Health Insurance (Variation of Fees and Medical Services) (No. 25) Regulations

Legislation au C2004L04849 Regulations Not in force Legislative Instrument

Legislation content

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.

Overview

The Health Insurance (Variation of Fees and Medical Services) (No. 25) Regulations 2004 were enacted by the Australian government to amend the criteria for recognising accredited dental practitioners as orthodontists under the Health Insurance Act 1973. This legislative amendment was introduced to address the issue of overly restrictive criteria that excluded a number of competent practitioners from being recognised as orthodontists. The regulations were issued under the authority of the Minister for Health, with the aim of broadening the scope of practitioners who can provide services for the treatment of cleft lip and palate conditions. By modifying rule 42 of the rules of interpretation in the table of medical services, the regulations now allow for the recognition of orthodontists based on their qualifications, experience, and demonstrated competence, as assessed by the Medical Benefits (Dental Practitioners) Advisory Committee. This change aims to ensure that patients have access to a wider pool of qualified professionals while maintaining the quality of care provided under the Act.

Scope and Application

The Health Insurance (Variation of Fees and Medical Services) (No. 25) Regulations, issued under the authority of the Minister for Health, serve to amend the Health Insurance Act 1973 by adjusting the criteria for the recognition of orthodontists, thus affecting the medical services table and related fees prescribed in Schedule 1. This legislation applies to accredited dental practitioners who provide services listed in the table of medical services, particularly those related to the treatment of cleft lip and palate conditions. The new criteria now recognise orthodontists based on their registration under a relevant state or territory law or through demonstrated competence by qualifications or experience, assessed by the Medical Benefits (Dental Practitioners) Advisory Committee. The regulations extend across the Commonwealth, impacting all states and territories by virtue of the Act’s provisions, and they came into operation upon notification in the Commonwealth of Australia Gazette. These amendments ensure that more practitioners can be recognised as competent orthodontists, thereby expanding the scope of authorised providers within the health insurance framework.

Key Provisions

The key provisions of these regulations revolve around the modification of fees and medical services under the Health Insurance Act 1973 (hereafter referred to as the Act). Section 4 of the Act allows for the variation or replacement of the table of medical services, and these regulations specifically amend the criteria for recognising orthodontists under Rule 42 of the rules of interpretation of the table of medical services (sub-rule 42(2)). The amendments were necessitated by the previous criteria being too restrictive, excluding competent practitioners who could not be registered or licensed as orthodontists but who practised exclusively in the field (Section 4). The new rules substitute the criteria in sub-rule 42(2) to better reflect the competence of accredited dental practitioners. Furthermore, the definition of “relevant law” in sub-rule 42(3) is amended to include laws that provide for the registration or licensing of orthodontists, and the definition of “Committee” is also included for the first time, referring to the Medical Benefits (Dental Practitioners) Advisory Committee established under section 136 of the National Health Act 1953. The obligations and requirements imposed by these regulations are primarily on accredited dental practitioners who wish to be recognised as orthodontists for the purposes of rendering certain medical services listed in the table of medical services. These practitioners must now either be registered under a relevant law as an orthodontist or demonstrate their competence in orthodontics to the Committee (sub-rule 42(2)). The Committee, as defined, is tasked with assessing the qualifications and experience of practitioners who apply to be recognised as orthodontists, ensuring they meet the necessary standards to provide the specified services. The relevant law, as amended, must provide for the registration or licensing of orthodontists, thereby creating a clear pathway for practitioners to achieve the necessary recognition. Failure to comply with these regulations may result in practitioners being unable to render certain medical services listed in the table of medical services, which could impact their eligibility for Commonwealth medical benefits and the fees they can charge for these services. While the regulations do not explicitly outline specific penalties or consequences for non-compliance, any breaches of the criteria for recognition could lead to disputes regarding the eligibility for medical benefits, potentially resulting in legal challenges or administrative reviews. The overarching consequence would be the exclusion from the benefits and services specified under the Act, thereby affecting the financial and professional standing of the practitioners involved.

Legal classification tags

Area of Law
Health Law
Insurance Law
Instrument
Regulation
Concepts
Definitions & Interpretation
Licensing & Registration
Regulatory Standards

Interactions

Authorises

All Versions

Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.