EXPLANATORY STATEMENT
Select Legislative Instrument 2012 No. 16
Health Insurance Act 1973
Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 1)
Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides that the
Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Part II of the Act provides for the payment of Medicare benefits for professional services rendered to eligible persons. The effect of section 9 of the Act is that Medicare benefits are calculated with reference to the fees for medical services set out in prescribed tables.
Subsection 4(1) of the Act provides that the Regulations may prescribe a table of medical services (other than diagnostic imaging services and pathology services), which sets out items of medical services, the fees applicable for each item, and rules for interpreting the table. The Health Insurance (General Medical Services Table) Regulations 2011 (the Principal Regulations) currently prescribe such a table.
The regulation amends the Principal Regulations to implement a 2011‑12 Budget decision, and otherwise ensures that the medical services funded through the Medical Benefit Schedule continue to be up-to-date and representative of best medical practice. There are three elements to the regulation which are outlined below.
Ophthalmology
Through the Mid-year Economic and Fiscal Outlook 2011‑12 Budget the Government announced that it will amend the Medicare Benefits Schedule and Veterans’ Benefits for new and revised listings to include:
- an amendment to item 109 to encourage ophthalmologists to provide additional comprehensive eye examinations to children by increasing the schedule fee by 50 per cent and lifting the age eligibility from children up to eight years of age to children up to and including nine years of age; and
- aligning an existing ophthalmology item (42740) for either the injection of therapeutic substances into the eye or removal of material from the eye for diagnostic purposes with current best clinical practice.
Mental Health
Amendments to rules that apply to Group A20 – Mental Health Care. This includes:
- an update to a reference which was unintentionally not updated when the regulatory rules were reorganised as part of the 2010 GMST; and
- an amendment to the rules governing the circumstances under which patients might claim for the preparation or review of a mental health plan; and
- to reinstate the exceptional circumstances provision for General Practitioner focussed psychological strategies for 1 March 2012 to 31 December 2012.
Non-Medicare Service
Endovenous laser treatment has been assessed by the Medical Services Advisory Committee and items (35220 and 35222) were introduced on 1 November 2011. The regulation removes Endovenous laser treatment from the Dictionary as a non-medicare service.
Details of the regulation are set out in the Attachment.
Consultation
Ophtalmology
Consultation in relation to items 1 and 6 involved the Royal Australian and New Zealand College of Ophthalmologists and the Australian Society of Ophthalmologists.
Mental Health and Non-Medicare Service
No specific consultation took place in relation to these elements (items 2 to 5 and item 7). However, in making these elements the Government has taken into consideration the recommendations made by the Senate Community Affairs References Committee and has listened to feedback from the consumers, allied mental health professionals, general practitioners and peak professional organisations.
Statement of Compatibility with Human rights
The regulation 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.
The Act specifies no conditions which need to be met before the power to make the regulation may be exercised.
The regulation is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The regulation commences on 1 March 2012.
Authority: Subsection 133(1) of the
Health Insurance Act 1973
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATION 2012 (No. 1)
Section 1 – Name of Regulation
This section provides that the title of the regulation is the Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 1).
Section 2 – Commencement
This section provides for the regulation to commence on 1 March 2012.
Section 3 – Amendment of the Health Insurance (General Medical Services Table) Regulations 2011
This section provides that Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2011 (the 2011 Regulations).
Schedule 1 – Amendments
Item [1] – Schedule 1, Division 2.4, table, item 109
This item amends item 109 to increase the schedule fee by 50 per cent and lift the age eligibility from children up to eight years of age to children up to and including nine years of age.
Item [2] – Schedule 1, subparagraph 2.20.3(2)(c)(ii)
This item corrects the reference to paragraph 20.2.7(1)(b) from 57(1)(b).
Item [3] – Schedule 1, subclauses 2.20.6(3) to (5)
This item amends the rules governing the circumstances under which patients might claim for the preparation or review of a mental health plan.
Item [4] – Schedule 1, subparagraph 2.20.7(2)(a)(i)
This item corrects a typographical error.
Item [5] – Schedule 1, paragraph 2.20.7(2)(b), except the note
This item reinstates the exceptional circumstances provision for GP focussed psychological strategies.
Item [6] – Schedule 1, Division 2.44, table, item 42740
This item amends item 42740 and introduce two new items 42738 and 42739 to provide clarity for ophthalmological injection of therapeutic substances.
Item [7] – Dictionary, definition of non-medicare service, paragraph (b)
This item removes the term ‘endovenous laser treatment, for varicose veins’ from the definition of a non-medicare service.