Health Insurance (General Medical Services Table) Amendment Regulations 2010 (No. 2)

Administered by Department of Health, Disability and Ageing

Legislation au F2010L00501 Regulations Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

 

Select Legislative Instrument 2010 No. 27

 

Health Insurance Act 1973

 

Health Insurance (General Medical Services Table) Amendment Regulations 2010 (No. 2)

 

 

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 with 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 fees applicable for each item, and rules for interpreting the table.  The Health Insurance (General Medical Services Table) Regulations 2009 (the Principal Regulations) currently prescribe such a table.

 

The Regulations amend five items in the Principal Regulations.

 

These amendments

  • amend the descriptor in item 37220 so that a fee may be paid for anaesthesia provided in conjunction with the  prostate cancer treatment specified in that item; and
  • amend the descriptors in items 104, 16401, 16590 and 16591 to give effect to measures in the 2009-10 Budget which cap Medicare benefits under the extended Medicare safety net for obstetric services.

 

Details of the Regulations are set out in the Attachment.

 

Consultation was undertaken with the Australian Medical Association and Medicare Australia for all amendments.  For the obstetric items (16401, 16590, 16591), consultation was also undertaken with the Royal Australian College of General Practitioners, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the National Association of Specialist Obstetricians and Gynaecologists.  The AMA and the craft groups supported the amendments.

 

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 March 2010. 

 

 


ATTACHMENT

 

DETAILS OF THE HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2010 (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 2010 (No. 2).

 

Regulation 2 - Commencement

 

This regulation provides for the Regulations to commence on 1 March 2010.

 

Regulation 3 – Amendment of the Health Insurance (General Medical Services Table) Regulations 2009

 

This regulation provides that Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2009 (the Principal Regulations).

 

Schedule 1 – Amendments

 

Rules of interpretation

 

Item [1]  Schedule 1, subrule 3(2A)

 

This item removes the definition of 'therapeutic substance' from the Principal Regulations, thereby allowing treating medical practitioners freedom to exercise their clinical judgement as to which 'therapeutic substance’ best meets the individual needs of their patients.      

 

Item [2]  Schedule 1, subrule 9(1)

 

This item amends the specified rule so that the definition of professional attendance also applies in obstetric items 16401, 16404, 16590 and 16591 which were introduced on 1 January 2010.

 

Item [3]  Schedule 1, subrule 13(3)

 

This item amends the specified rule to include items 16590 and 16591 in a group of items whose services may be provided by medical practitioners excepting a medical practitioner employed in a public hospital unless the medical practitioner is working out of their public hospital employment.  The purpose of identifying these items is to prevent them from being used to shift service costs from the state/territory health systems to medicare.

 

Item [4]  Schedule 1, rule 82

 

This item amends the specified rule to clarify the fact that it was intended to include semen preparation in the definition of ‘embryology laboratory services’.

 

Item [5]  Schedule 1, rule 88

 

This item amends the specified rule so that the specific definition of ‘delivery’ also applies in obstetric items 16590 and 16591.

 

 

 

Services and Fees

 

Items [6] to [8]  Schedule 1, items 104, 16401, 16590 and 16591

 

These items amends the descriptors in items 104, 16401, 16590 and 16591 to give effect to measures in the 2009-10 Budget, which cap patient benefits under the extended Medicare safety net for obstetric services.

 

Item [9]  Schedule 1, item 37220

 

This item amends the descriptor in item 37220 so that a fee is payable for anaesthesia provided in conjunction with the prostate cancer treatment specified in that item.

 

Overview

The Health Insurance (General Medical Services Table) Amendment Regulations 2010 (No. 2) were introduced to make amendments to the Health Insurance (General Medical Services Table) Regulations 2009, which were enacted under the Health Insurance Act 1973. The primary aim of this Act was to establish a national health insurance scheme, Medicare, to provide access to medical services and hospital treatment for eligible persons. The Regulations seek to address specific gaps in the original framework by updating the fees for certain medical services and implementing measures to cap patient benefits for obstetric services, as outlined in the 2009-10 Budget. The Australian Parliament enacted these Regulations to ensure that the Health Insurance Act could effectively provide for the payment of Medicare benefits for professional services rendered to eligible persons, with specific amendments to the General Medical Services Table to reflect changes in clinical practices and budgetary measures. The policy objective behind these amendments is to maintain the sustainability of the Medicare system while ensuring that medical practitioners have the flexibility to provide the best possible care to their patients.

Scope and Application

The Health Insurance (General Medical Services Table) Amendment Regulations 2010 (No. 2) amends the Health Insurance (General Medical Services Table) Regulations 2009 under the Health Insurance Act 1973. These regulations apply to medical practitioners, patients, and Medicare, specifically affecting the payment of Medicare benefits for professional services rendered to eligible persons. The amendments pertain to the fees for medical services and the rules for interpreting the table of medical services, which are set out in the Principal Regulations. The changes include adjustments to descriptors and fees for specific medical services, such as anaesthesia for prostate cancer treatment and obstetric services, to align with budgetary measures and clinical practices. The regulations extend across the Commonwealth, ensuring a uniform approach to the payment of Medicare benefits. The Act does not specify exclusions, but certain items, such as diagnostic imaging and pathology services, are not covered by these regulations. The amendments are effective from 1 March 2010, and further adjustments can be made through subordinate instruments as necessary.

Key Provisions

The Health Insurance (General Medical Services Table) Amendment Regulations 2010 (No. 2) (Regulations) primarily amend the Health Insurance (General Medical Services Table) Regulations 2009 (Principal Regulations) to align with certain policy measures introduced in the 2009-10 Budget. These amendments are detailed in Schedule 1, which modifies various rules and items to reflect changes in the medical services table and the associated fees. Specifically, the Regulations amend five items in the Principal Regulations. For instance, item 37220 has been altered to allow a fee for anaesthesia provided in conjunction with prostate cancer treatment, while items 104, 16401, 16590, and 16591 have been updated to implement caps on Medicare benefits for obstetric services under the extended Medicare safety net (sections 3(6) to 3(8) of Schedule 1). The Regulations impose specific obligations on medical practitioners and other parties involved in the provision and administration of Medicare benefits. Medical practitioners must adhere to the updated descriptors and fee structures as outlined in the amended items, ensuring that they exercise their clinical judgment in accordance with the new definitions and rules provided (section 3(2A) and section 3(9)(1) of Schedule 1). Additionally, the Regulations require that certain medical services, particularly those related to obstetrics, be provided by medical practitioners who are not employed in public hospitals, unless they are working outside their public hospital employment (section 3(13)(3) of Schedule 1). This is to prevent the shifting of service costs from state/territory health systems to Medicare. Failure to comply with the provisions of the Regulations may result in legal consequences. While the Act itself does not specify particular offences or penalties for breaches of the Regulations, any non-compliance could potentially lead to civil or criminal liability depending on the nature and extent of the breach. The specific consequences would depend on the interpretation of the Regulations by the courts and the relevant administrative actions taken by the Department of Health or other authorised bodies. It is crucial for all parties to understand and adhere to the updated medical services table to avoid any potential legal repercussions.

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