Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) AMENDMENT REGULATIONS 2001 (NO. 2) 2001 NO. 80

STATUTORY RULES 2001 No. 80

Issued by the Authority of the Minister for Health and Aged Care

Health Insurance Act 1973

Health Insurance (Pathology Services Table) Amendment Regulations 2001 (No. 2)

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

The Act provides for the payment of professional services through Medicare benefits to all eligible persons.

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.

Section 4A of the Act provides that a table of pathology services may be prescribed. The Health Insurance (Pathology Services Table) Regulations 2000, which commenced on 1 November 2000, prescribe such a table.

The amendment Regulations implement a number of changes to the Pathology Services Table as follows:

•       a restructure of the Prostate Specific Antigen (PSA) test items and introduction of a new item;

•       new items for testing for Antineutrophil Cytoplasmic Antibodies (ANCA) and accompanying new Rule. and

•       a minor amendment to item 71109 to remove reference to all items now covered by the ANCA items and to clarify Rule 4 of the Rules of Interpretation.

The overall effect of the changes is anticipated to have no major financial implications and will be incorporated within the expenditure targets under the Pathology Quality and Outlays Agreement for 2000/2001.

The changes have been developed in cooperation with the two peak pathology professional bodies, the Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices, through the Pathology Services Table Committee (PSTC).

Details of the regulations are set out in the Attachment.

The Regulations commenced on 1 May 2001.

ATTACHMENT

Regulation 1 cites the regulations as the Health Insurance (Pathology Services Table) Amendment Regulations 2001 (No. 2).

Regulation 2 prescribes a commencement date of 1 May 2001.

Regulation 3 prescribes the amendments to the Health Insurance (Pathology Services Table) Regulations 2000. The changes under Regulation 3, Schedule 1 are:

•       a restructure of Prostate Specific Antigen (PSA) items 66656 and 66659 with the introduction of a new item 66655 for clinically suspected prostatic disease. The new structure provides for more appropriate PSA testing without restricting access to this test;

•       four new immunology items (71153 - 71159) for the measurement of Antineutrophil Cytoplasmic Antibodies (ANCA) in the assessment or diagnosis of systemic inflammatory disease or vasculitis. A new Rule of interpretation to accompany these new items to provide clarification;

•       an amendment to immunology item 71109 by removing reference to glomerular basement membrane and neutrophil cytoplasm as they are covered in the new ANCA items; and

•       an amendment to Rule 4 (1) to include reference to items 66503, 66506, 66509, 66512 and 66515. This rule covers the exemptions to Rule 3 and the amendment clarifies which items are exempted in the intensive care setting.