Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2004 (NO. 5) 2004 NO. 184

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 payment of Medicare benefits in respect of professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services set out in prescribed Tables.

Subsection 4 (1) of the Act provides that the regulations may prescribe a table of medical services (other than diagnostic imaging services and pathology services) that sets out items of medical services, the amount of fees applicable in respect of each item and rules for interpretation of the table. The Health Insurance (General Medical Services Table) Regulations 2003 (the Principal Regulations) currently prescribe such a table.

The purpose of the Regulations is to allow services provided by eligible non-vocationally recognised medical practitioners, under the Rural Other Medical Practitioners Program (the Program), to attract the full Medicare rebate, being the same rate as that for services provided by practitioners who are vocationally recognised under section 3F of the Act, where they are provided in certain areas currently precluded from the Program.

Eligibility for the Program is determined using the Rural, Remote and Metropolitan Area (RRMA) classification system. Currently, the full rebate is only available for medical practitioners providing services in RRMA 3-7 locations (rural and remote areas or centres with a population up to 99,999). The amendment will extend the scope of the Program to RRMA 1-2 areas (capital cities or other metropolitan centres with a population greater than 100,000). This amendment was initiated by the extension of the Program to 'areas of consideration' within the MedicarePlus Enhancements, announced by the Government on 10 March 2004, which are areas that are not classified RRMA 3-7 locations but exhibit the characteristics of rural areas.

The Regulations amend the definition of "eligible non-vocationally recognised medical practitioner" in relation to the Program, as well as the definition of the Program itself, in part 2 of Schedule 1 to the Principal Regulations, to remove the requirement that eligible practitioners be restricted to providing services in a rural or remote area under the RRMA Classification.

Details of the Regulations are set out in the Attachment.

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

The Regulations commence on 1 July 2004.

ATTACHMENT

Details of the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 5)

Regulation 1 provides for the Regulation to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulations 2004 (No. 5).

Regulation 2 provides for the Regulations to commence on 1 July 2004.

Regulation 3 provides that the Health Insurance (General Medical Services Table) Regulation 2003 be amended as set out in Schedule 1.

Schedule 1

Item [1] Schedule 1, Part 2, paragraph 3(3)(a)

This item substitutes a new paragraph 3(3)(a) to remove the requirement that eligible medical practitioners may only provide services in rural and remote areas under the Rural Other Medical Practitioners Program (the Program). This reflects the extension of the scope of the Program. This item also removes the requirement for eligible medical practitioners to register an interest in achieving vocational registration (with the Royal Australian College of General Practitioners under section 3F of the Health Insurance Act 1973), and reinforces the requirement for medical practitioners to provide services in accordance with the Program.

Item [2] Schedule 1, Part 2, paragraph 3(4)(a)

This item amends subrule 3(4)(a) to reflect the requirement for medical practitioners to provide services in accordance with the Program.