EXPLANATORY STATEMENT
Select Legislative Instrument 2008 No. 188
Health Insurance Act 1973
Health Insurance (General Medical Services Table) Amendment Regulations 2008 (No. 3)
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.
A table of general medical services is currently prescribed by the Health Insurance (General Medical Services Table) Regulations 2007 (the Principal Regulations) which commenced on 1 November 2007.
The purpose of the Regulations is to add a new rule to the Principal Regulations which prohibits the use of items 11000–12217 and 12500–12533 in the General Medical Services Table (GMST) for home-based sleep studies (i.e. overnight investigations for sleep apnoea, for a period of at least 8 hours duration). This rule will further clarify the original purpose of these items which is that they not be used for home-based sleep studies.
The amendment is part of the on-going management of the GMST. The Australian Medical Association, Medicare Australia, and the relevant craft groups have been consulted in the development of this rule.
The Department of Health and Aging consulted the Australian Medical Association, the Australasian Sleep Association, the Thoracic Society of Australia and New Zealand, the Royal Australian College of General Practitioners and the Rural Doctors Association of Australia regarding the introduction of a rule governing home-based sleep studies. Individual representations by medical practitioners were also submitted to the Department, which were noted and responded to.
The Act specifies no conditions which need to be met before the power to make the Regulations is exercised.
The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Regulations commence on 1 October 2008.
Overview
The Health Insurance (General Medical Services Table) Amendment Regulations 2008 (No. 3) were enacted under the authority of the Health Insurance Act 1973 to address a specific issue within the framework of Medicare benefits. This legislative instrument was introduced to clarify and restrict the use of certain items in the General Medical Services Table (GMST) for home-based sleep studies. These regulations aim to ensure that the items 11000–12217 and 12500–12533 are not used for overnight investigations for sleep apnoea, thereby adhering to the original intent of these items. The Australian Government, through the Department of Health and Ageing, consulted with relevant medical associations and practitioner groups, including the Australian Medical Association and the Australasian Sleep Association, to develop these amendments. The regulations, which commenced on 1 October 2008, are part of the ongoing management of the GMST and are intended to provide greater clarity and governance over the use of these medical service items within the Medicare system.
Scope and Application
The Health Insurance (General Medical Services Table) Amendment Regulations 2008 (No. 3) applies to all entities and persons involved in the provision and administration of Medicare benefits, specifically targeting the services listed in the General Medical Services Table (GMST) as outlined in the Health Insurance Act 1973. These regulations govern the fees for medical services provided to eligible persons under Medicare, ensuring compliance with the prescribed tables and rules for interpreting the table. The amendment introduced by these regulations explicitly prohibits the use of certain items in the GMST, namely items 11000–12217 and 12500–12533, for home-based sleep studies. This legislative change aims to clarify the intended use of these items, ensuring they are not applied to overnight investigations for sleep apnoea lasting at least eight hours, conducted at home. The jurisdictional reach of these regulations is national, as they are made under the authority of the Commonwealth of Australia. The regulations extend the application of the Act through subordinate instruments, clarifying specific conduct and transactions related to the provision of medical services.
Key Provisions
The Health Insurance (General Medical Services Table) Amendment Regulations 2008 (No. 3) (the Regulations) introduce a specific rule to the General Medical Services Table (GMST) that aims to clarify the use of certain medical service items in relation to home-based sleep studies (subsection 4(1)). This amendment specifically prohibits the use of items 11000–12217 and 12500–12533 for home-based sleep studies, which are overnight investigations for sleep apnoea lasting at least eight hours (subsection 133(1)). These items are intended for other medical services, and the amendment seeks to ensure they are not misapplied to home-based sleep studies. This legislative change was developed in consultation with key stakeholders, including the Australian Medical Association, Medicare Australia, and various professional medical associations.
Under these Regulations, parties and entities governed by the Health Insurance Act 1973 are required to adhere to the new rule prohibiting the use of certain GMST items for home-based sleep studies. Medical practitioners, Medicare providers, and any other entities involved in the provision of Medicare benefits must ensure they are compliant with this specific amendment. This includes correctly identifying the applicable items for sleep studies and ensuring that services provided are accurately coded and billed according to the updated rules in the GMST.
Failure to comply with the provisions of these Regulations can result in significant consequences. While the explanatory statement does not explicitly outline the penalties or consequences for non-compliance, the Act and associated regulations typically include provisions for both civil and criminal penalties. Civil penalties might include fines, while criminal penalties could involve imprisonment, depending on the nature and severity of the breach. The maximum penalties would be as specified in the relevant sections of the Health Insurance Act 1973 or any other related legislation. It is crucial for all parties involved to understand and adhere to these requirements to avoid any potential legal repercussions.