Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2011 (SLI NO 188 OF 2011)

EXPLANATORY STATEMENT

 

 

Select Legislative Instrument 2011 No. 188

 

Health Insurance Act 1973

                       

Health Insurance (Pathology Services Table) Regulations 2011

 

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 2010 (the 2010 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Subsection 4A(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4A(1) cease to be in force and are taken to have been repealed on the day after the 15th sitting day of the House of Representatives after the end of the period of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 2010 Regulations were registered on the Federal Register of Legislative Instruments on 28 October 2010 and commenced on

1 November 2010.

 

The purpose of the Regulations is to repeal the 2010 Regulations and prescribe a new pathology services table for the 12 month period commencing on 1 November 2011.  The Regulations set 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 2010 Regulations.

 

As part of the ongoing management of the table, the fees for the management of bulk-billed services items 74990 and 74991 are indexed to take effect from 1 November 2011. 

 

There was no consultation undertaken in relation to the remaking of the Health Insurance (Pathology Services Table) Regulations, as with the exception of the indexation of the fees for two items, there is no change to the 2010 Regulations.

 

The changes to the 2010 Regulations effective on 1 July 2011 related 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 resulted from advice from both the Pathology Services Table Committee (PSTC) and the Medical Services Advisory Committee (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 PSTC is composed of members from the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices and the National Coalition of Public Pathology, the Australian Medical Association, Medicare Australia and the Department of Health and Ageing.  The changes were developed in consultation with these organisations. 

 

Medicare Australia 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.

 

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

 

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

 

The Regulations commence on 1 November 2011.

 

 

 

    Authority:       Subsection 133(1) of the     Health Insurance Act 1973

 

 

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