EXPLANATORY STATEMENT
STATUTORY RULES NO. 5 OF 1989
HEALTH INSURANCE ACT 1973 HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (NO. 50) 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 in effect that medicare benefits shall be calculated by reference to the fees for medical services set out in the table of medical services (the table) in Schedule 1 to the Act.
Section 4 of the Act provides, among other things, that the regulations may prescribe a table of medical services (other than pathology services) in accordance with the form of the table set out in Schedule 1 and that upon commencement of a regulation prescribing a table of medical services the table so prescribed has effect as if it were set out in Schedule 1 in the place of the table in that Schedule. The Health Insurance (Variation of Fees and Medical Services) (No.49) Regulations prescribe such a table.
The Health Insurance (Variation of Fees and Medical Services) (No.50) Regulations have made changes to the table previously prescribed, in relation to urological services, gynaecological services, and have made a number of minor amendments, corrections and clarifications of existing items. They have also amended the rules for interpretation, which form part of the Regulations.
The proposed changes to the urological services set out in Schedule 1 of the Regulations are the result of extensive discussions with relevant professional organisations and represent a restructuring of those services to reflect modern urology practice. Increased Medicare expenditure resulting from the new fees associated with the restructuring is estimated to be less than $10,000 per annum and could well be cost neutral with the emergence of new lithotripsy units which attract lower Medicare benefits.
Schedule 2 and paragraphs 3(c) and 3(e) of the Regulations contain changes to gynaecological services which are the result of discussions with the relevant professional organisation on matters outstanding from the earlier restructuring of obstetric and gynaecological services introduced into the table of medical services from 1 August 1988
Schedule 2 and paragraphs 3(c) and 3(e) also contain a number of proposed minor amendments, corrections and clarification of items following the 1 August 1988 change to the table of medical services and include as well proposed consequential changes to some general surgical services following the restructuring of urology services.
The amendment to Rule 39 of the rules for interpretation of the table of medical services contained in paragraphs 3(a) and 3(b) of the Regulations has the effect of extending that rule to apply to item 186 of the table which relates to the fitting of contact lenses. The application of Rule 39 to item 186 means that a medical service specified in item 186 will be taken to be a medical service for the purposes of the Act if, and only if, the service is performed by an optometrist on a patient in one of the classes of patient set out in Rule 39.
The application of Rule 39 to item 186, which in effect restricts the circumstances in which benefits are payable under that item, is associated with the recent repeal of section 13 of the Health Insurance Act 1973. This section previously provided for the payment of a lower benefit where certain conditions (conditions identical to those currently set out in Rule 39) had not been met. Unless these conditions are met there will, in the future, be no benefit payable. The conditions in question relate to the medical condition of the patient in question and the need, from a medical point of view, for the contact lenses.
The Regulations came into effect on 1 February 1989.