Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2019

Administered by Department of Health, Disability and Ageing

Legislation au F2019L01308 Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health

 

Health Insurance Act 1973

 

Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2019

 

Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by legislative instrument, determine that a health service not specified in an item in the general medical services table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were specified in the Table.

 

The Table is set out in the regulations made under subsection 4(1) of the Act, which is repealed and re-made each year. The most recent version of the regulations is the Health Insurance (General Medical Services Table) Regulations 2019.

 

This instrument relies on subsection 33(3) of the Acts Interpretation Act 1901 (AIA).  Subsection 33(3) of the AIA provides that where an Act confers a power to make, grant or issue any instrument of a legislative or administrative character (including rules, regulations or by-laws), the power shall be construed as including a power exercisable in the like manner and subject to the like conditions (if any) to repeal, rescind, revoke, amend, or vary any such instrument.

 

Purpose

The amendments made by the Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2019 (the Amendment Determination) is part of a consequential change to the heart health assessment services from 1 November 2019.

 

On 1 April 2019, two new health assessment services (items 699 and 177) were introduced to provide patients a comprehensive assessment of their cardiovascular health, identification of any physical or lifestyle-related risks to their cardiovascular health, and a comprehensive preventive health care plan to improve their cardiovascular health.

 

The Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Determination 2019 (the Principal Determination) listed the new items to subsidise access to heart health assessment services lasting at least 20 minutes by a general practitioner (item 699) or a medical practitioner working in general practice (item 177). A patient is currently eligible for a Medicare benefit of $73.95 for a service to which item 699 applied and $59.15 for a service to which item 177 applied.

From 1 November 2019, the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019 will increase the Medicare benefit amount a patient will be eligible for a service provided under items 699 and 177, from 85% of the schedule fee to 100% of the schedule fee. Increasing the benefit to 100% of the schedule fee will align the heart health assessment items with other health assessment services in Group A14 of the Table, which have a benefit of 100% of the schedule fee.

 

The purpose of the Amendment Determination is to maintain the benefit parity through a reduction of the schedule fees for the items so there is no change in the amount of Medicare benefit a patient will be eligible for a heart health assessment service. A patient will continue to be eligible for a Medicare benefit of $73.95 for a service to which item 699 applies and $59.15 for a service to which item 177 applies.

 

Consultation

Consultation was not undertaken on the instrument as the changes are machinery in nature and do not affect the nature of the heart health assessment services or the Medicare benefit amount a patient will receive. The change is administrative only and will provide that the heart health assessment items reflect equivalent items in Group A14 of the Medicare Benefits Schedule, which have a benefit calculation of 100% of the schedule fee.

 

Details of the Determination are set out in the Attachment.

The Determination commences immediately after the commencement of Schedule 1 of the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019.

 

The Determination is a legislative instrument for the purposes of the Legislation Act 2003.

Authority:     Subsection 3C(1) of the

 Health Insurance Act 1973

 


ATTACHMENT

Details of the Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2019

 

Section 1 – Name

 

Section 1 provides for the instrument to be referred to as the Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2019.

 

Section 2 – Commencement

 

Section 2 provides that the instrument commences immediately after commencement of Schedule 1 of the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019.

 

Section 3 – Authority

 

Section 3 provides that the instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

 

Section 4 – Schedules

 

Section 4 provides that each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

 

Schedule 1 – Amendments

 

Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Determination 2019

 

Item 1 – Schedule 1 (item 699, column 3)

Item 1 omits the schedule fee of $86.95 for item 699 and substitutes with an amended fee of $73.95. There will be no change to the Medicare benefit amount the patient receives for a service ($73.95) due to the amendments made by the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019).

 

Item 2 – Schedule 1 (item 177, column 3)

Item 2 omits the schedule fee of $69.55 for item 177 and substitutes with an amended fee of $59.15. There will be no change to the Medicare benefit amount the patient receives for a service ($59.15) due to the amendments made by the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019).

 

 

 


Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

 

Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2019
 

This instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

 

Overview of the Determination

The amendments made by the Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2019 (the Amendment Determination) is part of a consequential change to the heart health assessment services from 1 November 2019.

 

On 1 April 2019, two new health assessment services (items 699 and 177) were introduced to provide patients a comprehensive assessment of their cardiovascular health, identification of any physical or lifestyle-related risks to their cardiovascular health, and a comprehensive preventive health care plan to improve their cardiovascular health.

 

The Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Determination 2019 (the Principal Determination) listed the new items to subsidise access to heart health assessment services lasting at least 20 minutes by a general practitioner (item 699) or a medical practitioner working in general practice (item 177). A patient is currently eligible for a Medicare benefit of $73.95 for a service to which item 699 applied and $59.15 for a service to which item 177 applied.

From 1 November 2019, the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019 will increase the Medicare benefit amount a patient will be eligible for a service provided under items 699 and 177, from 85% of the schedule fee to 100% of the schedule fee. Increasing the benefit to 100% of the schedule fee will align the heart health assessment items with other health assessment services in Group A14 of the Table, which have a benefit of 100% of the schedule fee.

 

The purpose of the Amendment Determination is to maintain the benefit parity through a reduction of the schedule fees for the items so there is no change in the amount of Medicare benefit a patient will be eligible for a heart health assessment service. A patient will continue to be eligible for a Medicare benefit of $73.95 for a service to which item 699 applies and $59.15 for a service to which item 177 applies.

Human rights implications

This instrument engages Articles 9 and 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the rights to health and social security.

The Right to Health

The right to the enjoyment of the highest attainable standard of physical and mental health is contained in Article 12(1) of the ICESCR. The UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not a right for each individual to be healthy, but is a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.

The Committee reports that the ‘highest attainable standard of health’ takes into account the country’s available resources. This right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs, and conditions necessary for the realisation of the highest attainable standard of health.

The Right to Social Security

The right to social security is contained in Article 9 of the ICESCR. It requires that a country must, within its maximum available resources, ensure access to a social security scheme that provides a minimum essential level of benefits to all individuals and families that will enable them to acquire at least essential health care. Countries are obliged to demonstrate that every effort has been made to use all resources that are at their disposal in an effort to satisfy, as a matter of priority, this minimum obligation.

The Committee reports that there is a strong presumption that retrogressive measures taken in relation to the right to social security are prohibited under ICESCR. In this context, a retrogressive measure would be one taken without adequate justification that had the effect of reducing existing levels of social security benefits, or of denying benefits to persons or groups previously entitled to them. However, it is legitimate for a Government to re-direct its limited resources in ways that it considers to be more effective at meeting the general health needs of all society, particularly the needs of the more disadvantaged members of society.

Analysis

This instrument maintains the right to health and social security. This instrument is part of a package of legislative changes which will make consequential amendments to the heart health assessment services from 1 November 2019. The Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019 will increase the Medicare benefit amount a patient will be eligible for a service provided under items 699 and 177, from 85% of the schedule fee to 100% of the schedule fee. Increasing the benefit to 100% of the schedule fee will align the heart health assessment services with other heart health assessment services in Group A14 of the Table, which have a benefit of 100% of the schedule fee. 

 

Subject to commencement of that instrument, this instrument will reduce the schedule fees for the heart health assessment items so there is no change in the Medicare benefit amount a patient will receive. A patient will continue to be eligible for a Medicare benefit of $73.95 for a service to which item 699 applies and $59.15 for a service to which item 177 applies.

Conclusion

This instrument is compatible with human rights as it maintains the right to health and the right to social security.

 

Andrew Simpson

Assistant Secretary

MBS Review Unit

Medical Benefits Division

Health Financing Group

Department of Health

Overview

The Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2019 was enacted by the Australian Parliament and came into effect to address the need for adjustments in the Medicare benefit amounts for heart health assessment services. This amendment is a consequential change resulting from the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019, which increased the Medicare benefit from 85% to 100% of the schedule fee for certain heart health assessment services. The purpose of the Amendment Determination is to ensure that the Medicare benefit amounts for these services remain unchanged despite the increase in the Medicare benefit percentage. This was achieved by reducing the schedule fees for the relevant items, maintaining the current Medicare benefit amounts for patients. The Health Insurance Act 1973 provides the authority for this amendment, empowering the Minister for Health to make such changes through a legislative instrument. This determination aims to uphold the rights to health and social security as articulated in the International Covenant on Economic, Social and Cultural Rights, by ensuring that patients continue to receive the same level of Medicare benefits for heart health assessments, thereby maintaining equitable access to healthcare services.

Scope and Application

The Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2019 applies to the health services specified under items 699 and 177 in the general medical services table, which are heart health assessments provided by general practitioners or medical practitioners working in general practice. This instrument is made under the authority of subsection 3C(1) of the Health Insurance Act 1973 and operates at a national level, affecting all individuals eligible for Medicare benefits in Australia. The Amendment Determination aims to adjust the schedule fees for these heart health assessment services, ensuring that the Medicare benefit amount remains consistent for patients. Specifically, it reduces the schedule fees for items 699 and 177 to maintain the benefit parity as the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019 increase the Medicare benefit amount from 85% to 100% of the schedule fee. The changes are administrative in nature, designed to align the heart health assessment services with other health assessment services in Group A14 of the Medicare Benefits Schedule, without altering the actual benefits received by patients.

Key Provisions

The Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2019 amends the Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Determination 2019. Specifically, it adjusts the schedule fees for heart health assessment services, which were introduced on 1 April 2019, to ensure that the Medicare benefit amounts for patients remain unchanged. These adjustments are necessary due to another regulation, the Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019, which increases the Medicare benefit for these services from 85% to 100% of the schedule fee from 1 November 2019. The changes to the schedule fees are designed to maintain benefit parity, so that patients will continue to receive the same Medicare benefit amounts as before. Under this Amendment Determination, the schedule fee for item 699 is reduced from $86.95 to $73.95, while the schedule fee for item 177 is reduced from $69.55 to $59.15. Despite these reductions in the schedule fees, the Medicare benefit amounts for patients will remain at $73.95 for services to which item 699 applies and $59.15 for services to which item 177 applies. This ensures that patients do not face any financial burden due to the changes in the schedule fees, and that they continue to have access to comprehensive heart health assessments without any change in their out-of-pocket costs. The Amendment Determination imposes obligations on the parties involved, particularly medical practitioners and patients. Medical practitioners who provide heart health assessment services under items 699 and 177 must ensure that they bill the correct schedule fee as per the amendments in the Determination. They must also ensure that they provide the comprehensive heart health assessment services as outlined in the Principal Determination, which includes a thorough assessment of the patient's cardiovascular health and a preventive health care plan. Patients, on the other hand, are required to be aware of their eligibility for the Medicare benefit and the amount they will receive for these services. They should also ensure that their medical practitioners correctly bill the services to avoid any discrepancies in their out-of-pocket costs. There are no specific offences, penalties, or civil/criminal consequences outlined in the Amendment Determination itself. However, any breach of the Health Insurance Act 1973 or the regulations made under it could potentially result in penalties under the Act. For instance, section 120A of the Act provides for penalties for fraudulent claims, with maximum penalties including fines and imprisonment. Similarly, section 120B provides for penalties for over-claiming, with maximum penalties including fines and imprisonment. These provisions underscore the importance of compliance with the Act and the regulations, particularly for medical practitioners who must ensure accurate billing to avoid any legal repercussions.

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