EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Other non-referred services) Determination 2012
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by writing, determine that a health service not listed in the general medical services table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. The Table is set out in the Health Insurance (General Medical Services Table) Regulations which are remade each year.
Purpose
The Health Insurance (Other non-referred services) Determination 2012 (the Determination) enables certain medical practitioners who were able to provide non-referred attendance services under Group A2 of the Table (‘other non-referred services’) before 1 November 2011 to provide equivalent services under the Determination.
Until 31 October 2011, other non-referred services could be accessed by:
- specialists and consultant physicians,
- all general practitioners (GPs), including GPs registered on the vocational register, who were subject to a final determination under s 106TA of the Act disqualifying them from providing general practitioner attendance services in Group A1 of the Table; and
- all medical practitioners who were not specialists, consultant physicians or general practitioners.
From 1 November 2011 with the making of the new Table, eligibility to access other non-referred services was inadvertently restricted to medical practitioners subject to a final determination under s 106TA of the Act disqualifying them from providing general practitioner attendance services in Group A1 of the Table, other than GPs registered on the vocational register, specialists and consultant physicians.
The Determination creates new Medicare items, equivalent to the current non-referred services under the Table, but which are able to be accessed by the full cohort of practitioners who were able to provide these services prior to 1 November 2011.
Statement of human rights compatability
The Determination is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Consultation
As this is a change to correct a drafting oversight and re-establish the status quo of access to other non-referred services no consultation with stakeholders was undertaken.
A determination made under subsection 3C(1) of the Act is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
ATTACHMENT
Details of the Health Insurance (Other non-referred services) Determination 2012.
Section 1 – Name of Determination
Section 1 provides that the title of the Determination is the Health Insurance (Other non-referred services) Determination 2012.
Section 2 – Commencement and Cessation
Section 2 provides for the Determination to commence on the day it is registered and to cease at midnight on 31 October 2012. It is the Department’s intention to seek an amendment to the Table to restore the ability of affected practitioners to access the other non-referred services in Group A2 of the Table from that time.
Section 3 - Definitions
Subsection 3(1) defines terms used in the Determination.
A key term is 'relevant service' which means a health service as defined in subsection 3C(8) of the Act that is specified in the Schedule to the Determination. There are 12 such relevant services in the Schedule to the Determination.
Subsection 3(2) provides that a reference in the Determination to a provision of an Act or regulations is a reference to that provision as in force from time to time.
Section 4 - Treatment of a relevant service
Paragraph 4(a) provides that a relevant service specified in the Schedule to the Determination shall 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 that make provision 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 the Table that related to the service and specified a fee in respect of that service, being the fee specified in the Schedule to the Determination in relation to the service.
Section 5 – Application of this section to certain general practitioners
Section 5 provides that the section applies to general practitioners who are subject to a final determination under section 106TA of the Act which directs that the practitioner be disqualified from providing professional services from Group A1 of the Table (general practitioner attendances), and the practitioner provides a service included in the Schedule to the Determination.
Section 106TA of the Act provides for the making of final determinations by the Determining Authority under the Professional Services Review Scheme.
Section 6 – Specification of items
Subsections 6(1) and 6(2) provide that provisions in the Table and the Health Insurance Regulations 1975, respectively, shall have effect as if the items listed in the Schedule were also specified in those provisions.
One important effect of this is that Medicare benefit for the items specified in the Schedule to the Determination is paid at 100% of the Schedule fee for the item.
Section 7 – Meaning of amount under section 7
Section 7 defines a basis for the calculation of the fee that should apply to eight items from the schedule. The calculation is based on the number of patients seen.
Schedule – Relevant Services and Fees
The Schedule sets out the relevant services and assigns to each relevant service the applicable item number, item descriptor and fee.