Commonwealth Numbered Regulations - Explanatory Statements

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NATIONAL HEALTH REGULATIONS (AMENDMENT) 1993 NO. 261

STATUTORY RULES 1993 No. 261

Issued by authority of the Minister for Health

National Health Act 1953

National Health Regulations (Amendment)

Section 140 of the National Health Act 1953 (the Act) provides that the Governor-General may make regulations for the purposes of the Act.

The term day hospital facility, is presently defined in subsection 4(1) of the Act as follows:

"(a)       premises registered as a hospital under a law of a State or Territory relating to the registration of hospitals; or

(b)       premises, or premises included in a class of premises, prescribed for the purposes of this paragraph;

but does not include:

(c)       a recognized hospital, a private hospital or a hospital declared by the Minister to be a hospital for the purposes of the definition of "hospital" in subsection 3(1) of the Health Insurance Act 1973; or

(d)       premises, or premises included in a class of premises, prescribed for the purposes of this paragraph;"

Subregulation 2.1 of the proposed regulations corrects a grammatical error in the existing Regulation 4.

Subregulation 2.2 of the proposed regulations inserts a new Subregulation 4(2) which will prescribe the Tweed Heads Medical Centre (the Centre) as premises which are not a day hospital facility for the purposes of paragraph (d) of the above definition.

The New South Wales (NSW) Department of Health enacted State legislation on 1 January 1993 which requires doctors, consulting rooms to be licensed as day hospital facilities where anaesthesia beyond 'simple sedation' is administered.

Prior to NSW enacting its 1 January 1993 legislation, the Commonwealth Department of Health, Housing, Local Government and Community Services notified the NSW Health Department that there was a probability that a number of premises, while required to be licensed as day hospital facilities under NSW law, would not be suitable for recognition under the National Health Act. Such facilities would not qualify for health insurance benefits for 'hospital treatment' undertaken in the facilities.

It was considered that an appropriate arrangement in such cases would be that the premises retain the status of 'consulting rooms' (while still adhering to standards under State law) with the effect that health insurance benefits would not be payable in respect of procedures performed in those rooms.

Prior to enactment of the NSW legislation, the Tweed Heads Medical Centre operated as 'doctors' consulting rooms'. As such, services rendered in the Centre attracted Medicare benefits at the rate of 85 per cent of the Medicare Benefits Schedule (MBS) fee, under paragraph 10(2)(b) of the Health insurance Act 1973. This meant that the Centre could bulk bill and receive payment at 85 per cent of the MBS fee.

However, once doctors, rooms are licensed as a day hospital facility Medicare benefits become payable under paragraph 10(2)(a) of the Health Insurance Act 1973 and bulk billed services attract payment at the rate of 75 per cent of the MBS fee.

The proprietor of the Tweed Heads medical Centre requested that it not be a "day hospital facility" for the purposes of the Act so that it could continue to bulk bill patients at the rate of 85 per cent of the MBS fee. The request was initiated because the Centre's viability and it's ability to retain professional staff are threatened if, as at present, the Centre is only permitted to bulk bill at the rate of 75 per cent of the MBS fee.

The NSW Health Department supports the proprietor's request on condition that the Centre continues to meet State requirements for licensing.

The regulations commenced on Gazettal.