Federal Register of Legislation - Australian Government

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SR 1998 No. 137 Regulations as made
These Regulations amend the Health Insurance (1997-98 General Medical Services Table) Regulations.
Tabling HistoryDate
Tabled HR29-Jun-1998
Tabled Senate30-Jun-1998
Gazetted 25 Jun 1998
Date of repeal 01 Nov 1998
Repealed by Health Insurance (1998-99 General Medical Services Table) Regulations 1998

Health Insurance (1997-98 General Medical Services Table) Regulations (Amendment) 1998 No. 137

EXPLANATORY STATEMENT

STATUTORY RULES 1997 NO. 137

Issued by authority of the Minister for Health and Family Services

Health Insurance Act 1973

Health Insurance (1997-98 General Medical Services Table) Regulations (Amendment)

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 (the table), (other than diagnostic imaging services and pathology services). The Health Insurance (1997-98 General Medical Services Table) Regulations currently prescribe 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 Regulations amend the current table of general medical services by introducing new services (e.g., consultant physician attendances, head and neck surgery, vascular surgery, cardio thoracic surgery, ophthalmological surgery and paediatric and orthopaedic surgery). They also amend the descriptions and/or fees of other services. Two new rules of interpretation of the table are introduced to cover a description of "complex paediatric case and a derived fee definition for item 18033. Rule 42 is amended to reflect the inclusion of item 17506 in the existing derived fee as it has the same derived fee base as item 17503. Other minor amendments to rules 9, 10 and 11 have been included to correct minor omissions when drafting the original regulation.

Changes to the table resulted from ongoing reviews by the Medicare Benefits Consultative Committee designed to ensure that the table reflects current medical practice.

Details of the Regulations are set out in the Attachment.

The regulations came into effect on 1 July 1998.

ATTACHMENT

Details of the Regulations are as follows:-

Regulation 1 provides for the Regulations to commence on 1 July 1998.

Regulation 2 provides that the General Medical Services Table is to be amended as set out in the Regulations.

Subregulation 3.1 amended subrule 9 (2) of the rules of interpretation to add items previously omitted in Statutory Rule 298.

Subregulation 3.2 amended subrule 10 (2) of the rules of interpretation to add items previously omitted in Statutory Rule 298.

Subregulation 3.3 amended subrule 11 (2) of the rules of interpretation to include item 13757 as this item may be performed on behalf of a medical practitioner under that practitioners supervision.

Subregulation 3.4 amended rule 42 of the rules of interpretation for the derived fee for item 13603 to reflect an amount of $526. 10 as the calculation base. Previously the derived fee was based on the fee for item 13603.

Subregulation 3.5 amended existing rule 40 of the rules of interpretation to reflect the derived fee for new item 17506 for assistance in the administration of an anaesthetic which is being inserted in Part 2 of the Schedule. The fee for item 17503 and new item 17506 are calculated using the same fee base.

Subregulation 3.6 provided for a new rule of interpretation to define "complex paediatric case" in new item 17506. It also provides for a new rule of interpretation for the derived fee for item 18033. Item 18033 provides for the administration of an anaesthetic in connection with a procedure covered by an item which has not been allocated anaesthetic units.

Subregulation 3.7 amended the description, parts of descriptions or the fees of items in Part 2 of the Schedule.

The period covered by the item 319 was amended to reflect a calendar year for clarity when assessing by the Health Insurance Commission. The "rolling year" concept caused problems with the Health Insurance Commission's processing system.

Anaesthetic values were added to the descriptions of items 16606-16615. The anaesthetic values have been negotiated and agreed with the Australian Society of Anaesthetists (ASA) and the Australian Medical Association (AMA).

Fees of Items 17965, 17968, 17974, 17980, 17983, 17986, 17989, 17992, 17995, 17998, 18001, 18004, 18007, 18010, 18013, 18016, 18019, 18021, 18022, 18026, 18027, 18030, 18031, 18032, 18035, 18102, 18103, 18105, 18109, 18113, 18118 and 18119 were amended to align with the anaesthetic dollar value they represent.

Anaesthetic values were added to the descriptions of items 18021 and 18022. The anaesthetic values were negotiated and agreed with the Australian Society of Anaesthetists (ASA) and the Australian Medical Association (AMA).

The descriptions of items 18210 and 18211 were amended to cover perioperative nerve block by deleting the words "knee surgery" and replacing them with "knee, ankle or foot" to cover either procedure.

The description of item 30253 was amended by deleting the words "or removal of tumour from" and replacing them with "of' to clarify the procedure.

The description of item 30255 was amended by deleting the words "removal of " and replacing them with "relocation of " to clarify the procedure.

The descriptions of items 34103 and 34106 was amended by deleting reference to "procedure" and now clarifies the procedures associated with other vascular items.

The descriptions of items 34148, 34151 and 34154 were amended to allow for the removal of carotid tumours to more accurately be reflected in procedures descriptions.

Fees for items 38550, 38553, 38556, 38559, 38562, 38565, 38568 and 38571 were increased as a result of funding made available through the deletion of item 3 85 74 in Subrule 3.

The descriptions of items 42610, 42611, 42614 and 42615 were amended to cater for the removal of the nasolacrimal tube without reinsertion of the tube.

The description of item 42710 was amended to add the word "Assist". The addition of the word "Assist" is based on a clinical requirement for a surgical assistant to be present at the procedure.

The description of item 42863 was amended by deleting the words "eyelid upper" and replacing them with "eyelid" to clarify the intent of the procedure.

The description of item 45545 was amended to clarify that the operative technique for this procedure must be surgical.

The fee of item 45623 was reduced as a result of consultations between the Department of Health and Family Services and the Royal Australian College of Ophthalmologists.

The description of item 45761 was amended by deleting the words "of nerves and bone grafts" and replacing them with "of nerves and vessels and bone grafts" to cover either procedures.

The descriptions of items 52360 to 52375 were amended to clarify that the procedure is not intended to be utilised in a multi-operational fashion.

Subregulation 3.8 amended the descriptions relating to the payment for out-of-hospital psychiatric consultations under items 300 to 318 to "calendar year". This replaces the words " 12 month period". This change was necessary due to the problems within the Health Insurance Commission's claims processing system with the "rolling year" concept.

Subregulation 3.9 introduced new items (385, 386, 387 and 388) to cover attendances by consultant occupational physicians.

Subregulation 3.10 introduced new items to cover services associated with assistance in the administration of an anaesthetic, head and neck surgery, vascular surgery, cardio thoracic surgery, ophthalmological surgery and paediatric and orthopaedic surgery.

The restructure of head and neck surgery services (items 30026 - 30255) reflects changes in clinical practice in this area and recognises the emergence of head and neck surgery as a speciality area of medicine. Changes included the introduction of a series of items to cover excision of lymph nodes to replace other items, a revision of items covering tracheostomy and the inclusion of items to specifically cover excision of parapharyngeal and aerodigestive tract tumours.

New item (32507) and amended descriptors for vascular surgery procedures - covering ligation of arteries and veins and resection of carotid tumours to better reflect the intention of the items and to lift inappropriate restrictions within some items.

New items (38573 and 38627) and amended descriptors in some cardio-thoracic surgery procedures -cover operative management of acute infective endocarditis in association with heart valve surgery, and adjustment and repositioning of extra-corporeal membrane oxygenation cannulae. Amendments were also included to existing items to provide for insertion of transvenous electrode as part of an automatic defibrillator system. These services were not previously catered for in the table.

New items (42543 and 42651) and amended descriptors in some ophthalmological surgery procedures -include new items to cover revision ptosis surgery, epithelial debridement of cornea for eliminating band keratoplasty, and exploration of the retrobulbar aspect of the orbit with removal of tumour or foreign body. These services were not adequately described in the table. Amendments were also included to cover the removal of vitreous to allow for vitrectomy to be claimed with certain other intraocular procedures.

Inclusion of new items (48613, 48640 and 50394) in paediatric orthopaedic surgery to specifically provide for combined anterior and posterior approaches to certain spinal surgery services, and to reinstate benefits for treatment of acetabular dysplasia which had previously been covered by a Medicare Benefits Advisory Committee precedent.

The changes have been agreed with the AMA and the relevant professional craft groups. The groups involved in discussions were: The Australian Society of Anaesthetists, Australian Society of Otolaryngology Head and Neck Surgery, Royal Australasian College of Surgeons, Australasian Society of Cardiac and Thoracic Surgeons, Royal Australian College of Ophthalmologists, Australian Society of Plastic Surgeons and the Australian Orthopaedic Association.

Subregulation 3.11 and 3.12 amended item number descriptions, added new items and renumbers old item numbers, allowing for a more logical sequence of procedures relating to urea breath testing, plastic surgery, arrhythmia ablation services, ear nose and throat surgery and osteotomies and osteectomies of the mandible and maxilla as agreed to with the relevant professional craft groups.