EXPLANATORY STATEMENT
STATUTORY RULES 1984 NO. 30
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (NO. 31) 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 medicare 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 amended, prescribed a table under section 4 of the Act.
Following amendments by the Health Legislation Amendment Act 1983, section 9 of the Act provides that medicare benefit shall be calculated by reference to fees for medical services set out in the table of medical services in Schedule 1 to the Act. Medicare benefit is normally payable, in accordance with section 10 of the Act, at a rate of 85% of the relevant fee specified in the table of medical services. An additional amount of medicare benefit is payable where required to ensure that the difference between the benefit payable and the fee specified in the table of medical services does not exceed $10.00 in relation to a single professional service, or an aggregate of $150.00 per claimant in a year in relation to multiple professional services.
The Government agreed that the fees, used for the calculation of medicare benefit, set out in the table of medical services should be increased by 4.3%. The effect of this increase is, for example, to raise the fee specified in the table of medical services for a standard consultation with a general practitioner in New South Wales from $13.20 to $13.80, and consequently the normal medicare benefit in relation to such a consultation from $11.25 to $11.75.
The statutory rules repeal the regulations prescribing the superseded table of medical services and prescribe a new table of medical services incorporating the increased fees. The statutory rules also effect a minor administrative amendment to item 180 of the table of medical services relating to a professional attendance by a participating optometrist which is the first or sole attendance in a single course of attention. The amendment requires the course of attention to be the sole course in any calendar year, and not any period of 12 months as previously.
The statutory rules came into operation on 1 March 1984.