EXPLANATORY STATEMENT
Select Legislative Instrument 2011 No. 27
Health Insurance Act 1973
Health Insurance Amendment Regulations 2011 (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 benefit for professional services rendered to eligible persons. Part II, section 9 provides that this benefit be calculated with reference to fees set out in tables in the Health Insurance (General Medical Services Table) Regulations (the GMST Regulations). Part II, paragraph 10(2)(aa) provides that a professional service may attract a benefit equal to 100 per cent of its applicable fee. Regulation 6EF of the Health Insurance Regulations 1975 provides that professional services attracting a 100 per cent benefit shall be listed in Schedule 6 to these Regulations.
On 1 January 2010, professional service item number 2702 (preparation of a ‘General Practice Mental Health Treatment Plan’) was added to the tables in the GMST Regulations. However, in an oversight, it was not simultaneously listed in Schedule 6 to the Health Insurance Regulations 1975.
The Regulations rectify this omission by adding item 2702 to Schedule 6, with retrospective effect to 1 January 2010. Since this retrospectivity does not disadvantage or impose liabilities on any person other than the Commonwealth, subsection 12(2) of the Legislative Instruments Act 1973 does not operate to prevent the Regulations from taking effect.
The Act specifies no conditions which need to be met before the power to make the Regulations may be exercised.
The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
As the amendments rectify a drafting oversight and have no practical effect on the payment of medicare benefit, no consultation was undertaken.
Overview
The Health Insurance Amendment Regulations 2011 (No. 1) were introduced to address an oversight in the existing regulatory framework concerning the Health Insurance Act 1973. This Act, enacted by the Commonwealth Parliament, is designed to facilitate the provision of health insurance benefits, including Medicare, to eligible Australians. The oversight in question involved the omission of a specific professional service item, number 2702, from Schedule 6 of the Health Insurance Regulations 1975, despite its inclusion in the relevant fee tables as of 1 January 2010. These regulations aim to correct this error by adding item 2702 to Schedule 6 with retrospective effect from 1 January 2010. This ensures that the professional services attracting a 100 per cent Medicare benefit are accurately listed, thereby maintaining the integrity of the legislative intent without imposing any new liabilities or disadvantages on individuals.
Scope and Application
The Health Insurance Amendment Regulations 2011 (No. 1) apply to the Commonwealth of Australia and are made pursuant to the authority provided by subsection 133(1) of the Health Insurance Act 1973. These regulations pertain to the calculation and payment of Medicare benefits for professional services rendered to eligible individuals, ensuring alignment with the fees specified in the Health Insurance (General Medical Services Table) Regulations. Specifically, they address a discrepancy where a particular professional service, identified as item number 2702 (preparation of a ‘General Practice Mental Health Treatment Plan’), was added to the General Medical Services Table on 1 January 2010 but was inadvertently omitted from Schedule 6 of the Health Insurance Regulations 1975. The Regulations amend this oversight by including item 2702 in Schedule 6 with retrospective effect from the same date, thereby ensuring that the service is appropriately recognised and compensated without affecting the rights or liabilities of any individual or entity. These amendments are purely corrective and do not impose any new conditions or thresholds, nor do they exclude any specific persons or entities from their application.
Key Provisions
The Health Insurance Amendment Regulations 2011 (No. 1) amend the Health Insurance Regulations 1975 by adding professional service item number 2702 (preparation of a ‘General Practice Mental Health Treatment Plan’) to Schedule 6 (paragraph 6EF). This item, which was omitted from Schedule 6 despite being added to the Health Insurance (General Medical Services Table) Regulations on 1 January 2010, now ensures that services qualifying for a 100 per cent Medicare benefit are appropriately listed. The regulation operates retrospectively from 1 January 2010, thereby aligning the records with the original intent and schedule of the Health Insurance Act 1973.
The primary obligation imposed by these Regulations is the inclusion of service item number 2702 in Schedule 6, which clarifies the entitlement of medical practitioners to the full Medicare benefit for services rendered. The Health Insurance Act 1973 (section 10(2)(aa)) stipulates that such professional services may attract a benefit equal to 100 per cent of the applicable fee. By rectifying the oversight in the Health Insurance Regulations 1975, the Amendment Regulations ensure that this benefit is correctly applied and recorded. This alignment is crucial for the accurate administration and auditing of Medicare payments, ensuring that healthcare providers receive the appropriate compensation for services provided.
There are no specific offences, penalties, or civil/criminal consequences outlined in the Regulations for the failure to list service item number 2702 in Schedule 6 prior to this amendment. However, the retrospective nature of the amendment ensures that the oversight does not result in any financial disadvantage or additional liabilities for healthcare providers or patients. The Act and the Regulations are designed to streamline the process of claiming benefits, ensuring that the system operates efficiently and correctly. Any discrepancies in the listing of services could potentially lead to administrative errors or disputes over the rightful compensation for services provided, but these Regulations effectively mitigate such risks by correcting the oversight.