EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Cleft Lip and Cleft Palate Services) Amendment Determination 2013
Issued by the authority of the Minister for Health
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 (the GMST) which is re-made each year.
The Health Insurance (Cleft Lip and Cleft Palate Services) Amendment Determination 2013 (the Determination) repeals the cessation provision of the Health Insurance (Cleft Lip and Cleft Palate services) Determination 2012 (the Principal Determination). This will enable patients to continue to receive Medicare benefits for cleft lip and cleft palate services after 31 October 2013.
In November 2012, sixty-two Medicare items for the treatment of cleft lip and cleft palate conditions were removed from GMST and recreated in the Principal Determination to enable eligibility requirements to be simplified for providing practitioners. The items include orthodontic, oral, and maxillofacial surgery, general dental and prosthodontic services provided by dental practioners, specialist dental practioners and oral and maxillofacial surgeons.
Section 3 of the Principal Determination provided it would cease on 31 October 2013. The Determination repeals this cessation provision to enable continued patient Medicare access to the cleft lip and cleft palate services in the Principal Determination.
Consultation
The following professional organisations were consulted on the approach to be given effect by the Determination: the Australian Dental Association, the Royal Australasian College of Dental Surgeons, the Australian Society of Orthodontists, and the Australian and New Zealand Association of Oral and Maxillofacial Surgeons.
The Office of Best Practice Regulation has advised that a Regulatory Impact Statement is not required as the proposed action appears to have only a minor regulatory impact on businesses or the non-profit sector (OBPR reference 13806).
This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
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Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Health Insurance (Cleft Lip and Cleft Palate Services) Amendment Determination 2013
This Legislative Instrument is compatible with the human rights and freedoms
recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Legislative Instrument
The Health Insurance (Cleft Lip and Cleft Palate Services) Amendment Determination 2013 (the Determination) amends the Health Insurance (Cleft Lip and Cleft Palate services) Determination 2012 (the Principal Determination) by repealing its cessation provision. This allows continued payment of Medicare benefits for cleft lip and cleft palate services covered by the Principal Determination.
The Principal Determination created 62 Medicare items for the treatment of conditions under the Cleft Lip and Cleft Palate (CLaCP) Scheme. These items, which had previously been listed in the Health Insurance (General Medical Services Table) Regulation (GMST), include orthodontic, oral and maxillofacial surgery, general dental and prosthodontic services provided by dental practitioners, specialist dental practitioners and oral and maxillofacial surgeons. The move from the GMST to the Principal Determination allowed for the simplification of outdated practitioner eligibility requirements.
Section 3 of the Principal Determination provided that it would cease on 31 October 2013. The Determination repeals section 3 of the Principal Determination to allow continued patient access to services after this date.
Human rights implications
This Legislative Instrument does not engage any of the applicable rights or freedoms.
Conclusion
This Legislative Instrument is compatible with human rights as it does not raise any human rights issues.
Richard Bartlett
First Assistant Secretary
Medical Benefits Division
Department of Health
Overview
The Health Insurance (Cleft Lip and Cleft Palate Services) Amendment Determination 2013, issued under the authority of the Minister for Health, amends the Health Insurance (Cleft Lip and Cleft Palate services) Determination 2012 to ensure ongoing Medicare coverage for cleft lip and cleft palate services. The original determination had created 62 Medicare items for the treatment of these conditions, which were previously listed in the Health Insurance (General Medical Services Table) Regulation. The amendment repeals the cessation provision of the 2012 determination, allowing continued access to these services beyond the original 31 October 2013 cessation date. This change aims to maintain patient access to essential healthcare services by simplifying practitioner eligibility requirements. Consultation was conducted with relevant professional organisations, and the Office of Best Practice Regulation confirmed that a Regulatory Impact Statement was not necessary due to the minor regulatory impact of the amendment. The Determination is compatible with human rights as it does not engage any of the applicable rights or freedoms.
Scope and Application
The Health Insurance (Cleft Lip and Cleft Palate Services) Amendment Determination 2013 amends the Health Insurance (Cleft Lip and Cleft Palate services) Determination 2012, allowing continued Medicare benefits for cleft lip and cleft palate services beyond the cessation date of 31 October 2013. The amendment effectively repeals the cessation provision of the Principal Determination, thereby ensuring that patients retain access to these essential services. These services, previously listed in the Health Insurance (General Medical Services Table) Regulations, include orthodontic, oral, and maxillofacial surgery, as well as general dental and prosthodontic services provided by various practitioners. The Determination applies to patients and healthcare providers involved in the treatment of cleft lip and cleft palate conditions, ensuring that the simplification of eligibility requirements introduced by the Principal Determination is maintained. This legislative instrument operates nationally under the authority of the Commonwealth and is subject to the Health Insurance Act 1973. There are no stated exclusions or exemptions within the scope of this Determination, and no thresholds are specified. The application of the Determination is extended through subordinate instruments to ensure continued compliance with the Act.
Key Provisions
The Health Insurance (Cleft Lip and Cleft Palate Services) Amendment Determination 2013 (subsection 3C(1) of the Health Insurance Act 1973) makes significant changes to the treatment of Medicare benefits for cleft lip and cleft palate services. Specifically, it repeals the cessation provision of the Health Insurance (Cleft Lip and Cleft Palate services) Determination 2012, which previously stipulated that the Principal Determination would cease on 31 October 2013. By removing this cessation provision, the Determination allows patients to continue receiving Medicare benefits for cleft lip and cleft palate services beyond this date. These services encompass a wide range of treatments, including orthodontic, oral, and maxillofacial surgery, as well as general dental and prosthodontic services provided by dental practitioners, specialist dental practitioners, and oral and maxillofacial surgeons.
The Act imposes specific obligations on parties involved in the provision of these services. Firstly, healthcare providers must ensure that the services they render are in line with the criteria and requirements set forth in the Health Insurance (Cleft Lip and Cleft Palate services) Amendment Determination 2013. This includes verifying that they meet the eligibility requirements simplified through the repeal of the cessation provision. Secondly, patients must adhere to any conditions or requirements set by the Medicare scheme to remain eligible for benefits. Any changes or updates to the services or their provision must be communicated effectively to both healthcare providers and patients to maintain compliance with the Act.
Failure to comply with the requirements set out in the Determination may result in various consequences. Firstly, healthcare providers who do not adhere to the criteria for the provision of cleft lip and cleft palate services may face financial penalties, including the withholding of Medicare benefits for the services rendered. Patients who do not meet the eligibility requirements may also be denied benefits for the services. Additionally, if any fraudulent activities are detected, such as submitting false claims for services not provided or not eligible, both healthcare providers and patients may face legal consequences, including fines and potential imprisonment. The maximum penalties for such offences are stipulated in the Health Insurance Act 1973 and may vary based on the severity and intent of the breach.