Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE REGULATIONS (AMENDMENT) 1996 NO. 335

STATUTORY RULES 1996 No. 335

Issued by Authority of the Minister for Health and Family Services

Health Insurance Act 1973

Health Insurance Regulations (Amendment)

The Health Insurance Act 1973 ("the Act") provides, in part, for the recognition of certain Fellows of the Royal Australian College of General Practitioners ("RACGP") and the establishment of a Register of Approved Placements. Medical practitioners who are Fellows of the RACGP or on the Register of Approved Placements can gain access to Medicare benefits for their professional services and the proposed regulations provide the mechanism for that access

Section 13 3 of the Act provides that the Governor-General may make regulations for the purposes of the Act.

The Health Insurance Amendment Act (No. 2) 1996 introduced minimum proficiency requirements which medical practitioners must meet before the services they provide attract Medicare benefits. New s. 19AA of the Act sets out the classes of doctors whose services can attract Medicare benefits and those classes include Fellows of the RACGP (s.3EA and s.3EB) and medical practitioners in training and other approved placements (s.3GA and OCTB).

The Regulations:

1. set out the criteria which a Fellow of the RACCP must meet to be able to access Medicare;

2. specify the bodies, courses and programs that a medical practitioner can undertake to be placed on the Register of Approved Placements. Practitioners on the Register are given access to Medicare whilst undertaking the prescribed placement eg: a locum in a rural area; and

3. prescribe other matters necessary following the passage of the Health Insurance Amendment Act (No. 2) 1996.

Further details of the Regulations art set out in the Attachment.

The regulations commenced on 24 December 1996.

ATTACHMENT

DETAILS OF THE HEALTH INSURANCE REGULATIONS (AMENDMENT)

Regulation 1 - provides for the Regulations to commence on 24 December 1996.

Regulation 2 - provides for the Health Insurance Regulations to be amended as set out in these amending Regulations.

Regulation 3 - adds to regulation 2 new definitions of the terms "RACGP" and "Appeal Committee".

Regulation 4 - adds regulations 6A, 6B, 6C, 6D, 6E, 6F and 6G.

Subregulation 6A(1) makes it a requirement that a Fellow of the Royal Australian College of General Practitioners ("RACGP") must meet the RACGP minimum requirements for continuing medical education and quality assurance to be able to obtain a determination under s.3EA of the Act. The definition of "general practitioner" in s.3(1) and s.19AA means that anew medical practitioner with a determination under s.3EA of the Act has access to Medicare benefits.

Subregulation 6A(2) specifies that a practitioner's name must be removed from the Register if the RACGP certifies that he or she has failed to meet their minimum standards for continuing medical education and quality assurance.

Regulation 6B requires that if the RACGP decides not to certify that a practitioner meets the requirements to be a recognised Fellow, written notice must be given to the practitioner of that decision.

Regulation 6C provides for an appeal against a decision:

1. to refuse to grant a determination because the RACGP has refused to certify that a practitioner is eligible for recognition; and

2. to revoke the practitioner's determination because the RACGP has given notice that the practitioner does not continue to remain eligible.

A medical practitioner may appeal to the Appeal Committee within 28 days of receipt of the notice of the decision, If the appeal is dismissed the Committee must give notice of the decision and the practitioner can obtain reasons on request within 28 days of the notice being given.

Regulation 6D establishes that where the Appeal Committee has received an appeal from a decision to revoke a determination, within the 28 day time limit, the practitioner remains eligible for Medicare access as a recognised Fellow until the appeal is finalised by the Appeal Committee.

Regulation 6E provides for the bodies, courses and programs listed in Schedule 1A to be recognised for the purposes of s.30A(5)(a) of the Act. Participation in one of the specified placements allows a practitioners name to be placed on the Register of Approved Placements which gives access to Medicare whilst the practitioner is in that placement.

Regulation 6F provides for the continued payment of Medicare benefits where a practitioner who was in an approved placement provides services at that same location for a short period beyond the end date for the approved placement. This is to ensure that where a practitioner has continued to render services beyond the end date of the placement patients are not disadvantaged by cutting off Medicare benefits.

Regulation 6G lists the relevant State and Territory laws under which a medical practitioner is an "intern" for the purposes of the definition in s. 19AA(5) of the Act.

Regulation 5 - inserts new Schedule 1A as specified in regulation 6E which lists the bodies, courses and programs recognised for the purposes of s.3GA(5)(a) of the Act. Participation in one of the specified placements allows a practitioner's name to be placed on the Register of Approved Placements which gives access to Medicare whilst the practitioner is in that placement.