Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1994-1995 PATHOLOGY SERVICES TABLE) REGULATIONS (AMENDMENT) 1994 NO. 361

STATUTORY RULES 1994 No. 361

Issued by the authority of the Minister for Human Services and Health Health Insurance Act 1973

Health Insurance (1994-1995 Pathology Services Table) Regulations (Amendment)

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 that the regulations may prescribe a table of pathology services that sets out the items of pathology services, the fees for each item and rules of interpretation for the table. The Health Insurance (1994-1995 Pathology Services Table) Regulations (Amendment) [the proposed regulations] amend the table.

The Health Insurance (1994-1995 Pathology Services Table) Regulations (the PST) have been revised to reflect a fee rise of 1.27% for all pathology services and to amend the wording of several items and Rules.

Changes to the PST include: Rules 4 and 11, have been amended slightly; a new provision has been added to Rule 11; Rule 6 has been re-written; three new rules, Rule 6A, 7A and 7B, have been added to clarify the interpretation of items; four items have been omitted; four new items have been added; twenty items have had minor amendments and a range of changes have been made to the index to accommodate the changes to the table.

Details of the Regulations, which have been developed with the cooperation and consent of the pathology industry in the Pathology Services Table Committee, are as follows:

Rules of Interpretation (Part 1 of PST)

Sub-regulation 3.1 substitutes in subrule 4(1) the word "described" for "specified".

Sub-regulation 3.2 adds the drug sulfasalazine to the list of exemptions under subrule 4(2)(d) and sub-regulation 3.3 substitutes item number 66221 for item number 66217 in subrule 4(3)(a) as 66217 has been rewritten as 66221.

Sub-regulation 3.4 revises Rule 6 to clarify its meaning and make it easier to enforce and sub-regulation 3.5 inserts new Rule 6A to ensure that no item, other than one so designated, can be split between laboratories. Where an item is split no medicare benefit is payable.

Sub-regulation 3.6 inserts Rule 7A to clarify the conditions under which a medicare rebate will be payable when a test for HDL cholesterol is performed; and Rule 7B defines the "abnormal levels of TSH" referred to in item 66329 on thyroid function testing, and stresses the need for the requesting doctor to state the clinical reason for the test on the request form.

Sub-regulation 3.7 amends subrule 11(4) to correct a typographical error and now refers to "Groups P1 to P8" instead of "Groups P1 to P9". Sub-regulation 3.8 adds new subrule 11(9) to ensure that item 73921 is payable only once per patient episode. This prevents Approved Pathology Authorities from generating multiple payments of item 73921 through the inappropriate referral of requests for designated pathology services to a number of Approved Pathology Authorities.

Items (Part 2 of PST)

Sub-regulation 3.9 makes the following changes to items in the table. All items in the PST have had a Schedule fee increase of 1.27% subject to the rounding rules and the need to preserve fee relativities for coned items. A misprint, whereby item 65049 was mistakenly labelled 95049, has been corrected. Also within item 73529 a typographical error has been corrected by replacing item number 73529 by 73527.

Sub-regulation 3.10 makes a minor editorial amendment.

Sub-regulation 3.11 omits item numbers 66217 and 66219, which are tests for faecal occult blood, and in sub-regulation 3.12 inserts item 66221 as this new item more appropriately reflects current medical practice.

Sub-regulation 3.11 also omits items 66291 and 66371 and subregulation 3.16 substitutes items 66327 and 66329 which provide a first line test for suspected thyroid disorders and a more comprehensive test which can then be performed if certain clinical conditions are met.

Sub-regulation 3.15 revises item 66317 on HDL cholesterol testing to emphasise the need for certain clinical conditions to be met before the test is performed, and the pathologist's responsibility to cheek with the requesting practitioner if the necessary details are not supplied on the request form.

Sub-regulation 3.17 adds a new item 66419 to provide specifically for an oral glucose test as this test did not fit well within the general item number 66201.

Sub-regulations 3.14, 3.17 and 3.19 revise items 66241, 66417 and 69241 in line with revised Rule 6 to clarify the number of tests "designated pathology services" have been which may be claimed when split, with some services being performed by the first Approved Pathology Authority and some being referred to another unrelated Approved Pathology Authority.

Other sub-regulations make the following minor amendments to individual items - minor editorial amendments have been made to items 65037, 65049, and 7352; the words "(item is subject to rule 6)" have been added to the end of items 66229, 66235, 66237, 66405, 66407, 66409, 66411, 66413, 69229, 69231, 69233, 69235 and 69237; and the words "(item is subject to subrule 11(9) have been added to the end of the specimen referred item 73921.

Abbreviations (Part 3 of PST)

Sub-regulations 3.21 - 3.29 propose a number of changes to abbreviations in the table which are all consequential on the amendments proposed to items in the table. Four entries have been omitted from the index, one entry has been amended and five new entries have been added.

Apart from the across-the-board fee rise of 1.27%, the changes introduced in the proposed Regulations are expected to be cost neutral. The additional costs occasioned by the new item for oral glucose testing, 66419, will be offset by the savings achieved through the tightening up of the provisions relating to the designated pathology services and the emphasising of the clinical restrictions on the payment of Medicare benefits for HDL cholesterol testing and thyroid function tests.

The Regulation commenced on 1 November 1994.