EXPLANATORY STATEMENT
STATUTORY RULES 1984 NO.
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL
SERVICES) (NO. 33) REGULATIONS
1984 No. 217
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 benefit 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. 32) Regulations, in pursuance of section 4 of the Act, prescribe the present table of medical services.
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 normally 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 patient in a year in relation to multiple professional services.
The table of medical services contains 4 items relating exclusively to attendances by optometrists who are participating optometrists under the Act. The fees specified in these items
have been adjusted annually since 1975 following either negotiations with the Australian Optometrical Association or an independent public inquiry. An independent inquiry, conducted by Mr Deputy President K.C. McKenzie of the Australian Conciliation and Arbitration Commission, recommended a further adjustment of these fees with effect from 1 September 1984. This adjustment involved an increase of 8.9% in the current level of the fees. The effect of this was to increase the fee specified in item 180 of the table of medical services, relating to a sole or first attendance in a single course of attention by the participating optometrist, from $30.00 to $32.50.
The statutory rules amend the Health Insurance (Variation of Fees and Medical Services) (No. 32) Regulations by substituting the increased fees for attendances by participating optometrists in the relevant items of the table of medical services set out in the Schedule to those regulations. The statutory rules also make amendments of a drafting nature to the description of service contained in item 180 of the table of medical services.
The statutory rules came into operation on 1 September 1984.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 33) Regulations 1984 were enacted under the authority of the Minister for Health to address discrepancies and ensure the ongoing relevance of fees for medical services provided by participating optometrists under the Health Insurance Act 1973. These regulations amend the existing fees set out in the table of medical services, as prescribed in the Health Insurance (Variation of Fees and Medical Services) (No. 32) Regulations, to reflect an 8.9% increase recommended by an independent inquiry led by Mr Deputy President K.C. McKenzie of the Australian Conciliation and Arbitration Commission. This adjustment was necessary to keep the fees in line with current economic conditions and the cost of providing these services. The Health Insurance Act 1973, enacted by the Australian Parliament, aims to provide a comprehensive health insurance scheme that ensures access to essential health services, and the regulations play a crucial role in maintaining the integrity and effectiveness of this scheme by periodically updating the fees and services covered.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 33) Regulations 1984 applies to optometrists who are participating optometrists under the Health Insurance Act 1973. These regulations govern the fees for medical services provided by participating optometrists, including the calculation of the medicare benefit, which is normally payable at a rate of 85% of the relevant fee specified in the table of medical services. The table of medical services, which contains descriptions of each medical service and the fee for the calculation of the medicare benefit, is subject to variations and replacements through regulations made under section 4 of the Act. The current regulations amend the fees for attendances by participating optometrists, reflecting an increase recommended by an independent inquiry. The adjustments involve an 8.9% increase in the current level of fees for specific optometric services, with effect from 1 September 1984. This legislative amendment ensures the fees for participating optometrists are updated and aligned with the prescribed table of medical services, facilitating the accurate calculation of medicare benefits for these services.
Key Provisions
The primary sections of the Health Insurance (Variation of Fees and Medical Services) (No. 32) Regulations, as amended by the statutory rules, involve adjustments to the fees for medical services provided by participating optometrists. These changes are detailed in the Schedule to the regulations, which includes updated fees for specific services, as well as modifications to the descriptions of certain services. Section 9 of the Act outlines the method for calculating the Medicare benefit, which is based on the fees set out in the table of medical services in Schedule 1. The regulations stipulate that Medicare benefit is normally payable at a rate of 85% of the relevant fee, with an additional amount payable to ensure the difference between the benefit and the specified fee does not exceed certain thresholds.
The obligations imposed by these regulations on the parties involved, particularly participating optometrists and patients, are to adhere to the updated fees for the specified medical services as set out in the amended table of medical services. This means that optometrists must charge the new fees for the services listed, and patients can expect to receive Medicare benefits based on these revised fees. Furthermore, the regulations require participating optometrists to update their billing practices to reflect these changes and ensure accurate calculation and payment of Medicare benefits.
Breach of these regulations could potentially lead to civil or administrative consequences. While the specific penalties for non-compliance are not detailed in the explanatory statement, it is reasonable to infer that failure to adhere to the updated fees and service descriptions could result in disputes over Medicare benefits and potential penalties under the Health Insurance Act 1973. The maximum penalties for breaches of the Act could include fines or other administrative actions, although the exact penalties would depend on the nature and severity of the breach. It is important for participating optometrists to stay compliant with these regulations to avoid any legal or financial repercussions.