EXPLANATORY STATEMENT
STATUTORY RULES 1986 NO. 156
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (NO. 41) 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.
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. Schedule 1 contains items setting out the description of each medical service and the fee for the calculation of medicare benefit applicable in each State. Medicare benefit is normally payable, in accordance with section 10 of the Act, at a rate of 85% of the relevant fee set out 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 set out 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.
Section 4 of the Act provides that the table of medical services 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 (‘the Regulations’), as amended, prescribe the present table of medical services pursuant to section 4 of the Act. The present table is set out in the Schedule to the Regulations.
The Minister for Health has agreed to recommendations which have been made by the Medical Benefits Schedule Revision Committee. The Committee is a non-statutory body, comprising representatives of the Australian Medical Association and the Commonwealth, which advises the Minister for Health on revisions which should be made to the table of medical services. The Committee has made recommendations in connection with the introduction of magnetic resonance imaging technology into Australia, to the effect that the description of one item should be amended and that another item should be deleted.
Magnetic resonance imaging is a recently-developed diagnostic technology which produces pictures of the body by means of a magnetic field in conjunction with radio waves, rather than by the use of X-rays. The procedure produces images which are superior to those produced by current procedures, is non-intrusive and does not present a radiation hazard.
Regulation 3 amends the Schedule to the Regulations to give effect to the amendments recommended by the Committee. Regulation 2 provides for the amendments to come into operation on 1 July 1986.
It is expected that the first magnetic resonance imaging unit in Australia will become fully operational in Sydney on 1 July 1986. The regulations are intended to replace items in the table of medical services which related to the procedure while it was still under evaluation.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 41) Regulations 1986 were enacted to address the need for updating the table of medical services within the Health Insurance Act 1973. The Act, administered by the Commonwealth Parliament, aims to provide health insurance benefits, with medical fees and services outlined in the Act and its Schedules. The explanatory statement indicates that these regulations were issued under the authority of the Minister for Health to implement amendments recommended by the Medical Benefits Schedule Revision Committee. This committee, composed of representatives from the Australian Medical Association and the Commonwealth, advises on the necessary revisions to the table of medical services, ensuring they reflect current medical practices and technologies.
The introduction of magnetic resonance imaging (MRI) technology in Australia necessitated changes to the existing table of medical services to accurately reflect this new diagnostic technology. MRI offers significant advancements over traditional imaging methods by providing superior images without the use of X-rays or radiation, and thus posed a need for regulatory updates. The regulations seek to incorporate these changes by amending the descriptions of certain items and deleting obsolete ones, effective from 1 July 1986, aligning with the anticipated operational commencement of the first MRI unit in Sydney on that date.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 41) Regulations 1986, made under the authority of the Health Insurance Act 1973, apply to all entities and individuals involved in the provision and administration of medical services that are covered under the Medicare scheme in Australia. This includes medical practitioners, allied health professionals, and patients who are eligible for Medicare benefits. The regulations specifically pertain to the fees and descriptions of medical services listed in the table of medical services in Schedule 1 to the Act, which dictates how medicare benefits are calculated. The geographic reach of these regulations is national, as they apply to medical services provided in all states and territories within Australia. The regulations amend the existing table of medical services to reflect the introduction of magnetic resonance imaging technology, with specific changes including the amendment of one item and the deletion of another, effective from 1 July 1986. The regulations do not specify any exclusions or exemptions, but they do extend the application of the Act by amending the table of medical services as permitted under section 4 of the Health Insurance Act 1973.
Key Provisions
The key provisions of the Health Insurance (Variation of Fees and Medical Services) (No. 41) Regulations pertain to modifications in the table of medical services detailed in Schedule 1 of the Health Insurance Act 1973 (sections 4 and 9). These regulations are necessary for the implementation of the Act and are made under section 133. Specifically, Regulation 3 adjusts the Schedule to reflect the amendments recommended by the Medical Benefits Schedule Revision Committee, which advises on revisions to the table of medical services. Regulation 2 stipulates that these changes will take effect from 1 July 1986, aligning with the anticipated full operation of the first magnetic resonance imaging unit in Sydney on that date.
Under these regulations, the obligations imposed on parties include adherence to the new descriptions and fees set out in the amended Schedule. Medical practitioners, patients, and other stakeholders must comply with these updated terms for the calculation and payment of medicare benefits related to magnetic resonance imaging services. The changes ensure that the descriptions and fees reflect the current, advanced state of the technology, providing accurate and updated guidelines for billing and reimbursement.
Failure to comply with these regulations may lead to financial discrepancies in the provision of services, and potentially, legal consequences. Although the explanatory statement does not explicitly outline criminal or civil penalties for non-compliance, the regulations are intended to maintain the integrity of the medicare system. Any deviation from the prescribed fees and descriptions could result in disputes over the validity of claims and the appropriate level of medicare benefits payable. It is imperative for all parties to ensure their practices align with these regulatory changes to avoid any legal or financial repercussions.