Health Insurance Regulations (Amendment) 1996 No. 231
EXPLANATORY STATEMENT
STATUTORY RULES 1996 No. 231
Issued by authority of the Minister for Health and Family Services
Health Insurance Act 1973
Health Insurance Regulations (Amendment)
The Health Insurance Act 1973 (the Act) provides in part for the payment of Medicare benefits for professional services rendered by medical practitioners and for certain professional services rendered by dental practitioners and optometrists.
Section 133 of the Act provides that the Governor-General may make regulations for the purposes of the Act.
Section 4AA of the Act provides that the regulations may prescribe a table of diagnostic imaging services (the table). The Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations prescribe such a table.
Subsection 16B(1) of the Act provides in part that Medicare benefits are not payable for an Rtype diagnostic imaging service rendered by the providing practitioner unless the service was requested in writing by a medical practitioner, a dental practitioner, a chiropractor, a physiotherapist or a podiatrist. An R-type service is a diagnostic imaging service identified with the symbol (R) and comprise the majority of services in the Table. Subsection 16B(6) of the Act provides an exemption to that requirement where the providing practitioner is a consultant physician or a specialist in a particular specialty (other than the specialty of diagnostic radiology).
Subsections 16B(2), (3), (3A) and (3B) of the Act provide that regulations may prescribe
R-type diagnostic imaging services specified in regulations that may be requested by dental practitioners, chiropractors, physiotherapists or podiatrists.
Subsection 16B(11) of the Act provides that regulations may prescribe R-type diagnostic imaging services that may be rendered by a medical practitioner without the requirement for a written request where that medical practitioner meets requirements for an exemption as a pre-existing practice.
Subsection 19(6) of the Act provides in part that a Medicare benefit is not payable unless prescribed information is recorded on accounts or assignment forms.
Subsection 23DQ(1) of the Act provides that regulations may specify the form in which a subsection 16B(1) request must be made and the information that must be included in the request.
Regulations 10 and 11 of the Health Insurance Regulations specify R-type items that may be requested by practitioners who are registered or licensed under relevant State or
Territory laws as dental practitioners, chiropractors, physiotherapists or podiatrists. Dental practitioners are divided into dental practitioners, dental practitioners approved by the Minister under paragraph (b) of the definition of a professional service in subsection 3(1) of the Act (oral and maxillofacial specialists) and prosthodontists.
Regulation 12 of the Health Insurance Regulations specifies R-type items that may be rendered by medical practitioners who meet the pre-existing practice requirement.
Paragraph 13(17)(a) of the Health Insurance Regulations specifies, for the purposes of subsection 19(6) of the Act, additional information that must be shown on accounts or assignment forms for diagnostic imaging services rendered by specialists where the services rendered are exempted from the written request provisions under subsection 16B(6) of the Act.
Regulation 19 of the Health Insurance Regulations specifies the information that must be included in a subsection 16B(1) request by a medical practitioner.
The Regulations amend Regulations 10, 11 and 12 of the Health Insurance Regulations by replacing the item numbers with the equivalent item numbers that apply under the Health Insurance (1996-1997 Diagnostic Imaging Services Table) Regulations that commences from 1 November 1996.
The Regulations amend paragraph 13(17)(a) of the Health Insurance Regulations by including consultant physicians as a class of practitioners where additional information must be shown on accounts or assignment forms where the service rendered was a diagnostic imaging service.
The Regulations amend Regulation 19 of the Health Insurance Regulations so that it applies to all practitioners and not only to medical practitioners, who make a subsection 16B(1) request for a diagnostic imaging service. Requesting practitioners, other than medical practitioners, who will be required to provide the specified information will be dental practitioners (including oral and maxillofacial surgeons and prosthodontists), chiropractors, physiotherapists and podiatrists.
The effect of the amendments to Regulations 10, 11 and 12 preserve patients' benefit entitlements for services rendered on and from 1 November 1996 when the current Diagnostic Imaging Services Table is repealed and a new Table is substituted by the Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations.
The effect of the amendments to paragraph 13(17)(a) of the Health Insurance Regulations Will be to require consultant physicians to provide the same information on accounts or assignment forms that is required to be provided by specialists. The change follows amendments to the Act in 1995.
The effect of the amendments to Regulation 19 require requesting dental practitioners, chiropractors, physiotherapists and podiatrists to provide the same information in a subsection 16B(1) request as that provided by requesting medical practitioners. The change follows amendments to the Act in 1995.
The Regulations come into effect from 1 November 1996.