Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT REGULATIONS 2001 (NO. 1) 2001 NO. 79

STATUTORY RULES 2001 No. 79

Issued by authority of the Minister for Health and Aged Care

Health Insurance Act 1973

Health Insurance (General Medical Services Table) Amendment Regulations 2001 (No. 1)

The Health Insurance Act 1973 (the Act) provides for payments by way of Medicare benefits and payments for hospital services.

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

Section 4 of the Act provides that the regulations may prescribe a table of medical services, (other than diagnostic imaging services and pathology services) (the table). The Health Insurance (General Medical Services Table) Regulations 2000 prescribed such a table.

Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services set out in the table.

The purpose of the Regulations is to amend the current table of general medical services to increase the fee levels for attendances by general practitioners. The fee level increases are as a result of an agreement between the Government and the profession under the General Practice Memorandum of Understanding (the MoU). The increase is to ensure that the general practitioner rebate payments meet the three-year guaranteed minimum outlays as agreed to in the MoU. The increase has been calculated to equate to an increase of 2.12 percent on general practitioner attendance items. The increase also includes a 50% increase in emergency after hour attendance items, aimed at increasing the availability of after hours care by general practitioners.

Other changes to the table result from ongoing reviews by the Medicare Benefits Consultative Committee designed to ensure that the table reflects current medical practice. These include insertion of new items, deletion of obsolete services, amendment of fees to reflect an appropriate remuneration for the service and the amendment of existing item descriptions for correction or clarification.

Details of the Regulations are set out in the Attachment.

The Regulations came into effect on 1 May 2001.

ATTACHMENT

Details of the Health Insurance (General Medical Services Table) Amendment Regulations 2001 (No. 1)

Regulation 1 provides for the Regulations to be referred to as the Health Insurance (General Medical Services Table) Amendment Regulations 2001 (No. 1)

Regulation 2 provides for the Regulations to commence on 1 May 2001.

Regulation 3 provides for the Health Insurance (General Medical Services Table) Regulations 2001 to be amended as set out in Schedule 1.

The General Medical Services Table is generally amended mid year, to reflect modem medical practice. Listed below are the relevant changes and amendments that have been agreed to by the Minister of Health and Aged Care relating to decisions and reviews undertaken by the Department in association with the medical profession.

Schedule 1 - Table of General Medical Services

Part 1 - Rules of Interpretation

Item 1 provides for a definition of assistance at an operation. Previously the entitlement for a surgical assistant to claim benefits has been detailed in the item descriptors of relevant items. In order to further define the entitlement of a benefit for an assistant at a surgical procedure, the Attorney General's Department has provided an appropriate definition of the word "Assist" in the rules of interpretation of the table.

Item 2 amends rule 8 relating to derived fees for general practitioner attendances to reflect the increase in fee levels that address the current underspend as agreed under the General Practice Memorandum of Understanding.

Part 2 - Services and Fees

There have been several reviews of services in the table undertaken by the Department over the last 6 months. These reviews relate to services provided in the fields of sports physicians attendances, colorectal surgery, urological and gynaecological surgery, plastic and reconstructive surgery and orthopaedic surgery. All other minor changes result from negotiations with the profession in order to reflect modern medical practice within the table.

Item 3 introduces new items 444, 445, 446, 447 448 and 449 to provide for attendances provided by sports physicians in the practice of sports medicine.

Item 4 omits 4 items from the table that were renumbered to allow them to be regrouped with similar items which will allow a greater ease of locating the correct item descriptor when practitioners itemise accounts.

Item 5 covers a range of amended services throughout the table, as follows:

Amends the descriptions of items 30187, 30190 and 30196 to include the use of the erbium laser, which allows greater control and a faster healing process.

Amends the description of item 32131 to clarify that the procedure is carried out by a transanal approach.

Amends the description of items 35638, 35641, 35753, 36528, 36567, 36615, 36803) 36806, 36809, 37044 and 37209. These changes have resulted from a major review of relevant services undertaken in association with the Australian and New Zealand Association of Urological Surgeons and the National Association of Specialist Obstetricians and Gynaecologists. The purpose of these amended descriptors and new services is to reflect and encourage appropriate medical practice.

Amends the description of item 45528 to clarify the intent of the item.. . The intent of the item was for the procedure to be undertaken on the breast. The description of items 45543 and 45544 is to clarify whether one or both breasts were included in the procedure. The description of items 45652 and 45669 are to include the use of the erbium laser, which allows greater control and a faster healing process.

Amends the description of item 50351 to clarify that the item is to be used for the treatment of developmental dislocation of the hip and not congenital dislocation.

Item 6 covers a range of new services throughout the table, as follows:

New item 3 5 616 to provide for the procedure of microwave endometrial ablation which has a number of clinical advantages over similar procedures. The procedure is faster than transcervical resection of the endometrium and also allows for any hysteroscopy performed on the same day.

New items 35754, 36529, 36532, 36533, 36652, 36654, 36656, 37042, 37043, 37340, 37341, 37343 and 37418. These new procedures have resulted from a major review of relevant services undertaken in association with the Australian and New Zealand Association of Urological Surgeons and the National Association of Specialist Obstetricians and Gynaecologists. The purpose of these amended descriptors and new services is to reflect and encourage appropriate medical practice.

Four new item numbers 50349, 50350, 50352 and 50353 to be relocated within the table to allow them to be regrouped with similar items which will allow a greater ease of locating the correct item descriptor when practitioners itemise accounts.

Item 7 amends fees for general practitioner attendances to reflect the increase in fee levels that address the current underspend as agreed under the General Practice Memorandum of Understanding.