Health Insurance Regulations (Amendment) 1995 No. 409
EXPLANATORY STATEMENT
STATUTORY RULES 1995 No. 409
Issued by the authority of the Minister for Human Services and Health
Health Insurance Act 1973
Health Insurance Regulations (Amendment)
The Health Insurance Act 1973 (the Act) provides for payments by way of Medicare benefits, payments for hospital services and payments for matters concerning related committees and tribunals.
Section 133 of the Act provides that the Governor-General may make regulations for the purposes of the Act.
A new section 3J has been inserted into the Act which provides that a person who is not an Australian citizen or a permanent resident and has entered Australia under a temporary visa to practise as a doctor (temporary resident doctor) is not a medical practitioner for the purpose of the Act unless the Minister determines otherwise.
New section 3J is part of a package of measures aimed at reducing the incidence of "moonlighting" by temporary resident doctors. "Moonlighting" is where temporary resident doctors provide medical services outside their visa and registration conditions. The moonlighting measures are a 1995-96 Budget initiative, which are anticipated to save $18.5m in Medicare outlays over the next four years.
Two new subregulations 13(1A) and 13(1B) will be added to the Health Insurance Regulations in an effort to improve policing and enforcement mechanisms available to the Commonwealth to reduce moonlighting by temporary resident doctors.
Regulation 13 prescribes the particulars to be recorded on accounts, receipts and bulk billing agreements for medical practitioners.
Under new subregulation 13(1A) temporary resident doctors who will be deemed to be medical practitioners for the purposes subsection 3J(1) of the Health Insurance Act 1973 will be required to put their name, address and provider number on accounts, receipts or bulk billing agreements for professional services which they provide.
New subregulation 13(1B) will require all medical practitioners, apart from temporary resident doctors referred to above, to put their name and address or their provider number on any account, receipt or bulk billing agreement for professional services which they provide.
New subregulations 13(1A) and 13(1B) are prescribed in reliance on section 133 of the Act.
The proposed Regulations would commence on the same day on which items 1 to 4 of the Human Services and Health Legislation Amendment Act (No. 2) 1995 commences.
Overview
The Health Insurance Regulations (Amendment) 1995 No. 409 were enacted to address the issue of "moonlighting" by temporary resident doctors in Australia, which refers to doctors providing medical services outside the terms of their visas and registration conditions. This amendment was issued under the authority of the Minister for Human Services and Health and is part of a broader legislative initiative aimed at reducing the incidence of such activities, thereby saving an estimated $18.5 million in Medicare outlays over four years. The policy objective behind these amendments is to strengthen the enforcement mechanisms against moonlighting through improved record-keeping requirements, ensuring that accounts, receipts, and bulk billing agreements for professional services provided by medical practitioners, including temporary resident doctors, are properly documented with necessary identifiers such as name, address, and provider number.
Scope and Application
The Health Insurance Regulations (Amendment) 1995 No. 409 amends the Health Insurance Act 1973, specifically targeting the eligibility of medical practitioners for Medicare benefits. The Act applies to medical practitioners, including temporary resident doctors who have entered Australia on a temporary visa to practise medicine. The amendment seeks to prevent "moonlighting" by these temporary resident doctors, where they provide medical services outside their visa and registration conditions. This amendment is part of a broader initiative expected to save $18.5 million in Medicare outlays over four years. The regulations also introduce new requirements for temporary resident doctors to include their name, address, and provider number on accounts, receipts, and bulk billing agreements. These new requirements are designed to enhance the enforcement mechanisms against moonlighting by ensuring clearer identification and accountability of medical services provided. The regulations are set to commence on the same day as specified items of the Human Services and Health Legislation Amendment Act (No. 2) 1995.
Key Provisions
The main operative sections of the Health Insurance Regulations (Amendment) 1995 No. 409 introduce a new section 3J into the Health Insurance Act 1973, which aims to clarify the status of temporary resident doctors. Specifically, section 3J (1) states that a person who is not an Australian citizen or a permanent resident and has entered Australia under a temporary visa to practise as a doctor (temporary resident doctor) is not considered a medical practitioner for the purposes of the Act unless the Minister determines otherwise. This provision is intended to prevent "moonlighting", where temporary resident doctors provide medical services outside their visa and registration conditions. Additionally, two new subregulations, 13(1A) and 13(1B), have been added to the Health Insurance Regulations to enhance enforcement mechanisms. Subregulation 13(1A) mandates that temporary resident doctors include their name, address, and provider number on accounts, receipts, or bulk billing agreements for professional services they provide, whereas subregulation 13(1B) requires all other medical practitioners to include their name and address or provider number on similar documents.
The obligations and requirements imposed by the Health Insurance Regulations (Amendment) 1995 No. 409 are primarily targeted at temporary resident doctors and other medical practitioners. Temporary resident doctors, who are subject to the new section 3J, must ensure that their name, address, and provider number are clearly stated on all accounts, receipts, or bulk billing agreements related to their professional services. This is aimed at improving transparency and accountability. Other medical practitioners, under subregulation 13(1B), must include their name and address or their provider number on similar documents. These requirements are intended to streamline the recording and auditing process for medical services provided, thereby facilitating better monitoring and enforcement against moonlighting activities.
The Health Insurance Regulations (Amendment) 1995 No. 409 does not explicitly outline specific offences, penalties, or consequences for breaches of the new provisions. However, any failure to comply with the requirements outlined in the regulations could potentially lead to legal consequences under the broader framework of the Health Insurance Act 1973 and related legislation. For instance, non-compliance could result in administrative actions, such as fines, or could be subject to review by the relevant authorities, including the Minister, who has the power to determine the status of temporary resident doctors. While the regulations themselves do not specify maximum penalties, any breaches of the Health Insurance Act 1973 or related regulations could incur civil or criminal penalties as per the applicable laws.