EXPLANATORY STATEMENT
STATUTORY RULES 1983 NO. 231
ISSUED BY 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 which are necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Section 33 of the Act provides for the payment by the Commonwealth of daily bed payments in respect of each day upon which an approved bed is occupied by an eligible person as an in-patient in a private hospital in a State or the Australian Capital Territory. The Act defines an approved bed as a bed included in the number of beds to which the approval of a hospital under section 24 of the Act relates, and defines an eligible person as being an Australian resident, which is also defined under the Act. The Northern Territory is, by virtue of section 23E of the Act, regarded as a State for the purposes of section 33.
Sub-section 33(1) of the Act provides for two levels of daily bed payment, being $28 in the case of a surgical bed and $16 in any other case. A surgical bed is deemed under sub-section 33(5) of the Act to be an approved bed occupied by an eligible person, during a stay as an in-patient of a hospital, to whom there is rendered a ‘surgical procedure’ during that stay. A ‘surgical procedure’ is defined by sub-section 33(12) of the Act as meaning a service to which a prescribed item relates. An item is defined in the Act as an item in the table of medical services, prescribed for the purpose of section 4 of the Act by the Health Insurance (Variation of Fees and Medical Services) (No. 26) Regulations as amended. The table sets out in items the medical services recognised for medical benefits purposes under the Act.
The purpose of the regulations is to amend the list of items prescribed, by Regulation 4A of the Health Insurance Regulations (‘the Regulations’), as ‘surgical procedures’ for the purposes of sub-section 33(12) of the Act. This list of items is contained in Schedule 4 to the Regulations. The regulations amend that Schedule by the inclusion of 9 additional
items and the omission of 5 items from those previously prescribed. These amendments are necessary to reflect variations to the table of medical services relating to surgery of a substantial nature, arising from the Health Insurance Variation of Fees and Medical Services (No. 29) Regulations, which came into operation on 1 November 1983.
Section 33 of the Act will be repealed with effect from 1 February 1984 by section 40 of the Health Legislation Amendment Act 1983 (Act No. 54, Assented to on 1 October 1983). The statutory rules would therefore cease to have authority under the Act from that date.
The statutory rules came into operation on 1 November 1983 to coincide with the date of effect the Health Insurance (Variation of Fees and Medical Services) (No. 29) Regulations.
Overview
The Health Insurance Regulations (Amendment) Statutory Rules 1983, issued under the authority of the Minister for Health, amend the Health Insurance Regulations 1973. These regulations were enacted to address the need to update the list of 'surgical procedures' for the purposes of determining the appropriate level of daily bed payment under the Health Insurance Act 1973. The policy objective is to ensure that the daily bed payments reflect the most current medical services recognised for medical benefits purposes. The regulations amend Schedule 4 to the Health Insurance Regulations by adding nine items and removing five items from the list of surgical procedures, aligning with changes made by the Health Insurance (Variation of Fees and Medical Services) (No. 29) Regulations, which came into effect on 1 November 1983. These statutory rules took effect on the same date to ensure continuity in the application of the amendments. It should be noted that Section 33 of the Health Insurance Act 1973 will be repealed on 1 February 1984, making these regulations void from that date.
Scope and Application
The Health Insurance Regulations (Amendment) Statutory Rules 1983 No. 231, issued by authority of the Minister for Health, amend the Health Insurance Regulations to update the list of 'surgical procedures' for the purpose of determining eligibility for higher daily bed payments under section 33 of the Health Insurance Act 1973. The amended Regulations reflect changes to the table of medical services due to the Health Insurance Variation of Fees and Medical Services (No. 29) Regulations. This amendment applies to Australian residents who are in-patients in private hospitals in states and territories, including the Northern Territory, as these areas are regarded as states for the purposes of section 33 of the Act. The Act provides for two levels of daily bed payment, with a higher payment for surgical beds. The inclusion of additional items and the omission of others from the list of surgical procedures ensures the regulations remain aligned with current medical practices and fee structures. These statutory rules were enacted to take effect on 1 November 1983 and will cease to have authority from 1 February 1984, when section 33 of the Act is repealed by the Health Legislation Amendment Act 1983.
Key Provisions
The Health Insurance Regulations (Amendment) Statutory Rules 1983 (No. 231) primarily amend the list of items prescribed as 'surgical procedures' under Regulation 4A of the Health Insurance Regulations 1973 (the Regulations) (sections 1–3). These regulations are made under sub-section 133(1) of the Health Insurance Act 1973 (the Act) and aim to update the list of surgical procedures to reflect changes in the table of medical services. These changes are in turn based on the Health Insurance (Variation of Fees and Medical Services) (No. 29) Regulations, which came into effect on 1 November 1983. The amendments to the Regulations involve the inclusion of nine new items and the removal of five existing items from the Schedule 4 list of surgical procedures.
These regulations impose obligations on health insurers and healthcare providers to accurately classify the types of beds occupied by eligible persons (Australian residents) in private hospitals. Under section 33 of the Act, two levels of daily bed payments are applicable: $28 for surgical beds and $16 for any other type of bed. A surgical bed is defined as an approved bed occupied by an eligible person undergoing a surgical procedure during their stay in hospital. The regulations ensure that the definition of 'surgical procedure' remains aligned with the updated table of medical services, which in turn determines the eligibility for higher daily bed payments. Healthcare providers must ensure that the correct type of bed is used for each patient to ensure the appropriate level of reimbursement is provided by the insurer.
Failure to comply with these regulations could result in incorrect claims being made for daily bed payments. While the Act does not explicitly outline specific offences, penalties, or consequences for breaches of the regulations, any discrepancies in the classification of beds or the services provided could lead to financial discrepancies or audits by the relevant authorities. It is important for all parties involved to adhere to these regulations to avoid any potential legal or financial repercussions. Additionally, it is worth noting that section 33 of the Act, which these regulations support, will be repealed from 1 February 1984, as per the Health Legislation Amendment Act 1983 (No. 54). Consequently, these statutory rules will cease to have authority from that date.