Health Insurance Commission Regulations (Amendment) 1996 No. 322
EXPLANATORY STATEMENT
Statutory Rules 1996 No. 322
Issued by Authority of the Minister for Health and Family Services
Health Insurance Commission Act 1973
Health Insurance Commission Regulations (Amendment)
Section 8E of the Health Insurance Commission Act 1973 (the Act) provides that the Health Insurance Commission (the HIC) shall perform such functions in relation to health related matters as are prescribed. Section 44 of the Act provides for the Governor-General to make regulations.
Regulation 3P in the Health Insurance Commission Regulations allows the HIC to perform the function of administering the Better Practice Program (the Program), which is a voluntary program designed to provide financial recognition for general practices that focus on patient needs and provide continuing, comprehensive whole of patient care.
Before a general practice can receive financial recognition under the Program, a decision must be made that the practice is eligible to participate and another decision made as to the amount of any payment.
To be eligible, practices must meet the eligibility criteria that require practices to employ appropriately trained medical practitioners, provide out of surgery visits and ensure that their patients have access to appropriate after hours care. Eligible practices may receive four quarterly payments, the amount of which is determined by the HIC in accordance with a payment formula. Practices need to reapply for the Program annually and the MC receives new applications on a rolling basis, with re-applications being due on the anniversary of the date on which the practices application was first approved.
The Program is currently under review, and it is expected that the Program will undergo changes in 1997, If significant changes occur, practices currently participating in the Program may be required to reapply for the new Program when it comes into effect. This would mean that many practices. would have to go through a re-registration process twice in the same year.
The Department of Health and Family Services and the HIC are developing a transitional arrangements to ensure that practices currently participating in the Program can be incorporated within the new restructured Program with least disruption. The amendments to Regulation 3P enable the HIC to continue to make payments without practices having to reapply for the Program and are intended to avoid placing an onerous burden of additional paperwork on practices and to minimise the administrative burden and costs for the HIC.
Details of the amendments to Regulation 3P are attached.
The amendments to Regulation 3P will commence on gazettal, but will retrospectively apply to all practices that cease to be eligible for the Program from 1 December 1996. This is because most practices are due to reregister for the Program for the third time as of this date.
The amendments to Regulation 3P are not in contravention of s48 of the Acts Interpretation Act 1901. The amendments are beneficial to practices participating in the Program, as they remove the requirement on practices to provide additional paperwork to the HIC. Quarterly Payments to practices will continue as usual.
ATTACHMENT
Details of Proposed Amendments to Regulation 3P
The Primary Purpose of the proposed amendment to Regulation 3P of the Health Insurance Commission Regulations is to enable the HIC to continue to make payments to eligible practices participating in the Better Practice Program on or after 1 December 1996, without the practices being required to re-apply for the Program. This is a transitional arrangement designed to reduce the administrative burden on practices while the Program is undergoing a comprehensive review.
Specifically:
* proposed subregulation 3 - amends subparagraph 3P(2)(c)(ii) to remove a typing error.
* proposed subregulation 4.1 - amends paragraph 3P(6)(b) to correct an erroneous reference to a subparagraph.
* proposed subregulation 4.2 - inserts a new subregulation 3P(9)(a) to provide an express mechanism for practices to withdraw from the Program.
* proposed subregulation 4.3 - inserts a new subregulation (10A) which extends the eligibility period of practices, which cease to be eligible for the Program in the year starting on 1 December 1996, from four to eight payment quarters. The extended eligibility period will not apply for practices whose eligibility has been cancelled by the HIC because they have stopped meeting the Program's eligibility criteria or because the practice has withdrawn from the Program
* proposed subregulation (10B) - enables the HIC to extend a practices eligibility by 1 to 4 payment quarters, in the year starting on 1 December 1997.
Overview
The Health Insurance Commission Regulations (Amendment) 1996 No. 322 was enacted to amend the Health Insurance Commission Regulations and was issued by the authority of the Minister for Health and Family Services under the Health Insurance Commission Act 1973. The primary aim of this amendment was to address the administrative burden on general practices participating in the Better Practice Program, a voluntary initiative designed to recognise and financially support general practices that focus on patient needs and provide comprehensive care. The policy objective was to facilitate a smooth transition for practices during the review and restructuring of the Program, thereby minimising the need for additional paperwork and administrative costs.
These amendments specifically sought to ensure that general practices would not need to reapply for the Program during the transition period and would be able to continue receiving quarterly payments without interruption. The amendments included correcting typographical errors, updating references, and providing mechanisms for practices to withdraw from the Program and for the HIC to extend the eligibility period for certain practices. The changes aimed to reduce the administrative burden on participating practices and the HIC, ensuring continuity of support while the Program undergoes significant changes.
Scope and Application
The Health Insurance Commission Regulations (Amendment) 1996 No. 322 applies to general practices participating in the Better Practice Program administered by the Health Insurance Commission (HIC) under the Health Insurance Commission Act 1973. The amendment aims to facilitate smoother transitional arrangements for practices affected by the review and restructuring of the Program. It applies to practices that would otherwise have to reapply for the Program, thereby alleviating the administrative burden and paperwork on practices. The amendments are intended to avoid imposing additional costs and administrative duties on practices that are already participating in the Program. The scope of this regulation is primarily within the Commonwealth jurisdiction, as it pertains to the activities and administration of the HIC, an entity established under federal legislation. The regulation includes specific provisions that correct errors and introduce mechanisms for practices to withdraw from the Program and for the HIC to extend the eligibility period of practices in certain circumstances. Notably, the regulation does not alter the eligibility criteria or the core objectives of the Better Practice Program but seeks to address administrative inefficiencies arising from the Program’s review.
Key Provisions
The Health Insurance Commission Regulations (Amendment) 1996 No. 322 primarily modifies Regulation 3P of the Health Insurance Commission Regulations, enabling the Health Insurance Commission (HIC) to administer the Better Practice Program more effectively during a period of review and potential restructuring. Section 8E of the Health Insurance Commission Act 1973 empowers the HIC to perform functions related to health matters as prescribed, and Section 44 allows the Governor-General to make regulations. Regulation 3P specifically permits the HIC to administer the Better Practice Program, which recognises and financially supports general practices that meet certain eligibility criteria, such as employing appropriately trained medical practitioners and ensuring patient access to after-hours care.
The amendments to Regulation 3P impose certain obligations on the HIC and participating general practices. The HIC must now administer the Program without requiring practices to re-apply for the Program, provided they meet the eligibility criteria and the extended eligibility periods. Practices are required to ensure they continue to meet the eligibility requirements and submit re-applications annually. The HIC must also implement the new mechanisms for practices to withdraw from the Program and extend their eligibility where necessary. These amendments aim to reduce the administrative burden on practices and ensure continuity of payments.
There are no explicit offences, penalties, or civil/criminal consequences mentioned in the explanatory statement for breaches of the amended regulations. However, any failure by practices to meet the eligibility criteria or by the HIC to administer the Program correctly could potentially lead to disputes or administrative actions. The primary focus of the amendments is to streamline the administrative process and ensure that practices receive continued financial recognition during a period of review, rather than to impose punitive measures.
The amendments to Regulation 3P, which include correcting typographical errors, rectifying erroneous references, and providing mechanisms for practices to withdraw and extend their eligibility, are designed to facilitate a smoother transition during the review of the Better Practice Program. By reducing the administrative burden on practices and ensuring continuity of payments, these changes aim to support general practices in maintaining high standards of patient care while the Program undergoes its comprehensive review.