EXPLANATORY STATEMENT
STATUTORY RULES 1984 NO. 310
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL
SERVICES) (NO. 35) 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 amended by subsequent regulations, prescribe the previous 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 of 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 Minister for Health agreed to various amendments of the table of medical services affecting
145 new or existing items. These amendments had been recommended by the Schedule Revision Committee, a body comprised of 5 representatives of the Australian Medical Association and 5 Commonwealth officers which advises the Minister for Health. The amendments involve: the introduction of 67 new items; the deletion of 24 existing items; the revision of the description of medical service in 52 items; and the revision of the fee specified for medicare benefit purposes in 2 items.
The statutory rules repeal the regulations which prescribe the previous table of medical services and prescribe a new consolidated table of medical services incorporating the new, as well as earlier, amendments of the table.
The statutory rules came into operation on 1 November 1984.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 32) Regulations were enacted in 1984 under the authority of the Minister for Health, pursuant to the Health Insurance Act 1973. This legislation was introduced to address the need for periodic updates to the fees and descriptions of medical services listed in the Act's table of medical services, ensuring that the services and their remuneration remain current and reflective of the evolving healthcare landscape. The regulations were developed following recommendations from the Schedule Revision Committee, which comprises representatives from the Australian Medical Association and Commonwealth officers, thus providing a balanced approach to the amendments. The primary objective of these regulations is to maintain the integrity of the Medicare system by ensuring that benefits are appropriately calculated and paid to healthcare providers.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 35) Regulations, issued under the authority of the Minister for Health, pertain to the Health Insurance Act 1973. These regulations apply to the table of medical services, which is set out in Schedule 1 of the Act, and its interpretation, allowing for amendments to the fees associated with medical services and the services themselves. These amendments, as recommended by the Schedule Revision Committee, involve the introduction of new medical service items, the deletion of existing items, the revision of descriptions for certain services, and adjustments to fees for the calculation of the Medicare benefit. This Act applies nationally, affecting all individuals and entities that provide or receive medical services covered under the Medicare scheme, as well as any industry stakeholders involved in the provision of such services. The scope of these regulations is broad, covering all medical services listed in the table, and their application extends across all states and territories in Australia. The statutory rules, which came into effect on 1 November 1984, replace previous regulations and establish a new consolidated table of medical services, thereby ensuring that the Act's provisions are updated and implemented effectively.
Key Provisions
The Health Insurance (Variation of Fees and Medical Services) (No. 35) Regulations, made under section 133 of the Health Insurance Act 1973, detail amendments to the table of medical services, which specifies descriptions and fees for medical services. These amendments, recommended by the Schedule Revision Committee, include the addition of 67 new items, the removal of 24 existing items, and changes to the descriptions of services in 52 items, as well as fee adjustments in 2 items. This consolidated table of medical services, which incorporates all previous amendments, is intended to reflect the current medical practices and ensure that the fees for medical services are updated accordingly.
Entities governed by the Health Insurance Act 1973, particularly medical service providers and patients, must adhere to the new table of medical services as specified in these regulations. Medical practitioners and service providers are required to bill their services according to the updated descriptions and fees. Patients, on the other hand, should be aware of the changes in the services covered and the applicable fees, as this will impact the amount of Medicare benefit they receive. This adherence to the updated table is crucial for maintaining the integrity of the Medicare system and ensuring that medical services are fairly compensated.
Failure to comply with the updated table of medical services can result in various consequences. Medical service providers who do not bill according to the new regulations may face discrepancies in their Medicare benefits, potentially leading to financial losses or disputes with the government. Patients who are billed incorrectly may also face issues with their health insurance claims, leading to additional costs or denial of benefits. While these regulations do not explicitly outline criminal or civil penalties for non-compliance, the integrity of the Medicare system is paramount, and deviations from the specified fees and descriptions could result in audits or investigations by the relevant authorities.
The regulations came into effect on 1 November 1984, and all stakeholders are expected to implement the changes accordingly. The updated table ensures that the medical services are accurately described and appropriately compensated, reflecting the current standards of healthcare. This continuous updating process is essential for maintaining the efficacy and fairness of the Medicare system, ensuring that it remains a reliable support for both healthcare providers and patients.