EXPLANATORY STATEMENT
STATUTORY RULES 1982 NO.191
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
Health Insurance (Variation of Fees and Medical Services) (No. 25) Regulations
Section 133 of the Health Insurance Act 1973 (‘the Act’) provides that the Governor-General may make regulations prescribing all matters required, permitted, necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Schedule 1 to the Act contains a table of medical services and rules for the interpretation of the table. The table of medical services contains items which set out the description of each medical service and the fees for medical benefits purposes applicable in each State in respect of the service.
Section 4 of the Act provides that the table of medical services, items or rules of interpretation in Schedule 1 to the Act may be varied or replaced by regulations, and that regulations replacing such a table may be amended by regulations.
The Health Insurance (Variation of Fees and Medical Services) (No. 22) Regulations, as amended by subsequent regulations, prescribe a table under Section 4 of the Act.
Section 9 of the Act provides that Commonwealth medical benefits shall be calculated by reference to the fees for medical services set out in the table. The amount of medical benefit paid by a registered medical benefits organization out of its basic medical benefits table in respect of a medical service is also, by virtue of the definition of “guaranteed medical benefit” in subsection 4(1) of the National Health Act 1953, based on the fees set out in the table.
Rule 42 of the rules of interpretation of the table of medical services refers to items in Part 12 of the table relating to services for the treatment of cleft lip and palate conditions expressed as being rendered by, or following a referral by, an accredited dental practitioner who is a recognized orthodontist. An accredited
dental practitioner is defined in sub-section 3(1) of the Act to mean a dental practitioner accredited by the Minister in writing. Sub-rule 42(2) of the rules of interpretation sets out the circumstances in which an accredited dental practitioner is to be taken to be a recognized orthodontist.
For the purposes of sub-rule 42(2) a “relevant law” was previously defined as a law of the State or Territory, in which the service was rendered, that provided for the registration or licensing of dental practitioners or dentists. Sub-rule 42(2) previously provided that where a relevant law made provision for the separate registration or licensing of orthodontists, a recognized orthodontist was an accredited dental practitioner who was so separately registered or licensed. Where a relevant law did not make such provision for registration or licensing but an authority established under that law for the registration or licensing of dental practitioners or dentists recognized certain practitioners as orthodontists, sub-rule 42(2) provided that a recognized orthodontist was an accredited dental practitioner so recognized. Sub-rule 42(2) further provided that
where no such provision existed for the registration, licensing, or recognition of orthodontists, an accredited dental practitioner who practised exclusively as an orthodontist was to be taken to be a recognized orthodontist.
The previous criteria for according status as a recognized orthodontist under sub-rule 42(2) had proved over-restrictive in excluding numbers of accredited dental practitioners with the level of competence considered necessary to render services relating to items in the table of medical services restricted to recognized orthodontists. They excluded from recognition, for example, accredited dental practitioners who have not registered, or cannot be registered, as orthodontists who nevertheless practise as orthodontists on a regular or exclusive basis and have done so for many years. The Minister for Health therefore agreed to the amendment of the previous criteria to remedy this situation.
The statutory rules provide for the amendment of rule 42 of the rules of interpretation by the substitution in sub-rule 42(2) of new criteria for according status as a recognized orthodontist, and the amendment of sub-rule 42(3) to provide for a definition of “Committee” and an amended definition of “relevant law”. A relevant law is now defined as a law of a State or Territory in which the service is rendered that provides for the registration or licensing of dental practitioners or dentists as orthodontists. Under the new criteria, a person who is an accredited dental practitioner shall be taken to be a recognized orthodontist if he is registered under a relevant law or if, by means of his qualifications or experience, he demonstrates to the “Committee” his competence in the field of orthodontics applicable to the rendering of services specified in Division 1 of Part 12 of the table of medical serivces. The services specified in Division 1 of Part 12 of the table of medical services are all expressed as being rendered by a recognized orthodontist. The Committee is defined as meaning the Medical Benefits (Dental Practitioners) Advisory Committee established under section 136 of the National Health Act 1953.
The statutory rules came into operation on the date of their notification in the Commonwealth of Australia Gazette.