EXPLANATORY STATEMENT

 

Select Legislative Instrument 2009 No. 270

 

Health Insurance Act 1973

 

Health Insurance Amendment Regulations 2009 (No. 3)

 

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, in part, that Medicare benefits shall be calculated by reference to the fees for medical services set out in prescribed tables. Section 10 of the Act provides, in part, that the benefit for services that are provided out of hospital and are prescribed by the regulations for the purposes of paragraph 10(2)(aa) is an amount equal to 100 per cent of the Schedule fee.

 

Section 6EF of the Health Insurance Regulations 1975 (the Principal Regulations) is made pursuant to paragraph 10(2)(aa) of the Act and currently prescribes services for which the benefit is 100 per cent of the Schedule fee.

 

The Regulations amend the Principal Regulations to give effect to rule 28 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009, which is to come into effect on 1 November 2009. Rule 28 provides for a bulk billing incentive to be paid for diagnostic imaging services that are provided out of hospital. When a provider accepts the Medicare rebate as full payment for these services, the Schedule fee is reduced by 5 per cent and rebates paid at 100 per cent of this revised fee. This constitutes an increase of around 10 per cent of the Schedule fee compared to the usual rebate rate of 85 per cent.

 

Details of the Regulations are set out in the Attachment.

 

The changes to the Health Insurance Regulations 1975 were developed without stakeholder consultation, because this change is administrative only and gives effect to changes to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008. Those changes did involve stakeholder input, in that submissions to the 2009-10 Budget, of which these were one, emerged from a Strategic Review of Pathology and Diagnostic Imaging Services conducted by the Department of Health and Ageing in the 12 months prior. This Review included broad and extensive consultation with key stakeholders, including the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association. Approximately 30 submissions were received and considered.

 

The Act specifies no conditions that need to be satisfied before the power to make the Regulations may be exercised.

 

The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

The Regulations commence on 1 November 2009.

ATTACHMENT

 

 

DETAILS OF THE HEALTH INSURANCE AMENDMENT REGULATIONS 2009 (No. 3)

 

Regulation 1 – Name of Regulations

 

This regulation provides for the Regulations to be referred to as the Health Insurance Amendment Regulations 2009 (No. 3).

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on 1 November 2009.

 

Regulation 3 – Amendment of the Health Insurance Regulations 1975

 

This regulation provides that Schedule 1 amends the Health Insurance Regulations 1975 (the Principal Regulations).

 

Schedule 1 – Rules of Interpretation

 

Schedule 1 sets out changes to regulation 6EF – Services for which medicare benefit is 100 per cent of Schedule fee.

§         The wording of paragraph (a) is amended for clarity

§         Paragraph (b) is added, to prescribe services listed on the diagnostic imaging services table to receive 100 per cent of the Schedule fee that has been reduced by

5 per cent, in accordance with rule 28 of Schedule 1 to the Health Insurance
(Diagnostic Imaging Services Table) Regulations 2009.