Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE REGULATIONS (AMENDMENT) 1994 NO. 20

STATUTORY RULES 1994 No. 20

Issued by the authority of the Minister for Health

Health Insurance Act 1973

Health Insurance Regulations (Amendment)

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

The Regulations are necessary to amend the Health Insurance Regulations as a consequence of a determination by the Minister to provide two specific items in respect of bone densitometry under the provisions of section 3C of the Health Insurance Act and thus facilitate the payment of medicare benefits for such services. Section 3C of the Act allows the Minister to determine items and Schedule fees for services not listed in the General Medical Services Table.

The payment of medicare benefits in respect of bone densitometry was prohibited as a result of a determination issued under the provisions of section 19A of the Health Insurance Act which empowers the Minister to exclude benefits for professional services in prescribed circumstances. Such services are prescribed under Regulation 14 of the Health Insurance Regulations. Benefits for bone densitometry were excluded as from 21 June 1989 following a recommendation by the Medicare Benefits Advisory Committee (MBAC).

BACKGROUND

The MBAC recommendation was based on the fact that the methods used for the purpose of measuring bone density for osteoporosis assessment (bone densitometry) were not proven. The Committee considered that until such time as firm scientific evidence of the value of osteoporosis assessment using the various bone density measurement techniques were available, medicare benefits should not be payable.

A further recommendation was made to the Minister by MBAC on 6 December 1993. Based on its review of current scientific knowledge and clinical practice, MBAC recommended the payment of medicare benefits but that benefits be confined to two clinical applications with certain guidelines and restrictions applying in order to promote quality and appropriate use of the technology. This recommendation was accepted by the Minister.

THE REGULATIONS

Subregulation 3.1 therefore omits paragraph 14(2)(d) of the Health Insurance Regulations to remove the blanket prohibition on the payment of medicare benefits for bone densitometry tests. This amendment of the Health Insurance Regulations allows the payment of medicare benefits for the tests under the conditions specified in the section 3C Determination.

The regulation commences on 1 March 1994. This allows the payment of benefits in accordance with the section 3C Determination from 1 March 1994.