Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE AMENDMENT REGULATIONS 2004 (NO. 2) 2004 NO. 75

Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.

The Act provides, in part, for payments of medicare benefits in respect of professional services rendered to eligible persons. Section 19AA provides, in part, that a medicare benefit is not payable in respect of a professional service unless the person who rendered the service first became a medical practitioner on or after 1 November 1996 and is, within the meaning of the Act, a "specialist", a "consultant physician", a "general practitioner" or a person registered pursuant to section 3GA of the Act. Section 19AA was introduced in 1996 with the aim of ensuring that the long term medical workforce in Australia is of a high quality and to assist in dealing with workforce distribution problems.

Section 3GA of the Act provides for the registration of certain medical practitioners in approved placements as recorded in the Register of Approved Placements that is maintained by the Health Insurance Commission. In particular, paragraph 3GA(5)(a) provides for the entry of a practitioner's name on the Register of Approved Placements where the practitioner applies and a body specified in the regulations gives written notice to the Managing Director of the Health Insurance Commission that the applicant is undertaking a course or program of a kind specified in the regulations, together with the duration and location of the course or program. The relevant bodies and courses are specified in Part 2 of Schedule 5 to the Health Insurance Regulations 1975 (the Principal Regulations).

Entry of a practitioner's name in the Register of Approved Placements allows the payment of medicare benefits for professional services rendered by the practitioner where section 19AA of the Act would otherwise prevent the payment of medicare benefits in respect of the practitioner's services.

The purpose of the Regulations is to allow medicare benefits to be paid in respect of professional services rendered by medical practitioners registered as participants in the Approved Placements for Sports Physicians Program (the Program).

The Training Program for the Australasian College of Sports Physicians (the Training Program) is currently an approved placement program under section 3GA of the Act. However, sports medicine is not currently recognised as a speciality under the Act. The result is that participants in the Training Program are eligible to access Medicare Benefits Schedule items, but become ineligible when they graduate if they are affected by section 19AA of the Act. The establishment of the Program is intended to overcome this difficulty.

The Program is restricted to graduates who have gained Fellowship following the completion of the prescribed training program listed pursuant to section 3GA and who are participating in continuing professional development activities through the Australasian College of Sports Physicians.

The objective of the Program is to utilise the services of trained sports physicians to provide medical practitioner services in this specified area of medical practice. The Program is administered by the Department of Health and Ageing.

The Regulations include the Program in Part 2 of Schedule 5 of the Principal Regulations and hence specify that Program for the purposes of the Register of Approved Placements.

The Regulations also amend the existing item, specifying the training program for the Australian College of Sports Physicians for the purposes of section 3GA of the Act, to reflect a name change of the body to the Australasian College of Sports Physicians.

The Act specifies no conditions that need to be met before the power to make the Regulations maybe exercised.

Details of the Regulations are set out in the Attachment.

The Regulations commence on the date of their notification in the Gazette.

ATTACHMENT

DETAILS OF THE HEALTH INSURANCE AMENDMENT REGULATIONS 2004 (No. 2)

Regulation 1 provides for the Regulations to be referred to as the Health Insurance Amendment Regulations 2004 (No. 2).

Regulation 2 provides for the Regulations to commence on the date of their notification in the Gazette.

Regulation 3 provides for the Health Insurance Regulations 1975 to be amended as set out in Schedule 1.

Schedule 1

Item [1]

This item amends existing Item 13 of Part 2 of Schedule 5 to the Principal Regulations to reflect a name change to the Australasian College of Sports Physicians, which was formerly known as the Australian College of Sports Physicians.

Item [2]

This item inserts a new Item 21 into Part 2 of Schedule 5 to the Principal Regulations. This amendment specifies the Commonwealth Department of Health and Ageing's Approved Placements for Sports Physicians Program as a program for the purposes of section 3GA of the Act.