EXPLANATORY STATEMENT
STATUTORY RULES 1986 NO. 19
ISSUED BY THE AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
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 necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Sub-section 19(6) of the Act provides that a medicare benefit is not payable for a professional service unless prescribed particulars in relation to that professional service are included on the account, receipt for fees or assignment form under section 20A of the Act. Regulation 2ADA of the Health Insurance Regulations (‘the Regulations’) prescribes the particulars for the purposes of sub-section 19(6) of the Act.
Following consultation with the medical profession the Government recently agreed to a number of changes to the administration of health insurance legislation. A number of these were contained in the Health Legislation Amendment Act
(No 2) 1985 which received Royal Assent on 16 December 1985. Another of the issues agreed to was the relaxation of the prescribed particulars to be provided on accounts, receipts or assignment forms which are set out in existing regulation 2ADA.
Regulation 2 of the Statutory Rules gives effect to this agreement by amending regulation 2ADA by:
• rewording paragraph 2ADA(1)(a) to require only the recording of the patient’s name to whom the professional service relates in place of the existing requirement for surname, first name and initials of any subsequent name;
• replacing paragraph 2ADA(1)(b) to remove the requirement to record the item number and to require only the recording of the date on which the professional service was rendered and a description of that service which is sufficient to identify the item relating to that service in the Medicare Benefits Schedule; and
• removing the obligation to record a practitioner’s provider number on an account, receipt or assignment form and making it an option to record that provider number. This involves changes to sub-regulation 2ADA(4) and (5).
Paragraph 2(c) of the Statutory Rules amended sub-regulation 2ADA(4) which prescribes the particulars in relation to professional services to which an item in a Division (other than Division 9) of Part 7 or in Part 8, 8A, 9A or 11 of the table of benefits to be provided by practitioners claiming or receiving benefits. The amendment to sub-regulation 2ADA(4) requires the recording of the practitioner’s or approved pathology practitioner’s name and either the address of the place of practice or the provider number in respect of the place of practice, on claims, receipts or assignment forms. Paragraphs 2(d) and (e) of the Statutory Rules will also amend paragraphs 2ADA(5)(a) and (5)(b), which relate to prescribed particulars in relation to professional services other than professional services to which an item in a Division (other than Division 9) of Part 7 or in Part 8, 8A, 9A or 11 of the table relates, by giving the practitioner the option of supplying, along with his name, either the address of the place of practice at which the service was rendered or the provider number of the place of practice.
Regulation 1 of the Statutory Rules provides that the Regulations commence on 22 February 1986.