EXPLANATORY STATEMENT

 

Select Legislative Instrument 2005 No. 170

 

Issued by the Authority of the Minister for Health and Ageing

 

Health Insurance Act 1973

 

Health Insurance (General Medical Services Table)

Amendment Regulations 2005 (No. 3)

 

Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides, in part, 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 set 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 2004 (the Principal Regulations) currently prescribe such a table.

 

The purpose of the Regulations is to provide more flexibility in the claiming and completion period of the diabetes annual cycle of care.  The Principal Regulations provide that the diabetes annual cycle of care covers a period of 12 months.  The Regulations allow a cycle of care to be completed within a period of 11 to 13 months.

 

The Regulations also reduce the number of consultations required under the 3 Step Mental Health Process, to provide more flexibility for GPs in the treatment of patients with a mental health disorder.  The Principal Regulations provide that GPs must undertake the 3 steps of assessment, planning and review in a minimum of 3 consultations of at least

20 minutes duration.  The Regulations allow for the 3 steps to be completed in a minimum of 2 consultations of at least 20 minutes duration.

 

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

 

The Regulations are taken to have commenced on 1 May 2005 , which is the date on which related changes were made to the Medical Benefits Schedule.

 

 

The retrospective effect of the amendments is not be contrary to subsection 12(2) of the Legislative Instruments Act 2003 as the changes are be beneficial in nature, and do not affect the rights of any person so as to disadvantage that person.  Nor do they impose liabilities on any person in respect of anything done, or omitted to be done, before the date of notification.

 

Consultation

Consultation has occurred through the Practice Incentives and Enhanced Primary Care Advisory Group (PERAG), the National Integrated Diabetes Working Group (NIDWG) and the Better Outcomes Implementation Advisory Group (BOIAG).  The proposed changes have been unanimously supported.

 

The PERAG was established to advise on the detailed design and implementation of changes to the Practice Incentives Program arising from the Red Tape Taskforce and includes members from the Australian Medical Association, Australian Division of General Practice, Rural Doctors Association of Australia and the Royal Australian College of General Practitioners.

 

The NIDWG is an expert group advising the Department on issues related to diabetes in Australia and is made up of experts in the areas of clinical, general practice, consumer and public health.

 

The BOIAG advises the Department on the implementation of the Better Outcomes in Mental Health Care Program (BOIMHC). This group includes representatives from a number of key stakeholder groups including the Australian Divisions of General Practice, the Mental Health Council of Australia, the Australian Medical Association, the Royal Australian College of General Practitioners, the Australian Psychological Society, the Rural Doctors Association of Australia, Royal Australian and New Zealand College of Psychiatrists, the General Practice Mental Health Standards Collaboration and beyondblue.

ATTACHMENT

 

Details of the Health Insurance (General Medical Services Table) Amendment Regulations 2005 (No. 3)

 

Regulation 1 – Name of Regulations

 

This regulation provides that the title of the Regulations is the Health Insurance (General Medical Services Table) Amendment Regulations 2005 (No. 3).

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to be taken to have commenced on 1 May 2005.

 

Regulation 3 – Amendment of the Health Insurance (General Medical Services Table) Regulations 2004  

 

This regulation provides that the Health Insurance (General Medical Services Table) Regulations 2004 (the Principal Regulations) are amended as set out in the Schedule.    

 

Schedule 1 – Amendments

 

Item [1] – Schedule 1, Part 2, subrule 62 (1)

Subrule 62 (1) currently provides that an item in Subgroup 2 of Group A18 or Subgroup 2 of Group A19 cannot be claimed for a patient who has already been provided with an item in either of those subgroups in the previous 12 months.   Both subgroups relate to the completion of an annual cycle of care for patients with established diabetes mellitus.  This item reduces the time period in which more than one item from those subgroups cannot be claimed, from 12 months to 11 months. 

 

Item [2] – Schedule 1, Part 2, subrule 62 (2)

Subrule 62 (2) currently describes the requirements for completing an annual cycle of care of a patient with established diabetes mellitus.  This item amends the description so that it refers to a cycle of care, over a period of at least 11 months and up to 13 months.  

 

Item [3] – Schedule 1, Part 2, paragraph 62 (2) (b)

Paragraph 62 (2) (b) currently requires that the cycle of care include a comprehensive eye examination if the patient has not received such an examination in the 12 months preceding the cycle of care.  This item changes the 12 month period to a period of between 11 and 13 months. 

 

Item [4] –Schedule 1, Part 2, subrule 77 (3)

This item amends paragraph 77 (3)(a) to enable the 3 Step Mental Health Process to be completed in a minimum of 2 consultations.

 

Item [5] - Schedule 1, Part 3, Group A18, Subgroup 2, heading

This item replaces the reference to an annual cycle of care in the heading of Subgroup 2 of Group A18 of Part 3 of Schedule 1 to the Principal Regulations with a reference to a cycle of care.

Item [6] - Schedule 1, Part 3, Group A19, Subgroup 2, heading

This item replaces the reference to an annual cycle of care in the heading of Subgroup 2 of Group A19 of Part 3 of Schedule 1 to the Principal Regulations with a reference to a cycle of care.

 

Item [7] – Further amendments – cycle of care

This item amends items 2517, 2518, 2521, 2522, 2525, 2526, 2620, 2622, 2624, 2631, 2633 and 2635 in Subgroup 2 of Group A18 and Group A19 of Schedule 1 to the Principal Regulations, to omit the term ‘an annual cycle of care’ and insert the term ‘cycle of care’.