Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 3) 2004 No. 126
EXPLANATORY STATEMENT
STATUTORY RULES 2004 No. 126
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. 3)
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 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 by the Australian Government on 18 November 2003 to strengthen and protect Medicare. The new item allow a Medicare benefit to be paid when a medical practitioner undertakes a comprehensive medical assessment for a permanent resident of a Residential Aged Care Facility. The new item will not be able to be claimed more than once in a twelve month period in respect of the same person.
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 July 2004.
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2004 (No. 3)
Regulation 1 provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 3).
Regulation 2 provides for the Regulations to commence on 1 July 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] Definition of 'Comprehensive Medical Assessment' in rule 43B
This item inserts a new rule 43B into Part 2 of Schedule 1 to the Principal Regulations to define the term 'Comprehensive Medical Assessment' for the purposes of new item 712 (see item [2] below).
Item [2] New item 712
This item introduces a new item 712 into Part 3 of Schedule 1 to the Principal Regulations to allow for attendance by a medical practitioner at a residential aged care facility or at consulting rooms for a comprehensive medical assessment of a permanent resident of a residential aged care facility. This also stipulates patient eligibility (including that the item could not be claimed more than once in a twelve month period in respect of the same person) and the fee payable for this item.
Overview
The Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 3) were enacted to address a specific gap in the provision of medical services under the Health Insurance Act 1973. This piece of legislation was introduced to enable the payment of Medicare benefits for comprehensive medical assessments of permanent residents in Residential Aged Care Facilities, a service that was previously not covered under existing medical service items. The regulations were made under the authority of the Minister for Health and Ageing, and they aim to give effect to the policy objective of strengthening and protecting Medicare, as announced by the Australian Government. The regulations amend the existing Health Insurance (General Medical Services Table) Regulations 2003 by adding a new item and defining the conditions for its application, ensuring that such assessments are appropriately compensated and can only be claimed once per twelve-month period for the same individual. These amendments took effect from 1 July 2004.
Scope and Application
The Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 3) amend the existing table of medical services under the Health Insurance Act 1973 to include a new item for a comprehensive medical assessment of a permanent resident of a residential aged care facility. These regulations apply to medical practitioners and other relevant entities involved in providing medical services to eligible persons, particularly those in residential aged care facilities. The regulations do not specify any exclusions or thresholds but limit the claim for this new item to once per twelve months for the same individual. The regulations extend the application of the Act by adding a new provision that allows for the payment of Medicare benefits for the defined medical assessment service, enhancing the scope of services covered under the Act. The amendments are effective from 1 July 2004, and the regulations are made under the authority of the Minister for Health and Ageing, ensuring they are consistent with the overarching provisions of the Health Insurance Act 1973.
Key Provisions
The Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 3) amend the existing table of medical services by introducing a new item, specifically item 712, into the Health Insurance (General Medical Services Table) Regulations 2003. Regulation 1 designates these amendments as the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 3), while Regulation 2 stipulates that these amendments take effect from 1 July 2004. Regulation 3 then amends the Principal Regulations by incorporating Schedule 1. Schedule 1 details the specific changes, including the introduction of a new definition for 'Comprehensive Medical Assessment' and the addition of item 712, which allows a medical practitioner to claim a Medicare benefit for conducting a comprehensive medical assessment for a permanent resident of a residential aged care facility.
Under the new provisions, the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 3) impose specific obligations on medical practitioners and residents of residential aged care facilities. Medical practitioners are required to adhere to the newly defined 'Comprehensive Medical Assessment' and must ensure that this service is provided within the stipulated parameters, including the limitation that it can only be claimed once per twelve-month period for the same resident. This means that if a medical practitioner conducts such an assessment, they must accurately document and claim the service according to the rules set forth in the new item 712. For the residents, this change means they can expect more thorough medical evaluations within the facilities, provided they meet the eligibility criteria stipulated in the new regulations.
The Act and the amending Regulations do not explicitly outline specific offences or penalties for breaches of the new provisions. However, any failure to comply with the conditions outlined in the new item 712 could potentially lead to civil or administrative consequences under the broader framework of the Health Insurance Act 1973. For instance, incorrect claims or misrepresentation of services rendered could be subject to penalties under the general provisions of the Act, which may include financial penalties or corrective actions against the practitioner. Given the absence of specific penalties in the Regulations, it is crucial for practitioners to adhere strictly to the new guidelines to avoid any legal repercussions.