Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (GENERAL MEDICAL SERVICES TABLE) AMENDMENT (CHRONIC DISEASE MANAGEMENT) REGULATION 2014 (SLI NO 158 OF 2014)

EXPLANATORY STATEMENT

Select Legislative Instrument No. 158, 2014

Health Insurance Act 1973

Health Insurance (General Medical Services Table) Amendment (Chronic Disease Management) Regulation 2014

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. 

Part II of the Act provides for the payment of Medicare benefits for professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits be calculated by reference to the fees for medical services set out in prescribed tables.

Section 4 of the Act provides that regulations may prescribe a table of medical services which sets out items of medical services, the fees applicable for each item, and rules for interpreting the table. The Health Insurance (General Medical Services Table) Regulations 2014 (GMST) currently prescribes such table.

The Amendment Regulation will amend the GMST to ensure that the medical services funded through the Medicare Benefits Schedule (MBS) represent best practice and are reflective of government commitments. The Amendment Regulation will implement the 2013-14 Budget measure - 'Medicare Benefits Schedule - Removing double billing', which is to take effect on 1 November 2014.

The Amendment Regulation will restrict 36 consultation items from being claimed with three chronic disease management items by the same provider, for the same patient, on the same day. This will improve the efficiency and effectiveness of Medicare by preventing the potential for practitioners to double bill Medicare for similar services.

Details of the Amendment Regulation are set out in the Attachment.

The Act specifies no conditions which need to be met before the power to make the Amendment Regulation may be exercised. 

The Amendment Regulation is a legislative instrument for the purposes of the Legislative Instruments Act 2003. 

The Amendment Regulation commences on 1 November 2014.

                                                                       Authority:     Subsection 133(1) of the

                                                                                                Health Insurance Act 1973 

ATTACHMENT

Details of the Health Insurance (General Medical Services Table) Amendment (Chronic Disease Management) Regulation 2014

Section 1 - Name

This section will provide for the regulation to be referred to as the Health Insurance (General Medical Services Table) Amendment (Chronic Disease Management) Regulation 2014.

Section 2 - Commencement

This section will provide for the regulation to commence on 1 November 2014.

Section 3 - Authority

This section will provide that the regulation is made under the Health Insurance Act 1973.

Section 4 - Schedules

This section will provide that each instrument specified in a Schedule to the instrument is amended or repealed as set out in the applicable items in the Schedule concerned.

Schedule 1 - Amendments

Item [1] - After clause 2.17.10 of Schedule 1

This item will insert clause 2.17.10A which restricts medical practitioners from claiming consultation items 3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 597, 599, 598, 600, 5000, 5003, 5020, 5023, 5040, 5043, 5060, 5063, 5200, 5203, 5207, 5208, 5220, 5223, 5227 and 5228 with chronic disease management items 721, 723, or 732 for the same patient, on the same day.

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