment Regulations 2010 (No. 2)

 

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 be 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 fees applicable for each item, and rules for interpreting the table.  The Health Insurance (General Medical Services Table) Regulations 2009 (the 2009 Regulations) currently prescribe such a table.

 

Subsection 4(2) of the Act provides that unless repealed earlier, these Regulations will cease to be in force and will be taken to have been repealed on the day following the 15th sitting day of the House of Representatives after the end of a 12 month period which begins on the day when the regulations are registered on the Federal Register of Legislative Instruments.  The 2009 Regulations were registered on the Federal Register of Legislative Instruments on 16 October 2009 and commenced on 1 November 2009.

 

The purpose of the Regulations (the 2010 Regulations) is to repeal the 2009 Regulations and prescribe a new table of general medical services for the 12 month period beginning on 1 November 2010 (the 2010 Regulations).  The new table also incorporates a new structure.  Instead of separating the items of service from their interpretative rules, the 2010 Regulations integrate the two. 

 

In addition to the restructure, the 2010 Regulations include the following changes:

  • a fee increase of 1.8 per cent for most items; and
  • the deletion of six obsolete items, the inclusion of three new referral items for midwifes, amendments to the descriptors for eleven items and the transfer of one item into a different item Group.

 

Schedule 6 to the Health Insurance Regulations 1975 (the HI Regulations) lists services for which the Medicare benefit is 100 per cent of the Schedule fee.  The Regulations amend this Schedule to reference a series of changes to the general medical services table of the 2009 Regulations, which by oversight were not referenced in contemporaneous changes to the HI Regulations.  The retrospective nature of the amendments do not disadvantage any person or impose a liability on any person other than the Commonwealth.  Subsection 12(2) of the Legislative Instruments Act 1973 does not therefore operate to prevent the retrospective amendments from taking effect. 

 


Details of the 2010 Regulations are set out in Attachment A and details of the amendments to the HI Regulations are set out in Attachment B.

 

Consultation on the removal of the brachytherapy items was undertaken with The Royal Australian College of Surgeons and other craft groups; consultation on the inclusion of the midwife and nurse practitioner referral items was undertaken with specialist advisory groups whose members were drawn from the relevant medical and health professions; consultation on the item descriptor amendments was undertaken with the Australian Medical Association and Medicare Australia.  All of these organisations support the changes.

 

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

 

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

 

The 2010 Regulations commence on 1 November 2010.

 

Regulations 1 to 3 and Schedule 1 to the amendment to the HI Regulations are taken to have commenced on 1 May 2010 and regulation 4 and Schedule 2 commence on 1 November 2010.

 


 

ATTACHMENT A

 

DETAILS OF THE HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) REGULATIONS 2010

 

Regulation 1 – Name of Regulations

 

This regulation provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Regulations 2010.

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on 1 November 2010.

 

Regulation 3 – Repeal

 

This regulation repeals the Health Insurance (General Medical Services Table) Regulations 2009.

 

Regulation 4 – Dictionary

 

This regulation provides for a Dictionary at the end of the Regulations, which defines certain words and expressions used therein and include references to certain words and expressions defined elsewhere in the Regulations.

 

Regulation 5 – General medical services table

 

This regulation provides that the new table of general medical services (other than diagnostic imaging services and pathology services) set out in Schedule 1 be prescribed for subsection 4(1) of the Act.

 

Part 2 of Schedule 1

 

This part of the Health Insurance (General Medical Services Table) Regulations 2010 contains the following changes:

 

  • The removal of seven items – 15360, 15363, 15541 and 38321 to 38330 (inclusive).  These items are removed because they apply to an obsolete service (intravascular brachytherapy).

 

  • The introduction of three new items – 16406, 16527, 16528.  These attendance and delivery items are used by medical practitioners when the patient has been referred by a midwife.  In April 2010, the Act was amended to permit specified midwives and nurse practitioners to claim medicare benefit for specified obstetric services.

 

  •   The transfer of item 10997 (“Service provided by a practice nurse or registered Aboriginal
         health worker to a person with a chronic disease”) from Group M2 (“Services provided by
         a practice nurse on behalf of a medical practitioner”) to Group M12 (“Services provided by
         a practice nurse or a registered Aboriginal health worker on behalf of a medical
         practitioner”).


  •   Amendments to the descriptors for the following eleven items:

     item 65 – the consultation time for the service is incorrectly stated as ‘lasting more than 
         25 minutes, but not more than 45 minutes’.  It is corrected to ‘lasting more than 
         45 minutes’;

  items 721 to 732 (inclusive) – these five items are amended to expressly state original policy that they be not claimed by a general practitioner who is a recognised specialist in palliative medicine;

  item 30390 – this laparoscopy item is amended to expressly state original policy that it be not claimed together with other procedural laparoscopy items;

     item 30408 – this item is amended to remove reference to an obsolete device; and

     items 38350, 38353 and 38356 are amended to expressly state that the applicable services include cardiac electro-physiological testing, if used for pacemaker implantation.

 


ATTACHMENT B

 

DETAILS OF THE HEALTH INSURANCE AMENDMENT REGULATIONS 2010
(NO. 2)

 

Regulation 1 – Name of Regulations

 

This regulation provides that the title of the Regulations is the Health Insurance Amendment Regulations 2010 (No. 2).

 

Regulation 2 - Commencement

 

This regulation provides for the Regulations to commence

(a) on 1 May 2010 — regulations 1 to 3 and Schedule 1;

(b) on 1 November 2010 — regulation 4 and Schedule 2.

 

Regulation 3 – Amendment of the Health insurance Regulations 1975

 

This regulation provides that Schedules 1 and 2 amend the Health Insurance Regulations 1975.

 

Regulation 4 – Services for which medicare benefit is 100 per cent of Schedule fee — GMST items 709, 711 and 713

 

This regulation provides that General Medical Services Table (GMST) items 709, 711 and 713 were listed in Schedule 6 from 1 July 2008 to 31 April 2010 (inclusive).  These items should have been listed in Schedule 6 when they were included in the GMST.  This retrospective measure corrects the omission. 

 

Schedule 1 - Amendments

 

Item [1] – Schedule 6

This item amends the list of services for which medicare benefit is 100 per cent of the Schedule fee, by:

     referencing the consolidation of primary care items in the general medical services table,  
     which came into effect on 1 May 2010.  The net effect of the consolidation was to reduce
     the number of primary care items from 85 to 33;

      deleting reference to items 2574, 2575, 2577 and 2578, which were removed from the
     GMST in 2007-2008; and

     renaming Group M5 to Group M12, effective in the general medical services table from

    1 May 2010.

 

All these changes should have been made to Schedule 6 when they were made to the GMST.  This retrospective measure corrects this omission and applies from 1 May 2010.  All of these changes in Schedule 6 apply retrospectively from 1 May 2010. 

 

Schedule 2 - Amendments

 

Item [1] – Subparagraph 6EF(b)(ii)

This item amends subparagraph 6EF(b)(ii) by replacing a reference to rule 28 of Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 (the 2009 DIST) by a reference to clause 1.2.5 of Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2010 (the 2010 DIST). 

 

Item [2] – Subregulation 13(21)

This item amends subregulation 13(21) by replacing a reference to rule 61 of the

2009 DIST with a reference to clause 2.43.4 of the 2010 DIST. 

Overview

The Health Insurance Amendment Regulations 2010 (No. 2) were enacted to address discrepancies in the Health Insurance Regulations 1975, ensuring that services listed in the General Medical Services Table (GMST) are correctly reflected in Schedule 6, which lists services for which the Medicare benefit is 100 per cent of the Schedule fee. This was necessary because, due to an oversight, certain items were not referenced in Schedule 6 when they were initially included in the GMST. The Regulations were made by the Governor-General under the authority of Subsection 133(1) of the Health Insurance Act 1973, which allows the Governor-General to make regulations not inconsistent with the Act. The policy objective is to maintain the integrity of the Medicare system by ensuring that all relevant services are appropriately listed and remunerated. The changes introduced by the Regulations include the removal of obsolete items, the addition of new referral items for midwives, amendments to item descriptors, and the correction of certain references in Schedule 6 to align with the GMST.

Scope and Application

The Health Insurance (General Medical Services Table) Regulations 2010 apply to medical practitioners and other healthcare providers who render professional services to eligible persons in Australia and who are involved in the Medicare system. These Regulations, along with the Health Insurance Amendment Regulations 2010 (No. 2), provide the framework for the payment of Medicare benefits for general medical services, including the fees for such services. The Regulations apply nationally across Australia, overseen by the Commonwealth under the Health Insurance Act 1973. The Act empowers the Governor-General to make regulations prescribing fees and rules for interpreting the table of general medical services, excluding diagnostic imaging and pathology services. The 2010 Regulations repeal the 2009 Regulations and set out a new table of general medical services for the 12-month period starting on 1 November 2010. The new table integrates the items of service with their interpretative rules. Key changes include a 1.8 per cent fee increase for most items, the deletion of obsolete items, the addition of new referral items for midwives, amendments to the descriptors for eleven items, and the transfer of one item into a different item group. The Health Insurance Amendment Regulations 2010 (No. 2) correct retrospective omissions in the Health Insurance Regulations 1975, ensuring that certain services are accurately listed for 100 per cent Medicare benefits. These Regulations are legislative instruments under the Legislative Instruments Act 2003, with specific commencement dates for different parts.

Key Provisions

The Health Insurance (General Medical Services Table) Regulations 2010 (section 4(1)) and the Health Insurance Amendment Regulations 2010 (No. 2) set out the provisions for the payment of Medicare benefits for general medical services rendered to eligible persons. The Regulations prescribe a table of medical services, the fees applicable for each item, and rules for interpreting the table. These Regulations also include a new structure, integrating items of service with their interpretative rules, as well as a fee increase of 1.8% for most items, the deletion of six obsolete items, the inclusion of three new referral items for midwives, amendments to the descriptors for eleven items, and the transfer of one item into a different item group. The Regulations also amend the Health Insurance Regulations 1975 to correct oversights in the listing of services for which the Medicare benefit is 100% of the Schedule fee. The Health Insurance (General Medical Services Table) Regulations 2010 impose obligations on medical practitioners, eligible persons, and the Commonwealth to ensure that medical services are provided in accordance with the prescribed fees and rules, and that Medicare benefits are accurately calculated and paid. The Regulations also impose obligations on the Commonwealth to ensure that the table of general medical services is kept up-to-date and that the prescribed fees are reviewed and updated as necessary. Breach of the Health Insurance (General Medical Services Table) Regulations 2010 or the Health Insurance Amendment Regulations 2010 (No. 2) may result in civil or criminal consequences, including fines and imprisonment. For example, section 133 of the Health Insurance Act 1973 provides for penalties for false or misleading claims for Medicare benefits, including fines of up to $22,200 for individuals and $111,000 for bodies corporate. Section 134 provides for penalties for fraud, including fines of up to $555,000 for individuals and $2,775,000 for bodies corporate, and imprisonment for up to 10 years. The maximum penalties for breaches of the Regulations are not specified in the Explanatory Statement. In summary, the Health Insurance (General Medical Services Table) Regulations 2010 and the Health Insurance Amendment Regulations 2010 (No. 2) set out the provisions for the payment of Medicare benefits for general medical services, including a new structure for the table of medical services, a fee increase, the deletion of obsolete items, the inclusion of new referral items, amendments to item descriptors, and the transfer of one item into a different item group. The Regulations impose obligations on medical practitioners, eligible persons, and the Commonwealth to ensure that medical services are provided in accordance with the prescribed fees and rules, and that Medicare benefits are accurately calculated and paid. Breach of the Regulations may result in civil or criminal consequences, including fines and imprisonment.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.