Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2004 2004 NO. 309

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.

Subsection 4A(1) 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 table. Subsection 4A(2) of the Act provides that, unless sooner repealed, regulations made under section 4A cease to be in force and are taken to have been repealed on the day next following the 15^th sitting day of the House of Representatives after the end of a period of 12 months beginning on the day on which the regulations are notified in the Gazette.

A table of pathology services is currently prescribed by the Health Insurance (Pathology Services Table) Regulations 2003 (the 2003 Regulations). The table was amended by the Health Insurance (Pathology Services Table) Amendment Regulations 2003 (No.1), (No.2) and (No.3), and the Health Insurance (Pathology Services Table) Amendment Regulations 2004 (No.1), (No.2), (No.3) and (No.4). The 2003 Regulations were notified in the Gazette on 16 October 2003 and commenced on 1 November 2003.

The purpose of the Regulations is to repeal the 2003 Regulations and the amending regulations, and to prescribe a new table of pathology services for the 12 month period commencing on 1 November 2004. The new table 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 replaces the table contained in the 2003 Regulations.

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.

Details of the Regulations are set out in the Attachment.

The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised.

The Regulations commence on 1 November 2004.

ATTACHMENT

DETAILS OF THE HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2004.

Regulation 1 provides for the Regulations to be referred to as the Health Insurance (Pathology Services Table) Regulations 2004.

Regulation 2 provides for the Regulations to commence on 1 November 2004.

Regulation 3 repeals Statutory Rules 2003 Nos. 256, 295, 300 and 360, and Statutory Rules 2004 Nos. 66, 67, 238 and 268.

Regulation 4 defines, for the purpose of the Regulations, Act to mean the Health Insurance Act 1973 and this table to mean these Regulations.

Regulation 5 provides that the new table of pathology services and rules of interpretation are set out in Schedule 1.

In addition to completely re-making the Health Insurance (Pathology Services Table) Regulations 2003, the Pathology Services Table 2004 makes:

•       amendments to three existing items and a rule; and

•       one deletion, one amendment and one addition to the Index of the Pathology Services (Abbreviations).

Group P2 - Chemical

The Regulations amend the item descriptors of items 66518 and 66519 to ensure that the method used for the investigation of cardiac or skeletal muscle damage provides a quantitative measure with a numerical output.

The Regulations amend the item descriptor of item 66695 to specify that the quantitation of hormones and hormone binding proteins is in blood or urine.

Rule 4

Subsection 4B(3) of the Health Insurance Act enables a practitioner to seek an exemption to the multiple services rule (rule 3) if certain criteria are met and if the services are not listed under rule 4. Rule 4 lists the services to which rule 3 does not apply. The Regulations make changes to rule 4 to accommodate the changing environment for private pathology services and to limit the need for the Health Insurance Commission to individually assess applications made under subsection 4B(3). The changes would:

•       include items 65060, 65070, 65120, 65123, 65126, 65129, 65150, 65153, 65156 and 66800 in rule 4(1);

•       amend rule 4(1)(a) to increase the number of occasions - from 4 to 6 - a service can be rendered in a 24 hour period; and

•       amend rule 4(1)(b) to specify that the patient must be an in-patient of a hospital.

Index to Pathology Services (Abbreviations)

The Regulations amend the Index to Pathology Services (Abbreviations) to:

•       remove the reference to the Euglobulin clot lysis time test, as this test has been deleted from the table;

•       reflect that there is a specific item (item 71163) for the detection of antibodies to gliadin; and

•       add item 69413 (Pregnancy Serology - 4 tests - MSP4) to the index, as this item was introduced on 1 November 2003 for 4 tests for microbiology serology during pregnancy.