Health Insurance Commission Regulations (Amendment) 1994 No. 257
EXPLANATORY STATEMENT
STATUTORY RULES 1994 No. 257
Issued by the authority of the Minister for Human Services and Health
Health Insurance Commission Act 1973
Health Insurance Commission Regulations (Amendment)
The Health Insurance Commission Act 1973 (the Act) provides for the constitution of a Health Insurance Commission (the Commission) and for purposes connected therewith.
Section 44 of the Act provides that the Governor-General may make regulations for the purposes of the Act.
Section 8E of the Act requires the Commission to perform such functions in relation to health and health insurance as are prescribed.
The new Regulations amend the Health Insurance Commission Regulations (the Regulations) in consequence of amendments made to the Health Insurance Act 1973 establishing the Professional Services Review Scheme from 1 July 1994.
The Review Scheme provides for the establishment of Professional Services Review Committees to review the conduct of practitioners (doctors, dentists, optometrists, chiropractors, physiotherapists and podiatrists) in connection with the rendering or initiating of services under Medicare to determine if the practitioner under review has engaged in inappropriate practice.
The Professional Services Review Scheme replaces Committees of Inquiry which consider whether a medical practitioner, a dental practitioner or an optometrist has rendered excessive services under Medicare.
Under the Professional Services Review Scheme, the Commission is responsible for referring to an independent Director of Professional Services Review practitioners suspected of having engaged in inappropriate practice.
Regulation 2 makes investigations related to inappropriate practice functions of the Commission.
Subregulation 2.1 specifies that the definitions listed in Regulation 2 have the same meaning as those in Part VAA (The Professional Services Review Scheme) of the Health Insurance Act 1973.
Subregulation 2.2 prescribes as Commission functions the prevention and detection of inappropriate practice.
Subregulation 2.3 prescribes as a Commission function the investigation of the conduct of a person suspected, on reasonable grounds, to have engaged in inappropriate practice for the purpose of making a referral to the Director of Professional Services Review.
Subregulations 2.4 and 2.5 delete references to supplanted committees.
Regulation 3 deletes a number of obsolete provisions.
Regulation 4 provides that the Commission retains .its functions in relation to matters referred to Committees of Inquiry before 1 July 1994 until those matters have been concluded.
The Regulations commence on gazettal.
Overview
The Health Insurance Commission Regulations (Amendment) 1994 No. 257 was enacted to amend the existing Health Insurance Commission Regulations to reflect changes introduced by the Health Insurance Act 1973. The Act was established to constitute a Health Insurance Commission and outline its functions. These regulations specifically address the implementation of the Professional Services Review Scheme, replacing the previous Committees of Inquiry which assessed excessive services under Medicare. The policy objective of these amendments is to ensure that practitioners suspected of inappropriate practice are referred to an independent Director of Professional Services Review for further review. The Regulations were issued by the authority of the Minister for Human Services and Health and are set to commence upon gazettal.
Scope and Application
The Health Insurance Commission Regulations (Amendment) 1994 No. 257 applies to the Health Insurance Commission and practitioners such as doctors, dentists, optometrists, chiropractors, physiotherapists, and podiatrists within the Commonwealth of Australia. These regulations amend the existing Health Insurance Commission Regulations to reflect the introduction of the Professional Services Review Scheme established by the Health Insurance Act 1973. This scheme is designed to ensure the integrity of services rendered under Medicare by establishing Professional Services Review Committees to review the conduct of practitioners suspected of engaging in inappropriate practice. The Commission’s role under these regulations includes the prevention and detection of inappropriate practice, conducting investigations into suspected inappropriate practice, and making referrals to the Director of Professional Services Review. The regulations also retain the Commission’s responsibility for matters referred to Committees of Inquiry prior to 1 July 1994 until those matters are concluded. The amendments extend to the definitions and functions outlined in the Health Insurance Act 1973, ensuring consistency and alignment with the new scheme.
Key Provisions
The main operative sections of the Health Insurance Commission Regulations (Amendment) 1994 No. 257 (the Amendment Regulations) pertain to the establishment and functions of the Professional Services Review Scheme. Section 2 of the Amendment Regulations (s 2) establishes that investigations related to inappropriate practice by healthcare practitioners are now a function of the Health Insurance Commission (the Commission). Regulation 2.1 (s 2.1) clarifies that the definitions in the Amendment Regulations align with those in Part VAA of the Health Insurance Act 1973, which pertains to the Professional Services Review Scheme. Regulation 2.2 (s 2.2) specifies that the prevention and detection of inappropriate practice are functions of the Commission, while Regulation 2.3 (s 2.3) mandates that the Commission investigate the conduct of individuals suspected of inappropriate practice for the purpose of making referrals to the Director of Professional Services Review.
The Amendment Regulations impose several obligations and requirements on the Commission. Firstly, under Regulation 2 (s 2), the Commission is tasked with conducting investigations into inappropriate practice by healthcare practitioners. This includes the prevention and detection of such practices, as well as the investigation of specific individuals suspected of inappropriate conduct. Regulation 3 (s 3) mandates the deletion of obsolete provisions that no longer apply under the new scheme, ensuring the Regulations remain current and relevant. Additionally, Regulation 4 (s 4) specifies that the Commission retains its functions in relation to matters referred to Committees of Inquiry before 1 July 1994 until those matters have been concluded.
The Amendment Regulations also outline potential consequences for breaches of the legislation. While specific offences, penalties, or consequences are not detailed within the Amendment Regulations themselves, breaches of the Health Insurance Act 1973, which the Amendment Regulations seek to implement, may result in civil or criminal penalties. For instance, under the Health Insurance Act 1973, penalties for providing false or misleading information to the Commission can include fines up to $22,200 for individuals and $111,000 for corporations, as well as potential imprisonment. Furthermore, practitioners found to have engaged in inappropriate practice may face disciplinary actions from their respective professional boards, which could include fines, suspension, or revocation of registration. These potential consequences underscore the importance of compliance with the requirements set out in the Amendment Regulations and the overarching Health Insurance Act 1973.