AUSTRALIAN GOVERNMENT
DEPARTMENT OF HEALTH
HEALTH INSURANCE ACT 1973
Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Services Provided on Norfolk Island) Direction 2022
I, Nigel Murray, Assistant Secretary, MBS Policy and Specialist Services Branch, Medical Benefits Division, delegate of the Minister for Health and Aged Care, pursuant to subsection 19(2) of the Health Insurance Act 1973 (the Act), hereby:
(1) REVOKE the Direction under subsection 19(2) of the Act that was granted on
1 July 2016 that Medicare benefits shall be payable in respect of a professional service, pathology service and diagnostic imaging service rendered on Norfolk Island by, on behalf of, or under an arrangement with the Commonwealth, a State, or an authority established by a law of the Commonwealth or law of a State.
(2) DIRECT that Medicare benefits shall be payable in respect of:
a) a professional service (as defined in Section 3 of the Act) which has been agreed to be provided by, or on behalf of, or under an arrangement under the Inter-Governmental Partnership Agreement on State Service Delivery to Norfolk Island between the Commonwealth of Australia and the State of Queensland, for which items specified:
(i) in the general medical services table (means the table
prescribed under subsection 4(1) of the Act) relate; and
(ii) in the pathology services table (means the table prescribed under subsection 4A(1) of the Act) which were rendered in a State or Territory other than Norfolk Island – if the pathology service rendered requires a pathology specimen collected from an eligible person on Norfolk Island; and
(iii) in the diagnostic imaging services table (means the table prescribed under subsection 4AA(1) of the Act ), where the diagnostic imaging procedure for use in the rendering of the diagnostic imaging service was performed on Norfolk Island; and
b) where the professional service is rendered to:
(i) an eligible person (as defined in Section 3 of the Act) on Norfolk Island; and
(ii) a patient who is not receiving an episode of hospital treatment (as defined in Section 121-5 of the Private Health Insurance Act 2007).
Note: ‘Professional service’ as used in this Direction is defined in the Act.
(3) DECLARE that this direction is effective from the date of signature.
Dated this 22 day of February 2022
Nigel Murray
Assistant Secretary
Medical Benefits Division
Health Resourcing Group
Department of Health
Overview
The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Services Provided on Norfolk Island) Direction 2022 is a notifiable instrument enacted by the Australian Government Department of Health. It was introduced to address a specific gap in Medicare coverage for services provided on Norfolk Island. This Direction revokes a previous Direction from 2016 and aims to ensure that Medicare benefits are payable for certain professional services rendered on Norfolk Island. This includes services that are provided under the Inter-Governmental Partnership Agreement on State Service Delivery between the Commonwealth of Australia and the State of Queensland. The policy objective is to align the provision of Medicare benefits with the current service delivery arrangements on Norfolk Island, ensuring that eligible persons receive the necessary medical services without undue financial burden. This Direction is effective from the date of signature, 22 February 2022, and was issued by Nigel Murray, the Assistant Secretary of the MBS Policy and Specialist Services Branch in the Medical Benefits Division, on behalf of the Minister for Health and Aged Care.
Scope and Application
The Health Insurance (Medicare Benefits Payable in Respect of Professional Services – Services Provided on Norfolk Island) Direction 2022 applies to professional, pathology, and diagnostic imaging services rendered on Norfolk Island. This Direction is made pursuant to subsection 19(2) of the Health Insurance Act 1973, and it outlines specific conditions under which Medicare benefits will be payable. These conditions include services agreed to be provided by, or on behalf of, or under an arrangement under the Inter-Governmental Partnership Agreement on State Service Delivery to Norfolk Island between the Commonwealth of Australia and the State of Queensland. The Direction specifies that benefits will apply to services listed in the general medical services, pathology services, and diagnostic imaging services tables of the Act, subject to certain conditions such as the collection of pathology specimens from eligible persons on Norfolk Island and the performance of diagnostic imaging procedures on Norfolk Island. This Direction revokes the previous Direction granted on 1 July 2016 and is effective from the date of signature, thereby updating the scope and application of Medicare benefits for services provided on Norfolk Island.
Key Provisions
The main operative sections of this legislation revolve around the revocation of a previous direction (Section 1) and the establishment of a new direction concerning Medicare benefits (Section 2). Specifically, Section 1 revokes the earlier Direction from 1 July 2016 that allowed Medicare benefits for professional, pathology, and diagnostic imaging services rendered on Norfolk Island. Section 2 introduces a new direction that permits Medicare benefits for certain professional services, pathology services, and diagnostic imaging services provided on Norfolk Island, subject to specific conditions. These conditions include the service being part of an arrangement under the Inter-Governmental Partnership Agreement on State Service Delivery between the Commonwealth of Australia and the State of Queensland, or the pathology specimen being collected from an eligible person on Norfolk Island, or the diagnostic imaging procedure being performed on Norfolk Island.
This Act imposes specific obligations on the parties and entities it governs. Firstly, healthcare providers and services must comply with the new direction concerning the provision and reimbursement of professional, pathology, and diagnostic imaging services on Norfolk Island. This includes ensuring that any services rendered meet the criteria specified under the new direction, such as being part of an arrangement under the Inter-Governmental Partnership Agreement or being rendered under specific conditions involving Norfolk Island. Furthermore, the Act requires that these services be rendered to eligible persons who are not receiving an episode of hospital treatment.
The legislation also outlines consequences for breach, including potential civil and criminal penalties. Although the specific penalties are not detailed in the provided text, breaches of the Health Insurance Act 1973 can lead to substantial fines and imprisonment. For instance, under the Act, individuals or entities found guilty of contravening the provisions related to Medicare benefits may face penalties such as fines up to a certain amount or imprisonment for a specified duration, or both. These penalties serve as a deterrent against non-compliance and ensure adherence to the legislative requirements.