EXPLANATORY STATEMENT

 

Select Legislative Instrument 2008 No. 212

 

Health Insurance Act 1973

 

Health Insurance (Pathology Services Table) Regulations 2008

 

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 2007 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Subsection 4A(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4A(1) cease to be in force and are taken to have been repealed on the day after the 15^th sitting day of the House of Representatives after the end of the period of 12 months, commencing on the day on which the regulations are notified on the Federal Register of Legislative Instruments. The 2007 Regulations were registered on the Federal Register of Legislative Instruments on 8 October 2007 and commenced on 1 November 2007.

 

The purpose of the Regulations is to repeal the 2007 Regulations and prescribe a new pathology services table for the 12 month period commencing on 1 November 2008. The Regulations 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 new table reproduce the table contained in the 2007 Regulations with some changes to the rules of interpretation and to the schedule of services, fees and complexity levels. As part of the ongoing management of the table the following changes are recommended, to take effect from 1 November 2008:

 

·        Chemical pathology –several item descriptors are updated to reflect pathology best practice, a new item is added for the quantitation of copper or iron in liver tissue biopsy and two minor fee adjustments (a 5c reduction) are made for consistency;

·        Microbiology – one item is amended to reflect a recent recommendation from the National Tuberculosis Advisory Committee for the detection of tuberculosis;

·        Tissue pathology - new items are added for the examination of tissue blocks and new items for examination of biopsy material is also added. Several existing items in the tissue pathology group have fee reductions to offset the cost of the new items or are amended to reflect the new items;

·        Genetics – several items are amended to reflect the latest techniques in genetics; and

·        Consequential rule changes are made to reflect the above.

 

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 RCPA), the Australian Association of Pathology Practices (the AAPP) and the National Coalition of Public Pathology (the NCOPP) through the Pathology Services Table Committee (the PSTC).

 

The PSTC includes two Commonwealth appointed advisers (one scientific, one medical) and members and observers from the Department of Health and Ageing, the AAPP, the RCPA, the NCOPP, the Australian Medical Association and Medicare Australia.

 

The PSTC also has a number of sub-committees comprising technical experts who advise the PSTC on matters relating to the different groups regarding the Pathology Services Table. In addition, there is a Statistics Subcommittee that undertakes investigation and analysis of Medicare and other data, and uses this to make recommendations to the PSTC. The PSTC also seeks and considers advice from relevant professional bodies on specific issues.

 

In accordance with its Terms of Reference, the PSTC makes recommendations to the Minister for Health and Ageing regarding fees for new items to be listed on the Pathology Services Table, deletion of items and amendment of item descriptors. Most new items arise from Medical Services Advisory Committee recommendations.

 

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 commence on 1 November 2008.

 

 

 

ATTACHMENT

 

 

DETAILS OF THE HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2008

 

Regulation 1 – Name of Regulations

 

This regulation provides for the Regulations to be referred to as the Health Insurance (Pathology Services Table) Regulations 2008.

 

Regulation 2 – Commencement

 

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

 

Regulation 3 – Repeal

 

This regulation repeals the Health Insurance (Pathology Services Table) Regulations 2007 (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 Table (Pathology Services Table) Regulations 2007 but with changes to the following provisions:

·        Part 2 – Rules of interpretation;

·        Part 3 – Services and fees; and

·        Part 5 – Complexity levels for histopathology items.

 

Part 2 – Rules of interpretation

 

Rules 6, 13,18A and 22 in Part 2 are changed. These changes reflect amendments to items in Part 3 to reflect best practice in chemical, microbiology, tissue pathology and genetic testing.

Rule 6 is amended by deleting paragraphs (5)(e) - for item 66697 or 69401—6 – X and; (6)(e) - for item 66697 or 69401 — 5. This reflects the ladder item change from 6 or more tests to five or more tests.

 

Rule 13 is amended to remove from the definition of biopsy material, the wording "other than a bone marrow biopsy ".

 

Rule 18A adds two new items. Item 66832 – a test described in item 66831 if rendered by a receiving APP; and item 73324 – a test described in item 73323 if rendered by a receiving APP – 1 or more tests.

 

Rule 22 adds two new items to the rule description. Item 66831, quantitation of copper or iron in liver tissue biopsy; and item 66832.

 

Part 3 – Services and fees

 

Fourteen Chemistry items (66500, 66566, 66650, 66695, 66697, 66719, 66752,

66764, 66767, 66770, 66819, 66822, 66831, 66832) are amended to reflect best practice in pathology.

 

Item 69401 is amended for the purpose of clarification. Item 69471 is amended to reflect a recommendation from the National Tuberculosis Advisory Committee.

 

New items are added to Tissue Pathology (72827, 72828, 72849, 72850) for the examination of tissue blocks, and existing items (72813, 72816, 72823, 72826, 72847) have offsetting fee reductions or amendments to reflect the new items.

 

Several Genetics items (73287, 73289, 73300, 73305, 73314, 73323) are amended to reflect the latest techniques in genetic testing. These changes result in the addition of a new item (73324) for occasions where a test is referred to another laboratory.

 

Part 5 – Complexity levels for histopathology items

 

Breast, orientated wide local excision for carcinoma, with margin assessment removes the weight requirement for the specimen to reflect best practice.