Health Insurance (Pathology Services Table) Amendment Regulations 2003 (No. 4) (Cth)

Health Insurance (Pathology Services Table) Amendment Regulations 2003 (No. 4)1

Statutory Rules 2003 No. 3602

I, PHILIP MICHAEL JEFFERY, Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.

Dated 18 December 2003

P. M. JEFFERY

Governor-General

By His Excellency’s Command

TONY ABBOTT

Minister for Health and Ageing

1Name of Regulations

 These Regulations are the Health Insurance (Pathology Services Table) Amendment Regulations 2003 (No. 4).

2Commencement

 These Regulations commence on 1 February 2004.

3Amendment of Health Insurance (Pathology Services Table) Regulations 2003

Schedule 1 amends the Health Insurance (Pathology Services Table) Regulations 2003.

Schedule 1Amendments

(regulation 3)

  

[1]Schedule 1, Part 2, after subrule 2 (3)

insert

Application of item 74990

• (4)

  Despite subrules (1), (2) and (3), if item 74990 applies to a pathology service, the fee specified in that item applies in addition to the fee specified in any other item in the table that applies to the service.

• (5)

  For item 74990:

bulk-billed, in relation to apathology service, means:

• (a)

  a medicare benefit is payable to a person in respect of the service; and

• (b)

  under an agreement entered into under section 20A of the Act:

  • (i)

    the person assigns to the practitioner by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and

  • (ii)

    the practitioner accepts the assignment in full payment of his or her fee for the service provided.

Commonwealth concession card holder means a person who is a concessional beneficiary within the meaning given by subsection 84 (1) of the National Health Act 1953.

unreferred service means a pathology service that:

• (a)

  is provided to a person by, or on behalf of, a medical practitioner, being a medical practitioner who is not a consultant physician, or specialist, in any speciality (other than a medical practitioner who is, for the purposes of the Act, both a general practitioner and a consultant physician, or specialist, in a particular speciality); and

• (b)

  has not been referred to the medical practitioner by another medical practitioner or person with referring rights.

[2]Schedule 1, Part 2, after paragraph 3 (2) (a)

insert

• (ab)

  that item is not item 74990; and

[3]Schedule 1, Part 2, subrule 18 (1), definition of set of pathology services, subparagraph (d) (ii)

substitute

• (ii)

  in an item in Group P10 (Patient episode initiation), Group P11 (Specimen referred) or Group P12 (Management of bulk-billed services).

[4]Schedule 1, Part 3, after item 73921

insert

Group P12 — Management of bulk-billed services
74990	A pathology service to which an item in this table (other than this item) applies if: (a) the service is an unreferred service; and (b) the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and (c) the person is not an admitted patient of a hospital or day-hospital facility; and (d) the service is bulk-billed in respect of the fees for: (i) this item; and (ii) the other item in this table applying to the service	5.85

Notes

1. These Regulations amend Statutory Rules 2003 No. 256, as amended by 2003 Nos. 295 and 300.

2. Notified in the Commonwealth of Australia Gazette