Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE AMENDMENT REGULATIONS 1999 (NO. 7) 1999 NO. 344

STATUTORY RULES 1999 No. 344

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

Health Insurance Act 1973

Health Insurance Amendment Regulations 1999 (No. 7)

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 our or giving effect to the Act.

Section 19AA of the Act prohibits access to a Medicare provider number to persons who have become, or have been deemed to become, medical practitioners on or after 1 November 1996. The effect of the prohibition is that such a medical practitioner, and their patients, cannot claim a Medicare benefit in respect of professional services performed by the practitioner. However, subparagraphs 19AA(1)(b)(iv) and 19AA(2)(b)(iv) contain an exception to the prohibition for the duration of a period for which a medical practitioner is registered under section 3GA of the Act.

Section 3GA of the Act establishes a Register of Approved Placements. If a practitioner is "enrolled in, or undertaking, a course of program of a kind specified in the regulations" (refer subparagraph 3GA(5)(a)(i)) then he or she is eligible to apply for listing on the Register of Approved Placements and once listed, will meet the requirements of subparagraphs 19AA(1)(b)(iv) and 19AA(2)(b)(iv). Paragraph 3GA(5)(b) also provides that a person can be listed on the Register of Approved Placements, where the applicant is, in accordance with the regulations, eligible for registration under this section.

The Regulations allow Medicare benefits to be paid in respect of services provided by a medical practitioner in districts of workforce shortage under the Specific Workforce Shortage Program (the Program).

The Regulations add Part 3 to Schedule 5 of the Health Insurance Regulations 1975. Schedule 5 contains a list of programs and administering bodies specified for the purposes of section 3GA approved placements, in accordance with paragraph 3GA(5)(a). The Regulations prescribe criteria for eligibility for the Register of Approved Placements under paragraph 3GA(5)(b).

Eligibility for the Program is prescribed in Part 3 of Schedule 5. Eligible persons will be able to work to address medical workforce shortages in areas of specific workforce shortage outside the scope of the Rural Locum Relief Program (RLRP). RLRP operates in locations with a Rural, Remote and Metropolitan Area (RRMA) 4-7, classified as small rural to remote areas. Areas of specific workforce shortage also exist from time to time in some locations with a RRMA code between 1 and 3, for example large rural centres.

The Regulations permit eligible overseas-trained doctors to provide services that attract a Medicare rebate in special circumstances where they do not meet the criteria set for RLRP.

The Program is restricted to small numbers of doctors who can demonstrate that they are providing services in an area of workforce shortage, either in general practice or a specialist area.

The Regulations will provide an opportunity for doctors awaiting recognition of postgraduate qualifications or entry to a training program to work in area of workforce shortage for a limited period of time, up to 12 months. The Program will enable doctors without recognised postgraduate qualifications to work in private practice on a long-term basis. It is not intended to operate as a substitute for postgraduate training.

Details of the Regulations are set-out in the Attachment.

The Regulations commence on 1 February 2000.

ATTACHMENT

Details of the Health Insurance Amendment Regulations 1999 (No. 7)

Regulation 1 prescribes the name of the Regulations as the Health Insurance Amendment Regulations 1999 (No. 7)

Regulation 2 provides that the Regulations commence on 1 February 2000.

Regulations 3 provides that Schedule 1 of the Regulations amends the Health Insurance Regulations 1975.

Items 1 and 2 of Schedule 1 amends regulation 6E to provide for a class of eligible persons prescribed under paragraph 3GA(5)(b) of the Act, without them being first notified to the Managing Director of the Health Insurance Commission (HIC) by a "specified body".

Item 3 provides that a person may apply for registration under section 3GA in accordance with Part 3 of Schedule 5 and inserts:

*       new regulation 6EA, which provides that the eligibility of the applicant is for the purposes of 3GA(5) of the Act; and

*       new regulation 6EB, and sub regulations 6EB (a), (b) and (c) which prescribe the criteria for the removal of medical practitioners from the Register of Approved Placements, namely recognition of their qualifications and cessation of eligibility due to lapse of prescribed period of registration.

Item 4 substitutes a new heading for Schedule 5 of the Regulations.

Item 5 inserts:

*       Part 3 of Schedule 5 which provides the eligibility requirements for participation in the Specific Workforce Shortage Program;

*       Item 1 (a) which prescribes that the location for the services under the Program will be provided in districts of workforce shortage. Item 1(b) provides that the medical practitioner will be registered on the Register of Approved Placements.,

*       Item 2(a)(i) which provides that medical practitioners will be required to be awaiting recognition of their qualifications by the appropriate Australian medical college. This means that to be eligible a medical practitioner needs to have applied for recognition, but to have not received a decision awarding or declining recognition. Item 2(a)(ii) prescribes the two groups of persons who are eligible for the Medicare Benefits Scheme (MBS) access under section 3GA, namely overseas trained doctors or former overseas medical students.

*       Item 2(b) provides that approval is granted to medical practitioners who meet the criteria in Item 2 (a)(i) and (ii).

An example of this is where an OTD specialist has medical registration, but is awaiting formal recognition of qualifications for the purpose of accessing MBS items at the specialist rate. As there is often only one opportunity to get this recognition in a year, the doctor's patients would be unable to get access to any MBS rebate during the period that the doctor waited, despite his or her being able to provide the service under medical registration.