EXPLANATORY STATEMENT

Select Legislative Instrument 2009 No. 61

Health Insurance Act 1973

Health Insurance (General Medical Services Table) Amendment Regulations 2009 (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.

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 are 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) which sets out items of medical services, the amount of fees applicable for each item, and rules for interpreting the table.  The Health Insurance (General Medical Services Table) Regulations 2008 currently prescribe such a table.

The Regulations amend the descriptors for 74 items to more accurately reflect current clinical practice.

These changes have been recommended in reviews by the Medicare Benefits Consultative Committee and other stakeholder consultation forums.  The reviews are designed to ensure that the table reflects current medical practice and encourages best medical practice.

The Act specifies no conditions which need to be met before the power to make the Regulations is exercised. 

Consultation was undertaken with the Australian Medical Association, Medicare Australia and the relevant craft groups.  All organisations consulted either requested the changes in question or raised no objections to departmental proposals.  For each new item and for each amended item, consultation was undertaken to develop an accurant and unambiguous item descriptor.

The craft groups consulted included the Australian and New Zealand Society of Vascular Surgeons, the Royal Australian and New Zealand College of Radiology, the Australian and New Zealand Society of Phlebology, and the Australasian College of Phlebology  (Items [2], [5] – [9]); the Colorectal Surgical Society of Australia and New Zealand, and General Surgeons Australia (Item [3]); the Gastroenterological Society of Australia (Items [3] and [4]); the Royal Australasian College of Physicians (Item [4]; the Royal Australasian College of Surgeons (Items [2],[ 4] –[ 9]); the Urological Society of Australia and New Zealand, and the Australian and New Zealand Association of Urological Surgeons (Items [10] –[ 48]); the Neurosurgical Society of Australasia, and the Australian and New Zealand Association of Neurologists (Items [9], [49] and [50]); the Australian Society of Orthopaedic Surgeons (Items [51] – [111]).

The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

The  Regulations commence on 1 May 2009.

   Authority: Subsection 133(1) of the

     Health Insurance Act 1973

ATTACHMENT

DETAILS OF THE HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2009 (No. 1)

Regulation 1 – Name of Regulations

This regulation provides that the title of the Regulations is the Health Insurance (General Medical Services Table) Amendment Regulations 2009 (No. 1).

Regulation 2 - Commencement

This regulation provides for the Regulations to commence on 1 May 2009.

Regulation 3 – Amendment of the Health Insurance (General Medical Services Table) Regulations 2008

This regulation provides that Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2008.

Schedule 1 - Amendments

Rules of interpretation

Item [1]

Subrule 13(2)

This item rectifies an unintended omission.  Currently, subrule 13(2) omits reference to paragraph (a) in subrule 13(1).  The effect of this omission is to deny a medical practitioner who has his or her own general-practice (or who has a service contract with a large private provider of GP-services) a Medicare fee when a practice nurse or other eligible person provides said practitioner with essential assistance in accordance with accepted medical practice.  This omission is rectified by inserting in subrule 13(2) a reference to 13(1)(a).

Item [2]

Rule 113A 

This item amends rule 113A to include references to items 32500 to 32517 (varicose veins), and to radiofrequency diathermy and radiofrequency ablation.  The purpose of the amendment is to prevent payment of fees under items 32500 to 32517 and item 35321 when the treatment involves radiofrequency diathermy and radiofrequency ablation.

Services and Fees

Items [3] to [6]

These amendments make items 32500 to 32517 subject to rule 113A in Schedule 1, Part 2 of this table.  This amendment  is consequential to the amendment to rule 113A in item [2] (supra) and prevents application of the items to treatment involving radiofrequency diathermy and radiofrequency ablation.

Item [7]

This amendment clarifies that item 35321 (peripheral arterial or venous catheterisation) does not apply to the treatment of varicose veins.

Items [8] to [19], [23], [25] and [29] to [38]

These amendments clarify that the specified items may not be applied to services which may be claimed under items 47933 or 47936.

Item [20]

This amendment clarifies the type of arthroscopic treatment to which item 45857 might be applied.

Items [21] to [22], [39] to [41], [43] to [46], [50] to [51], [55], [58] to [63], and [65]

These amendments provide that the specified items apply also when synovectomy is performed.

Item [24]

This amendment permits item 47465 to be used by a medical practitioner assisting during treatment of a fractured clavicle by open reduction.

Item [26]

This amendment clarifies item 47933 by defining the term ‘small exostosis’.

Item [27]

This amendment clarifies item 47936 by defining the term ‘large exostosis’.

Item [28]

These amendments clarify that fees will only be paid under items 47954, 47957 and 47966 when the procedures specified in these items are performed as independent procedures.

Item [42]

This amendment provides that item 49118 applies also when lavage is performed.

Items [47] to [49], [52] to [54], [56] to [57] and [64]

These amendments clarify that the specified items are limited to the arthroscopic procedures specified in these items.