EXPLANATORY STATEMENT

 

Select Legislative Instrument 2008 No. 32

 

Subject - Health Insurance Act 1973

Health Insurance (Pathology Services Table) Amendment Regulations 2008 (No. 1)

 

Subsection 133 (1) of the Health Insurance Act 1973 (the Act) provides that the

Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.

 

The Act provides, in part, 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.

 

Section 4A of the Act provides that the regulations may prescribe a table of pathology services that sets out items of pathology services, the amount of fees applicable in respect of each item, and rules for interpretation of the pathology services table. The Health Insurance (Pathology Services Table) Regulations 2007 (the Principal Regulations) currently prescribe such a table.

 

The Regulations amend the current table of pathology services in the Principal Regulations, as part of the ongoing management of the table. The changes consist of revised clinical descriptors for existing haematological and microbiology tests and a consequent amendment to rule 11 to reflect the changes to the haematological and microbiology items; a minor amendment to rule 4 clarifying restrictions to be applied to two haematology items; an amendment to rule 13 to include bone marrow biopsies; a minor amendment to rule 18 excluding testing for hepatitis B and C from certain restrictions; a fee reduction for two haematological items to compensate for an anticipated slight increase in utilisation of two immunochemistry items for bone marrow biopsies; and an equalisation of fees (at no cost) for related pregnancy and non-pregnancy serology items in microbiology.

 

These changes have been developed with the co-operation and support of the three peak pathology bodies, the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices and the National Coalition of Public Pathology, through the Pathology Services Table Committee.

 

Details of the Regulations are set out in the Attachment.

 

The Act specifies no conditions that need to be satisfied before the power to make Regulations may be exercised.

 

The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

The Regulations commence on 1 May 2008.

 

 

ATTACHMENT

 

 

DETAILS OF THE HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) AMENDMENT REGULATIONS 2008 (No. 1)

 

Regulation 1 – Name of Regulations

 

This regulation provides for the Regulations to be referred to as the Health Insurance (Pathology Services Table) Amendment Regulations 2008 (No. 1).

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on 1 May 2008.

 

Regulation 3 – Amendment of the Health Insurance (Pathology Services Table) Regulations 2007

 

This regulation provides that Schedule 1 amends the Health Insurance (Pathology Services Table) Regulations 2007, the Principal Regulations.

 

Schedule 1 – Amendments

 

Schedule 1 sets out a number of changes to the following provisions in Schedule 1 to the Principal Regulations:

§         Part 2 – Rules of interpretation;

§         Part 3 – Services and fees.

 

Part 2 - Rules of interpretation

 

Items [1] to [4]

Rule 4 provides exemptions to rule 3 which places a limit on the benefits payable during a single patient episode. It is amended to add an exemption for haematology items 65109 and 65110.

 

Rule 11 lists the specific rules that apply to the payment of benefits for tests for the investigation of a patient’s blood serum to check the level of protection against hepatitis. It is amended to reflect changes made in the Table to various hepatitis item descriptors and to simplify the rule.

 

Rule 13 provides the definition of tissue pathology and is amended to include bone marrow biopsy which had been specifically excluded. This is amended to ensure clinical best practice in tissue pathology for bone marrow biopsies.

 

Rule 18 limits the benefits payable to a total of three items with the highest fee in a patient episode. There are a number of exemptions to this rule included in rule 18A and the test for hepatitis B and C antibodies (69484) is added as an exemption.

 

 

 

 

 

Part 3 – Services and fees

 

Items [5] to [10]

Haematology item descriptors 65078, 65081, 65084, 65087 and microbiology item descriptors 69378, 69475, 69478, 69481 and 69494 is simplified to allow pathologists to provide clinical best practice when undertaking these tests.

 

There is a fee reduction for two haematology items for bone marrow biopsies (65084 and 65087) to compensate for an anticipated slight increase in utilisation of two tissue pathology items for bone marrow biopsies (72846 and 72847) as a result of a change to rule 13 above.

 

The fees for pregnancy and non-pregnancy serology items in microbiology are equalised to recognise that an equal amount of work is required. Fees are amended in items 69387, 69390, 69393, 69396, 69399, 69401, 69408, 69411, 69413 and 69415. Some fees are increased and some are reduced so it is cost-neutral overall.