Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE AMENDMENT REGULATIONS 1998 (NO. 8) 1998 NO. 370

STATUTORY RULES 1998 NO. 370

Issued by authority of the Minister for Health and Aged Care

Health Insurance Act 1973

Health Insurance Amendment Regulations 1998 (No. 8)

Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations 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.

The purpose of the regulations is to allow Medicare rebates to be paid to patients in respect of services provided by medical practitioners in the course of their training as sports physicians with the Australian College of Sports Physicians.

Section 19AA of the Act prevents a Medicare rebate from being paid to a patient in respect of a service rendered by a medical practitioner, where the practitioner completed their internship on or after 1 November 1996, unless: (a) the practitioner is recognised as a specialist, consultant physician or general practitioner; or (b) the practitioner is on the Register of Approved Placements created under section 3GA.

Section 3GA of the Act provides for the creation of a Register of Approved Placements. An "approved placement" is a place on a course or program specified in the regulations. Persons may be listed on the Register once they are enrolled in an approved placement. Once registered, a person is eligible to apply for a provider number for Medicare rebates for the work he or she is required to perform while on the course or program. This ensures that only persons in properly supervised and recognised training positions are able to provide services for which a Medicare rebate will be payable.

Paragraph 3GA(5)(a) of the Act requires a body to be specified in the regulations for the purpose of administering an approved placement. Subparagraph 3GA(5)(a)(i) provides for the relevant course or training program to be prescribed in the regulations.

The new regulations adds a new Item to Part 2 of Schedule 5 of the Health Insurance Regulations. Schedule 5 contains a list of programs and administering bodies specified for the purposes of section 3GA approved placements. The new Item adds a new administering body and a new program into Part 2 of Schedule 5. The new body is the Australian College of Sports Physicians and the new program is the Australian College of Sports Physicians training program.

The Sports Physicians training program is prescribed in Part 2 of Schedule 5 in order to address the difficulty experienced by trainees in obtaining training placements. The inability for trainees to provide services for which their patients could obtain a Medicare rebate was a strong disincentive to practices that would otherwise supervise training posts. Training for sports physicians is not available in salaried hospital positions, but only through private practice. It is therefore important for trainees that their patients have access to the Medicare rebate for services provided in the course of training.

A Regulation Impact Statement is attached.

The regulations commenced on Gazettal.

REGULATION IMPACT STATEMENT

Amendment to the Health Insurance Regulations

Background

Services provided to private patients in Australia are funded through a combination of Commonwealth government rebate (the Medicare benefits scheme) for a scheduled amount per service, private health insurance payments and 'out of pocket' payments made by patients.

Section 19AA of the Health Insurance Act 1973 (the Act) prevents a Medicare rebate from being paid to a patient in respect of a service rendered by a medical practitioner, where the practitioner completed their internship on or after 1 November 1996, unless: (a) the practitioner is recognised as a specialist, consultant physician or general practitioner; or (b) the practitioner is on the Register of Approved Placements created under section, 3GA.

The regulations prescribe the courses and programs in which a person must be enrolled before they will be eligible to be entered on the Register of Approved Placements in Schedule 5. The regulations also prescribe the bodies responsible for administration of prescribed courses and programs.

New medical practitioners covered by section 19AA may seek to train as sports physicians. The training program administered by the Australian College of Sporting Physicians is not prescribed in Schedule 5 to the regulations and so trainee sports physicians are ineligible to apply to be placed on the Register of Approved Placements. This means that while trainees can provide services as required by their training program, their patients cannot access Medicare rebates for the services. Because all sports physicians are trained in private practice, this places a significant cost burden upon their patients and may be a disincentive to practices which would otherwise supervise trainees.

Objective

The objective of the proposed regulatory amendment is to allow trainee sports physicians the opportunity to access Medicare rebates similar to the opportunity available to specialist trainees.

Alternatives

Option 1: take no action.

Option 2:       prescribe the training program administered by the Australian College of Sports Physicians in the regulations so trainees become eligible to be on the Register of Approved Placements.

Option 1 would not assist the trainees as they would not be able to access Medicare rebates in respect of services provided while on a training course. In a situation where both trainees and their supervisors were unable to provide a service with a Medicare rebate, it is likely that a patient would prefer to be treated by the supervisor. This reluctance on the part of patients could be expected to reduce available training opportunities.

Option 2 has been adopted as a solution to the problem.

Impact Analysis

Complexity of the regulation

The proposed regulation change required to achieve Option 2 above would be minimal. it would involve a small addition to Part 2 of Schedule 5 of the Health Insurance Regulations to approve the Australian College of Sports Physicians to administer the training program.

Primary impact

The main impact of the proposed regulation would be on the trainee sports physicians and their patients. The trainee sports physicians would have better access to some patients who may be reluctant to seek diagnosis and treatment where they are unable to receive a Medicare rebate to assist them to meet the cost of the service.

Secondary impact

The proposed amendment would have an impact on the patient consumers of the services, in that the services would be more readily available on demand. Ultimately the program would assist Australia's health care system to better meet patient needs.

Costs

The grant of provider numbers would add to the cost of the administration of the health system as it would permit trainee sports physicians to access a provider number in respect of the services that they provide while on the training program. For general practitioners, the cost would be approximately $176 000 per annum for each full time equivalent doctor with access to the general practice rate of Medicare rebate. In the case of trainee sports physicians, the cost would be significantly less as their access to Medicare rebates would be restricted to the lower 'Other Medical Practitioner' (OMP) rate. However, the cost is limited by the fact that only 12 training positions are offered each year by the Australian College of Sports Physicians

Administration of the program would be cost-neutral given that the Australian College of Sports Physicians would have primary responsibility for ensuring the proper supervision of trainees. The College would also provide the necessary information to the Health Insurance Commission to allow it to place trainees on its Register of Approved Placements for the purpose of their accessing a provider number.

Benefits

The proposed amendment would establish eligible trainee sports physicians on a similar footing to specialist trainees, who are currently able to access a provider number and Medicare rebate for work performed during training.

Consultation

The proposed amendment has been made in response to requests from the Australian College of Sports Physicians. The proposed amendment would establish a framework for voluntary participation in a program administered directly by the College. Trainee sports physicians would benefit by becoming eligible to provide services attracting Medicare rebates. Further consultation is therefore not necessary prior to the making of the amendment.