EXPLANATORY STATEMENT
STATUTORY RULES 1986 NO. 195
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES (NO. 42) 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, as amended (“the Regulations”), 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, with Rules for interpretation.
The Minister for Health has agreed to the 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 addition, deletion or alteration of the description of a number of items in the table.
The Health Insurance (Variation of Fees and Medical Services) (No. 42) Regulations give effect to the recommendations of the Committee. They also omit Part VII of the table of medical services, which sets out items relating to the provision of pathology services. In accordance with the amendments to the Act made by the Health Legislation Amendment Act 1986 (Act No. 75 of 1986, assented to on 24 June 1986), these items will now be prescribed in a separate table which will be amended when necessary by Ministerial determination rather than by regulations.
These Regulations also amend the Rules for the interpretation of the table of medical services to reflect the addition or deletion of certain items.
Regulation 2 provides for the amendments to come into operation on 1 August 1986.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 42) Regulations 1986 were enacted to address the need for regular updates to the table of medical services prescribed under the Health Insurance Act 1973. These regulations were issued under the authority of the Minister for Health and are aimed at ensuring that the fees and services covered by Medicare remain current and reflective of contemporary medical practices and standards. The Minister for Health agreed to the recommendations made by the Medical Benefits Schedule Revision Committee, a non-statutory body comprising representatives from the Australian Medical Association and the Commonwealth, which advises on necessary revisions to the table of medical services. These regulations implement the committee's recommendations, including the addition, deletion, or alteration of descriptions and fees for various medical services, while also omitting items related to pathology services which will now be prescribed in a separate table.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 42) Regulations 1986 apply to the table of medical services prescribed under the Health Insurance Act 1973, which sets out the fees for medical services for the calculation of medicare benefits. These regulations, which come into effect on 1 August 1986, implement recommendations from the Medical Benefits Schedule Revision Committee, a non-statutory body that advises the Minister for Health. They alter the descriptions of various medical services and remove pathology services from the table, which will now be regulated by Ministerial determination. The regulations also amend the Rules for interpreting the table of medical services to align with the changes made. The Act applies to the Commonwealth of Australia, affecting all entities and individuals who provide or receive medical services for which fees are prescribed under the Act. The Act's scope is national, impacting all states and territories within Australia, though the specific application of the fees may vary according to state regulations. These regulations extend the application of the Act by modifying the table of medical services and updating the interpretive rules, ensuring the medicare benefits are calculated accurately based on the current medical services fees.
Key Provisions
The main operative sections of the Health Insurance (Variation of Fees and Medical Services) (No. 42) Regulations involve the amendments and updates to the table of medical services as prescribed under section 4 of the Health Insurance Act 1973 (the "Act"). Section 4 of the Act authorises the Governor-General to make regulations varying or replacing the table of medical services, and the Regulations implement these changes. These amendments reflect recommendations from the Medical Benefits Schedule Revision Committee, a non-statutory body that advises on revisions to the table of medical services. Regulation 2 specifies that these amendments will take effect on 1 August 1986.
The obligations imposed by these Regulations primarily concern the updating and interpretation of the table of medical services, ensuring that the table reflects current medical practices and fee structures. The Regulations require the addition, deletion, or alteration of descriptions of medical services as recommended by the Committee. This includes the omission of Part VII of the table of medical services, which relates to pathology services, in line with amendments made by the Health Legislation Amendment Act 1986. These amendments must be accurately implemented in the Regulations to ensure compliance with the Act.
Under the Act, breaches of the Regulations may lead to civil and criminal consequences. While specific penalties are not detailed within the explanatory statement, the Act generally provides for penalties for non-compliance with its provisions. For example, section 136 of the Act empowers the Governor-General to make regulations prescribing penalties for breaches, which may include fines. The severity of penalties would depend on the nature and extent of the breach, with potential maximum penalties outlined in the relevant sections of the Act and any subsequent regulations. The Regulations themselves do not specify the penalties but indicate that they are subject to the broader legislative framework provided by the Act.