Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1996-97 PATHOLOGY SERVICES TABLE) REGULATIONS 1996 NO.232

STATUTORY RULES 1996 No. 232

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

Health Insurance Act 1973

Health Insurance (1996-97 Pathology Services Table) Regulations

Section 133 of the Act provides that the Governor-General may make regulations prescribing matters for the purposes of the Act.

Section 9 of the Act provides 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 a table of pathology services may be prescribed. The Health Insurance (1996199 7 Pathology Services Table) Regulations prescribe such a table.

The suggested changes to the Pathology Services Table in these proposed Regulations have been developed with the co-operation and support of the two peak pathology professional bodies, the Royal College of Pathologists of Australasia (RCPA) and the Australian Association of Pathology Practices (AAPP), through the Pathology Services Table Committee and the Pathology Consultative Committee.

Regulation 2 prescribes a commencement date of 1 November 1996 for the new Regulations.

Regulation 3 prescribes the new Pathology Services Table for 1996-1997 which sets down the pathology services eligible for Medicare benefits and the amount of the rebates payable,

Regulation 4 repeals Statutory Rules 1995 Nos. 281 and 301, and Statutory Rules 1996 Nos. 10 and 54.

The suggested changes to the 1995-1996 Pathology Services Table include an increase in the Schedule fees for the Patient Episode Initiation items (PEIs), the inclusion of two new items, the revision of the descriptions of another four items, minor amendments to the Rules of Interpretation (the Rules) and the revision of the index to the Pathology Services Table.

The Schedule fees for the PEIs (items 73901, 73903, 73905, 73907, 73909, 73911, 73913 and 73915) have been increased by $0.75 cents using part of the 1 November 1996 Schedule fee increase in Medicare benefits for pathology provided for in the 1996-97 Budget. These increases are in line with the terms of the three year Agreement between the Government and pathology profession which was announced in the 1996-97 Budget. Under the Agreement, which was negotiated with the two peak pathology professional bodies, the RCPA and the AAPP, pathology expenditure under the Medicare benefits arrangements will be capped to pre-determined amounts over the period 1996-97 to 1998-99. These amounts equate to an annual growth rate for pathology expenditure of around 6 two peak pathology professional bodies, the RCPA and the AAPP, pathology expenditure under the Medicare benefits arrangements will be capped to pre-determined amounts over the period 1996-97 to 1998-99. These amounts equate to an annual growth rate for pathology expenditure of around 6 per cent.

The Agreement, which took effect from 1 July 1996, contains a series of measures to manage pathology expenditure, with adjustments being made as necessary to operate within the cap's agreed parameters. At the end of August, the growth rate for Medicare outlays on pathology for 1996-97 was running below target at 4.5 percent. The proposed adjustments to the PEIs are in accordance with these provisions.

The other proposed changes to the 1995-1996 Pathology Services Table as follows:

*       two new items provide for the biochemical monitoring of bone loss in patients with proven low bone mineral density (item 66425), and in those with metabolic bone disease (item 66426);

-       the new items contain very specific restrictions, those in 66425 being in fine with those in the existing bone densitometry testing items 12306, 12309, and those in 664.26 requiring an established diagnosis of metabolic bone disease. These restrictions are aimed at preventing the items being used inappropriately;

*       a restriction has been added to item 66367 to ensure that Medicare benefits cannot be claimed twice in the same patient episode for testing for hydroxyproline using this item and one of the bone marker items;

*       the restrictions in the pregnancy serology items (69253, 69255 and 69257) have been amended to prevent claims being made for these items in conjunction with the new hepatitis items (69266 to 69279), and the combined chlamydia and hepatitis item (6928 1) in the same patient episode;

-       this is because the pregnancy serology items already include testing for the Hepatitis B surface antigen;

*       in the Rules, sub-rules 4(1)(b) and 4(3) of the 1995-96 Schedule no longer appear as they refer to items no longer appearing in the Table;

*       the numbering of the Rules has been revised, and their layout has been amended;

*       some minor changes, which do not alter the meaning of the text, have been made to Rules 4,6, 9, 15, 17, 18 and 19 for stylistic reasons;

*       the index to the Pathology Services Table has been extensively revised to update item numbers.