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The statutory rules repeal the regulations prescribing the superseded table of medical services and prescribe a new table of medical services incorporating the increased fees.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.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 31) Regulations 1984 were enacted under the authority of the Minister for Health to amend the fees and medical services prescribed under the Health Insurance Act 1973. These regulations were introduced to address the need for updating the fees used in the calculation of Medicare benefits, ensuring they remained reflective of current medical service costs. The Health Insurance Act 1973, administered by the Parliament of Australia, aims to provide a scheme of health insurance for the Australian public, with Medicare benefits calculated based on the fees for medical services outlined in a table within the Act. The policy objective of these regulations is to adjust these fees by 4.3%, thus increasing the Medicare benefits payable to patients, while also making a minor administrative adjustment to clarify the conditions under which certain optometry services qualify for Medicare rebates. The regulations came into effect on 1 March 1984, replacing the previous set of regulations and ensuring the Medicare scheme continues to meet the evolving needs of the community.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 31) Regulations pertain to the Health Insurance Act 1973 and apply to the medical services outlined in the Act's Schedule 1, which contains a table of medical services and rules for their interpretation. The Act applies to persons and entities engaged in the provision of medical services in Australia, and it governs the fees for these services as well as the calculation of Medicare benefits. The regulations establish a national standard for these fees and benefits, affecting all states and territories within Australia. The Act and the subsequent regulations do not exclude any specific persons, entities, or services from their purview, except as may be specified through subordinate instruments. These regulations were made under the authority granted by section 133 of the Act, which allows for the creation of regulations to prescribe matters required or permitted by the Act, and they came into effect on 1 March 1984, superseding the previous regulations and implementing a 4.3% increase in fees for medical services.
Key Provisions
The Health Insurance (Variation of Fees and Medical Services) (No. 31) Regulations (C2004L04855) amend the Health Insurance Act 1973 (the Act) by altering the fees and medical services outlined in Schedule 1, specifically in the table of medical services. This table details the description of each medical service and the applicable fee for the calculation of Medicare benefits across the various states. The changes include a 4.3% increase in the fees for medical services, which impacts the calculation of Medicare benefits as per section 9 of the Act. For instance, the fee for a standard consultation with a general practitioner in New South Wales has been increased from $13.20 to $13.80, and the Medicare benefit from $11.25 to $11.75. Additionally, there is a minor adjustment to item 180 in the table, modifying the condition for a professional attendance by a participating optometrist to specify that the course of attention must be the sole course in any calendar year, rather than any 12-month period.
Under the Act, the primary obligation imposed by these regulations is to ensure that the table of medical services is updated to reflect the new fees, and that these fees are used to calculate Medicare benefits. This obligation extends to medical practitioners, who must adhere to the new fees when providing services and billing for them, as well as to patients, who should be informed of the changes to the fees and benefits. The regulations also impose on the Minister for Health the responsibility of ensuring that the table of medical services is regularly updated and that any changes are communicated effectively to all relevant parties.
Failure to comply with the provisions of these regulations can result in significant penalties. While the specific consequences for breach are not detailed in the text, under the Act, breaches could potentially lead to civil or criminal penalties. Civil penalties may include fines or compensation for damages, while criminal penalties could involve imprisonment, depending on the nature and severity of the breach. The exact penalties would be determined by the courts, taking into account the specific circumstances of the breach and any mitigating factors.