Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2006 (NO. 1) (SLI NO 71 OF 2006)

EXPLANATORY STATEMENT

 

Select Legislative Instrument 2006 No. 71

 

Subject:       Health Insurance Act 1973

 

Health Insurance (General Medical Services Table) Amendment Regulations 2006 (No. 1)

 

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 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. 

 

A table of general medical services is currently prescribed by the Health Insurance (General Medical Services Table) Regulations 2005 (the Principal Regulations), which commenced on 1 November 2005. 

 

The purpose of the Regulations is to amend the cataract surgery items 42698, 42701, 42702, 42703, 42707, 42710, and 42716 in Schedule 1 to the Principal Regulations to remove the symbol ‘(H)’ from these items. The symbol ‘(H)’ limits the item to being performed or provided in a hospital or approved day hospital facility.  Removing the symbol ‘(H)’ would allow Medicare benefits to be payable for non-admitted patients.  

 

Details of the Regulations are set out in the Attachment.

 

The amendments follow advice from the Royal Australian and New Zealand College of Ophthalmologists, which advised that provided the procedure is performed in a quality accredited facility there is no detriment to the patient from a decision to treat the patient as an outpatient. The Australian Medical Association has also been consulted and has agreed to this change.  

 

The Act specifies no conditions that need to be met before the power to make the proposed 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 November 2005. The Office of Legislative Drafting and Publishing has provided advice that the proposed Regulations do not contravene subsection 12(2) of the Legislative Instruments Act 2003.

 

ATTACHMENT

Amendment to Health Insurance (General Medical Services Table) Amendment Regulations 2006 (No. 1)

 

Regulation 1 provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulations 2006 (No. 1).

 

Regulation 2 provides for the Regulations to be taken to commence on 1 November 2005.  The commencement date is retrospective so that non-admitted patients who were billed for these services since that date are not disadvantaged by a lack of coverage.  The Office of Legislative Drafting and Publishing has advised that the retrospective commencement date does not affect the rights of a person or impose liabilities on a person other than the Commonwealth and would comply with the Legislative Instruments Act 2003. 

 

Regulation 3 provides for Schedule 1 to amend the Health Insurance (General Medical Services Table) Regulations 2005.

 

Schedule 1

 

Item 1 removes the ‘(H)’ from item 42698, 42701, 42702, 42703, 42707, 42710, and 42716 to allow these procedures to be eligible for payment of Medicare Benefits whether or not they are performed in a hospital or approved day hospital facility. 

 

The item 42698 covers lens extraction excluding surgery performed for the correction of refractive error.

 

The item 42701 covers artificial lens insertion excluding surgery performed for the correction of refractive error.

 

The item 42702 covers lens extraction and insertion of artificial lens excluding surgery performed for the correction of refractive error.

 

The item 42703 covers artificial lens insertion in the posterior chamber and suture to the iris and sclera.

 

The item 42707 covers the removal of an artificial lens and replacement with a different lens, excluding surgery performed to correct a refractive error.

 

The item 42710 covers the removal of an artificial lens and replacement with a lens inserted into the posterior chamber and sutured to the iris or sclera.

 

The item 42716 covers the removal of a juvenile cataract.

 

 

 

 

 

 

 


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