Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE REGULATIONS (AMENDMENT) 1992 NO. 111

STATUTORY RULES 1992 No. 111

Issued by the authority of the Minister for Health, Housing and Community Services

Health Insurance Act 1973

Health Insurance Regulations (Amendment)

The Health Insurance Act 1973 (the Act) provides for the payment of medicare benefits for professional services rendered by medical practitioners and for certain professional services rendered by dental practitioners and optometrists.

Section 133 of the Act provides that the Governor-General may make regulations for the purposes of the Act.

The specific details of these amendments to the Health Insurance Regulations (the Regulations), are set out in the attachment. In summary, these amendments contain a number of discrete provisions including:

•       the prescription of authorities and persons to whom prescribed information may be divulged in prescribed circumstances (Regulations 3, 16 and 18);

•       the renumbering of certain prescribed items following the restructure of the Diagnostic Imaging Services Table (Regulations 4, 5, and 6);

•       the omission of regulations and associated Schedules consequent to repeal of the substantive legislation (Regulations 7, 9, and 19 - 21);

•       the inclusion of pathology services to detect the human immunodeficiency virus (HIV) in those services where medicare benefits are not payable (Regulation 8);

•       the omission of redundant provisions for superseded arrangements for approval of private hospitals and Commonwealth bed-day payments (Regulations 10 - 15, and 17); and

•       the renumbering of the Regulations to simplify presentation (Regulation 22).

ATTACHMENT

DETAILS OF HEALTH INSURANCE REGULATIONS (AMENDMENT)

Regulation 4 amended regulation 2ADAAA to show new item numbers for services which may be requested by dental practitioners following the restructure of the diagnostic imaging services table.

Regulation 5 amended regulation 2ADAAB to show new item numbers for services which may be requested by chiropractors, physiotherapists and podiatrists following the restructure of the Diagnostic Imaging Services Table.

Regulation 6 amended regulation 2ADAAC to show new item numbers for services which may qualify for exemption under the provisions relating to pre-existing diagnostic imaging practices. This change is also necessary as a result of the restructure of the Diagnostic Imaging Services Table.

Regulation 7 omitted regulation 2ADAA and the related Schedule 5 because the substantive legislation to which they relate has been repealed. Regulation 2ADAA provided that medicare benefits not be payable for certain medical expenses.

Regulation 8 amended subregulation 2ADB(2) to provide that a medicare benefit would not be payable for a pathology service in relation to the detection of the presence of the human immunodeficiency virus, as such services are funded in part by the Commonwealth through matched funding program grants to the States and Territories.

Regulation 9 omitted regulation 2AE, which prescribed procedures for public notification of disqualified practitioners for the purposes of medicare benefits, because the enabling section of the Act had been repealed.

Regulations 10 - 15 and 19 - 20 omitted regulations 3 - 7A and Schedules 4 and 5 and part of Schedule 1 to the regulations; these provisions related to arrangements for the approval by the Commonwealth of premises as private hospitals and the payment of Commonwealth bed-day payments in respect of patients in those approved private hospitals. As the substantive sections of the Act to which these regulations relate had been repealed, the regulations could be omitted.

Regulation 16 omitted regulation 9B, which had been dormant since 1986, and inserts a new regulation 9B which, for the purposes of Section 130(3A) of the Act, enables the Health Insurance Commission to provide prescribed information to to prescribed persons in the Department of Veterans Affairs (DVA) and in the Complaints Unit of the New South Wales Department of Health (Complaints Unit) and to State Medical Registration Boards (Medical Boards) in prescribed circumstances.

The purpose of the regulation is (i) to enable DVA, on the basis of the information from the Commission, to investigate duplicate claims for benefits on Medicare and DVA or claims erroneously made on the one agency rather than the other, and (ii) to allow the Complaints Unit and the Medical Boards, on the basis of information from the Commission, to investigate instances of possible fraud or excessive servicing by medical practitioners;.

The then Minister for Health in a letter dated 8 April 1986 to the Senate Standing Committee on Regulations and Ordinances, undertook to amend the Act to enable a regulation to be drafted which would meet the Committee's concerns about the potential for undue trespass upon personal privacy permitted by the existing regulation 9B under paragraph 130(3)(b) of the Act.

This latter provision was repealed and a new subsection 130(3A) inserted in the Act by Health Legislation Amendment Act (No.2) of 1986 which provided for the nature of the information to be disclosed, the persons to whom the information was to be disclosed and the circumstances in which the information could be disclosed, to be all prescribed by regulation.

Subregulations 9B(1) and (3) prescribe the circumstances under which prescribed information may be disclosed by the General Manager of the Health Insurance Commission, or a delegate, to DVA and to the Complaints Unit or the Medical Boards.

The information which may be disclosed to DVA is prescribed in Part 1 of Schedule 3, and the patient and practitioner information which may be disclosed to the Complaints Unit and the Medical Boards is prescribed in subregulations 9B(5) and (7).

The persons in DVA to whom prescribed information may be disclosed are prescribed in Parts 2 - 3 of Schedule 3 and the persons in the Complaints Unit and the Medical Boards to whom information may be disclosed are prescribed in Parts 4 - 5 of Schedule 3.

An earlier draft of the regulation was sent to the Privacy Commissioner and his comments on the draft were incorporated in later drafts of the regulation.

Regulation 21 amended Schedule 6 of the Regulations to show, by omitting a reference to the Royal Australasian College of Surgeons, that the Royal Australian College of Ophthalmologists is now the only organisation declared by the regulations to be a professional organisation in relation to the specialty of Ophthalmology for the purposes of subsection 3D(1) of the Act.

Regulation 22 renumbered the regulations.