EXPLANATORY STATEMENT HS/2/1997
SUBJECT: HEALTH INSURANCE ACT 1973
DETERMINATION UNDER SUBSECTION 3C(1) TO AMEND THE MEDICARE BENEFITS SCHEDULE FEE FOR ITEMS COVERING BILATERAL AUGMENTATION MAMMAPLASTY AND BILATERAL MELOPLASTY
Subsection 3C(1) of the Health Insurance Act (the Act) provides that the Minister may, by writing, determine that a health service not already included in the general medical services table (the table) is to be treated as if it were included in the table. Such a determination shall specify a fee in respect of the health service and shall be subject to the provisions of the Act and Regulations as if it were a health service included in the table.
The table, which is prescribed by Regulations under section 4 and section 133 of the Health Insurance Act, contains item numbers for, descriptions of and fees in respect of medical services which are, among other things, recognised for the purposes of the payment of Medicare benefits.
A previous Determination (HS/1/1997), made by the Minister for Health and Family Services, determined items and fees for bilateral augmentation mammaplasty and bilateral meloplasty pending the inclusion of the items in the table at the next amendment to the Health Insurance Regulations from 1 November 1997.
Due to an oversight the fees for the items were equated to the fees for the unilateral procedures, making no allowance for the second procedure performed on the same occasion.
This Determination corrects that error and increased benefits will apply retrospectively, effective from 19 June 1997. However, so as not to place a financial responsibility on health funds, they have been exempted from paying 'gap' benefits during the period 19 June 1997 and 18 August 1997 (the date the Determination was signed). This provision is necessary as the Acts Interpretation Act precludes retrospectivity in legislation if it imposes a financial liability on any person or organisation other than the Commonwealth. As a result of this action privately insured patients will not be eligible to claim 'gap' benefits from their health funds during this period.