Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE REGULATIONS (AMENDMENT) 1996 NO. 336

STATUTORY RULES 1996 No. 336

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 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.

Section 4AA of the Act provides that regulations may prescribe a table of diagnostic imaging services. The Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations prescribe such a table.

The purpose of the regulations is to extend the "sunset" provision for the medical practitioners who met the pre-existing practices requirement for an exemption from the written request requirements for diagnostic imaging services which are designated as R-type services in the table. Unless exempted from the written request requirement, a Medicare benefit is not payable for an R-type service. An R-type service is identified in the table with the symbol "(R)". These service comprise the majority of services in the table.

The effect of the regulation will be to preserve patients' benefit entitlements for prescribed Rtype diagnostic imaging services rendered on and from 1 January 1997 to 31 December 1997 by medical practitioners who otherwise meet the pre-existing practice requirement.

Subsection 16B(1) of the Act provides in part that Medicare benefits are not payable for an Rtype diagnostic imaging service rendered by the providing medical practitioner unless the service was requested in writing by another medical practitioner, a dental practitioner, a chiropractor, a physiotherapist or a podiatrist.

Subsection 16B(11) of the Act provides in part that prescribed R-type diagnostic imaging, services may be rendered by a medical practitioner without the requirement for a written request from another medical practitioner, a dental practitioner, a chiropractor, a physiotherapist or a podiatrist, where the rendering medical practitioner meets requirements for an exemption as a preexisting practice.

The requirements for an exemption as a pre-existing practice are that: the service was specified in regulations made for this purpose; the service was rendered by or on behalf of the providing practitioner in the course of treating his or her own patient; the providing practitioner determined that the service was necessary; the service was rendered before 1 January 1997; and during the period commencing 17 October 1988 and ending on 16 October 1990, at least 50 services had been rendered by or on behalf of the providing practitioner, each services being a service that would have been an R-type diagnostic imaging service if it had been rendered after the commencement of the amendments to the Act that enabled section 16B, was rendered at a location at which the first service was rendered and resulted in the payment of a Medicare benefit.

The requirement that the service be rendered before 1 January 1997 is set out in paragraph 16B(11)(d) of the Act. That paragraph also provides that that date may be varied by regulation.

Regulation 3 inserts a new regulation 12A in the Health Insurance Regulations. Regulation 12A amends the date set out in paragraph 16B(11)(d) of the Act from 1 January 1997 to 1 January 1998.

The Regulations commence on 1 January 1997.