Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1994-1995 PATHOLOGY SERVICES TABLE) REGULATIONS 1994 NO. 233

STATUTORY RULES 1994 No. 233

Issued by the authority of the Minister for Human Services and Health

Health Insurance Act 1973

Health Insurance (1994-1995 Pathology Services Table) Regulations

Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations for the purposes of the Act.

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

Section 4A of the Act provides, among other things, 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 table so prescribed has effect as if it were set out in Schedule 1A in place of the table in that Schedule. The Health Insurance (1994-1995 Pathology Services Table) Regulations prescribe such a table.

Regulation 3 repeals Statutory Rules 1993 No. 270, which constitutes the Health Insurance (1993-1994 Pathology Services Table) Regulations.

Regulation 4 prescribes the new Pathology Services Table for 1994 which sets down the pathology tests eligible for payment of medicare benefits and the amount of the rebates.

The Health Insurance (1993-1994 Pathology Services Table) Regulations (the PST) have been completely revised to clarify the meaning of its provisions, standardise wordings to ensure a greater degree of consistency to make it easier to be understand by users and easier to enforce.

Details of the Regulations are as follows:

Changes to the PST include: two of the Rules for the Interpretation of the PST (the Rules) have been omitted and replaced by additional definitions in Rules 1 and 10, a new provision has also been added to Rule 10, eighteen items have been reduced in number to ten items; and six items have been substantially amended.

Rules have been reworded and renumbered, and Rule headings added to assist users.

Rules of Interpretation

Former Rule 10 has been replaced by a definition of "serial examinations" in Sub-rule 1.(1), and Sub-rule 2.(3) has been expanded to include former Rule 5.

A definition of "cytology" has also been provided in Sub-rule 10.(1)(c), and a new Sub-rule 10.(2) has been introduced to prevent two items being claimed for tissue aspiration when tissue particles are found in material submitted for cytology.

Rule 12 has been amended to make it clear that when some tests in item 66235, or 66405 or 69229 are performed by an approved pathology authority who then refers other tests on to another approved pathology authority, the first authority can claim the item service fees and a Patient Episode Initiation fee per episode while the second laboratory can claim item service fees and a Specimen Referred fee.

Items

only twelve of the items in the PST have not been reworded. However, with the exception of the items mentioned below, all the wording changes are in form rather than substance and the meaning of the items remains unaltered.

Item 66245 has been omitted and replaced by items 66249 and 66250. This lifts the restriction on the number of electrophoresis tests attracting benefits where the tests are used to monitor patients with multiple myeloma, while still restricting payment of benefits for those tests used to demonstrate lipoprotein sub-classes.

A provision in item 66343, allowing the payment of benefits for tests ordered by a court or a parole board, has been omitted as this is contrary to the provisions of Section 19 of the Act.

Fourteen items, 66377-66403, have been omitted and replaced by seven new items, 66405-66417, containing a slightly modified version of the previous hormone items. The change has been made because the introduction of items 66377-66404 had led to an unexpected rise in benefit payments due to the crossassociation of tests proving much higher than anticipated.

A clause has been added to the descriptor for item 71061 (an immunology test) to prevent pathologists claiming an additional fee under item 66213 or 66215 (chemical tests) for the same procedure.

Following recent technological advances items 71105 (Fee $8.50) and 71107 (Fee $19.65) have been omitted and replaced by a new combined item 71106 with a fee of $11.00 (immunology tests for rheumatoid factors).

The words "including a total lymphocyte count by any method" have been added to item 71139 (immunology tests for leucocyte antigens) to prevent claims being made under two items for the same procedure.

Following the Immunology Sub-Committee's review of the utilisation of items in the Immunology Group (see Attachment A), the fees for items 71141 and 71147 have been reduced from $222.35 to $192.35, and from $33.60 to $31.60 respectively.

Item 73057 has been amended to prevent it being used in the monitoring of hormone replacement therapy as the use of the test for this purpose has not been scientifically validated.

A provision has been added to item 73529 (chorionic gonadotrophin test) to enable the service to be used in the management of ectopic pregnancies in symptomatic patients.

As "temporary licensed collection centres" have been phased out, item 73917 has been omitted and consequential amendments made to items 73907 and 73913.

Taken overall the financial effect of these changes is likely to be minimal with slight savings being realised.

These Regulations (with effect from 1 July 1994) will replace all previous Regulations.