EXPLANATORY STATEMENT
STATUTORY RULES 1987 No 166
ISSUED BY AUTHORITY OF
THE MINISTER FOR COMMUNITY SERVICES AND HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE REGULATIONS (AMENDMENT)
Section 133 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.
Subsection 10(1) of the Act provides that where medical expenses are incurred in respect of a professional service rendered in Australia to an eligible person, medicare benefit calculated in accordance with subsection 10(2) is payable, subject to the Act, in respect of that professional service. The Health Legislation Amendment Act 1987 (No 44) which will by virtue of section 2 of the Act come into operation on 1 August 1987 amends subsection 10(2) to provide that a lower medicare benefit is payable where a professional service is rendered to a person while the person is an in-patient of a hospital or day hospital facility.
Subsection 19(6) of the Act provides that a medicare benefit is not payable in respect of a professional service unless certain prescribed particulars are recorded on the account, receipt, assignment form or agreement form as the case may be. These particulars are prescribed by regulation 2ADA of the Health Insurance Regulations.
In order to implement the scheme for reduced payments for professional services rendered to a person as an in-patient it is necessary to prescribe particulars to enable identification of those professional services to which the reduced benefit applies.
These regulations amend Regulation 2ADA to prescribe such particulars.
The regulations also make several minor amendments to regulation 2ADA to reflect the introduction of new arrangements for the regulation of the provision of pathology services, with effect from 1 August 1987. The Act has been amended by the Health Legislation Amendment Act 1986 (Act No 75 of 1986, assented to on 24 June 1986), and the regulations amend several references to the Act to accord with the new legislation. The regulations also repeal or amend a number of provisions to remove references to pathology arrangements which will not be permitted under the new legislation.