EXPLANATORY STATEMENT
STATUTORY RULES 1986 NO 20
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.
The Health Legislation Amendment Act (No 2) 1985 inserted a number of new sections into the Act which require the making of consequential regulations for the purposes of those sections. New sub-section 3D(1) of the Act provides, among other things, that a medical practitioner domiciled in Australia who is a fellow of an organisation that is declared by the regulations to be a professional organisation in relation to a particular specialty and who has obtained a relevant qualification, shall upon payment of the prescribed fee, be recognised as a specialist for the purposes of the Act.
New sub-section 3E(2) of the Act provides that where a Ministerial determination is required for the recognition of a practitioner not domiciled in Australia the practitioner will be required to pay a prescribed fee when applying for recognition. Section 61 of the Act was also amended, among other things, to require the payment of a prescribed fee by practitioners seeking recognition as specialists or consultant physicians upon the recommendation of a Specialist Recognition Advisory Committee.
New Part VB of the Act which provides for the new Medicare Participation Review Committees, requires, among other things, the declaration by regulation of professional organisations for the purposes of the definition of ‘professional organisation’ in sub-section 124B(1).
New sub-section 129AC(2) enables the General Manager of the Health Insurance Commission to enter into an arrangement with a person for the payment of an amount recoverable for unlawfully paid benefits and payments made under the Act. The sub-section further provides that interest at the prescribed rate would be payable where no arrangement has been made within 90 days of notification of the debt or where the person subsequently defaults on the debt.
The Statutory Rules give effect to the new provisions of the Act. A Proclamation fixed 22 February 1986 as the date of commencement for these new provisions. Section 4 of the Acts Interpretation Act 1901 provides, among other things, that where an Act as amended confers a power to make legislation, including regulations, then the power may be exercised before the Act concerned comes into operation as if it had come into operation and takes effect on the day on which the Act concerned comes into operation. The Statutory Rules came into operation on the date fixed by the Proclamation.
Regulation 2 of the Statutory Rules inserted new regulation 2ABA into the Health Insurance Regulations (‘the Regulations’) to declare professional organisations in relation to particular specialties and the relevant qualification in relation to those organisations for the purposes of sub-section 3D(1).
The fee of $30, prescribed for the purposes of new sub-sections 3D(1), 3E(2) and 61(1A) in new regulations 2ABB, 2ABC and 9AA, respectively, is set out in regulations 2 and 3 of the Statutory Rules.
Regulation 4 of the Statutory Rules inserts new regulation 9AB into the Regulations to declare the Australian Dental Association Incorporated, the Australian Medical Association and the Australian Optometrical Association to be professional organisations for the purposes of the definition of ‘professional organisation’ in sub-section 124B(1) of the Act.
Regulation 5 will provide that the prescribed rate of interest for the purposes of sub-section 129AC(2) of the Act shall be 15 per cent per annum.
Overview
The Health Insurance Regulations (Amendment) Statutory Rules 1986 were issued by the authority of the Minister for Health under the Health Insurance Act 1973. These rules were introduced to address the need for updated regulations to align with amendments made to the Act by the Health Legislation Amendment Act (No 2) 1985. These amendments included provisions for the recognition of medical specialists, the establishment of fees for specialist recognition applications, and the creation of Medicare Participation Review Committees. The Parliament enacted these regulations to ensure that the Health Insurance Act could be effectively implemented with the new requirements, including the declaration of professional organisations and the setting of fees and interest rates for various specialist recognition processes.
Scope and Application
The Health Insurance Regulations (Amendment) Statutory Rules 1986, issued under the authority of the Minister for Health, amend the Health Insurance Act 1973. These amendments expand the scope of the Act by introducing new provisions regarding the recognition of medical practitioners as specialists and the establishment of Medicare Participation Review Committees. The regulations apply to medical practitioners domiciled in Australia who are fellows of professional organisations declared by the regulations to be relevant to their specialty. Additionally, they apply to practitioners not domiciled in Australia who seek Ministerial recognition, requiring them to pay a prescribed fee as stipulated in the Act. The Act also extends to the declaration of professional organisations by regulation, which are necessary for the definition of ‘professional organisation’ under the Act. The geographic reach of the Act is national, applying across Australia. The regulations also set out the fees for specialist recognition and the rate of interest for unpaid debts as per the amended Act. Notably, the amendments allow for the extension or restriction of the Act's application through subordinate instruments, ensuring flexibility in its implementation.
Key Provisions
The main operative sections of the Statutory Rules provide for the implementation of various new provisions inserted into the Health Insurance Act 1973 by the Health Legislation Amendment Act (No 2) 1985. Under sub-section 3D(1) of the Act, medical practitioners who are fellows of declared professional organisations and hold relevant qualifications are recognised as specialists upon payment of a prescribed fee, as outlined in regulation 2ABA (paragraph 2). The new sub-section 3E(2) requires practitioners not domiciled in Australia to pay a prescribed fee when applying for recognition, with the fee set at $30 as per regulation 2ABB (paragraph 3). Similarly, sub-section 61(1A) mandates that practitioners seeking recognition as specialists or consultant physicians must pay a fee upon the recommendation of a Specialist Recognition Advisory Committee, again set at $30 as per regulation 2ABC (paragraph 3). The new Part VB of the Act, concerning Medicare Participation Review Committees, requires the declaration of professional organisations by regulation, with the Australian Dental Association Incorporated, the Australian Medical Association, and the Australian Optometrical Association specified as professional organisations in regulation 9AB (paragraph 4). Furthermore, sub-section 129AC(2) enables the General Manager of the Health Insurance Commission to enter into arrangements for the payment of unlawfully paid benefits, with a prescribed interest rate of 15 per cent per annum as per regulation 5 (paragraph 5).
The obligations and requirements imposed by the Act and the Regulations on the parties involved include the declaration of professional organisations and relevant qualifications for medical practitioners seeking specialist recognition, as stipulated in regulation 2ABA (paragraph 2). Medical practitioners must pay the prescribed fee to be recognised as specialists, as outlined in regulations 2ABB, 2ABC, and 9AA (paragraphs 3 and 4). The Specialist Recognition Advisory Committee must recommend practitioners for recognition as specialists or consultant physicians, with applicants required to pay the prescribed fee of $30 as per regulation 2ABC (paragraph 3). Additionally, the General Manager of the Health Insurance Commission is authorised to enter into arrangements for the payment of unlawfully paid benefits, with interest at the prescribed rate of 15 per cent per annum payable if an arrangement is not made within 90 days or if the person defaults on the debt, as per regulation 5 (paragraph 5).
The Statutory Rules outline several potential offences and penalties for breaches of the Act and the Regulations. One significant consequence is the imposition of interest on debts not settled within 90 days or upon default, with the prescribed rate being 15 per cent per annum as per regulation 5 (paragraph 5). While the maximum penalties for specific breaches are not explicitly stated in the Statutory Rules, the Act generally provides for penalties for unlawful payments, which may include fines or other financial penalties. Practitioners failing to pay the prescribed fees for recognition may not be recognised as specialists or consultant physicians, resulting in professional and financial disadvantages.