Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2010 (SLI NO 265 OF 2010)

EXPLANATORY STATEMENT

 

Select legislative Instrument 2010 No. 265

 

Health Insurance Act 1973

 

Health Insurance (Pathology Services Table) Regulations 2010

 

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 2009 (the 2009 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Subsection 4A(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4A(1) cease to be in force and are taken to have been repealed on the day after the 15th sitting day of the House of Representatives after the end of the period of

12 months, commencing on the day on which the regulations are notified on the Federal Register of Legislative Instruments. The 2009 Regulations were registered on the Federal Register of Legislative Instruments on 24 September 2009 and commenced on

1 November 2009.

 

The purpose of the Regulations is to repeal the 2009 Regulations and prescribe a new pathology services table for the 12 month period commencing on 1 November 2010. 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 reproduces the table contained in the 2009 Regulations with some changes to the rules of interpretation and to the schedule of services and fees and in order to align it with stylistic changes in the Health Insurance (General Medical Services Table) Regulations 2010 effective 1 November 2010.

 

Clause 1.2.3 makes reference to the endorsement of a ‘Rule 3 exemption’ on an account. To align with the rest of the stylised Regulations this automatically is changed to a ‘Clause 1.2.2 exemption’ however as this is specific wording required on the account this amendment require system changes by Medicare Australia and all pathology providers across Australia. In order to implement this change into their systems these organisations require a large lead time. Clause 1.2.3 of the Regulations therefore continues to reference ‘Rule 3 exemption’ and indicate that this is taken to be Clause 1.2.2 for the purpose of the Regulations.

 

The Health Insurance Amendment (Midwives and Nurse Practitioners) Act 2010, which commenced on 12 April 2010, amended the Act to provide for new arrangements to enhance and expand the role of midwives and nurse practitioners. Under the new arrangements, from 1 November 2010 participating midwives and nurse practitioners will be able to take a greater role in providing quality health care through the Medicare scheme, including through requesting certain pathology services.

 

The Regulations amend the 2009 Regulations to reflect the ability of participating midwives and nurse practitioners to request certain pathology services.

 

As part of the ongoing management of the table items 74990 and 74991 are indexed to take effect from 1 November 2010.

 

Details of the Regulations are set out in the Attachment.

 

Advice on all aspects of the measure has been sought from nursing, midwifery, consumer and medical groups, including the Australian Medical Association (AMA), through the Maternity Services Advisory Group, Nurse Practitioner Advisory Group and the associated technical advisory groups.

 

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 2010.

 

 

 


ATTACHMENT

 

 

DETAILS OF THE HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2010

 

Regulation 1 – Name of Regulations

 

This regulation provides for the Regulations to be referred to as the Health Insurance (Pathology Services Table) Regulations 2010.

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on 1 November 2010.

 

Regulation 3 – Repeal

 

This regulation repeals the Health Insurance (Pathology Services Table) Regulations 2009.

 

Regulation 4 – Dictionary

 

This regulation provides that for the purpose of the Regulations, the dictionary at the end of the Regulations defines certain words and expressions.

 

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 – Pathology services

 

Schedule 1 sets out a pathology services table (the Table) which is similar to the table in the Health Insurance Table (Pathology Services Table) Regulations 2009 but with changes to the following provisions:

·        Part 2 – Services and fees.

 

Part 2 – Services and fees

 

Schedule 1, Part 2, Division 1.2, Clause 1.2.3

 

Clause 1.2.3 references the endorsement of a ‘Rule 3 exemption’ on an account rather than ‘Clause 1.2.2 exemption’. ‘Rule 3 exemption’ is legislated in name only and the Regulations indicate that Rule 3 is taken to be Clause 1.2.2 for the purpose of the Regulations.


 


Schedule 1, Part 2, Division 1.2, Clause 1.2.6.(2)

 

This item amends Division 1.2.6.(2) of the Table to provide that where a general practitioner, participating midwife or participating nurse practitioner requests a set of pathology services, those services are treated as one service for the purposes of the ‘coning rule’ in rule 18 of the 2009 Regulations. Currently, rule 18 only applies to a set of services requested by general practitioners.

 

The episode coning rule requires that where more than three pathology services are requested in a patient episode, Medicare benefits equivalent to the fees for the three items with the highest Schedule fee only are payable.

 

Schedule 1, Part 2, Division 2.12 (Group P12 – Management of Bulk-Billed Services)

 

The fees and benefits for Group P12 (Management of Bulk-Billed Services), following indexation, are amended as follows: item 74990 – new fee of $6.75; and item 74991 – new fee of $10.25.

 

Dictionary

 

This item amends the Dictionary of the Table to include participating midwives and participating nurse practitioners as requesting practitioners under the definition of ‘patient episode’ by replacing the reference to services “requested by one or more practitioners” with reference to services requested by “one or more practitioners, participating midwives or participating nurse practitioners”.

 

A patient episode refers to a pathology service or services, provided to a patient whose need for the services was determined on the one day or, if more than one service is performed on the specimen, within fourteen days. This is irrespective of whether the services are requested by one or more practitioners, are covered by one or more items, are performed by one or more practitioners or are performed on the same or different days.

 

Restyling

 

The stylistic changes to the Regulations include a change of terminology such that rules in the 2009 Regulations are referred to as clauses. The correspondence between rules and clause numbers is detailed in the table below.

 

2009 Regulations Rule

2010 Regulations Clause

1

Dictionary

2

1.2.1, 2.12.1

3

1.2.2

4

1.2.3, 2.1.1, 2.2.2

5

2.1.2

6

1.2.4

7

1.2.5

8

2.2.1

9

2.2.5

10

2.3.1

11

2.3.3

12

2.4.2

13

2.5.1, 2.6.1

14

2.10.1, 2.11.1

15

2.11.2

16

2.11.3

17

1.1.1

18

1.2.6

18A

1.2.7

19

2.3.5

20

2.7.1

21

2.2.4

22

2.2.7

23

2.4.4

24

1.2.8, 2.4.5

25

2.2.3, 2.2.6, 2.2.7, 2.3.4, 2.4.1, 2.8.1

26

2.3.2

27

2.4.3, 2.7.2

 

 


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