Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) AMENDMENT REGULATIONS 2002 (NO. 1) 2002 NO. 77

Statutory Rules 2002 No. 77

Issued by the authority of the Minister for Health and Ageing

Health Insurance Act 1973

Health Insurance (Pathology Services Table) Amendment Regulations 2002 (No. 1)

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

Section 10 of the Act provides for payments of Medicare benefits in respect of professional services rendered to 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 prescribed tables.

Subsection 4A of the Act provides that the table of pathology services may be prescribed in regulations. The Health Insurance (Pathology Services Table) Regulations 2001 prescribes such a table.

The purpose of the amendment to the Health Insurance (Pathology Services Table) Regulations 2001 is to amend five existing items, delete two items and include a new complexity level for histopathology items.

The overall effect of the proposed changes is anticipated to have no major financial implications and can be incorporated within the expenditure targets under the Pathology Quality and Outlays Agreement.

The change's have been developed with the co-operation and support of the two peak pathology 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.

Details of the amendments are provided at the Attachment.

The amendments commenced on gazettal.

ATTACHMENT

Regulation 1 cites the regulations as the Health Insurance (Pathology Services Table) Amendment Regulations 2002 (No. 1).

Regulation 2 prescribes a commencement date of gazettal.

Regulation 3 prescribes the amendments to the Health Insurance (Pathology Services Table) Regulations 2001.

The changes under Regulation 3, Schedule 1 are:

•       Removal of the reference to electrophoresis from general chemistry item 66500. The electrophoresis technique is now appropriately covered under a number of other items.

•       Amendment of drugs of abuse item 66626 to allow for 36 tests in a 12 month period in line with current practice. The item currently allows for 21 tests in a 12 month period. The Pathology Services Table Committee received advice on this matter from a number of groups that conduct drug treatment programs indicating that most programs run for at least 3 months with a follow up maintenance period. Testing is generally 3 times per week for the first 3 months (36 tests).

•       Amendment to Prostate Specific Antigen (PSA) item 66655 to remove ambiguity and confusion created by the phrase 'clinically suspected prostatic disease' in the item descriptor. The original intention for this item was that the decision to order a PSA test to be at the discretion of the treating practitioner who may consider such indications as age or family history, rather than obvious clinical symptoms, as an appropriate reason to request the test for a patient.

•       A minor amendment to faeces culture item 69345 to further clarify specimen

collection requirements.

•       The removal of the words 'including serial dilution (if performed)' from the Human chorionic gonadotrophin (HCG) pregnancy item 73527, as this test is considered to be outdated.

•       A new complexity level for 'Small bowel - biopsy, all sites (complexity 4)'.

•       Deletion of items 65139 (quantitation of plasminogen) and 65140 (quantitation of euglobulin clot lysis time), following consistently low utilisation and limited clinical application.