EXPLANATORY STATEMENT
Select Legislative Instrument 2008 No. 112
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2008 (No. 2)
Health Insurance (General Medical Services Table) Amendment Regulations 2008 (No. 2)
Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations prescribing all matters required 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’ which sets out the ‘items’ of medical services, the fees for each item and rules for interpreting the table. Subsection 4AA (1) of the Act makes similar provisions for diagnostic imaging services.
A table of general medical services is currently prescribed by the Health Insurance (General Medical Services Table) Regulations 2007 (the Principal Regulations) and a table of diagnostic imaging services is currently prescribed by the Health Insurance (Diagnostic Imaging Services Table) Regulations 2007 (the DIST Regulations), both of which commenced on 1 November 2007.
The Regulations are part of the on-going management of the General Medical Services and Diagnostic Imaging Services Tables and incorporate recommendations from the Medicare Benefits consultative Committee (MBCC) which are designed to ensure that the Medicare Benefits Scheme reflects current medical practice and encourages best practice.
The MBCC is an informal consultative forum established by agreement between the Minister of Health and Ageing and the Australian Medical Association (the AMA) with representation from the Department of Health and Ageing, Medicare Australia, the AMA and the craft groups.
The Regulations include:
- new and amended rules to:
- define eligibility, content and/or delivery of services covered in new items;
- provide standardised definitions of terms;
- the introduction of new items onto the list of Services and Fees; and
- the amendment of existing items.
Details of the Regulations are set out in the Attachment.
The Act specifies no conditions which must be met before the power to make the Regulations is exercised.
The Regulations are legislative instruments for the purposes of the Legislative Instruments Act 2003.
The Regulations commence on 1 July 2008.
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) AMENDMENT REGULATIONS 2008 (No. 2)
Regulation 1 – Name of Regulations
This regulation provides that the title of the Regulations is the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2008 (No. 2).
Regulation 2 - Commencement
This regulation provides for the Regulations to commence on 1 July 2008.
Regulation 3 – Amendment of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2007
This regulation provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2007 are amended as set out in Schedule 1.
Schedule 1 – Amendment
Item [1] amends item 59736 for certain sterilisation reversal procedures in line with 2008-09 Budget commitments to reinstate benefits.
DETAILS OF THE HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2008 (No. 2)
Regulation 1 – Name of Regulations
This regulation provides that the title of the Regulations is the Health Insurance (General Medical Services Table) Amendment Regulations 2008 (No. 2).
Regulation 2 - Commencement
This regulation provides for the Regulations to commence on 1 July 2008.
Regulation 3 – Amendment of the Health Insurance (General Medical Services Table) Regulations 2007
This regulation provides that Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2007.
Schedule 1 - Amendments
Rules of interpretation
Item [1]
Subrule 3(1)
This item introduces standard definitions of ‘patient’s usual medical practitioner’ and ‘practice nurse’. These standard definitions replace definitions which varied in wording, but not substance.
Item [2]
Subrule 3(1)
This item introduces a standard definition of ‘registered Aboriginal health worker’.
Items [3] and [4]
Rule 10 and subrule 10(1)
These items recognise new item 289 (‘autism’) (see item [22] below) by amending the heading of rule 10 and the list of items in subrule 10(1).
Item [5]
Rule 19A
This item introduces a new rule to define the application of new items 135 and 289 (see items [21] and [22] below). This rule limits the patient (a child aged under 13 years with autism or other developmental problems) to the services provided under either new item 135 or new item 289. The services comprise assessment and diagnosis, and the preparation of a treatment and management plan, drawn up by either a paediatrician (item 135) or a psychiatrist (item 289) for the child’s ongoing development.
Item [6]
Subrules 20(1A), 20(1B) and 20(1C)
This item introduces three new subrules which define eligibility for the services provided by new items 709 and 711 (‘Healthy Kids Check’) (see items [23] and [24] below), that the patient be
4 years old, that they have/are receiving their age-appropriate immunisation(s) and that they may avail themselves of the services provided under item 709 (services provided by a GP) or item 711 (services provided by a practice nurse under GP supervision).
Item [7]
Subrules 20(2A) and 20(2B)
This item introduces two subrules. Subrule 20(2A) defines eligibility for new item 713 (see item [25] below), patients aged at least 40 years but under 50 years, and with a high risk of developing type 2 diabetes and is not an in-patient. Subrule 20(2B) defines the ‘Australian type 2 diabetes risk assessment tool’ which is used in new Item 713. These new items introduce the Commonwealth’s component of the Council of Australian Government’s initiative aimed at reducing diabetes incidence.
Item [8]
Rule 22A
This item introduces a rule to define the content and delivery of services provided by new items 709 and 711 (‘Healthy Kids Check’), that the check be comprehensive and that, whenever possible, it be undertaken by the patient’s ‘usual medical practitioner’ so as to promote continuity of care.
Item [9]
Rule 24A
This item introduces a new rule to define the content of new item 713 (type 2 diabetes risk evaluation), the risk factors to be reviewed and appropriate interventions.
Item [10]
Subrule 27(10)
This item removes a redundant definition of ’practice nurse’.
Item [11]
Rule 60
This item clarifies that an ‘outer metropolitan specialist trainee’ is a participant in the Outer Metropolitan specialist Trainee Program which is administered by the Department of Health and Ageing. Program participants are eligible for higher Medicare payments.
Item [12]
Subrule 65(1)
This item removes a redundant definition of ‘registered Aboriginal health worker’.
Item [13]
Subrule 66(1)
This item removes the redundant definition of ‘registered Aboriginal health worker’.
Item [14]
Subrule 66(2)
This item renumbers the subrule following the removal of subrule 66(1) in item [13].
Item [15]
Subrules 68(1), 69(1) and 70(1)
This item removes redundant definitions of ‘practice nurse’.
Item [16]
Rule 71
This item removes the redundant definitions of ‘practice nurse’ and ‘registered Aboriginal health worker’.
Item [17]
Subrule 72(1)
This item removes redundant definitions of ‘practice nurse’.
Item [18]
Rule 78A
This item introduces a rule to clarify existing policy that current Medicare Benefits Scheme items may not be used to claim benefits for a service associated with the use of a pain pump in post-surgical pain management.
Item [19]
Rule 113A
This item introduces a new rule limiting the application of item 35321, so that it may not be claimed if the service is provided at the same time as, or in connection with endovenous laser treatment for varicose veins.
Services and Fees
Item [20]
New item 135 provides a one-off paediatric consultation for assessment, diagnosis and preparation of a treatment and management plan for a patient aged under 13 years with autism or other pervasive developmental disorder.
Item [21]
New item 289 provides a one-off psychiatric consultation for assessment, diagnosis and preparation of a treatment and management plan for a patient aged under 13 years with autism or other pervasive developmental disorder.
Item [22]
New item 709 introduces a one-off health check for a four year old patient who is receiving or has received their age-appropriate immunisation; the check to be undertaken by a medical practitioner.
Item [23]
New item 711 introduces a one-off health check for a four year old patient who is receiving or has received their age-appropriate immunisation; the check to be undertaken by a practice nurse on behalf of, and under the supervision of a medical practitioner.
Item [24]
New item 713 introduces a type 2 diabetes risk evaluation for a patient aged 40 to 49 (inclusive) with a high risk of developing type 2 diabetes, as determined by the Australian Type 2 Diabetes Risk Assessment Tool; the evaluation to be undertaken by a medical practitioner.
Items [25]
This item amends the descriptor of therapeutic nuclear medicine item 16018 to extend its applicability.
Item [26]
This item amends the descriptor of regional nerve block item 18292 to extend its applicability.
Item [27] to [34] and items [37] to [44]
These items introduce 16 new anaesthesia items to reflect current clinical practice.
Items [35], [36] and [45]
These items amend anaesthesia items 20920, 20942 and 22007, respectively, to reflect current clinical practice.
Items [46] and [47]
These items amend the descriptors of items 30487 (bowel surgery) and 35321 (peripheral arterial or venous catheterisation) to clarify their policy intent.
Items [48] and [49]
Item [48] amends item 35700 and Item [49] amends items 37616 and 37619 to reinstate benefits for sterilisation reversal procedures.
Item [50], [51] and [52]
Items [50] and [51] amend ophthalmology items 42644 and 42740, respectively, and item [52] amends orthopaedic surgery items 49503 and 49506, to clarify their policy intent.