EXPLANATORY STATEMENT HS/4/1996
SUBJECT: HEALTH INSURANCE ACT 1973
DETERMINATION UNDER SUBSECTION 3C(1) TO PROVIDE MEDICARE BENEFITS FOR ASSISTANCE AT OPERATION FOR SPECIFIED SERVICES
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.
From 1 November 1996, the table provides for assistance at operation for services identified in the table by the word" Assist". The previous provision for surgical assistance was based on the fee level for the particular procedure. This change to the arrangement for payment of Medicare benefits for surgical assistance was one of a range of savings measures announced by the Government in the 1996/97 Budget. All procedural items in the table which were previously eligible for assistance because of their fee level were examined to determine if they also met a clinical need requirement. A number of items were identified as not meeting this need and have been excluded from the provisions of the table for surgical assistance.
However, subsequent to the Budget decision, it has been accepted that there are a number of excluded services for which surgical assistance is in fact justified. This was based on advice from the medical profession and the USA's Medicare experience. This Determination, made by the Minister for Health and Family Services, provides for Medicare benefits to be payable for surgical assistance for these services pending an amendment to the health insurance regulations.