EXPLANATORY STATEMENT
STATUTORY RULES 1985 NO. 5
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (NO. 36) REGULATIONS
Section 133 of the Health Insurance Act 1973 (‘the Act’) provides, in part, 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 each service.
Section 4 of the Act provides that the table of medical services in Schedule 1 to the Act may be replaced by regulations; that items or rules of interpretation in that table may be varied
or replaced by regulations; and that the regulations replacing such a table may themselves be amended by regulations. The Health Insurance (Variation of Fees and Medical Services) (No. 35) Regulations prescribe the present table of medical services pursuant to section 4 of the Act.
Section 9 of the Act provides that medicare benefits 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.
Part 12 of the table of medical services contains 50 items relating to orthodontic, surgical,
general, and prosthodontic services rendered to prescribed dental patients by accredited dental practitioners for the treatment of cleft lip and cleft palate conditions. An accredited dental practitioner is a dental practitioner accredited by the Minister in writing for the purposes of the definition of that term in sub-section 3(1) of the Act. A prescribed dental patient is defined in that sub-section to mean a person who has not attained the age of 22 years and who has been certified in the approved form by a medical practitioner, or by a dental practitioner approved by the Minister for this purpose, to be suffering from cleft lip or cleft palate condition.
The Minister for Health with the concurrence of the Treasurer and the Minister for Employment and Industrial Relations agreed that the fees specified in Part 12 of the table of medical services be increased by the overall amount of 28.07% with effect from 1 February 1985. This amount had been calculated by reference, through known economic indicators, to movements since 1981 in the cost and income components of dental practice as identified
in a survey conducted by the Australian Dental Association. Except for an interim increase of 4.3% in March 1984, these fees had not been increased since the inception of the relevant items on 1 January 1981. The effect of the increases is, for example, to increase the fee specified in item 8902, relating to a professional attendance and planning of treatment by an orthodontist, from $31.50 to $40.50.
The statutory rules amend the Health Insurance (Variation of Fees and Medical Services) (No. 35) Regulations by substituting a revised Part 12, incorporating the new fees, in the table of medical services set out in the Schedule to those regulations.
The statutory rules came into operation on 1 February 1985.