Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE REGULATIONS (AMENDMENT) 1995 NO. 300

STATUTORY RULES 1995 No. 300

Issued by authority of the Minister for Human Services and Health

Health Insurance Act 1973

Health Insurance Regulations (Amendment)

The Health Insurance Act 1973 (the Act) provides in part 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 Regulations are necessary to amend the Health Insurance Regulations as a consequence of an agreement reached between the Government and the medical profession on the definition of an emergency medical situation for the purposes of payment of benefits under the Medicare referral arrangements.

Regulation 3 amends the Health Insurance Regulations by:

(1) substituting a new subregulation for subregulation 30(4) to make provision for the payment of Medicare benefits at the specialist or consultant physician level for attendances on patients in emergency situations where the patients condition meets certain criteria; and

(2) introducing a new subregulation, subregulation 30(5), which establishes the criteria to define an emergency situation for the purposes of the Medicare referral arrangements, e.g. where the patient is at risk of serious morbidity or mortality requiring urgent assessment and resuscitation or is suffering from suspected acute organ or system failure.

It is considered that existing subregulation 30(4) does not adequately make provision for the waiver of the written referral requirements in situations where a specialist or consultant physician considers the patient's condition necessitates emergency specialist treatment and time does not permit compliance with the normal referral requirements. This situation is clarified in the new subregulation.

The new subregulation 30(5) provides a uniform definition of what is considered to be an emergency medical situation for the purposes of the Medicare referral arrangements.

Regulation 4 amends subregulation 31(3) by introducing a restriction on the validity of referrals given under subregulation 30(4) to one attendance on the patient. This provision will align referrals given under these circumstances with those given in similar situations under subregulation 30(2). This was not included in earlier regulations due to an oversight.

The Regulations commence on 1 November 1995.