Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1992 PATHOLOGY SERVICES TABLE) REGULATIONS 1991 NO. 442

STATUTORY RULES 1991 No. 442

Issued by the authority of the Minister for Health, Housing and Community Services

Health Insurance Act 1973

Health Insurance (1992 Pathology Services Table) Regulations

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

Section 133 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.

Section 4A of the Act provides that the Regulations may prescribe a table of pathology services in accordance with the form of table set out in Schedule 1A and that, upon commencement of a Regulation prescribing a table of pathology services, the prescribed table has effect as if it were set out in Schedule 1A in place of the table in that Schedule. The Health Insurance (1991-1992 Pathology Services Table) Regulations prescribe such a table.

Section 9 of the Act provides, in effect, that medicare benefits shall be calculated by reference to the fees for pathology services set out in the table of pathology services (the table) in Schedule 1A to the Act.

These Regulations introduce patient episode initiation (transaction fee) items, and result from major reforms to the practice of pathology announced in the 1991 Budget. The Pathology Advisory Committee, an industry/government body, has endorsed the reforms.

The Minister for Health, Housing and Community Services agreed to the amendments, the details of which are set out below, which amended the table and its rules of interpretation.

Regulation 3 repealed Statutory Rule 1991 No.353 which consisted of the table including the rules of interpretation which has operated since 1 December 1991.

Regulation 4 introduced the new table and rules of interpretation to operate from 1 February 1992.

Proposed rule of interpretation 1 revises the term "patient episode". Otherwise proposed rules 1 - 10 mirror rules 1 - 4 and rules 6 - 11 of Statutory Rule 1991 No.353 which have operated since 1 December 1991. Of rule 5 in Statutory Rule 1991 No.353 sub-rule 5(1) is included as a definition in new rule 11, and sub-rules 5(2) and (3) are omitted because they describe the circumstances in which the "SP" and "OP" symbols do not apply, and there are no longer "SP" and "OP" rates for pathology services in the table.

In the proposed new rule of interpretation 11 sub-rule 11(1) includes a number of definitions from part IIA of the Act and of the terms "prescribed laboratory", "institution" and "treating practitioner" for the purposes of the 9 items in new Group P10 and 1 item in new Group P11 of the table, which will carry the patient episode initiation fees.

Other fees for items in the proposed table, apart from certain histopathology and cytology items, have been reduced to 70% of the former "SP" rate.

The Regulations will come into effect on 1 February 1992.