EXPLANATORY STATEMENT
STATUTORY RULES 1985 NO. 207
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (NO. 38) 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 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 37) Regulations prescribe the present table of medical services pursuant to 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.
Item 4319 of the table of medical services relates to the medical service, as described in the item, of:
“circumcision of a person under six months of age, where medically indicated”.
The regulations amend the Health Insurance (Variation of Fees and Medical Services) (No.37) Regulations by amending item 4319 to remove from the description of medical service in that item the words “where medically indicated”.
The amendment brings the description of medical service in item 4319 into line with those in items 4327, 4338 and 4345 of the table of medical services. These other items, which also relate to the procedure of circumcision, but in different age groups, do not contain the words where “medically indicated”.
The Minister for Health agreed to recommend this amendment following representations from the Jewish Board of Deputies and the Australian Federation of Islamic Councils.
The regulations came into operation on 1 September 1985.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 38) Regulations 1985 were enacted to amend the Health Insurance (Variation of Fees and Medical Services) (No. 37) Regulations 1985, which prescribe the table of medical services under the Health Insurance Act 1973. These regulations were introduced to address a specific issue regarding the description of a medical service related to circumcision of a person under six months of age, specifically removing the phrase "where medically indicated" from the service description. This change aligns the description of this service with other related circumcision services listed in the table of medical services, thereby ensuring consistency across similar procedures. The regulations were issued under the authority of the Minister for Health following representations from the Jewish Board of Deputies and the Australian Federation of Islamic Councils, and they came into effect on 1 September 1985. The overarching policy objective was to maintain uniformity and clarity in the description of medical services provided under the Act.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 38) Regulations, made under the Health Insurance Act 1973, pertain to the regulation and administration of medical services fees in Australia, specifically focusing on the alteration of fees for certain medical procedures. These regulations amend the existing Health Insurance (Variation of Fees and Medical Services) (No. 37) Regulations by modifying item 4319 in the table of medical services to exclude the phrase "where medically indicated" from the description of the medical service related to circumcision of a person under six months of age. This amendment aims to standardize the descriptions of circumcision services across different age groups, aligning item 4319 with items 4327, 4338, and 4345, which pertain to circumcision in other age categories but do not include the "medically indicated" qualifier. The application of these regulations is nationwide, affecting all parties involved in the provision and reimbursement of health services under the Medicare system, including healthcare providers, patients, and health insurers. The changes came into effect on 1 September 1985, thereby impacting the calculation and payment of Medicare benefits for the specified medical service.
Key Provisions
The primary operative sections of the Health Insurance (Variation of Fees and Medical Services) (No. 38) Regulations (C2004L04862) involve amendments to the table of medical services, specifically item 4319, which concerns the medical service of circumcision for a person under six months of age. The regulation seeks to remove the phrase "where medically indicated" from the description of the service in item 4319, thereby aligning it with the descriptions in other items related to circumcision for different age groups (items 4327, 4338, and 4345). This amendment was made following representations from the Jewish Board of Deputies and the Australian Federation of Islamic Councils. These changes aim to standardise the descriptions across related medical services, ensuring consistency in the application of the medical benefits schedule.
The Act imposes several obligations and requirements on the parties involved. Firstly, the Minister for Health is required to make regulations under section 133 of the Health Insurance Act 1973 that prescribe all matters necessary to carry out or give effect to the Act. These regulations must align with the provisions of the Act, ensuring that any amendments to the table of medical services or the interpretation rules are consistent with the overall legislative framework. Additionally, medical practitioners and health insurers must adhere to the updated table of medical services when providing and processing claims for the specified medical services. This ensures that the fees and benefits are correctly applied and that there is a transparent and standardised process for billing and reimbursement.
The regulations also outline consequences for breaches. While specific penalties are not detailed in the explanatory statement, it is understood that any non-compliance with the Act's provisions or the updated regulations could result in civil or criminal penalties. Such penalties might include fines or other sanctions as prescribed under the relevant legislation. The precise nature and extent of these penalties would typically be found in the principal Act or related regulatory frameworks. Compliance is crucial for both medical practitioners and insurers to avoid any legal repercussions and to ensure the smooth operation of the health insurance system.