EXPLANATORY STATEMENT
STATUTORY RULES 1984 NO. 265
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL
SERVICES) (NO. 34) 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 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, as previously amended, prescribe the present table of medical services in pursuance of Section 4 of the Act.
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 further increases to these fees for 1984. The Government had agreed to accept the recommendations flowing from the inquiry at the time of its setting up. A recommended interim increase to the fees of 8.9% from 1 September 1984 was given effect to by the Health Insurance (Variation of Fees and Medical Services) (No. 33) Regulations. A further increase to the fees of 1.06% was then recommended by Mr Deputy President McKenzie with effect from 1 October 1984. The effect of this increase was, for example, to raise 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 a participating optometrist, from $32.50 to $33.00.
The statutory rules further 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 came into operation on 1 October 1984.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 34) Regulations 1984 were enacted to update the fees for services provided by participating optometrists under the Health Insurance Act 1973. The Act, passed by the Commonwealth Parliament, establishes the Medicare system in Australia, providing subsidised access to medical services. These regulations address the need to periodically adjust the fees for optometrists' services to reflect changes in the cost of providing healthcare and to ensure that the fees remain equitable and sustainable. The policy objective is to maintain an efficient and effective healthcare system by ensuring that the fees for medical services are reviewed and updated in accordance with independent assessments and recommendations.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 34) Regulations, issued under the authority of the Minister for Health, pertain to the Health Insurance Act 1973. These regulations specifically address the variation of fees and medical services, amending the Health Insurance (Variation of Fees and Medical Services) (No. 32) Regulations. The Act applies to participating optometrists, and its scope includes the adjustment of fees for specific medical services as outlined in the table of medical services in Schedule 1. This adjustment is executed through subordinate regulations, which are necessary for implementing the provisions of the Act. The changes implemented by these regulations, which came into effect on 1 October 1984, reflect an increase in fees for services provided by optometrists, following recommendations from an independent inquiry. These adjustments ensure that the fees for certain services, such as a sole or first attendance in a single course of attention, are updated to reflect the recommended increases. The regulations have a national reach, applying across all states in Australia, and the changes are confined to the specific medical services detailed in the table of medical services, with no stated exclusions or exemptions.
Key Provisions
The primary operative sections of these regulations concern the variation of fees and medical services for optometrists under the Health Insurance Act 1973. Specifically, section 4 allows for the table of medical services, items, or rules of interpretation in Schedule 1 to be varied or replaced by regulations. Section 9 stipulates that the calculation of the Medicare benefit must be by reference to fees for medical services set out in the table of medical services in Schedule 1. These sections are crucial as they provide the legal framework for adjusting the fees for specific medical services, including those provided by optometrists, and ensuring that the Medicare benefit calculations are updated accordingly.
The obligations imposed by these regulations are primarily on the participating optometrists and the entities responsible for administering the Medicare scheme. Optometrists must comply with the updated fees set out in the table of medical services, and these fees must be adhered to when providing services to patients. The administrators of the Medicare scheme are required to use the updated fees in their calculations of the Medicare benefit payable for services provided by optometrists. This ensures that both providers and patients are aware of the correct fees and benefits applicable, facilitating smooth and accurate processing of claims.
Breach of these regulations can lead to various consequences, both civil and criminal. For instance, providing services at fees not specified in the updated table of medical services may result in incorrect billing and claims, potentially leading to financial penalties or legal action. Additionally, if the regulations are not adhered to, it could result in the non-payment of the correct Medicare benefit to patients, which could lead to further complications and disputes. While the explanatory statement does not detail specific maximum penalties, it is likely that breaches of these regulations could result in fines or other sanctions under the Health Insurance Act 1973 or related legislation.