HEALTH INSURANCE (1993-1994 GENERAL MEDICAL SERVICES TABLE) REGULATIONS 1993 NO. 272

HEALTH INSURANCE (1993-1994 GENERAL MEDICAL SERVICES TABLE) REGULATIONS 1993 NO. 272

STATUTORY RULES 1993 No. 272

Issued by the authority of the Minister for Health

Health Insurance Act 1973

Health Insurance (1993-1994 General Medical Services Table) Regulations

The Health Insurance Act 1973 (the Act) provides for payments by way of medicare benefits, payments for hospital services and payments for matters concerning related committees and tribunals.

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 (the table), (other than pathology services) in accordance with the form of table set out in Schedule 1 and that, upon commencement of a regulation prescribing the table, it has effect an if it were set out in Schedule 1 in place of the table in that Schedule.

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

Details of the regulations are as follow:

Regulation 2 provides for the regulations to commence an 1 November 1993.

Regulation 3 provides for the repeal of Statutory Rules 1992 Nos. 338, 347 and 398 and 1993 No. 145 which gave authority for the table which has been replaced.

Regulation 4 prescribes the new table of general medical services and rules of interpretation.

The new table has been varied to reflect changes to general practitioner services. The Government has been progressively implementing reforms to restructure general practice and Introduce incentives for general practitioners to provide primary care of improved quality and cost effectiveness.

Fundamental to these reforms in the identification of general practice an a distinct discipline within the health care system requiring specific postgraduate vocational training. This recognition was commenced in 1989 with the introduction of Vocational Registration of general practitioners and the development of "content based" items in the table (rather than merely on a time basis) for use by such practitioners. Medical practitioners qualifying for vocational registration are those recognized by the Royal Australian College of General Practitioners (RACGP) as being predominantly In general practice, having appropriate qualifications, training and experience, and meeting the College's requirements for ongoing quality assurance and continuing education.

The amendments extend the use of these content based Items to a wider group of practitioners. These include Fellows of the RACGP, providing they are in active practice and meet the College's requirements for quality assurance and continuing education. It also includes medical practitioners in recognised postgraduate general practice training programs during the period they are undertaking a formal placement In a general practice. These practitioners, together with vocationally registered practitioners, will be formally known as "general practitioners" for the purposes of this table. The criteria for recognition as a general practitioner are defined in the Rules of Interpretation.

The fees for services in the table have been adjusted an announced in the 199311994 Budget. Fees have been adjusted as follows:

Other changes incorporated in the table flow mainly from reviews facilitated through the Medicare Benefits Consultative Committee. These changes involve the introduction of new services, deletion of obsolete services and amendment to the descriptions and/or fees of other services. These changes are designed to ensure that the table reflects current medical practice. Details of these changes are as follow:

(a)       Removal of skin cancer by serial curettage and cryotherapy items relating to these services (items 30196 to 30205) have been restructured to clarify the intent of the services and to Improve patient outcomes. A key element to the proposed changes is the requirement to obtain histopathological proof of skin cancer before medicare rebates are payable.

(b)       Nerve blocks (items 18206 to 18298) - restructure of these services acknowledges that regional and field nerve blocks are generally performed for the purpose of management of pain. The proposed restructure and increased fee levels have been made on the basis that chronic and acute pain management has become a major anaesthesia subspecialty over recent years due, in part, to the development of techniques such as patient controlled analgesia, interpleural analgesia and epidural Infusions. To date these developments have not been reflected in the table.

(c)       other minor amendments have been made to the descriptions of a number of services (items 13824, 15518 to 15530, 32004, 32005, 35300, 35303, 35306, 35309, 35312, 35315, 38497, 38500, 38503, 38640, 42653, 42656 and 42659) to clarify their intent or to remove ambiguities. A specific item (Item 15536) has been Introduced to cover radiation oncology planning for brachytherapy, that is, treatment through the insertion of radioactive sources into the body. Also, a new Item has been introduced (item 30609) to cover laparoscopic repair of femoral and inguinal hernias.

New and amended rules have been introduced for the purpose of interpreting the table. These are as follow:

(a)       As mentioned above a rule has been inserted for the purpose of prescribing the qualifications necessary for recognition as a general practitioner. Information relating to the qualifications as well as the acronym "RACGP" in Included at subrule 1(1).

(b)       The existing rule defining an intensive care unit has been extended to include a definition of a neonatal intensive care unit (see subrule 1(1)).

(c)       Rules 2, 3 and 5 have been rephrased to better clarify their intent. Rules 9, 10 and 11 have been varied to reflect changes resulting from new and deleted items.

(d)       Rule 15 has been amended to include five additional locations where benefits will be attracted in respect of an anaesthetic administered in association with a magnetic resonance imaging examination.

(e)       A new rule has been included for the purpose of clarifying the requirement in the descriptions of items 30196 to 30203 (inclusive) that histopathological proof of malignancy is necessary (new rule 36 included).

(f)       The dollar amounts stated in rules 6, 16 and 17 have been amended to reflect changes to derived fees resulting from the general fee increase. A new rule (rule 35) has been introduced to establish a derived fee for item 18219.

The remaining rules are unchanged.

The Regulations come into effect on 1 November 1993.