Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1995-96 GENERAL MEDICAL SERVICES TABLE) REGULATIONS(AMENDMENT) 1996 NO. 106

STATUTORY RULES 1996 No. 106

Issued by Authority of the Minister for Health and Family Services

Health Insurance Act 1973

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

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 (General Medical Services Table) Regulations, Statutory Rules 1995 No. 298 currently prescribe such a table.

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.

The Regulations amend the current table of general medical services by introducing new services (e.g., hyperbaric oxygen therapy - subregulation 4.4; therapeutic haemapheresis -subregulation 4.6; peripheral arterial or venous catheterisation - subregulation 4.31), deleting obsolete services (e.g., certain urological procedures - proposed subregulation 4.35) and amending the descriptions and/or fees of other services. They also introduce 1 new rule of interpretation of the table and amend existing rules to correct omissions and take account of changes to items in the table.

Changes to the table resulted from ongoing reviews by the Medicare Benefits Consultative Committee designed to ensure that the table reflects current medical practice.

Details of the Regulations are set out in the Attachment.

The regulations came into effect an 1 July 1996.

ATTACHMENT

Details of the Regulations are as follows:

Regulation 1 provided for the Regulations to commence on 1 July 1996.

Regulation 2 provided that the General Medical Services Table be amended as set out in the Regulations.

Subregulation 3.1 amended subrule 1 (1) of the rules of interpretation by inserting a definition of "comprehensive hyperbaric medicine facility" for the purposes of items in the table containing this reference.

Subregulations 3.2 and 3.4 amended subrule 10(2) and 11(2) respectively of the rules of interpretation to delete reference to items 11303 and 13315 from the list of items that require personal attendance by medical practitioners. Item 11303 was incorrectly listed as it can be performed by persons other than medical practitioners. Item 13315 has been deleted from the table.

Subregulations 3.3 and 3.5 amended subrule 10 (2) and 11(2) respectively of the rules of interpretation to include new item 13030 which has a requirement for the service to be provided by a medical practitioner. Items 13000, 13003 and 13012 have been deleted from the table.

Subregulations 3.6 to 3.8 amended subrule 12(2) of the rules of interpretation to include item 11303 and new items 13020, 13025, 13750, 13755 and 13760 as these services may be performed by persons other than medical practitioners.

Subregulation 3.9 amended subrule 22 (2) of the rules of interpretation to extend the item range as a consequence of the introduction of items 75150 and 75621 into the table.

Subregulation 3.10 amended rule 29 of the rules of interpretation to include item 16571, as a consequence of the introduction of this item into the table.

Subregulation 3.11 omitted rule 32. The meanings of "closed reduction" and "open reduction" are also contained in subrule 1 (1).

Subregulation 4.1 amended the description of item 11603 to address possible inappropriate practice associated with this procedure.

Subregulations 4.2 and 4.3 amended the description of item 11918 to clarify the intent of the item. The amendment provides for ail associated imaging to be covered when cystometrography is performed.

Subregulation 4.4 amended the descriptions of services in the table covering hyperbaric oxygen therapy. The changes to the descriptions relate to the requirement for hyperbaric oxygen therapy to be restricted to proper facilities (i.e. a comprehensive hyperbaric medicine facility) based on standards developed by the profession; and provide for the patient to be pressurised for a minimum of 1 hour 30 minutes.

Subregulation 4.5 omitted obsolete item 13315.

Subregulation 4.6 introduced new items into the table to cover haemapheresis as an adjunct to high dose chemotherapy for non-Hodgkin's lymphoma and Hodgkin's disease in prescribed circumstances.

Subregulation 4.7 introduced a new item into the table to cover administration of an anaesthetic in connection with change of a dressing or plaster undertaken in a hospital or day hospital facility.

Subregulation 4.8 amended the descriptions of items 18216, 18219, 18230 and 18232 to exclude caudal injection on the advice of the anaesthetic profession. "Caudal" is covered by "intrathecal" as contained in these items.

Subregulations 4.9 and 4.10 corrected minor anomalies in the description of item 30378, to clarify intent.

Subregulations 4.11 to 4.32 introduced amendments to vascular surgery services in the table, following a major review of these services. The changes are aimed at ensuring that the items reflect and encourage appropriate clinical practice. The changes have been agreed with the profession.

Subregulations 4.33 and 4.34 inserted anaesthetic unit values for items 35518 and 35658 which were inadvertently omitted from the previous regulations.

Subregulation 4.35 deleted several obsolete urological services from the table.

Subregulation 4.36 amended item 37415 to restrict the use of penile injection in the investigation and treatment of impotence, based on advice from the profession.

Subregulation 4.37 amended an anomaly that currently allows the payment of benefits for the removal of a ventilating tube from the ear. Benefits are payable for this procedure on an attendance basis only.

Subregulations 4.38 and 4.39 amended the anaesthetic values of items 45638 and 45641.