EXPLANATORY STATEMENT
STATUTORY RULES 1983 NO. 47
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
Health Insurance (Variation of Fees and Medical Services) (No. 28) 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 the calculation of medical benefits 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, as previously amended, 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 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.
Item 6415 of the table of medical services relates to the medical service of examination of the uterine cervix by magnifying colposcope of the Hinselmann type. The Minister for Health agreed to the amendment of item 6415 in accordance with a recommendation of the Medical Benefits Schedule Revision Committee, an advisory body consisting of 5 representatives of the Australian Medical Association and 5 Commonwealth officers. The amendment renders item 6415 applicable only in cases where the patient is referred for treatment by a medical practitioner
and there exist specified indications of malignant disease. This restriction is intended to prevent the use of colposcopic examination as a routine screening procedure and to limit the overutilisation of such examination by some medical practitioners. The amendment also effects an increase in the fees for the calculation of medical benefits contained in item 6415. This increase, from $16.20 to $30.00, restores the cost of this service to the relative level of the fees that applied prior to 1 September 1981 when a reduction was effected as a temporary measure to combat overutilisation. The amendments to the description of medical service and the restoration of the former fee level are considered to be a more effective and equitable means to overcome the overutilisation of the service.
The Minister for Health also agreed to the amendment of 6 items in the table of medical services relating to examination by computerised axial tomography using the equipment of a public hospital or a radiology unit specified in the rules for the interpretation of the table of medical services. In these items, the fees for the calculation of medical benefits currently specified in respect of New South Wales were 60% lower than those specified in respect of the other States. These lower
fees were originally intended to take into account the fact that medical practitioners in New South Wales did not enter into an arrangement whereby an agreed proportion of the fee received in respect of each service is paid to the relevant authority for the use of public equipment and facilities in the rendering of the service. Medical practitioners in New South Wales have now agreed to enter into such an arrangement. It was therefore considered necessary to amend the relevant 6 items by increasing the fees for medical services specified therein in respect of New South Wales to the same level specified in respect of the other States.
The statutory rules amend the Health Insurance (Variation of Fees and Medical Services) (No. 26) Regulations, as previously amended, to effect the desired amendments of the table of medical services.
The statutory rules came into operation on 1 May 1983.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 28) Regulations 1983 were enacted to address the need for adjustments in fees and medical services under the Health Insurance Act 1973. This legislation was introduced to ensure that the fees for certain medical services are set appropriately and that the use of specific medical procedures is controlled to prevent overutilisation. Enacted by the Parliament of Australia under the authority of the Minister for Health, these regulations aim to maintain equitable and effective healthcare practices by updating the fees and service descriptions in the table of medical services within Schedule 1 of the Act. The policy objective is to reflect changes in medical practice and to control costs while ensuring that the benefits provided are commensurate with the services rendered.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 28) Regulations, issued under section 133 of the Health Insurance Act 1973, govern the variation of fees and medical services provided under the Act, which applies to the Commonwealth of Australia. The Act affects medical practitioners, patients, and registered medical benefits organisations, as well as the broader healthcare industry, by regulating the fees for medical services and the interpretation of medical services listed in Schedule 1. The regulations extend to all states and territories within Australia, ensuring a uniform application of medical fees and services across the nation. The Health Insurance Act 1973 allows for the variation of fees and services through subordinate instruments, such as these statutory rules, which were implemented to address specific issues like the overutilisation of certain medical services and to adjust fees for medical services in New South Wales to align with those in other states. These regulations came into effect on 1 May 1983, providing an updated framework for the calculation of medical benefits based on the amended fees and service descriptions.
Key Provisions
The key operative sections of the Health Insurance (Variation of Fees and Medical Services) (No. 28) Regulations, issued under the authority of the Minister for Health, involve amendments to the fees and medical services table prescribed in the Health Insurance Act 1973 (section 4). These amendments are crucial as they directly affect the fees for specific medical services, which in turn determine the Commonwealth medical benefits paid (section 9). In particular, item 6415, relating to the examination of the uterine cervix by magnifying colposcope of the Hinselmann type, has been updated to apply only in cases where the patient is referred for treatment by a medical practitioner and there exist specified indications of malignant disease. Additionally, the fees for this service have been increased from $16.20 to $30.00. Similarly, fees for examination by computerised axial tomography using the equipment of a public hospital or a radiology unit in New South Wales have been increased to match those in other states.
The obligations imposed by the Act on the parties it governs include adherence to the updated fees and medical services table. Medical practitioners, registered medical benefits organisations, and patients must comply with the new specifications for the services and fees. Medical practitioners must ensure that their referrals and examinations align with the new criteria, while registered medical benefits organisations must update their payment calculations accordingly. Patients must be referred by a medical practitioner for the specified indications of malignant disease to be eligible for the colposcopic examination. The Minister for Health, through the Medical Benefits Schedule Revision Committee, has a responsibility to review and recommend changes to the fees and services table, ensuring they remain fair and effective.
Failure to comply with the new provisions can result in civil and criminal consequences. Although the specific offences and penalties are not detailed in the explanatory statement, under the Health Insurance Act 1973 and the National Health Act 1953, breaches may lead to penalties for overcharging or underpaying medical benefits. These penalties can include fines or other sanctions as prescribed by law. The Minister for Health retains the authority to enforce these regulations and ensure that all parties adhere to the updated fees and medical services table, maintaining the integrity of the medical benefits system.