EXPLANATORY STATEMENT
STATUTORY RULES 2004 NO. 387
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. 11)
Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides, in part, 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 set out items of medical services, the amount of fees applicable tin respect of each item and rules for interpretation of the table. The Health Insurance (General Medical Services Table) Regulations 2004 currently prescribe such a table.
The purpose of the Regulations is to amend the current table of medical services by introducing a new item, to provide a Medicare benefit for a cervical smear that is taken by a practice nurse on behalf of a medical practitioner in a regional, rural or remote area. The Regulations give effect to one of the measures in the Australian Government’s election policy, “Investing in Stronger Regions”.
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. 11)
Regulation 1 provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 11).
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) Amendment Regulations 2004 (the Principal Regulations).
Schedule 1 – Amendments
Item [1] - New rule 86
This item inserts new rule 86, which applies to item 10998 (see item [2] below).
Rule 86 describes the circumstances in which item 10998 applies, and defines the terms “enrolled nurse”, “general practice”, “practice location”, practice nurse”, “regional, rural or remote area” and “Rural, Remote and Metropolitan Areas Classification” for the purposes of item 10998.
Item [2] – New item 10998
This item inserts new item 10998 in Part 3 of Schedule 1 to the Principal Regulations.
Item 10998 applies where a practice nurse takes a cervical smear on behalf of a supervising medical practitioner in a regional, rural or remote area, where the patient is not an admitted patient of a hospital or approved day hospital facility.
Overview
The Health Insurance Act 1973 was enacted to facilitate the provision of Medicare benefits to eligible individuals for professional services rendered. The Act ensures that benefits are calculated according to fees set out in prescribed tables, with the Health Insurance (General Medical Services Table) Regulations 2004 detailing a table of medical services excluding diagnostic imaging and pathology services. The Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 11), issued under the authority of the Minister for Health and Ageing, aim to address a gap in the existing table by introducing a new item to provide a Medicare benefit for a cervical smear taken by a practice nurse on behalf of a medical practitioner in regional, rural, or remote areas. This amendment aligns with the Australian Government’s election policy, "Investing in Stronger Regions," by enhancing healthcare accessibility in less populated areas. The Regulations, which commenced on 1 January 2005, include new definitions and rules to specify the circumstances under which the new benefit applies.
Scope and Application
The Health Insurance Act 1973 applies to the payment of Medicare benefits for professional services rendered to eligible individuals, with a focus on medical services, excluding diagnostic imaging and pathology services. The Act authorises the Governor-General to create regulations that detail the fees for these services and the rules for interpreting the prescribed tables. The Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 11) introduce a new item to the table, providing a Medicare benefit for a cervical smear taken by a practice nurse on behalf of a medical practitioner in regional, rural, or remote areas, in line with the Australian Government’s policy to invest in stronger regions. The Regulations commence on 1 January 2005 and do not specify any conditions for their enactment. The scope of the Act extends to the entire Commonwealth of Australia, encompassing all eligible persons and entities, including medical practitioners and practice nurses operating within the designated areas. The Regulations themselves may extend or restrict application through subordinate instruments, as necessary.
Key Provisions
The main operative sections of the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 11) introduce new provisions to the existing Health Insurance (General Medical Services Table) Regulations 2004. Regulation 1 names the Regulations, while Regulation 2 specifies the commencement date, 1 January 2005. Regulation 3 refers to the amendments made in Schedule 1. The significant changes are detailed in Item [1] and Item [2] of Schedule 1. Item [1] introduces new rule 86, which outlines the conditions for the application of item 10998, including definitions for terms such as "practice nurse" and "regional, rural or remote area". Item [2] adds a new item 10998 to the table of medical services, which provides a Medicare benefit for a cervical smear taken by a practice nurse on behalf of a medical practitioner in a regional, rural or remote area.
The Regulations impose specific obligations on the parties involved, particularly medical practitioners, practice nurses, and patients. Medical practitioners must ensure that practice nurses who perform cervical smears are adequately supervised and that the services are provided in the specified regional, rural, or remote areas. Practice nurses must adhere to the conditions defined in rule 86 and ensure that the cervical smears are performed in accordance with the regulations. Patients must be informed that the service is eligible for a Medicare benefit if the conditions are met.
There are no specific offences, penalties, or consequences mentioned in the text for breach of the Regulations. However, any non-compliance with the Act or the Regulations may result in the denial of Medicare benefits for the services provided. This could have financial implications for the patients if they are not aware of the conditions required for the benefit to apply, and it could also affect the practice's ability to claim reimbursement for the services rendered. It is important for all parties to understand and comply with the regulations to avoid any potential issues with Medicare claims and benefits.