Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1992-1993 PATHOLOGY SERVICES TABLE) REGULATIONS (AMENDMENT) 1993 NO. 125

STATUTORY RULES 1993 No. 125

Issued by the authority of the Minister for Health

Health Insurance Act 1973

Health Insurance (1992-1993 Pathology Services Table) Regulations (Amendment)

Section 133 of the Health Insurance Act 1973 (the Act) provides that the GovernorGeneral may make regulations for the purposes of the Act.

Section 9 of the Act provides, in effect, that Medicare benefits shall be calculated by reference to the fees for medical services (including pathology services) set out in the table (which includes the pathology services table) in Schedule 1A to the Act.

Section 4A of the Act provides, among other things, that the regulations may prescribe a table of pathology services in accordance with the form of table set out in Schedule 1A and that, upon commencement of a regulation prescribing a table of pathology services, the table so prescribed has effect as if it were set out in Schedule 1A in place of the table in that Schedule. The Health Insurance (1992-1993 Pathology Services Table) Regulations (Amendment) amend such a table.

The Regulation amends the Pathology Services Table which sets down the pathology tests eligible for payment of Medicare benefits and the amount of the rebates. Amendments include the creation of eleven new items, deletion of five and changes to the wording of five. Fees have been decreased for two items and conditions surrounding the payment of benefits for some items have been changed. The overall effect is expected to be a slight increase in expenditure in Medicare benefits for pathology services. Specialist advice to the minister has been that these changes are justified and will result in an improvement in pathology practice.

Subregulations 3.1, 3.2, 3.7, and 3.8 are editorial amendments designed to improve the presentation of the Rules of Interpretation for the table or to clarify the meaning of the Rules.

Subregulation 3.3 inserts new subrule 2(3) which ensures that only the appropriate item can be claimed for a particular test or group of tests.

There are three proposed amendments to Rule 3A.

Subregulation 3.4 amends paragraph 3A(1)(a) reflecting a change in the description of an item in the pathology schedule.

Subregulation 3.5 removes an unintentional restriction in subrule 3A(2) on the number of tests, in a strictly defined category, which attract benefits within six months, provided that no more than six tests are performed per request form, and that the request is no more than six months old.

Subregulation 3.6 inserts new subrule 3A(2A) to ensure that if a treating practitioner requests that faecal specimens be collected on three different days so as to obtain a valid estimation, three patient episode initiation fees will be paid.

Subregulation 3.9 inserts new subrules 11(6) and 11(7). New subrule 11(6) provides for two patient episode fees to be paid when certain combinations of tests are ordered provided that they are performed by approved pathology practitioners in two separate approved pathology authorities. The combinations include: cytology and histology tests; cytology and other non-cytological tests; and histology and non-histological tests. Subrule 11(7) ensures that if multiple pathology specimens are collected from a patient on one day for one approved pathology authority, only one patient episode fee will be payable.

Subregulations 3.10 and 3.12 omit cholesterol and triglycerides from item 66201 and create new items to ensure that the ordering of lipid tests can be monitored.

Subregulation 3.11 omits item 66233, and subregulation 3.12 substitutes item 66343 which restricts the number-of drug assays which can be performed on patients participating in a drug abuse program from a possible 52 tests in a year to "21 assays in any 12 month period".

Subregulations 3.13 and 3.14 omit item 69225 and substitute two new items to cover new cost effective tests for Chlamydia and herpes simplex virus. Subregulation 3.14 also inserts a new item in the table for the detection of antibodies to hepatitis C to facilitate the monitoring of orders for this test.

Subregulation 3.15 omits three cytogenetic items and substitutes for them two new items which more correctly describe current practices in cytogenetics.

Subregulations 3.16 and 3.17 amend items in Group P9 of the table (Simple Basic Pathology Tests) to accommodate changes in the current provision of simple basic pathology tests by general practitioners. Also the fees for two items have been reduced to bring them in line with fees in other parts of the Pathology Services Table.

These Regulations would commence from 1 July 1993.