EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2021
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. The most recent version of the regulations is the Health Insurance (General Medical Services Table) Regulations (No. 2) 2020.
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
On 1 April 2019, two health assessment services 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) lists two 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).
The purpose of the Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2021 (the Amendment Determination) is to amend the two heart health assessment items (699 and 177) to provide that these services can only be performed on a patient who is 30 years of age or over. This will align the items with the current evidence-based age cohorts for the Australian Absolute Cardiovascular Disease Risk calculator, which is the basis for the assessment requirements for the heart health assessment items. The Australian Absolute Cardiovascular Disease Risk Calculator is available online at www.cvdcheck.org.au.
These changes were announced in the 2021-22 Budget as part of the Guaranteeing Medicare — changes to the Medicare Benefits Schedule measure.
The Amendment Determination will also increase the fees of the heart health assessment items by 0.9 per cent. This reflects the Government’s policy regarding Medicare indexation and means that patients will receive a higher Medicare benefit for these services from
1 July 2021.
Consultation
Consultation on the changes to the heart health assessment items was undertaken with the Royal Australian College of General Practitioners, Australian Medical Association and the Heart Foundation.
The Amendment Determination also continues the business as usual implementation of the Government’s policy on Medicare indexation, announced under the 2017-18 Budget Guaranteeing Medicare - Medicare Benefits Schedule - indexation measure, and is expected by stakeholders to be applied on 1 July of each year. The complete list of all indexed fees is available in the Medicare Benefits Schedule xml data file which is available for anyone to download on MBS Online (www.mbsonline.gov.au).
Details of the Amendment Determination are set out in the Attachment.
The Amendment Determination commences on 1 July 2021.
The Amendment 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 2021
Section 1 – Name
Section 1 provides for the Determination to be referred to as the Health Insurance (Section 3C Medical Services – Heart Health Assessment No.2) Amendment Determination 2021.
Section 2 – Commencement
Section 2 provides that the Determination commences on 1 July 2021.
Section 3 – Authority
Section 3 provides that the Determination 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 Determination is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Determination has effect according to its terms.
Schedule 1 – Amendments
Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Determination 2019 (the Principal Determination)
Item 1 – Schedule 1
Item 1 repeals and replaces the tables in Schedule 1 of the Principal Determination. The new tables include an amended item descriptor for items 699 and 177, which provide that these services must be performed on a patient who is 30 years of age or over, and increases the fees of items 699 and 177 by 0.9 per cent.
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
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
On 1 April 2019, two health assessment services 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) lists two 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).
The purpose of the Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Amendment Determination 2021 (the Amendment Determination) is to amend the two heart health assessment items (699 and 177) to provide that these services can only be performed on a patient who is 30 years of age or over. This will align the items with the current evidence-based age cohorts for the Australian Absolute Cardiovascular Disease Risk calculator, which is the basis for the assessment requirements for the heart health assessment items. The Australian Absolute Cardiovascular Disease Risk Calculator is available online at www.cvdcheck.org.au.
These changes were announced in the 2021-22 Budget as part of the Guaranteeing Medicare — changes to the Medicare Benefits Schedule measure.
The Amendment Determination will also increase the fees of the heart health assessment items by 0.9 per cent. This reflects the Government’s policy regarding Medicare indexation and means that patients will receive a higher Medicare benefit for these services from 1 July 2021.
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 will ensure that the appropriate patient cohorts can continue to access clinically relevant health services for a heart health assessment, and increases the Medicare benefit those patients receive when accessing these services.
Conclusion
This instrument is compatible with human rights as it maintains the right to health and the right to social security.
Paul McBride
First Assistant Secretary
Medical Benefits Division
Health Resourcing Group
Department of Health