EXPLANATORY STATEMENT
Select Legislative Instrument 2012 No. 296
Health Insurance Act 1973
Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 5)
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. Section 9 of the Act provides that Medicare benefits be calculated by 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) Regulation 2012 (the Principal Regulation) currently prescribes such a table.
The regulation amends the Principal Regulation to ensure that the medical services funded through the Medicare Benefits Schedule continue to be up-to-date and representative of best medical practice.
Schedule 1 to the regulation includes a number of minor changes to implement Government policies in relation to Medicare. This includes an amendment to the geographical classification system which determines eligibility for telehealth services. Eligibility will now be determined according to the Australian Standard Geographical Classification Remoteness Area (ASGC-RA) which defines remoteness areas based on population and proximity to population centres. This will introduce a fairer system which will better target funding to areas where access to specialist services is limited.
Details of the regulation are set out in the Attachment.
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 January 2013.
Consultation
These decisions were taken as part of the 2012-13 Budget, or to correct minor errors.
Authority: Subsection 133(1) of the
Health Insurance Act 1973
ATTACHMENT
Details of the Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 5)
Section 1 – Name of regulation
This section provides for the regulation to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 5).
Section 2 – Commencement
This section provides for the regulation to commence on 1 January 2013.
Section 3 – Amendment of Health Insurance (General Medical Services Table) Regulation 2012
This section amends the Health Insurance (General Medical Services Table) Regulation 2012.
Schedule 1 – Amendments
Items [1] to [10], [12] to [24] and [31] to [33] – Amendment to telehealth items
These items implement changes agreed at the 2012-13 Mid-Year Economic and Fiscal Outlook to amend the areas eligible for telehealth services from ‘outside an inner metropolitan area’ to ‘outside of major cities’ and introduce six new items for short video consultations with specialists.
Item [11] – Schedule 1, paragraphs 2.5A.2 (c) to (e)
This item amends clause 2.5A.2 to expand the definition of ‘eligible disability’. This will increase the range of conditions that are eligible for Medicare funded allied health services and is a result of the expansion of the Better Start Initiative for Children with Disabilities which is managed by the Department of Families, Housing, Community Services and Indigenous Affairs.
Items [25] to [30] and [34] – Amendments to improve the consistency of the Regulation
These items correct minor errors that were identified when the 1 November 2012 amendment regulations were being compiled with the Principal Regulation.
Overview
The Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 5) was enacted to amend the Health Insurance (General Medical Services Table) Regulation 2012, which sets out the fees applicable for each medical service under the Health Insurance Act 1973. This regulation was introduced to address the need for the medical services funded through the Medicare Benefits Schedule to be kept current and reflective of best medical practices. The enacting body for this regulation is the Governor-General under the authority provided by subsection 133(1) of the Health Insurance Act 1973. The policy objective of this regulation is to ensure that the Medicare benefits are calculated accurately by reference to the fees set out in the prescribed tables and to implement government policies in relation to Medicare, including the fair distribution of funding for telehealth services. The regulation commenced on 1 January 2013 and includes amendments such as updating the geographical classification system for telehealth eligibility and expanding the definition of ‘eligible disability’ for allied health services.
Scope and Application
The Health Insurance Act 1973 applies to persons and entities involved in the provision and administration of health services within Australia, specifically concerning the payment of Medicare benefits for professional services rendered to eligible individuals. The Act allows for the regulation of fees for medical services through the establishment of prescribed tables, with the Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 5) providing specific details on these fees and the interpretation of the table. The regulation has a national reach as it pertains to the Medicare system, which is a federal scheme. The amendment regulation updates the geographical classification system for telehealth services eligibility based on the Australian Standard Geographical Classification Remoteness Area (ASGC-RA) to ensure the Medicare Benefits Schedule remains current and reflective of best medical practice. This regulation, which commenced on 1 January 2013, extends the application of the principal regulation by incorporating changes such as the introduction of new telehealth items for short video consultations with specialists and expanding the definition of 'eligible disability' for allied health services. The regulation does not specify any exclusions or thresholds, nor does it mention any exemptions, but it does clarify that the power to make these regulations is not subject to any conditions other than those set out in the Act itself.
Key Provisions
The Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 5) amends the Health Insurance (General Medical Services Table) Regulation 2012, which prescribes a table of medical services, the fees applicable for each item, and rules for interpreting the table (section 4(1) of the Health Insurance Act 1973). This amendment, effective from 1 January 2013, introduces a number of minor changes aimed at updating the medical services funded through the Medicare Benefits Schedule and ensuring they reflect best medical practices. These amendments were made to ensure that the medical services funded through the Medicare Benefits Schedule remain current and representative of best medical practice.
The main obligations imposed by this amendment regulation include updating the geographical classification system for telehealth services eligibility. This change will now be determined according to the Australian Standard Geographical Classification Remoteness Area (ASGC-RA), which categorises areas based on population and proximity to population centres. This adjustment aims to create a fairer system, better targeting funding to areas where access to specialist services is limited. Another significant obligation is the expansion of the definition of 'eligible disability', which will increase the range of conditions that are eligible for Medicare-funded allied health services. This change is a result of the expansion of the Better Start Initiative for Children with Disabilities.
Failure to comply with the provisions of the Health Insurance Act 1973 or the Health Insurance (General Medical Services Table) Amendment Regulation 2012 (No. 5) can lead to civil and criminal consequences. While the specific penalties are not detailed in the explanatory statement, breaches of the Act or its regulations could result in fines, imprisonment, or other penalties as prescribed by law. The maximum penalties for such offences depend on the nature and severity of the breach, but they can include substantial fines and imprisonment terms that align with the gravity of the infraction.