Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE AMENDMENT REGULATIONS 1999 (NO. 4) 1999 NO. 176

EXPLANATORY STATEMENT

STATUTORY RULES 1999 No. 176

Issued by the Authority of the Minister for Health and Aged Care

Health Insurance Act 1973

Health Insurance Amendment Regulations 1999 (No. 4)

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

The Act provides, in part, for the payment of medicare benefits for professional services rendered by medical practitioners and for certain professional services rendered by dental practitioners and optometrists.

Section 4AA of the Act provides that regulations may prescribe a table of diagnostic imaging services. The Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations 1998 prescribe such a table.

Section 9 of the Act provides that medicare benefits shall be calculated by reference to the fees for medical services (including diagnostic imaging services) set out in the table which includes the Diagnostic Imaging Services Table (the Table).

On 1 March 1999, a number of new computed tomography items were introduced to the Table. Essentially, the new items enabled a differentiation in payment on the basis of the age of the imaging equipment (capital sensitive items) with the new items being introduced to cover services on older machines.

Subsection 16B(1) of the Act provides in part that medicare benefits are not payable for an R-type diagnostic imagine, service rendered by the providing practitioner unless the service was requested in writing by a medical practitioner, a dental practitioner, a chiropractor, a physiotherapist or a podiatrist. An R-type service is a service identified with the symbol (R) and comprise the majority of services in the Table.

Subsection 16B(2) of the Act provides that regulations may prescribe R-type diagnostic imaging services specified in regulations that may be requested by a dental practitioner.

Regulation 10 of the Health Insurance Regulations specifies R-type items that may be requested by practitioners who are registered or licensed under relevant State or Territory laws as dental practitioners. Dental practitioners are divided into. dental practitioners., dental practitioners approved by the Minister under paragraph (b) of the definition of a professional service in subsection 3(1) of the Act (that is oral and maxillofacial specialists), and. prosthodontists.

Item 1A of the Regulations amends Regulation 10 of the Health Insurance Regulations by adding seven Medicare Benefits Schedule item numbers (56250, 56256, 565541, 56547, 57041, 57047 and 57345) which oral and maxillofacial surgeons can request. These items are capital sensitive versions of Computed Tomography items that oral and maxillofacial surgeons were previously eligible to request, prior to the amendments to the Table that commenced on 1 March 1999, and consequently it is appropriate that they continue to be eligible to claim for these services.

Item 2 of the Regulations amends Regulation 10 of the Health Insurance Regulations by omitting Medicare Benefits Schedule item 56019 from those items which prosthodontists can request. Item 56019 has been deleted from the Medicare Benefits Schedule as it is no longer clinically relevant, and consequently it is no longer possible for this item to be requested.

There are no objections to the proposals by the relevant organisations.

The Regulations commenced 1 September 1999.


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