EXPLANATORY STATEMENT
STATUTORY RULES 2004 NO. 386
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 10)
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 payment of Medicare benefits in respect of professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits shall 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) that sets out items of medical services, the amount of fees applicable in respect of each item and rules for interpretation of the table. The Health Insurance (General Medical Services Table) Regulations 2004 (the Principal Regulations) currently prescribe such a table.
The Principal Regulations currently provide a $7.65 incentive for the provision of certain bulk-billed services in regional, rural and remote areas, the whole of Tasmania, and
twenty-eight statistical sub-divisions (SSDs). The areas included in the eligible SSDs include the Australian Capital Territory, the Northern Territory, Palm Island and some urban areas.
The purpose of the Regulations is to allow medical practitioners not based in eligible areas, who are providing after hours services in eligible areas, to access the $7.65 incentive payment for certain bulk billed services.
Details of the Regulations are set out in the Attachment.
The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised.
The Regulations commence on 1 January 2005.
ATTACHMENT
Details of the health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 10)
Regulation 1 provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 10).
Regulation 2 provides for the Regulations to commence on 1 January 2005.
Regulation 3 provides for Schedule 1 to amend the Health Insurance (General Medical Services Table) Regulations 2004 (the Principal Regulations).
Schedule 1 – Amendments
Item [1]
This item inserts a reference to new item 10992 into the heading of rule 83. Item 10992 is inserted into the Principal Regulations by item [9], below.
Item [2]
This item inserts new subrule 83(1A) to specify that new item 10992 cannot be claimed in conjunction with item 10990. Item 10990 is the $5.10 bulk billing incentive which can be claimed by all medical practitioners for certain bulk billed services.
This item also amends subrule 83(2) to include a reference to new item 10992. This subrule specifies that the bulk billing incentives apply in addition to the fee specified for any other item that applies to a service.
Item [3]
This item inserts a reference to new item 10992 in subrule 83(3). Subrule 83(3) specifies the conditions under which the bulk billing incentives can be claimed.
Item [4]
This item inserts a reference to new item 10992 in subrule 83(4). Subrule 83(4) defines certain terms used the bulk billing incentive items.
Item [5]
This item inserts a definition of ‘eligible area’ in subrule 83(4). Eligible area is defined as regional, rural and remote areas, the whole of Tasmania, identified urban statistical sub-divisions and the statistical local area of Palm Island, QLD. This definition was previously contained in the item descriptor for item 10991, and is not changed.
Item [6]
This item amends item 10990 to specify that it cannot be claimed in conjunction with new item 10992. Item 10990 is the $5.10 bulk billing incentive which can be claimed by all medical practitioners for certain bulk billed services.
Item [7]
This item amends item 10991 to specify that it cannot be claimed in conjunction with the new item 10992. Item 10991 is the $7.65 bulk billing incentive which can be claimed by medical practitioners based in eligible areas only for certain bulk billed services.
Item [8]
This item amends item 10991 to clarify that the item can only be claimed for services provided at or from a practice location in an eligible area. The list of eligible areas is removed from this item, as the areas is moved to subrule 83(4) (see item [5], above).
Item [9]
This item inserts new item 10992, and the conditions under which the item may be claimed. The conditions provide that item 10992 must be claimed in conjunction with other specified after-hour items in the general medical services table.