Explanatory Memorandum
(Circulated by authority of the Minister for Health and Aged Care, the Hon Dr Michael Wooldridge, MP)Outline and financial impact statement
Outline
This bill contains amendments relating to four areas in the Health portfolio:
Schedule 1 - the Australian Institute of Health and Welfare,
Schedule 2 - the recognition of specialist medical practitioners; payment of Medicare benefits where cheques made out to general practitioners are not presented within a defined period of time, and
Schedules 3 and 4 - the 30% Rebate on private health insurance scheme.
In Schedule 1, the amendments to the Australian Institute of Health and Welfare Act 1987 (AIHW Act) broaden the Ministers capacity to nominate persons who have specific skills for appointment to the Institute, and extend the current legislative coverage of the Australian Institute of Health Ethics Committee to include welfare-related information and statistics. The amendments also include minor changes to maintain the relevance of reference to the National Health and Medical Research Council.
Schedule 2 contains two separate sets of amendments to the Health Insurance Act 1973 . The first set is primarily designed to simplify the process for recognising medical practitioners as specialists (but without changing the criteria for recognition).
For those Australian-domiciled practitioners who are Fellows of a College and hold relevant qualifications, the current scheme envisages that they may be recognised as specialists by means of a Ministerial determination under section 3D or under section 61 (but, in the latter case, following consideration by, and a recommendation of, a Specialist Recognition Advisory Committee). The proposed changes will involve such a practitioner automatically being recognised as a specialist, where the relevant College provides the Health Insurance Commission with a notice certifying that he or she satisfies the recognition criteria. Recognition will occur without the need for a Ministerial determination or consideration by a Specialist Recognition Advisory Committee.
The current provisions covering Australian-domiciled practitioners who are registered as specialists under a State law are replicated by the proposed new scheme.
The second setin Schedule 2, amendingthe Health Insurance Act 1973, will allow the Health Insurance Commission (the Commission) to pay Medicare benefits directly to general practitioners, where pay doctor via claimant cheques made out to the general practitioners are not presented within 90 days of issue.
Subsection 20(1) of the Health Insurance Act 1973 provides that Medicare benefits are payable only to the person who incurs the medical expenses (the patient). The patients right to receive the Medicare benefit is modified by subsection 20(2) which deals with the situation where a patient has not paid the medical expenses that he or she has incurred. In this situation, the patient can request that a cheque for the amount of the Medicare benefit be drawn by the Commission in favour of the medical practitioner who rendered the professional services. These cheques are referred to as pay doctor via claimant cheques. Subsection 20(2) requires that such cheques be given or sent to the patient personally. Subsection 20(2) does not allow for pay doctor via claimant cheques to be sent directly to the doctor.
The great majority of patients do present pay doctor via claimant cheques to their general practitioners in a timely manner. However, some cheques are received very late and some are never presented, leaving doctors with unnecessarily long delays or ultimately bad debts for medical services already provided in good faith.
To minimise this problem, the amendment to the Act will allow the Commission to pay the amount of benefit directly to a general practitioner. This will only be allowed where a pay doctor via claimant cheque has not been presented within 90 days from the date of issue and only applies to pay doctor via claimant cheques for services rendered by general practitioners.
Schedules 3 and 4 amend the Private Health Insurance Incentives Act 1998 (PHIIA) and the Health Legislation Amendment Act (3) 1999 , respectively. The amendments relate to the provision of incentives for private health insurance, commonly known as the Federal Government 30% Rebate on private health insurance.
The main amendment will allow the Health Insurance Commission to make payments to health funds that lodge low or late claims for the reimbursement under the premium reduction scheme for the 30% Rebate. Currently funds seek reimbursement for low or late claims under the Act of Grace provisions contained in section 33 of the Financial Management and Accountability Act 1997.
The other main amendment defines how the premium decrease for the 30% Rebate is to be applied and calculated.
The other amendments rectify minor technical inconsistencies relating to the last set of amendments to the PHIIA.
Financial impact statement
The Bill will have no significant financial impact.