EXPLANATORY STATEMENT
Select Legislative Instrument 2012 No. 140
Health Insurance Act 1973
Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 3)
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.
The Act provides, in part, for payments of medicare benefits in respect of professional services rendered to eligible persons by medical practitioners who are not vocationally registered but are undertaking approved placements in specified workforce programs which will lead to vocational registration. Section 3GA of the Act refers to the approved programs and courses in which a non-vocationally registered medical practitioner can participate in order to be eligible to provide rebateable services. (Section 3GA, section 3GC and section 19AA of the Act are collectively known as Medicare Provider Number Legislation.)
The approved programs and courses referred to in section 3GA of the Act are specified in Part 2, Schedule 5 of the Health Insurance Regulations 1975 (the HI Regulations). Recently, the status of several of these programs and courses changed. The 2010 Review into Medicare Provider Number Legislation recommended that Part 2, Schedule 5 of the HI Regulations be amended to reflect the changes.
In particular
- the Rural and Remote Area Placement Program (item 2), the Assistance at Operations Program (tem 5) and the Metropolitan Workforce Support Program (item 6) be removed from Part 2, Schedule 5 as they no longer exist; and
- the references to the Pre-vocational General Practice Placements Program being managed by the Royal Australian College of General Practitioners (item 19) or the Australian College of Rural and Remote Medicine (item 1) be removed from Part 2, Schedule 5 as the Program is now wholly managed through General Practice Education and Training Limited.
A separate proposal to amend the HI Regulations is being put forward. Consequential amendments to the Health Insurance (General Medical Services Table) Regulations 2011 would be required due to these changes; the regulation would make these amendments.
The Act specifies no conditions that 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 the day after it is registered.
The consultation for these changes largely took place through the 2010 Review of Medicare Provider Number Legislation, conducted by ARTD Consultants. As part of the Review, ARTD meet with key industry stakeholders during the consultation phase. Sixty-five participants engaged in one to one interviews or group meetings, six organisations provided formal submissions and 37 responses to a semi-structured electronic submission were received.
During the Review, the consultants liaised continually with the Medical Training Review Panel which includes representatives from all state and territory health administrations, recognised specialist medical colleges, medical schools, the Australian Medical Council, and a range of other professional, industrial and stakeholder bodies.
Authority: Subsection133(1) of the Health Insurance Act 1973
Overview
The Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 3) was enacted to align the Health Insurance Regulations 1975 with the current state of approved medical training programs under the Health Insurance Act 1973. This regulation addresses the problem of outdated references in the Health Insurance Regulations 1975 that no longer correspond to the existing medical training programs, ensuring that only current and relevant programs are recognised for the purposes of providing rebateable services. The regulation was made under the authority of Subsection 133(1) of the Health Insurance Act 1973, which allows the Governor-General to make regulations necessary for carrying out or giving effect to the Act. The policy objective, as recommended by the 2010 Review into Medicare Provider Number Legislation, is to maintain the integrity and relevance of the approved programs listed in the Health Insurance Regulations 1975, thereby ensuring that medical practitioners in approved placements are correctly identified and reimbursed for their services.
Scope and Application
The Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 3) applies to the Medicare Provider Number Legislation outlined in the Health Insurance Act 1973, specifically affecting payments for professional services rendered by non-vocationally registered medical practitioners undertaking approved placements. This regulation adjusts the Health Insurance Regulations 1975 to reflect changes in the status of several approved programs and courses, ensuring the regulatory framework remains current and accurate. The regulation removes outdated references to programs that no longer exist or have changed management, such as the Rural and Remote Area Placement Program, Assistance at Operations Program, and Metropolitan Workforce Support Program, as well as updates concerning the management of the Pre-vocational General Practice Placements Program. These changes are necessary to align the regulatory framework with the current structure and operation of approved placement programs, ensuring that only relevant and existing programs are considered for the provision of rebateable services under the Act. The regulation applies nationally across Australia and is designed to facilitate the smooth administration of Medicare benefits within the health sector.
Key Provisions
The Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 3) introduces specific amendments to the Health Insurance (General Medical Services Table) Regulations 2011. It primarily focuses on updating the list of approved programs and courses in which non-vocationally registered medical practitioners can participate to remain eligible for rebateable services. These amendments follow the recommendations of the 2010 Review into Medicare Provider Number Legislation, which identified the need to reflect changes in the status of certain programs. For instance, the Rural and Remote Area Placement Program, the Assistance at Operations Program, and the Metropolitan Workforce Support Program, which no longer exist, are removed from the list (Regulation 3). Similarly, references to the Pre-vocational General Practice Placements Program being managed by the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine are also removed, as the program is now managed through General Practice Education and Training Limited (Regulation 4). These changes ensure that the regulation remains current and reflective of the existing workforce programs.
Under the Health Insurance Act 1973, medical practitioners who are not vocationally registered but are participating in approved programs can provide services eligible for rebateable services. The obligations imposed by the amended regulation on parties involved include ensuring that any medical practitioner claiming rebates under the Act is participating in a program listed in the Health Insurance Regulations 1975. This includes maintaining accurate records of participation and compliance with the requirements set out in the Act and the regulations. Additionally, entities managing these programs, such as General Practice Education and Training Limited, must adhere to the stipulated guidelines and ensure that the programs they administer meet the criteria for inclusion in the approved list.
The Health Insurance Act 1973 does not explicitly outline offences, penalties, or civil/criminal consequences for breaches of the regulation. However, any non-compliance with the Act or the regulations could potentially lead to investigations by the relevant authorities, such as the Department of Health. If a medical practitioner or an entity is found to be in breach of the regulations, this could result in the denial of rebateable services, financial penalties, or other corrective actions as deemed necessary by the authorities. Although the specific penalties are not detailed in the regulation, they would be consistent with the broader legislative framework under which the Health Insurance Act operates.