EXPLANATORY STATEMENT
STATUTORY RULES 1985 NO. 229
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (NO. 39) 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, as previously amended, 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.
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 increased 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, determined further increases to these fees to apply from 23 September 1985. The Treasurer, the Minister for Employment and Industrial Relations, and the Minister for Health, on behalf of the Government, had previously agreed to accept the determination of the inquiry.
The determination of the inquiry involved an increase of 4.28% in the level of the fees. The effect of this has been, for example, 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 a participating optometrist, from $33.00 to $34.50, and the corresponding amount of medicare benefit from $28.05 to $29.35.
The statutory rules amend the Health Insurance (Variation of Fees and Medical Services) (No. 37) 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 23 September 1985.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 39) Regulations 1985 were enacted to adjust the fees for medical services provided by optometrists under the Health Insurance Act 1973. This legislative measure was introduced to address the need for periodic updates to the fees in line with economic changes and the cost of providing services. The regulations were issued under the authority of the Minister for Health and were designed to reflect the determinations of an independent public inquiry conducted by Mr Deputy President K.C. Mckenzie of the Australian Conciliation and Arbitration Commission, which recommended an increase in fees for optometrist services. The policy objective of these regulations was to ensure that the fees for medical services, and consequently the medicare benefits payable, remained reflective of the current economic conditions and the costs associated with delivering healthcare services.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 39) Regulations, issued under the authority of the Minister for Health, amend the Health Insurance (Variation of Fees and Medical Services) (No. 37) Regulations by adjusting the fees specified in the table of medical services set out in the Schedule. This Act applies to all participating optometrists who provide medical services to patients under the Medicare scheme in Australia, with the updated fees reflecting the determination of an independent public inquiry. The new fees, effective from 23 September 1985, are calculated to ensure that the medicare benefit remains at a rate of 85% of the relevant fee, with additional benefits paid where necessary to maintain the statutory limits on out-of-pocket expenses for patients. The regulations are designed to update the fees annually, following negotiations with the Australian Optometrical Association or through independent inquiries, ensuring that the medical services provided by optometrists are fairly compensated within the Medicare framework.
Key Provisions
The Health Insurance (Variation of Fees and Medical Services) (No. 39) Regulations 1985 primarily amend the Health Insurance (Variation of Fees and Medical Services) (No. 37) Regulations by updating the fees for medical services provided by participating optometrists under the Health Insurance Act 1973 (section 4). The Act itself, particularly section 9, mandates that the calculation of medicare benefits must be done using the fees outlined in the table of medical services, which is found in Schedule 1. These amendments reflect a 4.28% increase in fees, which have been agreed upon following an independent inquiry by Mr. Deputy President K.C. McKenzie of the Australian Conciliation and Arbitration Commission.
The Regulations impose specific obligations on the parties involved, primarily focusing on the implementation of the updated fees in the table of medical services. Medical practitioners, particularly optometrists who are participating under the Act, must now use the revised fees for billing purposes. The government agencies responsible for administering health insurance must also ensure that these updated fees are accurately reflected in their systems to properly calculate and disburse medicare benefits. The intent is to ensure that the new fees are accurately and uniformly applied across all relevant services.
Failure to comply with these Regulations can lead to several consequences. While the Act does not explicitly detail specific offences, breaches of the regulations could potentially lead to civil or administrative penalties. For example, inaccurate billing or failure to update fee schedules could result in financial discrepancies, leading to audits or investigations by the relevant health authorities. It is also possible that such non-compliance could impact the eligibility for medicare benefits for affected patients, thereby indirectly affecting the healthcare providers who rely on these payments. The maximum penalties, if applicable, would be determined by the relevant state or territory laws governing administrative compliance and health regulations, rather than being explicitly stated in these Regulations.