Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1992-1993 GENERAL MEDICAL SERVICES TABLE) REGULATIONS (AMENDMENT) 1993 NO. 145

STATUTORY RULES 1993 No. 145

Issued by the authority of the Minister for Health

Health Insurance Act 1973

Health Insurance (1992-1993 General Medical Services Table) Regulations (Amendment)

The Health Insurance Act 1973 (the Act) provides for payments by way of medicare benefits, payments for hospital services and payments for matters concerning related committees and tribunals.

Section 133 of the Act provides that the Governor-General may make regulations for the purposes of the Act.

Section 4 of the Act provides that the regulations may prescribe a table of medical services (the table), (other than pathology services) in accordance with the form of table set out in Schedule 1 and that, upon commencement of a regulation prescribing the table, it has effect as if it were set out in Schedule 1 in place of the table in that Schedule. The Health Insurance (1992-1993 General Medical Services Table) Regulations currently prescribe such a table for the purposes of section 4.

Subsection 4(4) of the Act provides that the regulations may amend a table and on commencement of the amendment the table as amended has effect in place of the table in Schedule 1.

Section 9 of the Act provides that medicare benefits shall be calculated by reference to the fees for general medical services set out in the table.

The Regulations amend the current table (Statutory Rules 1992 No's 338, 347 and 398) by introducing new services, deleting some existing services and amending the descriptions and/or fees of other services. They also introduce a new rule of interpretation to define an intensive care unit for the purposes of items in Subgroup T1-9 of the table.

Changes to the table result from ongoing reviews by the Medicare Benefits Consultative Committee designed to ensure that it reflects current medical practice. The major areas reviewed were cardiovascular (ECG) investigations, intensive care, chemotherapy and pain management.

Details of the regulations are as follows.

Subregulation 1.1 provided for the Regulations to commence on 1 July 1993.

Subregulation 2.1 provided for the Health Insurance (1992-1993 General Medical Services Table) Regulations to be amended as set out below.

Subregulation 3.1 inserts a definition of "intensive care unit" for the purposes of the Intensive Care Management and Procedures subgroup of the Miscellaneous Therapeutic Procedures Group of items in the table.

Subregulation 3.2 amends Rule of Interpretation 1.5, extending the definition of "referring practitioner" to allow dental practitioners approved by the Minister to refer patients directly to consultant physicians if the referral arises out of a dental service.

Subregulation 3.3 amends Rule of Interpretation 11.2 to add to the number of items of service which may be given by persons other than medical practitioners, either employed by medical practitioners or acting under their supervision, the new chemotherapeutic procedures being added to the table in these regulations.

Subregulations 3.4 and 3.5 reduce the fees for items 11221 and 11224 following an evaluation of computerised perimetry services. Computerised perimetry is an automated method used by ophthalmologists to diagnose and monitor the spread of glaucoma and to assist in the diagnosis of specific neurological disorders. Due to a significant reduction in the cost of equipment (which can now be manufactured locally) and a substantial increase in patient through-put, a reduction in fees is appropriate.

Subregulations 3.6 to 3.11 reflect the recommendations flowing from a review of respiratory, vascular and cardiovascular investigations and the emergence of new and simplified technology in this area.

Subregulation 3.12 amends the descriptions of items 12000 and 12003, distinguishing these items for allergy tests from the two following items in the table.

Subregulation 3.13 inserts in the Intensive Care Management and Procedures subgroup (of items) a number of additional items which cover advances in intensive care treatment and substitute new global management items for the existing items.

Subregulation 3.14 substitutes a number of items in the Chemotherapeutic Procedures subgroup of items in the table and a number of new items are added reflecting the changes in the delivery of chemotherapy by personnel and their use of technology.

Subregulations 3.15 and 3.16 expand the description of one item and insert a new item in the Other Therapeutic Procedures subgroup in the table.

Subregulation 3.17 amends the description of item 18212 to distinguish between the management of two different types of analgesia referred to in this item.

Subregulations 3.18 to 3.24 amend the descriptions of items to clarify their intent, correct anomalies and omissions to items identified during the ongoing reviews of various sections of the table.

Subregulations 3.25 to 3.53 amend the descriptions of a number of items, introduce new items and delete obsolete items from the cardiothoracic surgery and neurosurgical sections of the table. These changes flow from evaluations of earlier reviews as well as a review of items relating to pain management.

Subregulation 3.54 introduces a new item in the ear, nose and throat subgroup of the table to cover a new technique.

Subregulations 3.55 to 3.84 amend the descriptions of a number of items, introduce new items and delete obsolete items from the plastic and reconstructive surgery and orthopaedic surgery areas of the table following evaluations of earlier reviews of these areas.

The Regulations come into effect on 1 July 1993.