Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 1)

Legislation au C2004L02432 Regulations Not in force Legislative Instrument

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Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 1) 2004 No. 65

EXPLANATORY STATEMENT

STATUTORY RULES 2004 NO. 65

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. 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.

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 2003 currently prescribe such a table.

The purpose of the Regulations is to amend the current table of medical services by introducing a new item, and rules for determining its application, to give effect to changes announced in the Australian Government's MedicarePlus package. The new item allows a higher Medicare benefit to be paid to a practitioner in a regional, rural or remote area, or in Tasmania, where a bulk billed service is provided to an eligible patient who is under 16 years of age or who is a Commonwealth concession card holder.

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 May 2004.

ATTACHMENT

DETAILS OF THE HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2004 (No. 1)

Regulation 1 provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 1).

Regulation 2 provides for the Regulations to commence on 1 May 2004.

Regulation 3 provides for Schedule 1 to amend the Health Insurance (General Medical Services Table) Regulations 2003 (the Principal Regulations).

Schedule 1 - Amendments

Item [1] Heading of rule 77

This amends the heading of rule 77 to include new item 10991 (see item [8] below).

Item [2] Application of items 10990 and 10991 in subrule 77 (1)

This amends subrule 77 (1) to specify that either item 10990 or 10991, but not both items, can be claimed in relation to a medical service provided in a regional, rural or remote area, or in Tasmania. It also specifies that the fee payable under item 10990 or 10991 applies in addition to the fee for the medical service.

Item [3] Subrule 77 (2)

This amends subrule 77 (2) to specify that the definitions of "bulk-billed", "Commonwealth concession card holder" and "unreferred service" in subrule 77 (2) also apply to item 10991.

Item [4] Definition of "bulk-billed" in subrule 77 (2)

This amends subrule 77 (2) to replace the term "under whose supervision" with "on behalf of in the definition of "bulk-billed".

Item [5] Definition of "unreferred service" in subrule 77 (2)

This amends subrule 77 (3) to replace the term "under whose supervision" with "on behalf of in the definition of "unreferred service".

Item [6] New subrule 77 (3)

This inserts a new subrule 77 (3) to define the terms "practice location", "regional, rural or remote area" and "Rural, Remote and Metropolitan Areas Classification" for the purposes of item 10991.

Item [7] Item number 10990

This amends item 10990 to prevent item 10991 from being claimed in conjunction with item 10990.

Item [8] New item number 10991

This introduces a new item 10991 to allow an additional amount to be payable when any unreferred service is bulk billed and provided to a person under the age of 16 or a Commonwealth concession card holder (where that person is not an admitted patient at a hospital or day-hospital facility) and where the service is provided at or from a practice location in a regional, rural or remote area, or in Tasmania.

 

Overview

The Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 1) were enacted to address the need for adjustments in the Medicare benefits structure, particularly in regional, rural, and remote areas, as well as in Tasmania. This regulation, issued under the authority of the Minister for Health and Ageing, was made in accordance with Subsection 133(1) of the Health Insurance Act 1973, which empowers the Governor-General to create regulations necessary for the implementation of the Act. The primary objective of these regulations is to amend the existing table of medical services by introducing a new item, item 10991, which facilitates higher Medicare benefits for services provided under specific conditions, such as services rendered in designated areas to patients under 16 or to Commonwealth concession card holders, when those services are bulk billed. These amendments aim to better support healthcare practitioners in underserved regions and ensure equitable access to healthcare services across different areas.

Scope and Application

The Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 1) apply to practitioners and entities providing medical services under the Health Insurance Act 1973, particularly in regional, rural, or remote areas, or in Tasmania, for eligible patients. These Regulations amend the existing table of medical services by introducing a new item to allow for an increased Medicare benefit for certain services. Specifically, this applies to services provided to patients under 16 years of age or to Commonwealth concession card holders, when these services are bulk billed and performed in designated areas. The Regulations do not specify any exclusions or exemptions beyond what is outlined in the Health Insurance Act 1973, and they are intended to give effect to the MedicarePlus package changes announced by the Australian Government. The Regulations extend the application of the Act by amending the table of medical services and the associated fees, thereby affecting the payments for medical services rendered under Medicare.

Key Provisions

The Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 1) amend the Health Insurance (General Medical Services Table) Regulations 2003 by introducing a new item (item 10991) to the table of medical services. This new item, as detailed in Schedule 1, allows for a higher Medicare benefit to be paid to practitioners in regional, rural, remote areas, or in Tasmania, when they provide bulk-billed services to eligible patients under 16 years of age or Commonwealth concession card holders. The amendment is intended to support the Australian Government's MedicarePlus package by recognising the additional costs and difficulties faced by practitioners in these areas. Regulation 3 ensures that these amendments come into effect by modifying the Principal Regulations. Under these Regulations, medical practitioners must adhere to specific guidelines to be eligible for the higher Medicare benefits outlined in item 10991. For instance, the service must be bulk-billed, meaning no out-of-pocket expense is incurred by the patient, and the patient must either be under 16 years of age or hold a Commonwealth concession card. Furthermore, the service must be an unreferred service provided at or from a practice location in a regional, rural, or remote area, or in Tasmania. Practitioners must also ensure they do not claim both items 10990 and 10991 for the same service, as specified in item [7] and subrule 77(1). Definitions of terms such as "bulk-billed" and "unreferred service" have also been updated to clarify their application to item 10991. Failure to comply with the stipulations of these Regulations can lead to significant consequences. While the Explanatory Statement does not detail specific penalties, breaches of Medicare regulations generally attract financial penalties, and in severe cases, may lead to criminal charges. Non-compliance might also result in the practitioner being ineligible for the higher Medicare benefits, effectively reducing their compensation for services rendered under these conditions. Practitioners must therefore ensure strict adherence to these guidelines to avoid any adverse repercussions.

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