EXPLANATORY STATEMENT
STATUTORY RULES 1984 NO. 162
ISSUED BY THE AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE REGULATIONS (AMENDMENT)
Sub-section 133(1) of the Health 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.
An item, for the purposes of the Act, is defined in sub-section 3(1) of the Act as an item in the table of medical services, being the table of medical services prescribed under section 4 of the Act. A recognized hospital, for the purposes of the Act, is a hospital that is a recognized hospital for the purposes of an agreement under section 23F of the Act with a State or the Northern Territory for the provision of public hospital services, or a hospital declared by the Minister to be a recognized hospital
in the Australian Capital Territory or in a State or the Northern Territory where an agreement under section 23F has not been entered into.
Sub-section 17(1) of the Act provides that a medicare benefit is not payable in respect of a professional service in certain circumstances. Arising from paragraph 17(1)(aa) of the Act, medicare benefit is not payable if a professional service related to a “prescribed item” and was rendered to an in-patient or out-patient of a recognized hospital, or to other patients at a recognized hospital by a medical practitioner who was not acting in accordance with an approved agreement. An approved agreement for the purposes of section 17 of the Act is defined in sub-section 17(4) of the Act as an agreement in writing, in accordance with any relevant guidelines formulated by the Minister, between a medical practitioner and a recognized hospital that makes provision for the rendering at the hospital by the medical practitioner of professional services relating to items prescribed for the purposes of paragraph 17(1)(aa) of the Act.
Regulation 2ADAA of the Health Insurance Regulations (‘the Regulations’) prescribes for the purposes of paragraph 17(1)(aa) of the Act the items referred to in Schedule 5 to the Regulations. Regulation 2ADAA was inserted into the Regulations by Statutory Rules No. 5 of 1984 with effect from 1 March 1984.
The purpose of the regulations is the deletion of 42 items from those previously prescribed for the purposes of paragraph 17(1)(aa) of the Act. The Minister for Health had agreed, following discussions with the medical profession, that these items should not be the subject of section 17 of the Act. The regulations give effect to this by amending Schedule 5 to the Regulations.
The regulations are deemed to have come into effect on 1 March 1984. This retrospectivity of effect does not affect prejudicially the rights of any person or impose liabilities on any person in a manner contrary to sub-section 48(2) of the Acts Interpretation Act 1901.
Overview
The Health Insurance Regulations (Amendment) was issued in 1984 under the authority of the Minister for Health to amend the Health Insurance Regulations 1973. These regulations address a specific gap by modifying the list of medical services for which Medicare benefits are not payable under certain circumstances. As stated in the explanatory statement, the amendments were made following discussions with the medical profession and are intended to reflect the Minister’s agreement that certain items should no longer be subject to section 17 of the Act. The regulations aim to align the prescribed items in Schedule 5 with current medical practices and agreements, ensuring that Medicare benefits are only payable for services rendered in accordance with approved agreements between medical practitioners and recognized hospitals. This amendment does not adversely affect any existing rights or impose new liabilities contrary to the Acts Interpretation Act 1901.
Scope and Application
The Health Insurance Regulations (Amendment) Statutory Rules 1984, issued under the Health Insurance Act 1973, pertain to medical services and the provision of hospital services in Australia. They specifically address the scope of medicare benefits by altering the list of prescribed items under Schedule 5 to the Regulations. These regulations apply to medical practitioners, recognized hospitals, and patients receiving services in these hospitals. The amendments reflect agreements between the Minister for Health and the medical profession regarding which items should not incur a restriction on medicare benefits when provided under an approved agreement. The jurisdictional reach of these regulations is national, as they apply across all states and territories in Australia. Notably, the regulations do not specify any exclusions, exemptions, or thresholds within their scope, focusing instead on the removal of certain items from the list of restricted services. Any further specifications or clarifications may be made through subordinate instruments issued under the authority of the Minister for Health.
Key Provisions
The Health Insurance Regulations (Amendment) primarily modify the items listed in Schedule 5 of the Health Insurance Regulations, specifically addressing paragraph 17(1)(aa) of the Health Insurance Act 1973. These regulations, effective from 1 March 1984, involve the deletion of 42 items that were previously prescribed. This adjustment was agreed upon by the Minister for Health after consultations with the medical profession, aiming to refine the scope of professional services for which medicare benefits may not be payable under certain circumstances.
In terms of obligations, the Act imposes several requirements on parties involved. Medical practitioners must ensure they are acting in accordance with an approved agreement when providing professional services at a recognized hospital. Similarly, recognized hospitals are required to enter into and adhere to these approved agreements with medical practitioners. The Act also mandates that the Minister for Health consult with the medical profession when considering changes to the items prescribed under the Act. The Regulations themselves ensure these changes are implemented smoothly, without adversely affecting existing rights or imposing new liabilities contrary to the Acts Interpretation Act 1901.
The Health Insurance Act 1973 and the accompanying regulations also establish consequences for non-compliance. While the specific offences and penalties are not detailed in the provided excerpt, it is evident that failure to adhere to the prescribed agreements and regulations could result in civil or criminal liabilities. Given the Act's overarching purpose of regulating health insurance benefits and services, breaches could potentially lead to significant repercussions, including fines or other penalties as prescribed by law. The precise nature and extent of these penalties would typically be delineated in other sections of the Act or related legislation.