Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1995-1996 PATHOLOGY SERVICES TABLE) REGULATIONS(AMENDMENT) 1996 NO. 54

EXPLANATORY STATEMENT

STATUTORY RULES 1996 No. 54

Issued by the Authority of the Minister for Health and Family Services

Health Insurance Act 1973

Health Insurance (1995-1996 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).

Section 4A of the Act provides that a table of pathology services may be prescribed. The Health Insurance (1995-1996 Pathology Services Table) Regulations (the Pathology Services Table) prescribe such a table. The Health Insurance (1995-1996 Pathology Services Table) Regulations (Amendment) (the new regulations) will amend the Pathology Services Table.

The proposed Regulations, which amend the Pathology Services Table, have been developed through the Pathology Services Table Committee with the co-operation and support of the two peak pathology professional bodies, the Royal College of Pathologists of Australasia and the Australasian Association of Pathology Practices.

Regulation 1 prescribes a commencement date of 1 July 1996 for the new regulations.

Regulation 2 provides that the 1995-96 Pathology Services Table is amended as set out in the new regulations.

Sub-regulation 3.1 provides that a new provision should be added to Rule 1 in the "Rules for the Interpretation of the Pathology Services Table". The provision seeks to ensure that all tests performed within fourteen days on the one specimen are considered part of the same patient episode for reimbursement purposes, even if they are ordered on different days.

Sub-regulation 3.2 and sub-regulation 3.6 refer to a new set of hepatitis items (items 69266 - 69281) which have been developed to encourage more rational ordering of hepatitis tests. As the new items have been designed to cover all the common clinical conditions which are likely to be encountered by treating practitioners, only one item should be necessary in a patient episode.

*       Sub-regulation 3.2 introduces new Sub-rule SA to ensure that Medicare benefits will be payable for only one hepatitis item in a patient episode. It also defines what is meant by the words "currently elevated transaminase level" in item 69279. This restriction is intended to encourage appropriate ordering.

*       Sub-regulation 3.6 substitutes a new set of condition-based hepatitis items, 69266 - 69279, for earlier items 69243, 69245, 69247, 69249 and 69265 (deleted under sub-regulation 3.5).

Sub-regulations 3.4 and items 69285 - 69295 of sub-regulations 3.6 replace four single items, each of which provide for a particular test to be performed, and attract payment, up to three times in a patient episode, by sets of three separate items which cover one, two and three tests respectively. This change is being made to overcome difficulties posed by the original items to the Health Insurance Commission's payment systems.

*       Sub-regulation 3.3 removes item 66221

*       Sub-regulation 3.4 substitutes items 66422, 66423 and 66424 for item 66221.

*       Sub-regulation 3.5 removes items 69203, 69211, 69215, 69221, 69243, 69245, 69247, 69249, 69261, 9263 and 69265.

*       Sub-regulation 3.6 substitutes items 69285, 69286 and 69287 for item 69203 (deleted under subregulation 3.5).

*       Sub-regulation 3.6 substitutes items 69289, 69290 and 69291 for item 69211 (deleted under subregulation 3.5).

*       Sub-regulation 3.6 substitutes items 69293, 69294 and 69295 for item 69215 (deleted under subregulation 3.5).

Sub-regulation 3.6 also introduces a single general Chlamydia item 69262, replacing numbers 69221 (deleted under sub-regulation 3.5) and 69261 (deleted under sub-regulation 3.5) which described two different test methods for Chlamydia. The amendment is to comply with the principle that items in the Pathology Services Table, covering testing for particular diseases or conditions, should cover all testing methods rather than just one particular method.

Sub-regulation 3.6 also replaces item 69263 with item 69264 as the item descriptor for 69263 (deleted under sub-regulation 3.5) referred to the old Chlarnydia item numbers and therefore had to be amended to reflect the changes introduced in new item 69262.

Sub-regulation 3.6 also introduces two new items developed to assist practitioners treating patients with sexually transmitted diseases who frequently have to test for combinations of infections:

*       item 69281 which covers both syphilis and hepatitis serology; and

*       item 69282 which covers microscopy and culture to detect pathogenic micro-organisms and Chlarnydia testing. 96R063


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