Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATION 2014 (SLI NO 150 OF 2014)

EXPLANATORY STATEMENT

 

 

Select Legislative Instrument No. 150, 2014

 

Health Insurance Act 1973

 

Health Insurance (Pathology Services Table) Regulation 2014

 

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.

 

Part II of the Act provides for the payment of Medicare benefits for professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits be calculated by reference to the fees for medical services set out in prescribed tables.

 

Subsection 4A(1) of the Act provides that the regulations may prescribe a table of pathology services which sets out items of pathology services, the fees applicable for each item, and rules for interpreting the table.  The Health Insurance (Pathology Services Table) Regulations 2013 (the Principle Regulation) currently prescribes such a table.

 

Subsection 4A(2) of the Act provides that unless repealed earlier, this regulation will cease to be in force and will be taken to have been repealed on the day following the 15th sitting day of the House of Representatives after the end of a 12 month period which begins on the day when the regulation is registered on the Federal Register of Legislative Instruments.  The Principle Regulation was registered on the Federal Register of Legislative Instruments on 26 November 2013 and commenced on 2 December 2013. 

 

The purpose of the regulation is to repeal the Principle Regulation and prescribe a new table of pathology services for the 12 month period beginning on 1 November 2014.  The regulation also amends the Principle Regulation to ensure that the pathology services funded through the Medical Benefits Schedule (MBS) continue to be up-to-date, representative of best medical practice, and reflective of government commitments.

 

Schedule 1 of the Principle Regulation will be amended by;

 

-          inserting eight new items to provide a more targeted approach to existing arrangements for Vitamin D, B12, and Folate, as recommended by the Medical Services Advisory Committee (MSAC). As a consequence, the current items for Vitamin D, B12, and Folate (66608, 66609, 66599, and 66602) will be removed. As item 66609 will be made non-existent, it will be removed from subclause 1.2.6(2)(b) and replaced with new items 66834 and 66837. Clause 2.2.4 will be removed as it refers solely to items 66599 and 66602 which will be made non-existent, and

 

-          inserting two current MBS items (73336 and 73337) into the Principle Regulation from the Health Insurance (Pharmacogenetic Testing) Determination 2013 (No.1) and the Health Insurance (Pharmacogenetic Testing Epidermal Growth Factor Receptor) Determination 2013. This will be an administrative change that ensures the Principle Regulation is reflective of current MBS pathology services. As a consequence, item 73328 will be removed as that item was made redundant when items 73336 and 73337 were listed on the MBS.

 

The regulation will also implement the 2014-15 Budget measure, 'restrictions on the ability of doctors to claims items associated with administering autologous blood injections', which is to take effect on 1 January 2015. The implementation of this measure will require a new clause to be inserted that restricts practitioners from billing MBS items for services provided in connection with injections of blood or blood product that are autologous, as these services have not been assessed by the MSAC.

 

Consultation

 

The Vitamin D, B12, and Folate item changes went through the usual Medical Services Advisory Committee (MSAC) processes. The Department did not consult on the other minor changes as they are administrative in nature and uphold the status quo.

 

Details of the regulation are set out in the Attachment.

 

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

 

The regulation is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

The regulation commences as follows: Sections 1 to 4 of the regulation commence on the day after this instrument is registered; Sections 5 and 6 and Schedules 1 and 2 of the regulation commence on 1 November 2014; and Schedule 3 of the regulation commences on 1 January 2015.

 

 

                                                                       Authority:     Subsection 133(1) of the

                                                                                                Health Insurance Act 1973 


 

ATTACHMENT

 

Details of the Health Insurance (Pathology Services Table) Regulation 2014

 

Section 1 - Name

 

This section provides for the regulation to be referred to as the Health Insurance (Pathology Services Table) Regulation 2014.

 

Section 2 - Commencement

 

This section provides for the regulation to commence as follows:

 

(a)    on the day after this instrument is registered - Sections 1 to 4,

(b)   on 1 November 2014 - Sections 5 and 6,

(c)    on 1 November 2014 - Schedules 1 and 2, and

(d)   on 1 January 2015 - Schedule 3.

 

Section 3 - Authority

 

This regulation is made under the Health Insurance Act 1973.

 

Section 4 - Schedules

 

This section provides that each instrument specified in a Schedule to the instrument is amended or repealed as set out in the applicable items in the Schedule concerned.

 

Section 5 - Pathology services table

 

This section provides that the new table of pathology services set out in Schedule 1 be prescribed for subsection 4A(1) of the Act.

 

Section 6 - Dictionary

 

This section provides for a Dictionary at the end of the instrument, which defines certain words and expressions used in the instrument, and includes references to certain words and expressions which are defined elsewhere in the instrument.

 

Schedule 1 - Pathology services table

 

This part of the regulation contains the following changes to Medicare services:

 

-          remove reference to item "66609" in subclause 1.2.7(2)(b) and replace it with reference to items "66834, 66837",

-          remove clause 2.2.4 from Division 2.2 - Group P2,

-          remove items 66599, 66602, 66608, 66609 from Division 2.2 - Group P2,

-          insert new items 66833, 66834, 66835, 66836, 66837, 66838, 66839, and 66840 into Division 2.2 - Group P2,

-          insert a restriction to be applied to new item 66838 in subclause 2.2.3(7),

-          remove item 73328 from Division 2.7 - Group P7,

-          insert new items 73336 and 73337 in Division 2.7 - Group P7,

-          remove the following tests from the abbreviations table in Part 3: 

*         B12 vitamin,

*         D vitamin,

*         Folate - red cell,

*         Red cell folate and serum B12,

*         Red cell folate and serum B12 and serum folate if required,

*         Red cell folate and serum folate, Serum - B12,

*         Serum - folate (with B12),

*         Serum - folate (with B12 red cell folate),

*         Vitamins - B12, Vitamins - D,

*         Vitamins - folate, and

-          insert the following tests in the abbreviations table in Part 3:

*         B12 vitamin,

*         D vitamin,

*         Folate - serum,

*         Serum - B12,

*         Serum - Folate,

*         Vitamins - B12,

*         Vitamins - D, and

*         Vitamins - folate.

 

Schedule 2 - Repeals

 

This section repeals the Health Insurance (Pathology Services Table) Regulation 2013.

 

Schedule 3 - Amendments

 

Health Insurance (Pathology Services Table) Regulation 2014

 

Item [1] - At the end of Division 1.2 of Schedule 1

 

This item introduces new clause 1.2.9 to restrict items in the table from being claimed if the service in that item is provided to the patient at the same time, or in connection with, an injection of blood or a blood product that is autologous.

 

 

 

Statement of Compatibility with Human Rights Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011 Health Insurance (Pathology Services Table) Regulation 2014 This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011. Overview of the Legislative Instrument The Health Insurance (Pathology Services Table) Regulation 2014 repeals the Health Insurance (Pathology Services Table) Regulation 2013 to implement a 2014-15 Budget measure and otherwise ensure that pathology services funded through the Medicare Benefits Schedule (MBS) continue to be up-to-date, representative of best medical practice, and reflective of government commitments. In accordance with subsection 4A(1) of the Health Insurance Act 1973 (the Act) the regulation may prescribe a table of pathology services which sets out the items of services, the fees applicable for each item, and rules for interpreting the table. Schedule 1 of the PST is amended by; • inserting eight new items to provide a more targeted approach to existing arrangements for Vitamin D, B12, and Folate, as recommended by the Medical Services Advisory Committee (MSAC). As a consequence, the current items for Vitamin D, B12, and Folate (66608, 66609, 66599, and 66602) will be removed. As item 66609 will be made non-existent, it will be removed from subclause 1.2.6(2)(b) and replaced with new items 66834 and 66837. Clause 2.2.4 will be removed as it refers solely to items 66599 and 66602 which will be made non-existent, and • inserting two current MBS items (73336 and 73337) into the PST from the Health Insurance (Pharmacogenetic Testing) Determination 2013 (No.1) and the Health Insurance (Pharmacogenetic Testing Epidermal Growth Factor Receptor) Determination 2013. This is an administrative change that ensures the PST is reflective of current MBS pathology services. As a consequence, item 73328 is removed as that item was made redundant when items 73336 and 73337 were listed on the MBS. The regulation also implement the 2014-15 Budget measure, 'restrictions on the ability of doctors to claims items associated with administering autologous blood injections', which is to take effect on 1 January 2015. The implementation of this measure requires a new clause to be inserted that restricts practitioners from billing MBS items for services provided in connection with injections of blood or blood product that are autologous, as these services have not been assessed by the MSAC.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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