EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Cataract Surgery) Determination 2010
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may determine in writing that a health service not listed in an item in the General Medical Services Table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. The Table is set out in the Health Insurance (General Medical Services Table) Regulations 2009 which are re-made each year.
A determination made under subsection 3C(1) of the Act is a legislative instrument (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
The Health Insurance (Cataract Surgery) Determination 2010 (the Determination) will permit the payment of Medicare benefits for cataract surgery.
The Determination provides for fee changes to three items (item 42698, 42701 and 42702). Item 42698 will enable a Medicare benefit to be payable where a service for lens extraction is rendered. Item 42701 will enable a Medicare benefit to be payable where a service for the insertion of an artificial lens is rendered. Item 42702 will enable a Medicare benefit to be payable where a service for a lens extraction and insertion of an artificial lens is rendered.
The purpose of this Determination is to ensure that patients can receive medicare benefits for the cataract surgery services specified in the Schedule to the Determination.
This Determination commences on 1 February 2010 and revokes the Health Insurance (Cataract Surgery) Determination 2009 (No. 2).
Consultation
The Royal Australian and New Zealand College of Ophthalmologists and the Australian Society of Ophthalmologists were consulted and are supportive of fee relativities for the cataract item structure.
Details of the Determination are set out in the Attachment.
ATTACHMENT
Notes on sections in the Determination
Section 1
Section 1 provides the name of the Determination.
Section 2
Subsection 2(1) provides that the Determination commences on 1 February 2010.
The Determination enables the continued payment of medicare benefits for certain cataract surgery services.
Subsection 2(2) provides that the Determination ceases at midnight on 31 October 2010 unless sooner terminated.
Section 3
Section 3 defines terms used in this Determination. These terms are referred to in section 4 of the Determination.
Subsection 3(2) provides that a reference to a provision of an Act or regulations, is a reference to the provision as in force from time to time.
Section 4
Section 4 provides that a relevant service specified in the Schedule to the Determination will be treated from 1 February 2010 as if it were both a professional service and a medical service for the purposes of the provisions of the Act, the National Health Act 1953 and regulations made under each Act which provide for medical services or professional services.
Schedule
The Schedule to the Determination sets out the relevant services, assigns the applicable item number, item descriptor and fee for each service.
Overview
The Health Insurance (Cataract Surgery) Determination 2010, enacted by the Minister for Health and Ageing under the Health Insurance Act 1973, aims to address the gap in Medicare benefits for cataract surgery services. The Act permits the Minister to determine that certain health services not explicitly listed in the General Medical Services Table will be treated as if they were listed, provided they meet specified circumstances and statutory provisions. This Determination specifically targets cataract surgery services, enabling the payment of Medicare benefits for lens extraction, insertion of an artificial lens, and the combined service of both. The Determination was made following consultation with professional bodies such as the Royal Australian and New Zealand College of Ophthalmologists and the Australian Society of Ophthalmologists, who support the proposed fee structure. This legislative instrument ensures that patients can access the necessary medical services with the corresponding financial support through Medicare.
The policy objective of this Determination is to provide clarity and continuity in the payment of Medicare benefits for cataract surgery services, ensuring that patients can receive the required treatments without undue financial burden. By specifying the relevant services and assigning item numbers and fees, the Determination aims to streamline the process of accessing these benefits. The Determination, which commences on 1 February 2010 and revokes its predecessor from the same year, reflects a commitment to updating and refining the delivery of healthcare services in alignment with the evolving needs of the population.
Scope and Application
The Health Insurance (Cataract Surgery) Determination 2010, under subsection 3C(1) of the Health Insurance Act 1973, applies to the payment of Medicare benefits for specified cataract surgery services. The Act allows the Minister for Health and Ageing to determine in writing that certain health services, not listed in the General Medical Services Table, will be treated as if they were listed for specific statutory provisions and circumstances. This Determination ensures that patients can receive Medicare benefits for services including lens extraction, insertion of an artificial lens, and a combination of these services. It applies to the specified services as outlined in the Schedule, commencing on 1 February 2010 and revoking the previous Determination from 2009. The reach of this legislation is national, as it pertains to the Health Insurance Act 1973, which is a Commonwealth Act. There are no stated exclusions or exemptions in this Determination, but it can be extended or restricted through subordinate instruments as required by the Act. The Royal Australian and New Zealand College of Ophthalmologists and the Australian Society of Ophthalmologists have been consulted and support the fee relativities for the cataract item structure.
Key Provisions
The Health Insurance (Cataract Surgery) Determination 2010 (the Determination) is an important legislative instrument that allows for the continued payment of Medicare benefits for specified cataract surgery services. Under Section 2(1), the Determination commences on 1 February 2010 and is set to continue until midnight on 31 October 2010, unless terminated earlier. The Determination ensures that patients can receive benefits for services such as lens extraction, insertion of an artificial lens, and a combined service for lens extraction and insertion of an artificial lens, as detailed in the Schedule. These services are designated by item numbers 42698, 42701, and 42702 respectively, which are treated as professional and medical services under the Act and associated regulations.
The obligations imposed by the Determination are primarily on healthcare providers and Medicare, with the latter being required to facilitate the payment of benefits for the specified services. Healthcare providers must ensure that they render the services as outlined in the Schedule and correctly claim the associated Medicare benefits. Medicare, on the other hand, is obligated to process these claims and disburse the appropriate benefits to the providers, ensuring that the services rendered are reimbursed in accordance with the fees stipulated in the Schedule.
The Determination also outlines the consequences of non-compliance with its provisions. Any breach of the Determination may result in civil or criminal penalties, although the specific penalties are not detailed in the explanatory statement. Generally, under the Health Insurance Act 1973, penalties for non-compliance can include fines and, in severe cases, criminal charges. The maximum penalties would be dictated by the relevant sections of the Act and could involve substantial financial penalties or imprisonment, depending on the nature and severity of the breach.