Health Insurance Regulations (Amendment) 1992 No. 42
EXPLANATORY STATEMENT
STATUTORY RULES 1992 No. 42
Issued by the authority if the Minister for Health, Housing and Community Services
Health Insurance Act 1973
Health Insurance Regulations (Amendment)
The Health Insurance Act 1973 (the Act) provides 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.
The specific details of these amendments to the Health Insurance Regulations are set out in the attachment. In summary, these amendments contain discrete provisions which:
• repeal the regulations required to give effect to the Government's decision to abolish the medicare co-payment of $2.50, the $1.00 transaction fee and the $3.50 rebate reduction, all of which were introduced on 1 December 1991, and
• specify those diagnostic imaging services eligible for medicare benefits following requests by physiotherapists and podiatrists.
ATTACHMENT
DETAILS OF HEALTH INSURANCE REGULATIONS (AMENDMENT)
The regulations delete the definitions 'concessional beneficiary', 'patient contribution', 'prescribed GP service' and 'safety-net concession card, from regulation 2 and repeal regulation 2AC which specifies prescribed GP services'.
The regulations restrict medicare benefits to X-rays of the spine and pelvis when requested by a physiotherapist and to X-rays of the foot when requested by a podiatrist.
The definition of "requester number" in regulation 2 has been amended to make provision for the allocation, by the Health Insurance Commission, of identification numbers to physiotherapists and podiatrists.
Regulation 2ADAAB has been amended to prescribe the particular items of service that may be requested by physiotherapists and podiatrists. Items 57503, 57521 and 57527 in the diagnostic imaging services table relate to the radiological examination of extremities and the provision of a report. The Health Insurance (1991-1992 Diagnostic Imaging Services Table) Regulations prescribe such a table.
Subregulation 2ADA(1A) has been amended by repealing paragraphs (c) and (d) which relate to particulars to be included on patient's accounts, etc., for prescribed GP services where the patient is a concessional beneficiary.
Subregulation 2ADA(4) has been amended to require the provision of specified details of the specialist in diagnostic radiology providing the professional service. The existing provisions have been amended to apply where the services specified are provided by medical practitioners who are not specialists in diagnostic radiology.
Subregulation 2ADA(7) has been amended to include reference to physiotherapists and podiatrists.
A new regulation 2CF has been inserted requiring certain information on patients' accounts or receipts and on medicare direct-billed claims regarding practitioners, including physiotherapists and podiatrists, who request imaging services.
Overview
The Health Insurance Regulations (Amendment) 1992 No. 42, issued under the authority of the Minister for Health, Housing and Community Services, amends the Health Insurance Regulations 1973 to address specific issues within the health insurance framework. This amendment was enacted to repeal regulations associated with the abolition of the medicare co-payment, the $1.00 transaction fee, and the $3.50 rebate reduction, all of which were implemented on 1 December 1991. Additionally, the amendments aim to specify which diagnostic imaging services are eligible for medicare benefits when requested by physiotherapists and podiatrists. These changes are part of the broader objective to refine and update the regulatory framework to ensure it effectively supports the provision of healthcare services in line with current policy directions.
Scope and Application
The Health Insurance Regulations (Amendment) 1992 No. 42 apply to the administration and enforcement of the Health Insurance Act 1973, impacting medical practitioners, dental practitioners, optometrists, physiotherapists, podiatrists, and relevant patients across Australia. These amendments effectively abolish the medicare co-payment, the $1.00 transaction fee, and the $3.50 rebate reduction introduced on 1 December 1991, while also specifying the types of diagnostic imaging services eligible for medicare benefits when requested by physiotherapists and podiatrists. The amendments are national in scope, applying uniformly across all states and territories in Australia. The changes are primarily regulatory, achieved through the repeal of existing regulations and the introduction of new definitions and provisions, including the deletion of terms such as 'concessional beneficiary' and 'prescribed GP service', and the restriction of medicare benefits to certain diagnostic imaging services. The amendments also involve the allocation of identification numbers to physiotherapists and podiatrists to facilitate the claiming of medicare benefits for services they request. The Act's application may be further extended or detailed through subordinate instruments, which are not explicitly detailed in the explanatory statement.
Key Provisions
The Health Insurance Regulations (Amendment) 1992 No. 42 introduces several significant changes under the Health Insurance Act 1973. Firstly, it repeals the regulations that implemented the $2.50 medicare co-payment, the $1.00 transaction fee, and the $3.50 rebate reduction, which were introduced on 1 December 1991. These changes aim to streamline the payment process for medical services by removing these additional costs. Additionally, the amendment specifies the diagnostic imaging services that are eligible for medicare benefits when requested by physiotherapists and podiatrists, such as X-rays of the spine and pelvis by physiotherapists and X-rays of the foot by podiatrists.
The regulations impose specific obligations on parties involved in the provision and administration of health insurance services. For example, the Health Insurance Commission is now required to allocate identification numbers to physiotherapists and podiatrists to facilitate their requests for diagnostic imaging services. Furthermore, medical practitioners who are not specialists in diagnostic radiology must provide specified details of the specialist radiologist involved in the diagnostic imaging services they request. The amendment also mandates that certain information be included on patients' accounts or receipts and on medicare direct-billed claims regarding practitioners who request imaging services.
Non-compliance with the provisions of these regulations can lead to various consequences. Although the specific offences, penalties, or consequences for breaches are not detailed in the explanatory statement, it is common under Australian law for non-compliance with regulatory requirements to result in civil or criminal penalties. These penalties may include fines, imprisonment, or other sanctions depending on the severity and nature of the breach. The maximum penalties would typically be outlined in the relevant sections of the Health Insurance Act 1973 or other related legislation.