EXPLANATORY STATEMENT
STATUTORY RULES 1982 NO. 370
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
Health Insurance (Variation of Fees and Medical Services) (No. 27) Regulations
Section 133 of the Health Insurance Act 1973 (‘the Act’) provides that the Governor-General may make regulations prescribing all matters required or permitted by the Act to be prescribed, or 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 fee 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. 26) Regulations prescribe a table under section 4 of the Act.
…/2.
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 of medical services. The amount of medical benefit paid by a registered medical benefits organisation 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 sub-section 4(1) of the National Health Act 1953, based on the fees set out in the table of medical services.
The Minister for Health agreed to the replacement in the table of medical services of current items 792 and 797 by new items 791 and 793 containing revised descriptions of the medical services to which the items relate. These amendments had been recommended by the Medical Benefits Schedule Revision Committee, an advisory body consisting of 5 representatives of the Australian Medical Association and 5 Commonwealth officers.
New item 791 relates only to ultrasound examination by ultrasonic cross-sectional echography where the patient is not referred by a medical practitioner. New item 793 relates only to ultrasound examination by cross-sectional echography where the patient is referred by a medical practitioner who is not a member of the same
…/3.
successful study, a high response rate from subjects is needed, but, because of the impracticality of removing details of each subject’s identity before the records are analysed, protection of the privacy of the individuals involved in the study is regarded as paramount. Consequently the Ministers for Health and National Development and Energy have approved the incorporation of the ‘Atomic Test Personnel Study’ in regulations under the Act.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 27) Regulations 2004 were enacted to amend the fees and descriptions of certain medical services listed in the table of medical services under the Health Insurance Act 1973. This legislation was introduced to address the need for updated and more precise descriptions of medical services, particularly for ultrasound examinations, as recommended by the Medical Benefits Schedule Revision Committee. The committee comprises representatives from the Australian Medical Association and Commonwealth officers. The objective of these regulations is to ensure that the fees for medical services are accurately reflected in the table, thereby facilitating the calculation of Commonwealth medical benefits and the amount of medical benefit paid by registered medical benefits organisations.
These regulations were issued by authority of the Minister for Health, aligning with the policy objective of maintaining an up-to-date and accurate table of medical services to support the efficient administration of health insurance benefits. The incorporation of the ‘Atomic Test Personnel Study’ in these regulations also underscores a commitment to addressing specific health-related research needs while ensuring the privacy of study participants is protected.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 27) Regulations 2004, issued under Section 133 of the Health Insurance Act 1973, pertains to the regulation of fees and medical services provided under the Act. These regulations are designed to amend the table of medical services as set out in Schedule 1 of the Act, which includes descriptions and fees for various medical services across different states. The regulations are applicable to registered medical benefits organisations and patients who are beneficiaries of these services, as well as to the providers of such services. The scope of these regulations extends to the entire Commonwealth of Australia, as they are issued by authority of the Minister for Health. The regulations do not specify any exclusions or exemptions but are applicable to all parties involved in the provision and reimbursement of medical services under the Health Insurance Act 1973. Furthermore, these regulations can be extended or restricted through subordinate instruments as necessary, allowing for flexibility in addressing changes in medical practices and services.
Key Provisions
The main operative sections of the Health Insurance (Variation of Fees and Medical Services) (No. 27) Regulations concern the variation of the table of medical services and the fees applicable to medical benefits under the Health Insurance Act 1973 (referred to as 'the Act'). Section 9 of the Act dictates that the calculation of Commonwealth medical benefits is based on the fees specified in this table. In accordance with the Act, the table in Schedule 1 has been updated to replace existing items 792 and 797 with new items 791 and 793, respectively. Item 791 now pertains solely to ultrasound examinations by ultrasonic cross-sectional echography when the patient is not referred by a medical practitioner. Item 793, on the other hand, covers ultrasound examinations by cross-sectional echography when the patient is referred by a medical practitioner who is not a member of the same practice.
The obligations and requirements imposed by the Act on the parties it governs include adherence to the updated table of medical services and the associated fees. Registered medical benefits organisations are mandated to calculate medical benefits based on these fees. The Act also requires the Minister for Health to review and approve recommendations from the Medical Benefits Schedule Revision Committee, which consists of representatives from the Australian Medical Association and Commonwealth officers. This ensures that the table of medical services is kept up-to-date and reflects the current standards of medical practice.
The Act outlines specific offences and penalties for non-compliance with its provisions. Although the precise maximum penalties are not detailed in the explanatory statement, breaches of the regulations could result in civil or criminal consequences. For instance, if a registered medical benefits organisation fails to adhere to the fees set out in the table, it could face penalties including fines or other legal actions. Additionally, any misrepresentation or misuse of the medical services table could lead to legal repercussions for individuals or organisations involved.
The Act also incorporates the 'Atomic Test Personnel Study' into the regulations, highlighting the importance of privacy protection in research. This study, which involves detailed subject data, is regulated to ensure the confidentiality and integrity of the research participants. Any misuse of this data could lead to further legal consequences, reinforcing the Act's commitment to protecting individual privacy while advancing medical research.