Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE REGULATIONS (AMENDMENT) 1997 NO. 395

EXPLANATORY STATEMENT

STATUTORY RULES 1997 No. 395

Issued by authority of the Minister for Health and Family Services

Health Insurance Act 1973

Health Insurance Regulations (Amendment)

The Health Insurance Act 19 73 (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 in part that regulations may prescribe a table of diagnostic imaging services that sets out items of both R-type and NR-type, the amount of fees applicable for each item and rules of interpretation. The Health Insurance (1997-98 Diagnostic Imaging Services Table) Regulations prescribe such a table.

Subsection 16B(1) of the Act provides in part that Medicare benefits are not payable for an R-type 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 and the service is rendered prior to a "sunset" date and the rendering medical practitioner meets requirements for an exemption as a preexisting practice.

Sub-paragraph 16B(11)(d) of the Act provides that the "sunset" date is 1 January 1997 or a later date if prescribed by regulation.

Regulation 12A of the Health Insurance Regulations prescribes a date of 1 January 1998 for the purposes of sub-paraggraph 16B(11)(d) of the Act.

The regulations extend by twelve months the "sunset" provision for medical practitioners who meet the preexisting practices requirement giving exemption from the written request requirements for the diagnostic imaging R-type services.

The exemption provision was included in the Act following representations from the Royal Australian College of General Practitioners who were concerned that, unless the needs of some of their members were given special consideration, the proposed requesting arrangements would disadvantage those who had been providing diagnostic imaging services for many-years. Following discussions with the College, it was agreed that an exemption would be provided for medical practitioners who had been providing x-rays for many years on the basis that a "sunset" provision would apply and the College would develop accreditation guidelines. It has taken longer than envisaged to develop the guidelines.

The extension by twelve months of the sunset provision will enable the College to finalise the accreditation guidelines.

For patients, the effect of the proposed regulation will be to preserve benefit entitlements for R-type diagnostic imaging services rendered on and from 1 January 1998 to 31 December 1998 by medical practitioners who otherwise meet the pre-existing practice requirement.

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 1998; 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 of the 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 regulation amends regulation 12A of the Health Insurance Regulations by omitting the date "1 January 1998" and substituting the date "1 January 1999".

The regulations commence on 1 January 1998.


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