Explanatory Statement
STATUTORY RULES No. 230 of 1989
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL
SERVICES (NO. 51) 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) Regulations prescribe such a table.
By virtue of sub-section 4(6) of the Act, the No. 49 Regulations automatically cease to be in force on 26 October 1989, ie. the day next following the fifteenth sitting day of the House of Representatives 12 months after their notification in the Gazette. The No. 51 Regulations replace the Nos. 49 and 50 Regulations, which will also lapse within the next 12 months. The Minister for Community Services and Health agreed to the various recommendations and amendments, set out below, which amend the table of medical services and its rules for interpretation.
A restructuring of that part of the table relating to nuclear medicine services was undertaken following discussions between the Department of Community Services and Health and the Australian and New Zealand Association of Physicians in Nuclear Medicine and the Australian Medical Association. The item descriptions reflect current nuclear medicine practice and the cost of radiopharmaceuticals are incorporated in the Schedule fees for nuclear medicine investigations. The Minister agreed to the restructuring of this part of the table on 23 May and 1 June 1989.
Following a review of gynaecological oncology surgery and of the proposed introduction of new items to cover therapeutic hysteroscopy as well as endometrial biopsy, undertaken by the Department of Community Services and Health in consultation with
the Australian Society of Gynaecologic Oncologists, the Royal Australian College of Obstetricians and Gynaecologists and the Australian Medical Association, the Minister agreed to the recommendations of the review on 23 May and 1 June 1989.
On 23 May 1989 the Minister also approved the transfer to the table of a number of medical services for which medical benefits are presently payable under Ministerial determinations made under section 3C of the Health Insurance Act; the incidence of these items indicated that they more properly belonged to the table.
Certain other amendments to the table to correct or clarify existing item descriptions, and to incorporate changes proposed by the Medicare Benefits Advisory Committee (a statutory body comprising representatives of the Australian Medical Association and the Commonwealth which advises the Minister on revisions to the table), were also approved by the Minister on 23 May 1989.
The Minister on 1 June 1989 agreed to fee increases for certain radiology services which are based on newer low-osmolar contrast media (material injected into the body to improve X-ray images) which cause fewer adverse effects than older high-osmolar contrast media but cost four to five times as much.
For optometrical consultations the Minister agreed to increases in fees of 5.83% on 22 May 1989, based on an increase of that magnitude over the 12 months to 1 August 1989 in the Optometrical Fees Index.
The Minister agreed on 29 May 1989 to an amendment to the description of item 180 to allow payment of the benefit under that item for a patient who has a consultation with an optometrist practice for the first time, even when the patient has had another first-time consultation with another optometrist within the previous 24-mcnth period.
The Minister agreed to an overall Schedule fee increase of 5% to apply to all items in the Schedule as from 1 September 1989 apart from the pathology items which are included in a separate table and the fees for optometrical consultations which are to increase by 5.83%, as referred to above.
The proposed regulations include additions to and amendments of the Rules for Interpretation of the Table. The amendments to the Rules follow the amendments to the table, and the new Rules are included for clarification.