Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1992 PATHOLOGY SERVICES TABLE) REGULATIONS (AMENDMENT)1992 NO. 23

STATUTORY RULES 1992 No. 23

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

Health Insurance Act 1973

Health Insurance (1992 Pathology Services Table) Regulations (Amendment)

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 1273 (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 amendments to the Health Insurance (Pathology Services Table) Regulations limit the payment of medicare benefits for items 73901 to 73921 (inclusive) (for example the items which refer to the costs other than those directly associated with the pathology service) only to circumstances where a medicare benefit is payable for the pathology service which is rendered on the pathology specimen.

These amendments result from major reforms to the practice of pathology announced in the 1991 Budget. The Pathology Advisory Committee. a recently established industry/government body, has endorsed the reforms and recommended the amendments.

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

Subregulation 3(1) omits subrule 11(3) in the Rules of Interpretation to the table of pathology services and substitutes a new subrule which requires at least one of the items 65001 to 73529 to apply to the service to enable items 73901 - 73921 to be applicable.

Subregulation 3(3) inserts a new rule 11A into the Rules of Interpretation which provides that where item 73921 is applicable for a patient episode (that is, a specimen referred service) none of the items 73901 - 73917 can apply for that patient episode.

The Regulations came into effect on 1 February 1992.