Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1995-96) GENERAL MEDICAL SERVICES TABLE REGULATIONS 1995 NO. 298

STATUTORY RULES 1995 No. 298

Issued by authority of the Minister for Human Services and Health

Health Insurance Act 1973

Health Insurance (1995-96) General Medical Services Table Regulations

The Health Insurance Act 1973 (the Act) provides for payments by way of medicare benefits, payments for hospital services and payments for matters concerning related committees and tribunals.

Section 133 of the Act provides that the Governor-General may make regulations for the purposes of the Act.

Section 4 of the Act provides that the regulations may prescribe a table of medical services (the table), (other than diagnostic imaging services and pathology services). The Health Insurance (1994-1995 General Medical Services Table) Regulations currently prescribe such a table. The Act provides that, if not sooner repealed, these regulations cease to have effect 12 months after gazettal (which was on 31 October 1994) plus 15 sitting days.

Section 9 of the Act provides that medicare benefits shall be calculated by reference to the fees for general medical services set out in the table.

The purpose of the Regulations is to prescribe a new table of general medical services and rules of interpretation which will incorporate a general fee increase, the introduction of new services, the deletion of obsolete services and the amendment to the descriptions and/or fees of other services. The Regulations also provide for the repeal of the 1994-1995 General Medical Services Table. Further details of the Regulations are set out in the Attachment.

The Regulations come into effect on 1 November 1995.

Attachment

DETAILS OF THE HEALTH INSURANCE (1995-96 GENERAL MEDICAL SERVICES TABLE) REGULATIONS

Regulation 2 provides for the regulations to commence on 1 November 1995.

Regulation 3 provides for the repeal of the 1994-1995 General Medical Services Table.

Regulation 4 prescribes the new table of general medical services and rules of interpretation.

Rules of Interpretation

Amended rules have been introduced for the purpose of interpreting the table. These are as follow:

(a)       sub-rules 2(1)(d)(5) and 6(1)(a)(ii) have been amended so as to give .'emergency" the same meaning it has in the Health Insurance Regulations.

(b)       the dollar amounts stated in rules 7, 17,18 and 36 have been amended to reflect changes resulting from the general fee increase.

(c)       the item numbers in rules 10, 11, and 12 have been adjusted. to take into account item numbers added to and deleted from the table.

(d)       the item range in rule 23 has been extended from 11200 to 11206 to reflect the addition of items 12203 and 11206 to the table.

(e)       the heading for rule 28 has been changed to relate to the meaning of "delivery" rather than "confinement" to reflect change of wording in the relevant items.

(f)       in rule 29, 16517 has been replaced with 16519 to reflect the deletion of item 16517 from the table and its replacement by new item 16519.

(g)       in rule 35 the words "Amount under rule 34" have been replaced by the words "Amount under rule 35" to correct a previous error.

The remaining rules are unchanged.

Table of Services and Fees

The fees for services in the table have been adjusted in line with the announcement made in the 199511996 Budget. Fees have been adjusted as follow:

Range of items	Fee Adjustment
(a) 3-51	0.9 per cent
(b) 52-96	no increase
(c) 97-98	0.9 per cent
(d) 104- 164	1.8 per cent
(e) 170- 172	0.9 per cent
(f) 173	no increase
(f) all other items	1.8 per cent

Other changes incorporated in the table flow mainly from reviews facilitated through the Medicare Benefits Consultative Committee. These changes involve the introduction of new services, the deletion of obsolete services and amendment to the descriptions and/or fees of other services. The changes are designed to ensure that the table reflects current medical practice. Details of these changes are as follow:

(a)       items covering epicutaneous patch testing for allergic dermatitis (items 12012 to 12021) have been restructured to reflect the use of standard test batteries and that the use of the higher numbers of allergens is normally confined to specialised dermatological centres.

(b)        a major review of dermatological laser therapy (items 14100 to 14118) - items covering dermatological laser therapy have been restructured to reflect developments in laser technology which have changed the nature of the treatment regimes and times for treating severely disfiguring vascular lesions of the head and neck and port wine stains and haemangiomas. Also updated are dermatological items in the general surgery area (items 30187 to 30197) and plastic and reconstructive surgery items (items 45025, 45026, 45652, 45669) covering treatment by carbon dioxide laser.

(c)       a major review of obstetric services (items 16500 to 16573) - the first stage of the review, which basically relates to antenatal services, has been completed and provides for the:

(i)       removal of the routine antenatal attendances from the global item;

(ii)       removal of the reference to a maximum number of routine antenatal attendances;

(iii)       alignment of the antenatal attendance fee to the GP Level B surgery attendance item;

(iv)       maintenance of the existing structure of antenatal complication attendance items (with the exception of the change to item 16529 to lift the restriction of 2 visits in 7 days)

(v)       the alignment of the fees for antenatal complication attendance items to the GP Level B Surgery Attendance item;

(vi)       maintenance of the routine postnatal attendance items component in the global item but where the patient is transferred to another medical practitioner (other than the labour management practitioner) postnatal care visits can be claimed on an attendance basis;

(vii)       maintenance of the existing structure (plus the introduction of a new item) for postnatal complication attendance items but remove the restriction as to the treating practitioner, and increase fees; and,

a description change for management of second trimester labour to reflect appropriate medical practice.

(d)       changes to administration of anaesthetic items - some minor changes to correct fee anomalies (items 17971 and 18021) and to relocate items for anaesthesia in connection with hyperbaric treatment from Group T1 to T6 (items 18026 and 18027); and the introduction of new items for anaesthesia in connection with digital subtraction angiography (item 18022) and anaesthesia for children when the therapeutic or diagnostic procedure has not been allocated anaesthesia units (items 18030 to 18032).

(e)       a major review of cardio-thoracic items (items 38475 to 38508, 38577 to 38588, 38637 to 38647 and 38670 to 38680) - items covering cardiothoracic surgery have been restructured to reflect developments in this area, specifically retrograde cardioplegia, retrograde cerebroplegia and newer techniques involving valve repair and retention of complex valvular support structures. These improved surgical techniques are consistent with best practice and will lead to shorter intensive care and in-patient stays.

(f)       a review of skull-based neurosurgical items (items 39640 to 39662) - the outcomes of an earlier review in this complex surgical area involving delicate and intricate operative techniques with very long operative times and involving a number of surgical teams have been further refined.

(g)       other additions and amendments to the following areas to clarify intent or to remove ambiguities and anomalies:

- miscellaneous diagnostic procedures (item 12533)

- obstetrics (item 16633 and 16636)

- general surgery (items 30000 to 30023, 30052 to 30068, 30104 to 30107, 30186, 30213,30345, 30346, 30454, 30475, 30476, and 30487 to 30490)

- colorectal surgery (items 32000, 32003, 32005 to 32012, 32024, 32025, 32029 to 32042, 32099 to 32108, 32132, 32135, 32156 and 32159)

- gynaecological surgery (item 35658)

- urological surgery (36546 and 37011)

- cardio-thoracic surgery (item 38259 and 38436)

- neurosurgery (item 40332 and 40335)

- ENT surgery (items 41576, 41626, 41632, 41819, 41905)

- plastic and reconstructive surgery (items 45530, 45551, 45668, 45714)

- hand surgery (item 46494 and 46507)

- assistance at operations (item 51312)

- oral and maxillofacial services (items 52048, 52312)

Following a recommendation by the Optometrical Benefits Consultative Committee, a minor amendment has been made to the description of item 10906 (short consultation by an optometrist) to clarify its intention.