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.
Overview
The Health Insurance Regulations (Amendment) Statutory Rules 1986 were enacted to amend the Health Insurance Regulations under the Health Insurance Act 1973. These regulations were issued by the authority of the Minister for Health and aim to streamline the administration of health insurance by relaxing the prescribed particulars to be provided on accounts, receipts, or assignment forms. This change was agreed upon following consultation with the medical profession and is intended to make the process more convenient for practitioners while ensuring necessary information is still captured.
The statutory rules amend regulation 2ADA to simplify the required particulars for professional services, such as recording only the patient's name instead of detailed personal information, recording only the date and a description of the service rather than specific item numbers, and making the recording of a practitioner's provider number optional. These amendments reflect the policy objective of reducing administrative burden while maintaining the integrity and clarity of the information provided for Medicare benefits claims.
Scope and Application
The Health Insurance Regulations (Amendment) Statutory Rules 1986, issued under the authority of the Minister for Health, amend the Health Insurance Regulations to reflect recent changes to the administration of health insurance legislation. These changes are designed to simplify the requirements for recording particulars on accounts, receipts for fees, or assignment forms for professional services that attract Medicare benefits under the Health Insurance Act 1973. The amendments apply to practitioners who claim or receive benefits for professional services rendered to patients. The particulars prescribed in the amended regulations, particularly in regulation 2ADA, include the patient's name, the date and description of the service provided, and optional recording of the practitioner's provider number. These regulations have a national reach across Australia, as they are made under the authority of the Commonwealth and are applicable to all states and territories. The changes do not specify any exclusions or exemptions, but they do provide some flexibility by making certain details optional, such as the practitioner's provider number, thus reducing the administrative burden on healthcare providers while still ensuring that essential information is recorded for Medicare benefit purposes.
Key Provisions
The primary operative sections of the Health Insurance Regulations (Amendment) Statutory Rules 1986, which amend the Health Insurance Regulations, are contained within Regulation 2. These amendments are designed to streamline the administrative process for recording and claiming professional services under the Health Insurance Act 1973. Regulation 2ADA is specifically altered to modify the prescribed particulars required on accounts, receipts, or assignment forms for professional services. Under the new regulations, only the patient's name needs to be recorded (Regulation 2(a)), as opposed to the previous requirement of the surname, first name, and initials of any subsequent names. Additionally, the recording of the item number has been removed, with a new requirement to record the date of service and a description that identifies the service in the Medicare Benefits Schedule (Regulation 2(b)). The practitioner's provider number is no longer mandatory but optional (Regulation 2(c)). Moreover, practitioners must record their name and either the address of the practice or the provider number (Regulation 2(d) and (e)).
The Health Insurance Regulations (Amendment) impose specific obligations on healthcare providers and practitioners. They must now ensure that patient accounts, receipts, or assignment forms include the patient’s name and a description of the service rendered along with the date of service. Furthermore, practitioners have the option to include their name, the address of the practice, or their provider number, but this is not mandatory. These changes aim to simplify the administrative burden on healthcare providers while ensuring that the necessary information for processing Medicare claims is still available.
Failure to comply with the amended regulations may result in civil or administrative penalties. While the specific penalties are not detailed in the Explanatory Statement, under the Health Insurance Act 1973, non-compliance with regulations can lead to fines or other administrative actions. The precise penalties would be determined based on the nature and extent of the breach, as outlined in the relevant sections of the Act and any associated guidelines or interpretations by the administrative body responsible for enforcement.
In summary, the Health Insurance Regulations (Amendment) Statutory Rules 1986 introduce significant changes to the documentation requirements for professional services under the Health Insurance Act 1973. By reducing the mandatory particulars and providing flexibility in what information needs to be recorded, the amendments aim to ease the administrative process for healthcare providers. Compliance with these new requirements is essential to ensure that Medicare benefits can be processed correctly, with potential consequences for non-compliance as prescribed by the Act and relevant administrative guidelines.