EXPLANATORY STATEMENT
STATUTORY RULES 1986 NO. 377
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (NO. 45) REGULATIONS
Section 133 of the Health Insurance Act 1973 (“the Act”) provides in part that the Governor-General may make regulations, not inconsistent with the Act, 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 the fees for medical services set out in the table of general medical services in Schedule 1 to the Act. Schedule 1 contains items setting out the description of each medical service, the fee for the calculation of medicare benefit applicable in each State and rules for the interpretation of the table.
Section 4 of the Act provides that the table of general medical services may be varied or replaced by regulations. The Health Insurance (Variation of Fees and Medical Services) (No. 44) Regulations (Statutory Rules 1986 No. 318) prescribe the present table of general medical services pursuant to section 4 of the Act.
In the course of preparation of those Regulations, an incorrect fee was included in the table of general medical services. The fee in respect of item 4825 - central vein catheterisation by open exposure, using subcutaneous tunnel with pump or access port as with a Hickman or Broviac catheter in children under the age of 12 years, performed with 12 anaesthetic units - was prescribed as $156.00 for all States, whereas it should have been $200.00 for all States.
The Health Insurance (Variation of Fees and Medical Services) (No. 45) Regulations rectify this error by prescribing the appropriate fee.
Regulation 2 provides for the Regulations to come into operation on 19 December 1986.
Overview
The Health Insurance (Variation of Fees and Medical Services) (No. 45) Regulations 1986 were introduced to correct an error in the fees for medical services under the Health Insurance Act 1973. The original Health Insurance (Variation of Fees and Medical Services) (No. 44) Regulations had mistakenly set the fee for a specific medical service, namely central vein catheterisation by open exposure, using subcutaneous tunnel with pump or access port in children under the age of 12 years, at $156.00 instead of the correct amount of $200.00. The 1986 Regulations were enacted by authority of the Minister for Health to amend this error, ensuring that the fees for medical services are correctly reflected in the table of general medical services as required by section 4 of the Act. This correction is essential to ensure accurate calculation of Medicare benefits as stipulated in section 9 of the Act.
Scope and Application
The Health Insurance (Variation of Fees and Medical Services) (No. 45) Regulations 1986 apply to all persons and entities involved in the provision of medical services in Australia, particularly those that bill for services under the Medicare system established by the Health Insurance Act 1973. This Act governs the calculation of Medicare benefits, which are determined by reference to the fees for medical services outlined in the table of general medical services in Schedule 1. The regulations specifically address the correction of an error in the previously prescribed fee for a particular medical service, namely central vein catheterisation by open exposure, using subcutaneous tunnel with pump or access port as with a Hickman or Broviac catheter in children under the age of 12 years, performed with 12 anaesthetic units. The corrected fee, which should have been $200.00 for all States, was mistakenly listed as $156.00 in the prior regulations. The Act applies nationally across Australia, and the amendments are designed to ensure accurate billing and remuneration for the specified medical service. The application of these regulations is limited to the correction of the aforementioned fee and does not extend to other fees or services unless explicitly stated in further regulations.
Key Provisions
The Health Insurance (Variation of Fees and Medical Services) (No. 45) Regulations, made under section 133 of the Health Insurance Act 1973, are primarily concerned with correcting an error in the fee for a specific medical service listed in the table of general medical services in Schedule 1 to the Act. Regulation 2 specifies that these Regulations will come into operation on 19 December 1986. The main purpose of these Regulations is to rectify the fee for item 4825, which pertains to central vein catheterisation by open exposure using subcutaneous tunnel with pump or access port, such as with a Hickman or Broviac catheter in children under the age of 12 years, performed with 12 anaesthetic units.
These Regulations impose an obligation on the parties or entities governed by them to comply with the corrected fee set out in the table of general medical services. Specifically, they require that the fee for the medical service in question be set at $200.00 for all States, rather than the previously prescribed $156.00. This correction is essential to ensure that medicare benefits are calculated correctly and that healthcare providers are appropriately remunerated for their services.
Failure to comply with these Regulations could result in financial discrepancies in the calculation of medicare benefits, potentially leading to legal and administrative consequences. Although the Act does not explicitly state any specific offences, penalties, or civil/criminal consequences for breaches of these Regulations, it is implied that non-compliance could lead to disputes over the correct fee for the service, and potentially to legal action to rectify such discrepancies. The precise penalties for non-compliance would likely be determined based on the specific circumstances of any breach and would be subject to the relevant provisions of the Health Insurance Act 1973 and other applicable laws.