EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Management of Bulk-Billed After Hours and Unsociable Hours Services) Determination 2010
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may determine in writing that a health service not specified in an item in the General Medical Services Table (the Table) shall, in specified circumstances and for the purposes of specified statutory provisions, be treated as if it were so specified. The Table is set out in the Health Insurance (General Medical Services Table) Regulations 2009 which are re-made each year.
A determination made under subsection 3C(1) of the Act is a legislative instrument (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
The Health Insurance (Management of Bulk-billed After Hours and Unsociable Hours Services) Determination 2010 (the Determination) creates a new item for the management of certain bulk-billed services. The new item will enable the payment of an additional Medicare benefit to doctors for bulk-billing new after hours and unsociable hours attendance services under specified circumstances. The new after hours and unsociable hours attendance services, introduced from 1 May 2010 to simplify the Table as part of the Medicare Benefit Schedule (MBS) Review, are item numbers 597, 598, 599 and 600.
Medicare benefits are payable for the new management of bulk-billed services item where a medical practitioner:
(a) provides a service to which item 597, 598, 599 or 600 applies:
(i) as an unreferred service;
(ii) to a person who is under 16 or a Commonwealth concession card holder and who is not an admitted hospital patient;
(iii) outside of consulting rooms; and
(iv) in an eligible area (including a rural, regional or remote area, Tasmania, or other specified geographical area) and the eligible is not the area in which the practitioner’s practice is located; and
(b) bulk-bills both the ‘management of bulk-billed service’ item and the after hours or unsociable hours attendance item.
This Determination commences on 1 May 2010.
Consultation
Among the organisations consulted during the MBS Review were the Australian College of Rural and Remote Medicine, the Australian Medical Association, The Royal Australian College of General Practitioners, the Rural Doctors Association Australia, the National Aboriginal Community Controlled Health Organisations, the Department of Veterans’ Affairs, Medicare Australia and the Professional Services Review.
Details of the Determination are set out in the Attachment.
ATTACHMENT
Notes on sections in the Determination
Section 1
Section 1 provides the name of the Determination.
Section 2
Subsection 2(1) provides that the Determination commences on 1 May 2010.
Subsection 2(2) provides that the Determination ceases at midnight on 30 June 2010.
Section 3
Subsection 3(1) defines terms used in this Determination.
Subsection 3(2) provides that a reference to a provision of an Act or regulations is a reference to the provision as in force from time to time (as authorised by subsection 3C(3) of the Act).
Section 4
Paragraph 4(a) provides that a relevant service specified in the Schedule to the Determination is to be treated as if it were both a professional service and a medical service for the purposes of the provisions of the Act, the National Health Act 1953 and regulations made under each Act which provide for medical services or professional services.
Paragraph 4(b) provides that a relevant service specified in the Schedule to the Determination is to be treated as if there were an item in Group M1 – Management of bulk-billed services of the Table that related to the relevant service and specified a fee for that service, being the fee specified in the Schedule in relation to the service.
Section 5
Subsection 5(1) provides that where the service described in item 10985 is provided to a person, either item 10985 or item 10990 of the Table, but not both, applies to the service.
Section 6
Subsection 6(1) provides that subrules 67(3), 67(4) and 67(5) of the Table shall have effect as if item 10985 were also specified in each of the subrules. Accordingly:
(a) subrule 67(3) will have the effect that, where item 10985 applies to a medical service, the fee specified for that item will apply in addition to the fee specified for any other item in the Table that applies to the same medical service;
(b) subrule 67(4) will define the terms ‘bulk-billed’, ‘Commonwealth concession card holder’ and ‘unreferred service’ for the purposes of item 10985; and
(c) subrule 67(5) will define the terms ‘eligible area’, ‘practice location’ and ‘regional, rural or remote area’ for the purposes of item 10985. An eligible area is:
- an area classified as RRMA 3-7 under the Rural, Remote and Metropolitan Areas Classification;
- Tasmania; or
- a geographical area within certain Statistical Subdivisions (as specified in the Australian Standard Geographical Classification 2002) including Darwin City, Belconnen, Southern Adelaide, Eastern Outer Melbourne and Newcastle.
Subsection 6(2) provides that subrule 93(3) of the Table shall have effect as if subrule 93(3) referred to ‘items 10985, 10990, 10991 or 10992’. Subrule 93(3) will therefore prevent item 16400 of the Table, which relates to antenatal services provided by a midwife, nurse or registered Aboriginal Health Worker, from applying in conjunction with item 10985.
Schedule
The Schedule to the Determination sets out the relevant service, assigns the applicable item number, item descriptor and fee for the service.