EXPLANATORY STATEMENT
STATUTORY RULES 1987 NO.32
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE REGULATIONS (AMENDMENT)
Sub-section 133(1) of the Health Insurance Act 1973 (“the Act”) provides in part 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.
Sub-section 133(2) of the Act provides that where an item (being an item in the general medical services table) specifies a medical service that is to be rendered by a consultant physician, or a specialist, in the practice of his specialty to a patient who has been referred to him, the regulations may require that, for the purposes of the item, the patient be referred in a manner prescribed by the regulations.
Sub-section 19(6) of the Act provides in part that a medicare benefit is not payable in respect of a professional service
unless the person by or on behalf of whom the professional service was rendered has recorded on the account, or on the receipt, for fees in respect of the service, or on a form of assignment of medicare benefit, as the case may be, such particulars as are prescribed in relation to professional services generally or in relation to a class of professional services in which that professional service is included.
Regulation 10 of the Health Insurance Regulations (“the Regulations”) prescribes the manner in which a patient may be referred to a consultant physician or a specialist. At present, that manner is by means of a printed form, issued by the Department of Health, containing certain details.
Paragraph 2ADA(1)(c) of the Regulations prescribes the particulars to be recorded by a consultant physician or a specialist on an account, or a receipt, for fees or on a form of assignment of medicare benefit after a professional service has been rendered in reliance upon a referral.
The Minister for Health has agreed to certain recommendations which have been made by the Medicare Benefits Review Committee, which was established in part to recommend measures to encourage the provision of efficient and appropriate health care. The Committee has made several recommendations which are
intended to simplify the process by which referrals are conducted, including -
(a) the discontinuation of the printed referral forms issued by the Department of Health;
(b) the payment of medicare benefit in respect of a professional service rendered by a consultant physician or a specialist where no referral has been prepared but where a medical emergency exists; and
(c) the limitation of the period during which a referral may authorise treatment.
The Health Insurance Regulations (Amendment) give effect to these recommendations, firstly by amending the prescribed manner of making a referral to a consultant physician or a specialist and, secondly, by making amendments to the particulars prescribed in regulation 2ADA.
The manner of making a referral in regulation 10 is amended by providing for three alternative systems. The first is the preparation of a formal letter of referral containing prescribed information. The second is the making of an informal written communication requesting that the consultant
physician or specialist provide a professional service. The third is the making of an oral request that the consultant physician or specialist provide a professional service.
Consequent upon these amendments, sub-regulation 2ADA(1) is amended to require that a consultant physician or a specialist provide prescribed particulars to indicate which of the three alternative systems of referral was used in respect of the service rendered. In addition, the sub-regulation requires that a consultant physician or a specialist provide prescribed particulars in two new situations. The first is where a written referral, of either type, has been prepared but has subsequently been lost, stolen or destroyed. The second is where a service is rendered by a consultant physician or a specialist, and where the consultant physician or specialist forms the opinion that it is necessary that the service be rendered as quickly as possible.
The regulations also make a number of minor consequential amendments to the Regulations, and several references to other matters which have been superseded or which are subject to more modern drafting practice have been revised.
Regulation 2 provides for the amendments to come into operation on 7 March 1987.