Commonwealth Numbered Regulations - Explanatory Statements
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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATION 2012 (SLI NO 246 OF 2012)
EXPLANATORY STATEMENT
Select Legislative Instrument 2012 No. 246
Health Insurance Act 1973
Health Insurance (Pathology Services Table) Regulation 2012
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 2011 (the 2011 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Subsection 4A(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4A(1) cease to be in force and are taken to have been repealed on the day after the 15th sitting day of the House of Representatives after the end of the period of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 2011 Regulations were registered on the Federal Register of Legislative Instruments on 26 October 2011 and commenced on
1 November 2011.
The purpose of the regulation is to repeal the 2011 Regulations and prescribe a new pathology services table for the 12 month period commencing on 1 November 2012. The regulation sets 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 2011 Regulations, as amended by the Health Insurance (Pathology Services Table) Amendment Regulation 2012 (No. 1). This amendment was effective from 1 May 2012. It introduced new items (three genetic tests to determine eligibility for Government subsidised medicine) and amended the descriptors of existing items to reflect evidence-based best clinical practice and better value for money for both the Australian Government and the Australian people. These changes were 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 Medical Services Advisory Committee (MSAC).
The new table also includes three new tests under Genetics - Group P7 that have been recommended by the MSAC following consultation with the public and pathology stakeholders. The new items numbered 73333, 73334 and 73335 relate to genetic testing for hereditary mutations in the von Hippel-Lindau gene that cause VHL syndrome.
In addition, as part of the ongoing management of the table, the fees for the management of bulk-billed services items 74990 and 74991 are indexed with a date of effect of 1 November 2012. These items relate to unreferred pathology services performed by a medical practitioner (eg. a simple or basic pathology test performed by a medical practitioner instead of referral to a pathologist for testing) and therefore, are indexed by 1.9 per cent in line with the general medical services table of the Medicare Benefits Schedule. The remainder of the items on the pathology services table are not indexed as pathology outlays are managed under the Pathology Funding Agreement.
The Act specifies no conditions that need to be satisfied before the power to make the regulation may be exercised.
The regulation is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The regulation commences on 1 November 2012.
Consultation
These changes relate to the ongoing maintenance of the Pathology Services Table (PST) to reflect evidence-based best practice and appropriate funding; and the listing of new items on the PST to reflect new procedures and technology. They result from advice from the MSAC.
Where a change to the PST related to an application for public funding for a new technology or procedure, the application went through a MSAC process which included consultation with craft groups, the public and clinical experts. MSAC and its two sub-committees are composed of expert members from a wide range of fields including pathology.
The Department of Human Services was consulted concerning the impact of the changes on their business operations. The Department of Veterans' Affairs was advised of the changes to ensure that their schedule of benefits for veterans could be amended if necessary.
It has been concluded that the changes will have minimal impact on pathology practice in terms of costs to business and will lead to a closer correspondence between Medicare benefit structure and pathology practice.
Authority: Subsection 133(1) of the
Health Insurance Act 1973
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