EXPLANATORY STATEMENT

 

Select Legislative Instrument 2007 No. 100

 

 

Subject: Health Insurance Act 1973

 

Health Insurance (General Medical Services Table) Amendment Regulations 2007 (No. 4)

 

 

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 2006 (the Principal Regulations) which commenced on 1 November 2006.

 

The purpose of the Regulations is to amend the Principal Regulations as part of the on-going management of the General Medical Services Table, and also incorporate changes in items to the table resulting from review by the Medicare Benefits Consultative Committee. These reviews are designed to ensure that the table reflects current clinical practice and encourages best practice.

 

The Regulations include additions and amendments to the existing rules of interpretation. The Regulations also:

 

·        introduce 2 new items to the table;

·        amend the descriptors for 25 existing items to accurately reflect current clinical practice; and

·        remove 8 items which no longer reflect current clinical practice.

 

Broadly, consultation for these amendments included the Australian Medical Association, relevant professional medical craft groups and Medicare Australia. Relevant professional medical craft groups consulted included the Australian and New Zealand Society of Urological Surgeons, the Australian Society of Plastic Surgeons, the Cardiac Society of Australia and New Zealand, the Australian College of Midwives, the Australian College of Rural and Remote Medicine, the Royal Australian College of General Practitioners, the Australian Practice Nurse Association, the National Aboriginal Community Controlled Health Organisation, the Australian Orthopaedic Association, the Royal Australian and New Zealand College of Psychiatrists.

 

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

 

The amendment Regulations commence on 1 May 2007.

 

ATTACHMENT

 

Details of the Health Insurance (General Medical Services Table)
Amendment Regulations 2007 (No. 4)

 

Regulation 1 provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulations 2007 (No. 4).

 

Regulation 2 provides for the Regulations to commence on 1 May 2007.

 

Regulation 3 provides that Schedule 1 amends the Health Insurance (General Medical Services Table) Regulations 2006 (the Principal Regulations).

 

Schedule 1 - Amendments

 

Rules of interpretation

The following amendments to rules, insertion of new rules and deletion of rules are :

 

Item [1]

Rule 3 – general practitioner

This item amends the definition of ‘general practitioner’ allowing Item [2] below to be added.

 

Item [2]

Rule 3 – general practitioner

This item amends the definition of ‘general practitioner’ to include a practitioner who is undertaking a placement in general practice as part of the Remote Vocational Training Scheme administered by the Remote Vocational Training Scheme Limited.

 

Item [3]

Rule 14

This item introduces a new rule 14 to reflect that specialist trainees may be able to perform a Group T8 service under the direct supervision of a medical practitioner. Provision of such a service will be taken to be a personal attendance by the medical practitioner on a patient.

 

Item [4]

Paragraph 64C(1)(a)

This amends paragraph 64(1) (a) to better describe activities undertaken under item 16400.

 

Item [5]

This item corrects a typographical error in paragraph 64C (1) (c).

 

Item [6]

Rule 74

This substitutes the text of rule 74 to clarify the restriction applying telepsychiatry consultations to rural and remote areas.

 

Item [7]

Rule 76A

This item amends the heading of rule 76A to remove reference to rule 77 which relates to the Practice Incentive Program mental health incentive (see items [11], [18] and [19] below).

 

Item [8]

This item also amends subrule 76A(1) to remove reference to rule 77. (see item [11] below).

 

Item [9]

This item inserts a new definition in subrule 76A (1). The 3 Step Mental Health Process is defined to mean a service provided to a patient using the items 2574, 2575, 2577, 2578, 2704, 2705, 2707 or 2708 of the Principal Regulations, (which are to be removed with effect from 1 May 2007 – see items [18] and [10] below).

 

Item [10]

Rule 76A

This item amends paragraph 76A (2) (b) to clarify that the provision relates to a patient’s care. This corrects errors which have been identified with the rules that apply to items 2710, 2712 and 2713.

 

Item[11]

Rule 77

This item deletes rule 77 to remove reference to the Practice Incentives program - mental health initiative. New COAG mental health items now cover this Initiative.

 

Item[12]

Rule 77A

This item amends paragraph 77A (4) (a) to read “(a) reviews the matters mentioned in subrule 77A(1) as applicable;”. This is to correct errors which have been identified with the rules that apply to items 2710, 2712 and 2713.

 

Item [13]

This item amends paragraph 77A (4) (c) to read “(c) prepares a plan for crisis intervention and/or for relapse prevention, if appropriate and not previously provided”. This is to correct errors which have been identified with the rules that apply to items 2710, 2712 and 2713.

 

Item [14]

This item amends paragraph 77A (4) (d) to read “(d) re-administers the outcome measurement tool used in the assessment mentioned in subrule 77A (1) (a) (except if considered clinically inappropriate),”. This is to correct errors which have been identified with the rules that apply to items 2710, 2712 and 2713.

 

Item [15]

Rule 98

This item introduces a new rule 98 to clarify that intra-operative imaging cannot be charged in addition to the procedure for item 35412.

 

Services and Fees

 

Item [16]

Consultant Psychiatry

The fee for item 299 is amended to retain parity with other fee changes that are occurring in relation to Telepsychiatry.

 

Item [17]

Telepsychiatry

Items 353, 355, 356, 357 and 358 are amended to remove current geographical restrictions on the location of the provider, enabling all eligible providers to offer telepsychiatry services to rural and remote patients and to restore the 15% rebate differential between telepsychiatry and face to face consultation items.

 

Items 364, 366, 367, 369 and 370 are amended to remove the mandatory face to face consultation after every fourth telepsychiatry service and increase the schedule fee for items 367 and 369.

 

Item [18]

Practice Incentive Program - Mental Health Care

This deletes subgroup 4 of Group A18 (items 2574, 2575, 2577 and 2578) from the Principal Regulations, as the services described are covered by the introduction of new COAG mental health items, in November 2006, for general practitioners, clinical psychologists, and other allied health professionals to manage patients with a mental disorder which offer a higher level of rebate.

 

Item [19]

Practice Incentive Program - Mental Health Care

This deletes subgroup 4 of Group A19 (items 2704, 2705, 2707, and 2708) from the Principal Regulations, as the services described are covered by the introduction of new COAG mental health items, in November 2006, for general practitioners, clinical psychologists, and other allied health professionals to manage patients with a mental disorder which offer a higher level of rebate.

 

Item [20]

Etonogestrel Subcutaneous Implant

New item 30062 is introduced to provide the service of the removal of an Etonogestrel subcutaneous implant. The new item recognises the time and complexity involved in removing one of these implants.

 

Item [21]

General Surgery - Definitive Surgical Excision

Items 31300, 31305, 31310, 31315, 31320, 31325, 31330 and 31335 is amended to clarify that these items can be used for recurrent and secondary melanotic lesions.

 

Item [22]

High Dose Rate Brachytherapy

Item 37227 is amended to better reflect current actual practice.

 

Item [23]

Cardio Thoracic Surgery for Heart Catheterisation

Items 38200, 38203 and 38206 is amended to clarify the original intent of these items. The amendments make it clear that only one of the procedures outlined in the descriptors has to be performed in addition to the heart catheterisation.

 

Item [24]

Supercharging Pedicled Flaps

This item introduces new item 45561 to provide for a new surgical procedure, supercharging of pedicled flaps, which is currently not covered by existing items.

 

Item [25]

Free Tissue Transfer

Items 45564 and 45565 is amended to make it clear that when more than two microvascular anastomoses are performed, then it is appropriate to claim additional items to cover additional anastomoses.