EXPLANATORY STATEMENT
STATUTORY RULES 1982 NO.157
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE REGULATIONS (AMENDMENT)
Sub-section 133(1) of the Health Insurance Act 1973 (‘the Act’) provides 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 which are necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Section 33 of the Act provides for the payment by the Commonwealth of daily bed payments in respect of each day upon which an approved bed is occupied by an eligible person as an in-patient in a private hospital in a State or the Australian Capital Territory. The Act defines an approved bed as a bed included in the number of beds to which the approval of a hospital under section 2.4 of the Act relates, and defines an eligible person as being an Australian resident, which is also defined under the Act. The Northern Territory is, by virtue of section 23E of the Act, regarded as a State for the purposes of section 33.
Sub-section 33(1) of the Act provides for two levels of daily bed payment, being $28 in the case of a surgical bed and $16 in any other case. A surgical bed is deemed under sub-section 33(5) of the Act to be an approved bed occupied by an eligible person, during a stay as an in-patient of a hospital, to whom there is rendered a “surgical procedure” during that stay. A “surgical procedure” is defined by sub-section 33(12) of the Act as meaning a service to which a prescribed item relates. An item is defined in the Act as an item in the table. This table is the table of medical services, contained in Schedule 1 to the Act, which sets out as items the medical services recognised for medical benefits purposes under the Act.
The purpose of the statutory rules is to amend the list of items currently prescribed under sub-section 33(12) of the Act. This list of items, indicating the permissible “surgical procedures” for the purposes of section 33, is contained in Schedule 4 to the Health Insurance Regulations. The statutory rules amend Schedule 4 by including 19 additional items, and omitting 14 items from those items currently prescribed.
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The amendments to the list of prescribed items are consequent upon amendments of the table of medical services by the Health Insurance (Variation of Fees and Medical Services) (No. 24) Regulations which came into operation on 1 July 1982. The items included in the list are new items, inserted into the table of medical services by those regulations which, in common with the items already in the list, relate to surgery of a substantial nature. The items omitted from the list are items deleted from the table of medical services by those regulations.
The statutory rules came into operation on 1 July 1982 to coincide with the coming into operation of the Health Insurance (Variation of Fees and Medical Services) (No. 24) Regulations.
Overview
The Health Insurance Regulations (Amendment) Statutory Rules 1982 were enacted to update the list of medical services eligible for daily bed payments under the Health Insurance Act 1973. The Health Insurance Act provides for payments to eligible individuals for each day they occupy an approved bed in a private hospital, with different rates applying for surgical and non-surgical beds. The statutory rules were introduced to align the list of surgical procedures, as set out in Schedule 4 of the Health Insurance Regulations, with amendments to the table of medical services. This amendment ensures that the services eligible for higher daily bed payments accurately reflect current medical practices and the services recognised under the Act. The rules were issued by authority of the Minister for Health and came into effect on 1 July 1982, the same date as the Health Insurance (Variation of Fees and Medical Services) (No. 24) Regulations, which introduced changes to the table of medical services.
Scope and Application
The Health Insurance Regulations (Amendment) Statutory Rules 1982 No. 157, issued under the authority of the Minister for Health, amend the Health Insurance Regulations by modifying the list of prescribed items under sub-section 33(12) of the Health Insurance Act 1973. The Act applies to Australian residents who are eligible for daily bed payments when they occupy an approved bed in a private hospital in a state or territory, including the Northern Territory. The regulations establish two levels of daily bed payments, $28 for surgical beds and $16 for other beds, contingent on the occupancy of an eligible person undergoing a prescribed surgical procedure. The amendments reflect changes to the table of medical services, which now includes new surgical items and excludes others, as per the Health Insurance (Variation of Fees and Medical Services) (No. 24) Regulations effective from 1 July 1982. These statutory rules, which also came into effect on 1 July 1982, are designed to ensure that the list of prescribed surgical procedures for the purposes of section 33 of the Act remains current and comprehensive.
Key Provisions
The primary operative sections of these statutory rules, specifically Section 33 of the Health Insurance Act 1973, mandate the payment of daily bed payments for eligible persons staying as in-patients in private hospitals. The payments are set at $28 for a surgical bed and $16 for any other type of bed, as outlined in subsection 33(1). A surgical bed is specifically defined in subsection 33(5) as one where the in-patient receives a surgical procedure during their stay, with such procedures being detailed in Schedule 4 of the Health Insurance Regulations.
These regulations impose several obligations on the entities they govern. Firstly, they require that the list of prescribed surgical procedures, found in Schedule 4, must be updated to reflect any changes in the table of medical services. This ensures that the payments align with the current recognised medical services, as amended by subsequent regulations. Additionally, hospitals must ensure that the services they provide meet the criteria for being classified as a surgical procedure, thereby qualifying for the higher daily bed payment.
The statutory rules also establish the consequences for non-compliance with these provisions. While the explanatory statement does not explicitly detail penalties for breach, it is reasonable to infer that failure to comply with the regulations regarding the classification of surgical procedures could result in financial penalties or legal action. Given the context of statutory regulations under the Health Insurance Act, any breaches might lead to the withholding of payments or other financial sanctions, in addition to potential administrative or legal consequences. The exact nature and extent of these penalties would be further delineated in the Health Insurance Act itself, which could include civil or criminal liability depending on the severity and intent of the breach.