Health Insurance (Section 3C General Medical Services – Unscheduled specialist attendance) Determination 2019

Administered by Department of Health, Disability and Ageing

Legislation au F2019L00306 Not in force Legislative Instrument

Legislation content

Health Insurance (Section 3C General Medical Services – Unscheduled specialist attendance) Determination 2019

made under subsection 3C(1) of the

Health Insurance Act 1973

Compilation No. 1

Compilation date:    1 July 2019

Includes amendments up to: F2019L00605

Registered:    17 July 2019

 

About this compilation

This compilation

This is a compilation of the Health Insurance (Section 3C General Medical Services – Unscheduled specialist attendance) Determination 2019 that shows the text of the law as amended and in force on 1 July 2019 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Selfrepealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

 

 

 

 

Contents

1. Name

2. Commencement

3. Authority

4. Definitions

5. Treatment of relevant services

6. Application of provisions of the general medical services table

Schedule 1 – relevant services

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

 

1.  Name

  This instrument is the Health Insurance (Section 3C General Medical Services – Unscheduled specialist attendance) Determination 2019.

2.  Commencement

  This instrument commences on 1 April 2019.

3.  Authority

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

4.  Definitions

 (1) In this instrument:

Act means the Health Insurance Act 1973.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to medical services, professional services or items.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.

Schedule means a Schedule to this instrument.

Note: The following terms are defined in subsection 3(1) of the Act:

         clinically relevant service;

         general medical services table;

         item;

         professional service.

 (2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

 

5.  Treatment of relevant services

 

For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

(a)                    it were both a professional service and a medical service; and

(b)                    there were an item in the general medical services table that:

  1.       related to the service; and
  2.       specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

 

6.  Application of provisions of the general medical services table

(1)  Clause 1.1.5 of the general medical services table shall have effect as if item 115 contained in the Schedule were also specified in subclause 1.1.5(1).

(2)  Clause 1.2.2 of the general medical services table shall have effect as if item 115 contained in the Schedule were also specified in subclause 1.2.2(1).

(3)  Clause 1.2.4 of the general medical services table shall have effect as if item 115 contained in the Schedule were also specified in subclause 1.2.4(1).

(4)  Clause 1.2.5 of the general medical services table shall have effect as if item 115 contained in the Schedule were also specified in subclause 1.2.5(1).

(5)  Clause 1.2.6 of the general medical services table shall have effect as if item 115 contained in the Schedule were also specified in subclause 1.2.6(1).

(5)  Clause 1.2.7 of the general medical services table shall have effect as if item 115 contained in the Schedule were also specified in clause 1.2.7.

Schedule 1 – relevant services

Category 1 – Professional Attendances

Group A3 – Specialist attendances to which no other item applies

Item

Service

Fee ($)

115

Professional attendance at consulting rooms or in hospital by a specialist or consultant physician in the practice of the medical practitioner’s specialty after referral of the patient to the specialist or consultant physician by a referring practitioner—an attendance after the first attendance in a single course of treatment, if:

(a)    the specialist or consultant physician performs a scheduled operation on that patient on the same day; and

(b)    the operation is one to which an item in Group T8 of the general medical service table applies; and

(c)    the amount as the fee for service is the amount specified in subclause 1.2.3(2)(c) of the general medical services table; and

(d)   the attendance is unrelated to the scheduled operation; and

(e)    it is considered a clinical risk to defer the attendance to a later date.

For any particular patient, once only on the same day.

44.35

Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

 

Endnote 2—Abbreviation key

 

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

    /subsubparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

    effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

    effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

SubCh = SubChapter(s)

    cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

    commenced or to be commenced

 

Endnote 3—Legislation history

 

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Section 3C General Medical Services – Unscheduled specialist attendance) Determination 2019

15 Mar 2019 (F2019L00306)

1 Apr 2019 (s 2)

 

Health Insurance (Section 3C General Medical Services – Medicare Indexation) Amendment Determination 2019

11 Apr 2019 (F2019L00605)

Sch 1 (item 23): 1 July 2019 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

s 2.....................

rep LA s 48D

Schedule 1

 

Schedule 1................

am F2019L00605

 

 

Overview

The Health Insurance (Section 3C General Medical Services – Unscheduled Specialist Attendance) Determination 2019 was enacted under subsection 3C(1) of the Health Insurance Act 1973, and it commenced on 1 April 2019. This legislative instrument addresses the issue of unscheduled specialist attendances by ensuring that such services are treated as both professional services and medical services, and by specifying corresponding fees for these services. The primary objective is to provide clarity and consistency in the treatment of unscheduled specialist attendances under the health insurance framework. The Determination outlines the treatment of relevant services and specifies the application of provisions of the general medical services table, ensuring that the services are accurately reflected and appropriately remunerated. This instrument was made by the Commonwealth Government to enhance the administration and regulation of health services under the Health Insurance Act 1973.

Scope and Application

The Health Insurance (Section 3C General Medical Services – Unscheduled Specialist Attendance) Determination 2019 applies to the treatment of specified health services under the Health Insurance Act 1973, and it is concerned with the definition and treatment of relevant services provided by specialists or consultant physicians. These services are specifically related to unscheduled specialist attendances in certain clinical circumstances, as outlined in the Schedule to the Determination. The Determination applies to all persons and entities providing or receiving the specified services within Australia, as it is a Commonwealth instrument. The provisions in the Determination do not specify any exclusions or exemptions, but rather detail the specific conditions under which certain specialist attendances are to be treated as professional and medical services for the purposes of the Health Insurance Act. The application of the Determination is further detailed through the amendment of the general medical services table, ensuring that the specified services are recognised and remunerated appropriately. The Determination commences on 1 April 2019, as specified under section 2 of the instrument. It is made under subsection 3C(1) of the Health Insurance Act 1973, allowing for the specification of relevant services and the treatment of those services in accordance with the Act. The instrument includes a Schedule that specifies the relevant services, detailing the conditions under which they are provided and the corresponding fees. The relevant services are treated as if they were both professional and medical services, with the general medical services table being amended to include these services. The instrument does not specify any particular thresholds but rather defines the services and their treatment within the existing legislative framework. The application of this Determination is limited to the services and conditions specified within the instrument and its Schedule.

Key Provisions

The Health Insurance (Section 3C General Medical Services – Unscheduled Specialist Attendance) Determination 2019, as outlined in section 5, provides that relevant services provided in accordance with this instrument and as a clinically relevant service are to be treated, for the relevant provisions, as if they were both a professional service and a medical service. Furthermore, there is to be an item in the general medical services table that relates to the service and specifies for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service. The relevant services are specified in Schedule 1 of the Determination. These include professional attendances by a specialist or consultant physician in the practice of the medical practitioner’s specialty after referral of the patient to the specialist or consultant physician by a referring practitioner—an attendance after the first attendance in a single course of treatment, if certain conditions are met. Specifically, the specialist or consultant physician must perform a scheduled operation on that patient on the same day; the operation must be one to which an item in Group T8 of the general medical services table applies; the amount as the fee for service must be the amount specified in subclause 1.2.3(2)(c) of the general medical services table; the attendance must be unrelated to the scheduled operation; and it must be considered a clinical risk to defer the attendance to a later date. The Determination imposes specific obligations on the parties or entities it governs, particularly with respect to the provision and treatment of relevant services as outlined in section 5. The relevant services must be provided in accordance with the Determination and as a clinically relevant service. Furthermore, the Determination specifies that these services must be treated as both a professional service and a medical service for the purposes of the relevant provisions. Additionally, the Determination mandates that there be an item in the general medical services table that relates to the service and specifies the fee for the service in relation to each State, as detailed in Schedule 1. The Determination does not explicitly outline specific offences, penalties, or civil/criminal consequences for breaches within its text. However, breaches of the Health Insurance Act 1973 and related regulations generally may result in penalties. For instance, under the Health Insurance Act 1973, a person who contravenes a provision of the Act, or a regulation made under the Act, may be liable for a penalty. The penalties can vary depending on the nature and seriousness of the breach, but they can include fines and, in some cases, imprisonment. The specific penalties are not detailed in this Determination but would be governed by the overarching Act and any relevant regulations. It is important for parties and entities governed by the Determination to comply with its provisions to avoid potential penalties under the Health Insurance Act 1973.

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