Commonwealth Numbered Regulations - Explanatory Statements

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

Health Insurance Act 1973

Health Insurance Regulations (Amendment)

Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations for the purposes of the Act.

Subsection 19A(1) of the Act provides that such regulations may provide that, unless the Minister otherwise directs, medicare benefits are not payable in respect of professional services rendered in prescribed circumstances. Subsection 19A(2) provides that, in the case of professional services other than pathology services, such regulations shall not be made except in accordance with a recommendation made to the Minister by the medicare Benefits Advisory Committee (MBAC).

Subregulation 14(2) of the Health Insurance Regulations sets out the prescribed circumstances where medicare benefits are not payable in respect of professional services unless the Minister otherwise directs.

The Minister for Health, Housing and Community Services approved a recommendation made by the MBAC that medicare benefits should cease to be payable for services to obtain cadaver kidneys for transplantation.

Medicare benefits for professional services by medical practitioners in obtaining cadaver kidneys for transplantation were attracted under Medicare Benefits Schedule item number 36512. Benefits under this item as well as for any associated services were payable to the person in whom the kidney was implanted.

This arrangement was unsatisfactory both in terms of appropriateness, as the organ donation is a public rather than private service, and administrative practicability, as sometimes the medical practitioners providing the services associated with obtaining the kidney were not aware of the identities of the kidney recipients to be billed for the services, or the kidneys were not used for transplantation because there were no suitable recipients.

The arrangement became even more unsatisfactory following the implementation of a restriction under subregulation 14(2) precluding the payment of medicare benefits for transplantation of thoracic or abdominal organs other than kidneys. Costs associated with obtaining these types of organs are met by the Commonwealth and States through arrangements covering transplant units in Nationally Funded Centres. It is expected that cadaver nephrectomies will also be covered under these arrangements and/or by additional arrangements by the States.

The Regulations consequently amend the Health Insurance Regulations to implement the recommendation of MBAC.

The Regulation commences on 1 November 1992.

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