Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2006 (SLI NO 274 OF 2006)

EXPLANATORY STATEMENT

 

Select Legislative Instrument 2006 No. 274

 

Issued by the Authority of the Minister for Health and Ageing

 

Health Insurance Act 1973

 

Health Insurance (Pathology Services Table) Regulations 2006

 

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 2005 (the 2005 Regulations) currently prescribe such a table.

 

Subsection 4A(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4A(1) cease to be in force and are taken to have been repealed on the day after the 15th sitting day of the House of Representatives after the end of a period of 12 months, commencing on the day on which the regulations are notified on the Federal Register of Legislative Instruments. The 2005 Regulations were registered on the Federal Register of Legislative Instruments on 27 October 2005 and commenced on 1 November 2005.

 

The purpose of the Regulations is to repeal the 2005 Regulations and prescribe a new pathology services table for the 12 month period commencing on 1 November 2006. The new table will effectively reproduce the table contained in the 2005 Regulations, with some changes to the rules of interpretation and to the schedule of services and fees. The Regulations will set out items of pathology services which are eligible for Medicare benefits, the amount of fees applicable in respect of each item and rules for interpretation of the table.

 

The changes are part of the ongoing management of the table of pathology services and have been developed with the co-operation and support of the two peak pathology bodies, the Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices, 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 the Regulations may be exercised.

 

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

 

The Regulations will commence on 1 November 2006.

 

Authority: Subsection 133(1) of the

Health Insurance Act 1973


ATTACHMENT

 

DETAILS OF THE HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2006

 

Regulation 1 – Name of Regulations

 

This regulation provides for the Regulations to be referred to as the Health Insurance (Pathology Services Table) Regulations 2006.

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on 1 November 2006.

 

Regulation 3 – Repeal

 

This regulation will repeal the Health Insurance (Pathology Services Table) Regulations 2005 (as amended).

 

Regulation 4 – Definitions

 

This regulation provides that for the purpose of the Regulations, Act means the Health Insurance Act 1973 and this table means these Regulations.

 

Regulation 5 – Pathology Services Table

 

This regulation provides that the table of pathology services in Schedule 1 is prescribed for the purposes of subsection 4A(1) of the Act.

 

Schedule 1 – Table of pathology services

 

Schedule 1 sets out a pathology services table which is similar to the table in the Health Insurance (Pathology Services Table) Regulations 2005, but with changes to the following provisions:

§         Part 2 – Rules of interpretation; and

§         Part 3 – Services and fees.

 

Part 2 - Rules of interpretation

 

The Regulations would incorporate the following changes:

 

Paragraph 4(3)(h) is changed to remove the reference to potassium, as advised by the Pathology Services Table Committee.

 

Rule 26 is changed to reflect the addition of the new pathologist-determinable item 69367 to allow for three or more tests to facilitate the testing of at least three organisms using nucleic acid technology.

 

A pathologist-determinable item allows for the payment of Medicare benefits without a request from a medical practitioner, in circumstances where the services are requested and performed by or on behalf of an approved pathology practitioner (APP) and the services are determined by an APP to be necessary.


Rule 27 is added to outline the requirements for the use of item 73320 (HLA-B27 typing by nucleic acid amplification) as a pathologist-determinable item. The rule will specify that the recognised pathologist who renders the service in item 73320 must record the reasons for determining the need for this service including the result of the service rendered in item 71147 (HLA-B27 typing by serological methods).

 

Part 3 – Services and fees

 

The Regulations will incorporate the following changes:

 

Item 65139 – Plasminogen is deleted from the index of abbreviations in Part 4 of the Schedule, as this item no longer exists.

 

Item 69367 is added to provide a new item for 3 or more tests described in item 69364 for the detection of a virus or microbial antigen or microbial nucleic acid (not elsewhere specified).

 

Item 69365 is amended to apply to 2 tests only, in light of the new item 69367 which will provide for 3 or more tests described in item 69364.

 

Item 73320 (HLA-B27 typing by nucleic acid amplification) is amended to make provision for it to be rendered as a pathologist-determinable item in the circumstance where the result of item 71147 (HLA-B27 typing using serological methods) is unsatisfactory. The descriptor for item 73320 is also amended to state that this item includes a service described in item 71147 so that both items cannot be claimed, unless the service in item 73320 is rendered as a pathologist-determinable service, and that the item is subject to proposed rule 27.

 

The fees and benefits for Group P12 (Management of Bulk-Billed Services), following indexation, are amended as follows: item 74990 – new fee of $6.20; and item 74991 – new fee of $9.40. These represent increases of 2.1% due to indexation.

 

 

 

 


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