Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT (DURATION OF ATTENDANCE) REGULATION 2014 (SLI NO 194 OF 2014)

EXPLANATORY STATEMENT

Select Legislative Instrument No. 194, 2014

Health Insurance Act 1973

Health Insurance (General Medical Services Table) Amendment (Duration of Attendance) Regulation 2014

Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides that the

Governor-General may make regulations, not inconsistent with the Act, 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. 

Part II of the Act provides for the payment of Medicare benefits for professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits be calculated by reference to the fees for medical services set out in prescribed tables.

Subsections 4(1) of the Act provides that the regulations may prescribe a table of medical services which set out items of medical services, the fees applicable for each item, and rules for interpreting the table.  The Health Insurance (General Medical Services Table) Regulation 2014 (GMST) currently prescribes such a table. The Health Insurance Regulations 1975 (HI Regulations) prescribe other 'matters' which the Governor-General may make regulations for in accordance with subsection 133(1) of the Act.

The Health Insurance (General Medical Services Table) Amendment (Duration of Attendance) Regulation 2014 (the Regulation) amends the GMST to set a time limitation on specific general practice attendances funded through the Medicare Benefits Schedule (MBS) to ensure Government rebates continue to be up-to-date, representative of best practice medical practice, and reflective of Government commitments.

Previously, Level A general practice (GP) attendance items 3 and 5000 did not have a time requirement unlike the remaining GP attendances. In principle, it was always intended that these items would be billed for short, simple GP attendances, but in practice a substantial number of simple attendances lasting less than 10 minutes are billed as Level B GP attendance items 23 and 5020, which attract a higher Medicare-recommended fee and patient rebate.

The Regulation amends items 3, 23, 5000 and 5020 to better reflect the time that a GP spends with their patients. From 19 January 2015, Level A items will apply to a GP attendance lasting less than 10 minutes and amended Level B items will apply to a GP attendance lasting at least 10 minutes and less than 20 minutes. The overarching goal of these amendments is to ensure that Medicare expenditure accurately reflects the time a GP spends with a patient.

Consultation

In accordance with Section 18 of the Legislative Instruments Act 2003, the nature of the Regulation is such that it was inappropriate to consult. The decision to alter entitlement to Medicare benefits was taken as part of Government's Mid-Year Economic and Financial Outlook 2014-15.

Details of the Regulation are set out in the Attachment.

The Act specifies no conditions which need to be met before the power to make the regulation may be exercised. 

The Regulation is a legislative instrument for the purposes of the Legislative Instruments Act 2003. 

The Regulation commences on 19 January 2015.

                                                                       Authority:     Subsection 133(1) of the

                                                                                                Health Insurance Act 1973 

ATTACHMENT

Details of the Health Insurance (General Medical Services Table) Amendment (Duration of Attendance) Regulation 2014

Section 1 - Name

This section provides for the Regulation to be referred to as the Health Insurance (General Medical Services Table) Amendment (Duration of Attendance) Regulation 2014

Section 2 - Commencement

This section provides for the Regulation to commence on 19 January 2015.

Section 3 - Authority

This section provides that the Regulation is made under the Health Insurance Act 1973.

Section 4 - Schedules

This section provides that each instrument specified in a Schedule to the instrument is amended or repealed as set out in the applicable items in the Schedule concerned.

Schedule 1 - Amendments

Health Insurance (General Medical Services Table) Regulation 2014

Item [1] -Schedule 1 (item 3, column headed "Description")

This item amends item 3 so that it is limited to professional attendances lasting less than 10 minutes.

Item [2] - Schedule 1 (item 23, column headed "Description")

Item 2 amends item 23 so that is limited to professional attendances lasting at least 10 minutes and less than 20 minutes.

Item [3] - Schedule 1 (item 5000, column headed "Description")

Item 3 amends item 5000 so that it applies to a professional attendance after-hours lasting less than 10 minutes.

Item [4] - Schedule 1 (item 5020, column headed "Description")

Item 4 amends item 5020 so that it applies to a professional attendance after-hours lasting at least 10 minutes and less than 20 minutes.

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