Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2002 2002 NO. 245

STATUTORY RULES 2002 No. 245

Issued by the authority of the Minister for Health and Aging

Health Insurance Act 1973

Health Insurance (Pathology Services Table) Regulations 2002

Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations prescribing matters for the purposes of the Act.

The Act provides 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.

Subsection 4A(1) of the Act provides that the regulations may prescribe a table of pathology services setting out items of pathology services; the amount of fees applicable in respect of each item; and rules for interpretation of the table. Subsection 4A(2) provides that, unless sooner repealed, regulations made under section 4A cease to be in force and are taken to be repealed on the day next following the 15^th sitting day of the House of Representatives after the expiration of a period of 12 months commencing on the day on which the regulations are notified in the Gazette.

The purpose of the Regulations is to repeal the Health Insurance (Pathology Services Table) Regulations 2001 and to prescribe a table of pathology services for the 12 month period commencing on 1 November 2002, which sets out the 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 will replace the table contained in the Health Insurance (Pathology Services Table) Regulations 2001.

The Regulations include the following changes as part of the ongoing management of the pathology services table:

•       The restructure of the hepatitis items to significantly reduce their number while maintaining coverage of all antibody antigen tests done in hepatitis serology (items 69475 - 69493);

•       The creation of a new item 71162 for the diagnosis of coeliac disease or other gluten hypersensitivity syndromes;

•       The deletion of item 71067 (quantitation of immunoglobulins) and the creation of 4 separate items (71066, 71068, 71072 and 71074) detailing specific immunoglobulins;

•       The addition of two items for the investigation of recurrent infection (71133 and 71134);

•       Structural changes to the histopathology biopsy items; and

•       The removal of the time restriction of 4 patient episodes in 12 months for item 66656 (test for monitoring Prostate Specific Antigen levels).

Details of the Regulations are set out in the Attachment.

The changes have been developed with the co-operation and support of the two peak pathology bodies, the Royal College of Pathologists of Australasia (RCPA) and the Australian Association of Pathology Practices (AAPP), through the Pathology Services Table Committee and the Pathology Consultative Committee.

The Regulations are consistent with the provisions of the Pathology Quality and Outlays Agreement to manage pathology expenditure within agreed parameters. As part of this Agreement, the Pathology Consultative Committee will monitor the impact of the 1 November 2002 changes on overall expenditure on pathology, and support any necessary adjustments to ensure that the expenditure target is achieved.

The Regulations commence on 1 November 2002.

ATTACHMENT

Regulation 1 specifies the regulations as the Health Insurance (Pathology Services Table) Regulations 2002.

Regulation 2 prescribes a commencement date of 1 November 2002.

Regulation 3 repeals the Statutory Rules 2001 Nos. 281 and 312, and 2002 No. 77.

Regulation 4 prescribes definitions for the purpose of the Regulations.

Regulation 5 prescribes the new table of pathology services and rules of interpretation as set out in Schedule 1.

Pathology Services Table 2002 will incorporate a number of changes as follows:

Hepatitis Items

The hepatitis items have been restructured to significantly reduce their number while maintaining coverage of all antibody antigen tests done in hepatitis serology (items 69475 - 69493). The restructure provides for the deletion of 18 items (69414 - 69441 and 69447 - 69468), the creation of 7 new items (69475 - 69493), the amendment of 3 items (69405 - 69411) and consequential changes to the rules and abbreviations. The restructure simplifies the existing structure and it is anticipated that current difficulties with ordering and billing will decrease.

PSA Item

Item 66656 has been amended to remove the time restriction of 4 patient episodes in 12 months. This is in response to recent evidence indicating that some patients undergoing intensive treatment for aggressive prostate cancer require their PSA levels to be monitored more often than quarterly.

Coeliac disease or other gluten hypersensitivity syndromes

A new item 71162 has been created for diagnosis of coeliac disease or other gluten hypersensitivity syndromes. A further two items 71160 and 71161 have been created for the monitoring of these established diseases. These tests were previously covered under a general immunology item. The change recognises the increase in diseases associated with auto antibodies and is intended to encourage better testing for these diseases. As a consequence of these new items, a new interpretation (rule 24) outlining its use and a number of abbreviations has been created.

Specific immunoglobulins

Item 71067 has been deleted and 4 separate items created (71066, 71068, 71072 and 71074) detailing specific immunoglobulins. Items 71069 and 71071 have been amended to reflect this expansion. This expansion was deemed beneficial as a consequence of the new coeliac disease items.

Investigation of recurrent infection

Two additional items have been created for the investigation of recurrent infection (71133 and 71134) and a further item 71135 has been amended as a consequence of the new items.

Histopathology Biopsy Items

There are structural changes to the histopathology biopsy items. The changes include:

•       scheduled fee increases for the examination of complexity levels 5 and 6 (72830 and 72836);

•       amendment of specimen types for lip and skin biopsies and amendment to the complexity level for parathyroid glands; and

•       the expansion of items 72817 and 72825. Item 72817 will be limited to 2 to 4 specimens and complemented by a new item (72818) allowing for the examination of 5 or more specimens. Item 72825 will be limited to 5 to 7 specimens and complemented by a new item (72826) allowing for the examination of 8 or more specimens.

A number of existing items have been amended to remove anomalies and to reflect current clinical practice. Item 69370 has been referred to in items 69363 and 69375, and an additional reference to nucleic acids has been added to item 69372.

Rule 14(1) has been amended to reflect the replacement of the Licensed Collection Centres (LCC) Scheme with Approved Collection Centres (ACC) which commenced on 1 December 2001.

Rule 4(2) has been amended to include reference to leflunomide. This is in response to current clinical practice that requires liver function tests for patients undergoing ARAVA therapy.