EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Obstetric Item 15999) Determination HS/02/2005
Subsection 3C(1) of the Health Insurance Act 1973 (“the Act”) allows the Minister to determine in writing that a specified health service (which is not listed in the Medicare Benefits Schedule) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed.
The effect of subsection 3C(4) is that a determination made under subsection 3C(1) is a disallowable instrument within the meaning of the Acts Interpretation Act 1901.
On 31 August 2004 the Minister for Health and Ageing made Health Insurance Determination HS/09/2004 (“Determination HS/09/2004”) to allow the payment of Medicare benefits for the planning and management of pregnancy that has progressed beyond 20 weeks. Determination HS/09/2004 allowed coverage of management services performed by obstetricians that did not fit with existing Medicare items for medical consultations. Accordingly, Determination HS/09/2004 allowed the payment of benefits until 2 September 2005.
Health Insurance (Obstetric Item 15999) Determination HS/02/2005 (“the Determination”) replaces Determination HS/09/2004 with the cessation date that is extended until 31 October 2005. Extending the cessation date will mean that Medicare benefits can continue to be paid.
Details of the Determination are set out in the Attachment.
ATTACHMENT
NOTES ON CLAUSES
Clause 1 provides that the Determination may be cited as the Health Insurance (Obstetrics Item 15999) Determination HS/02/2005.
Clause 2 provides that the Determination commences on the day after it is registered on the Federal Register of Legislative Instruments and cease to have effect at the end of 31 October 2005.
Clause 3 revokes Health Insurance (Obstetric Item 15999) Determination HS/09/2004.
Clause 4 defines certain terms used in the Determination.
Clause 5 provides for the treatment of a relevant service as if it were both a professional services and a medical service and were an item in the general medical services table.
The Schedule sets out the health service to which the Determination relates and specifies the fee in respect to that service
Overview
The Health Insurance (Obstetric Item 15999) Determination HS/02/2005 was enacted to extend the cessation date of the previous Health Insurance Determination HS/09/2004, which allowed the payment of Medicare benefits for the planning and management of pregnancy beyond 20 weeks. The Health Insurance Act 1973 empowers the Minister for Health and Ageing to determine the treatment of specified health services not listed in the Medicare Benefits Schedule. This determination, issued under subsection 3C(1) of the Act, serves to ensure continued coverage of these services until 31 October 2005. The policy objective is to provide seamless access to essential healthcare services for pregnant women by ensuring that benefits are paid for services that were previously unlisted in Medicare. The enactment by the Minister for Health and Ageing aims to fill a gap in healthcare coverage, allowing the continued reimbursement of services crucial for managing advanced pregnancies.
Scope and Application
The Health Insurance (Obstetric Item 15999) Determination HS/02/2005 applies to the provision of health services related to the planning and management of pregnancies that have progressed beyond 20 weeks, specifically within the context of the Health Insurance Act 1973. The Determination allows for the payment of Medicare benefits for services that were previously not covered under the existing Medicare Benefits Schedule but are now treated as if they were listed items. This legislative instrument extends the cessation date of the previous Health Insurance (Obstetric Item 15999) Determination HS/09/2004, which originally allowed coverage until 2 September 2005, to 31 October 2005, ensuring continued coverage for these services. The Determination applies to persons and entities involved in the provision of these obstetric services, specifically obstetricians and related medical consultations, and it operates within the Commonwealth jurisdiction. The Determination includes no specific exclusions or thresholds other than those specified within its provisions and related to the particular services it covers. The applicability of the Determination may be further detailed or modified through subordinate instruments, although no such modifications are specified in the current document.
Key Provisions
The Health Insurance (Obstetrics Item 15999) Determination HS/02/2005 amends and extends the previous Health Insurance (Obstetric Item 15999) Determination HS/09/2005, which allowed for the payment of Medicare benefits for the planning and management of pregnancies that have progressed beyond 20 weeks. This newer Determination (Clause 3) revokes the earlier one and introduces a new cessation date of 31 October 2005 (Clause 2), thus extending the coverage period. The Determination (Clause 5) specifies that relevant services will be treated as if they were both professional services and medical services, and as items in the general medical services table. This means that the services will be covered under Medicare, and providers can claim benefits for these services.
The Act imposes several obligations on the parties involved. For instance, providers of obstetric services must ensure that the services they offer are in line with the specifications outlined in the Determination. This includes meeting the criteria for the services to be covered under Medicare. Patients, on the other hand, need to be aware that the benefits are available only under the terms and conditions specified in the Determination. Failure to comply with these terms could result in the services not being covered by Medicare. Furthermore, the Determination mandates that the relevant services be billed under the specified item number, ensuring consistency and transparency in billing practices.
Non-compliance with the provisions of the Determination can lead to various consequences. For providers, there could be civil penalties, including fines or the requirement to refund any benefits improperly claimed. In more severe cases, criminal charges could be brought against individuals who deliberately or negligently contravene the Act. The specific penalties are not detailed in the Determination but would generally align with those prescribed under the Health Insurance Act 1973 and the Acts Interpretation Act 1901. The potential penalties serve as a deterrent to non-compliance and ensure that the services are delivered and billed correctly under Medicare.