Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE AMENDMENT REGULATIONS 2008 (NO. 2) (SLI NO 209 OF 2008)

EXPLANATORY STATEMENT

Select Legislative Instrument 2008 No. 209

 

Health Insurance Act 1973

 

Health Insurance Amendment Regulations 2008 (No. 2)

 

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 purpose of the Regulations is to amend the Health Insurance Regulations 1975 (the Principal Regulations) to reflect the changes that are required to support the Health Insurance Amendment (90 Day Pay Doctor Cheque Scheme) Act 2008 (the Amending Act). The Amending Act amends section 20 of the Act to allow specialists and consultant physicians access to the 90 Day Pay Doctor Cheque Scheme where the original claim for the Medicare benefit is submitted electronically in the manner prescribed in the regulations.

 

A person is entitled to a Medicare benefit on presentation of a paid account for a professional service under the Act. However, when the patient is unable to pay the full amount of the account upfront, the patient may lodge an unpaid account with Medicare Australia and may request that a cheque for the amount of the Medicare benefit be drawn by Medicare Australia in favour of the medical practitioner who rendered the professional service. This cheque is sent to the patient, who is then responsible for presenting the cheque to the doctor along with any additional co-payment that may be required. This cheque is known as a ‘pay doctor via claimant cheque’.

 

In cases where the patient fails to present the cheque for payment within 90 days, the cheque is cancelled and Medicare Australia pays the general practitioner (GP) directly, via electronic funds transfer. This scheme, known as the 90 Day Pay Doctor Cheque Scheme (the Scheme) was introduced in 2001 to protect doctors from non-payment as a result of patients not forwarding the cheques and is currently only available to GPs.

 

The Amending Act allows the Scheme to be extended to services provided by or on behalf of specialists and consultant physicians. The Amending Act inserts a new subsection 20(6) into the Act to specify that the Scheme will only apply to specialist and consultant physician services where the claim for the Medicare benefit for their professional service has been made electronically.

 

The Regulations set out the conditions for specialists and consultant physicians to access the Scheme and also amend the existing arrangements for GPs.

 

Payment under subsection 20(3) of the Act can only be made to specialists and consultant physicians when the claim for Medicare benefits for their professional service is made using one of the following electronic claiming channels, Medicare Online, Medicare Easyclaim or ECLIPSE. Electronic claiming channels are dedicated paths that are administered by Medicare Australia and convey electronic claims for Medicare rebates. Medicare Online, Medicare Easyclaim and ECLIPSE are all approved electronic claiming channels administered by Medicare Australia.

 

The Principal Regulations currently require that for Medicare Australia to make an electronic payment to general practitioners, they must be enrolled in the Scheme and must provide Medicare Australia with written permission to give the Reserve Bank of Australia details of his or her bank account into which the payment may be made. GPs no longer be required to register with Medicare Australia and supply the written permission when the claim for Medicare benefits for their professional service is made using one of the electronic claiming channels. This change reduces the administrative burden on GPs and also ensures equity between GPs and specialists and consultant physicians under the Scheme. The existing arrangements for GPs relating to the other types of claiming, such as manual paper based claiming, remain unchanged.

 

Details of the Regulations are set out in the Attachment.

 

The amendments were made in response to repeated requests from the broader medical profession to extend the 90 Day Pay Doctor Cheque Scheme (the Scheme) to include specialists and consultant physicians. The industry has welcomed this beneficial measure which allows these medical practitioners to adopt the Scheme if they choose to take up electronic claiming. Medicare Australia undertook consultation through focus groups with pathology peak bodies, (such as Australian Association of Pathology Practices and the Royal College of Pathologist of Australia), and the Australian Medical Association, to address technical issues around payment methods for the relevant professional bodies affected. The Reserve Bank of Australia was also consulted as part of this process. The Department of Health and Ageing consulted with Medicare Australia on policy matters and the date of commencement of the amendment to ensure that the arrangements around the payment system were ready before the commencement of the Scheme.

 

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

 

The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

The Regulations commence on the commencement of Schedule 1 to the Amending Act. A separate Minute recommends that Schedule 1 commence on 1 November 2008.

 

 

 


ATTACHMENT

 

Details of the Health Insurance Amendment Regulations 2008 (No. 2)

 

Regulation 1 - Name of Regulation

 

This regulation provides that the title of the Regulations is the Health Insurance Amendment Regulations 2008 (No. 2).

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on the commencement of Schedule 1 to the Amending Act.

 

Regulation 3 – Amendment of Health Insurance Regulations 1975

 

This regulation provides that the Health Insurance Regulations 1975 (the Principal Regulations) are amended as set out in Schedule 1.

 

Schedule 1- Amendments

 

Schedule 1 amends the Health Insurance Regulations 1975 to specify the conditions that are to apply to GPs, specialists and consultant physicians for the purposes of the 90 Day Pay Doctor Cheque Scheme.

 

Item 1

This item replaces subregulation 13AA (2). Registration with Medicare Australia is no longer a requirement for GPs to be eligible for electronic payment under subsection 20(3) of the Act when the claim for Medical benefits is made using Medicare Online, Medicare Easyclaim and ECLIPSE. The existing arrangements (that the GP must register with Medicare Australia to receive electronic payments under the Scheme) for other types of claims for GP services remains unchanged.

 

This ensures that there is equity in the manner that GPs, specialists and consultant physicians are treated for the purposes of electronic claiming and the Scheme.

 

Item 2

This item inserts new regulations 13AB and 13AC.

 

Regulation 13AB allows the Medicare Australia CEO to make electronic payments for the amount of the Medicare benefit to a specialist or consultant physician, provided that the claim for the Medicare service was made using one of the following electronic claiming channels, Medicare Online, Medicare Easyclaim or ECLIPSE.

 

Subsection 20(6) of the Act provides that subsections 20(3) to 20(5) of the Act do not apply to a professional service rendered by or on behalf of a specialist or consultant physician, unless the claim for Medicare benefit for that service is made in an electronic manner prescribed.

Regulation 13AC prescribes for the purposes of subsection 20(6) of the Act that the claim for the Medicare benefit must be made using an electronic claiming channel listed in subregulation 13AB(2).


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