Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE COMMISSION REGULATIONS (AMENDMENT) 1996 NO. 322

EXPLANATORY STATEMENT

Statutory Rules 1996 No. 322

Issued by Authority of the Minister for Health and Family Services

Health Insurance Commission Act 1973

Health Insurance Commission Regulations (Amendment)

Section 8E of the Health Insurance Commission Act 1973 (the Act) provides that the Health Insurance Commission (the HIC) shall perform such functions in relation to health related matters as are prescribed. Section 44 of the Act provides for the Governor-General to make regulations.

Regulation 3P in the Health Insurance Commission Regulations allows the HIC to perform the function of administering the Better Practice Program (the Program), which is a voluntary program designed to provide financial recognition for general practices that focus on patient needs and provide continuing, comprehensive whole of patient care.

Before a general practice can receive financial recognition under the Program, a decision must be made that the practice is eligible to participate and another decision made as to the amount of any payment.

To be eligible, practices must meet the eligibility criteria that require practices to employ appropriately trained medical practitioners, provide out of surgery visits and ensure that their patients have access to appropriate after hours care. Eligible practices may receive four quarterly payments, the amount of which is determined by the HIC in accordance with a payment formula. Practices need to reapply for the Program annually and the MC receives new applications on a rolling basis, with re-applications being due on the anniversary of the date on which the practices application was first approved.

The Program is currently under review, and it is expected that the Program will undergo changes in 1997, If significant changes occur, practices currently participating in the Program may be required to reapply for the new Program when it comes into effect. This would mean that many practices. would have to go through a re-registration process twice in the same year.

The Department of Health and Family Services and the HIC are developing a transitional arrangements to ensure that practices currently participating in the Program can be incorporated within the new restructured Program with least disruption. The amendments to Regulation 3P enable the HIC to continue to make payments without practices having to reapply for the Program and are intended to avoid placing an onerous burden of additional paperwork on practices and to minimise the administrative burden and costs for the HIC.

Details of the amendments to Regulation 3P are attached.

The amendments to Regulation 3P will commence on gazettal, but will retrospectively apply to all practices that cease to be eligible for the Program from 1 December 1996. This is because most practices are due to reregister for the Program for the third time as of this date.

The amendments to Regulation 3P are not in contravention of s48 of the Acts Interpretation Act 1901. The amendments are beneficial to practices participating in the Program, as they remove the requirement on practices to provide additional paperwork to the HIC. Quarterly Payments to practices will continue as usual.

ATTACHMENT

Details of Proposed Amendments to Regulation 3P

The Primary Purpose of the proposed amendment to Regulation 3P of the Health Insurance Commission Regulations is to enable the HIC to continue to make payments to eligible practices participating in the Better Practice Program on or after 1 December 1996, without the practices being required to re-apply for the Program. This is a transitional arrangement designed to reduce the administrative burden on practices while the Program is undergoing a comprehensive review.

Specifically:

*       proposed subregulation 3 - amends subparagraph 3P(2)(c)(ii) to remove a typing error.

*       proposed subregulation 4.1 - amends paragraph 3P(6)(b) to correct an erroneous reference to a subparagraph.

*       proposed subregulation 4.2 - inserts a new subregulation 3P(9)(a) to provide an express mechanism for practices to withdraw from the Program.

*       proposed subregulation 4.3 - inserts a new subregulation (10A) which extends the eligibility period of practices, which cease to be eligible for the Program in the year starting on 1 December 1996, from four to eight payment quarters. The extended eligibility period will not apply for practices whose eligibility has been cancelled by the HIC because they have stopped meeting the Program's eligibility criteria or because the practice has withdrawn from the Program

*       proposed subregulation (10B) - enables the HIC to extend a practices eligibility by 1 to 4 payment quarters, in the year starting on 1 December 1997.


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