EXPLANATORY STATEMENT

 

Select Legislative Instrument 2005 No. 239

 

Health Insurance Act 1973

 

Health Insurance (Pathology Services Table) Regulations 2005

 

 

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  Subsection 4A(2) of the Act provides that, unless sooner repealed, regulations made under section 4A cease to be in force and are taken to have been repealed on the day after the 15^th sitting day of the House of Representatives after the end of a period of 12 months, which begins on the day on which the regulations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

 

A table of pathology services is currently prescribed by the Health Insurance (Pathology Services Table) Regulations 2004 (the 2004 Regulations).  The table was amended by the Health Insurance (Pathology Services Table) Amendment Regulations 2005 (No.1).  The 2004 Regulations were notified in the Gazette on 16 October 2004 and commenced on 1 November 2004. 

 

The purpose of the Regulations is to repeal the 2004 Regulations and the amending Regulations, and prescribe a new table of pathology services for the 12 month period commencing on 1 November 2005.  The new table effectively reproduce the table contained in the 2004 Regulations, with some amendments to the rules of interpretation and the schedule of services and fees.  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 changes were developed with the co-operation and support of the two peak pathology bodies, the Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices, through the Pathology Services Table Committee.

 

Details of the Regulations are set out in the Attachment.

 

The Act specified no conditions to be met before the power to make the Regulations was exercised. 

 

The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

The Regulations commence on 1 November 2005.

 

 

ATTACHMENT

 

 

Details of the Health Insurance (Pathology Services Table) Regulations 2005.

 

Regulation 1 - Health Insurance (Pathology Services Table) Regulations 2005

 

This Regulation provides that the title of the Regulations is the Health Insurance (Pathology Services Table) Regulations 2005.

 

Regulation 2 - Commencement

 

This Regulation provides for the Regulations to commence on 1 November 2005.

 

Regulation 3 – Repeal of the Health Insurance (Pathology Services Table) Regulations 2004

 

This Regulation provides that the Health Insurance (Pathology Services Table) Regulations 2004 is repealed.

 

Regulation 4 - Definitions

 

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

 

Regulation 5 – Rules of interpretation

 

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

 

In addition to re-making the Health Insurance (Pathology Services Table) Regulations 2004, the Pathology Services Table 2005 amends:

·        amend Rule 4;

·        insert new Rule 26;

·        amend Group P2 - Chemical;

·        amend Group P3 - Microbiology; and

·        amend the Index of the Pathology Services (Abbreviations).

 

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 changes are:

·        clarifies any ambiguity regarding all claimable items to be claimed in each of the 6 occasions that a specimen may be taken in paragraph 4(1)(a); and

·        amends paragraph 4(1)(c) to clarify that the test must be rendered immediately after collection and a result issued before the collection of new samples and another test performed.

 

Rule 26

 

The Regulations would make a new rule, rule 26, to describe the requirements for pathologist determinable services provided under items 69364 and 69365.

 

Group P2 – Chemical

 

The Regulations create two new items, 66711 and 66712, for the testing of cortisol in saliva in the investigation of Cushing’s syndrome and the management of congenital adrenal hyperplasia.

 

The Regulation delete items 66689 and 66692 to address concerns that the necessary resuscitation equipment and training are not generally available at pathology collection points to treat adverse reaction.

 

Group P3 - Microbiology

 

The Regulations would create items 69364 and 69365 for the detection of virus, microbial antigen or microbial nucleic acid not elsewhere specified in the PST.  The Regulations delete items 69315, 69369, 69370, 69372, 69373, 69374, 69375 and 69376 to decrease the complexity within the antigen items.

 

The Regulations make an amendment to the items descriptors for items 69303, 69306, 69309, 69312, 69318, 69321 and 69363 to accommodate the new antigen detection items.

 

The Regulations make an amendment to the item descriptors for items 69384, 69387, 69390, 69393, 69396, 69399, 69405, 69408, 69411 and 69413 plus add a new item 69415 to accommodate the introduction of human immunodeficiency virus (HIV) testing.

 

The Regulations create an item 69486 for high risk human papillomaviruses (HPV) testing in a patient who has received treatment for high grade intraepithelial abnormalities of the cervix.

 

Index to Pathology Services (Abbreviations)

 

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

·        include a specific item (66711) for the cortisol in saliva;

·        include is a specific item (69486) for Human Papillomaviruses (HPV);

·        allow Human Immunodeficiency Virus (HIV) testing  under the current general serology item (69384);

·        remove references to items 66689 and 66692; and

·        amend references to include the new antigen detection items (69364).