Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2004 (NO. 1) 2004 NO. 65

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.

The Act provides, in part, for payment of Medicare benefits in respect of professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services set out in prescribed Tables.

Subsection 4 (1) of the Act provides that the regulations may prescribe a table of medical services (other than diagnostic imaging services and pathology services) that sets out items of medical services, the amount of fees applicable in respect of each item and rules for interpretation of the table. The Health Insurance (General Medical Services Table) Regulations 2003 currently prescribe such a table.

The purpose of the Regulations is to amend the current table of medical services by introducing a new item, and rules for determining its application, to give effect to changes announced in the Australian Government's MedicarePlus package. The new item allows a higher Medicare benefit to be paid to a practitioner in a regional, rural or remote area, or in Tasmania, where a bulk billed service is provided to an eligible patient who is under 16 years of age or who is a Commonwealth concession card holder.

Details of the Regulations are set out in the Attachment.

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

The Regulations commence on 1 May 2004.

ATTACHMENT

DETAILS OF THE HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2004 (No. 1)

Regulation 1 provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 1).

Regulation 2 provides for the Regulations to commence on 1 May 2004.

Regulation 3 provides for Schedule 1 to amend the Health Insurance (General Medical Services Table) Regulations 2003 (the Principal Regulations).

Schedule 1 - Amendments

Item [1] Heading of rule 77

This amends the heading of rule 77 to include new item 10991 (see item [8] below).

Item [2] Application of items 10990 and 10991 in subrule 77 (1)

This amends subrule 77 (1) to specify that either item 10990 or 10991, but not both items, can be claimed in relation to a medical service provided in a regional, rural or remote area, or in Tasmania. It also specifies that the fee payable under item 10990 or 10991 applies in addition to the fee for the medical service.

Item [3] Subrule 77 (2)

This amends subrule 77 (2) to specify that the definitions of "bulk-billed", "Commonwealth concession card holder" and "unreferred service" in subrule 77 (2) also apply to item 10991.

Item [4] Definition of "bulk-billed" in subrule 77 (2)

This amends subrule 77 (2) to replace the term "under whose supervision" with "on behalf of in the definition of "bulk-billed".

Item [5] Definition of "unreferred service" in subrule 77 (2)

This amends subrule 77 (3) to replace the term "under whose supervision" with "on behalf of in the definition of "unreferred service".

Item [6] New subrule 77 (3)

This inserts a new subrule 77 (3) to define the terms "practice location", "regional, rural or remote area" and "Rural, Remote and Metropolitan Areas Classification" for the purposes of item 10991.

Item [7] Item number 10990

This amends item 10990 to prevent item 10991 from being claimed in conjunction with item 10990.

Item [8] New item number 10991

This introduces a new item 10991 to allow an additional amount to be payable when any unreferred service is bulk billed and provided to a person under the age of 16 or a Commonwealth concession card holder (where that person is not an admitted patient at a hospital or day-hospital facility) and where the service is provided at or from a practice location in a regional, rural or remote area, or in Tasmania.