Health Insurance (Variation of Fees and Medical services) (No. 6) Regulations (Cth)

Statutory Rules

1977 No. 192

REGULATIONS UNDER THE HEALTH INSURANCE ACT 1973*

I, THE GOVERNOR-GENERAL of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulations under the Health Insurance Act 1973.

Dated this twenty-seventh day of October 1977.

JOHN R. KERR

Governor-General

By His Excellency’s Command,

RALPH J. HUNT

Minister of State for Health

_________

 

HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (No. 6) REGULATIONS

Citation

1. These Regulations may be cited as the Health Insurance (Variation of Fees and Medical Services) (No. 6) Regulations.

Commencement

2. These Regulations shall come into operation on 1 November 1977.

Health Insurance (Variation of Fees and Medical Services) (No. 4) Regulations —amendment of Schedule

3. The Schedule to the Health Insurance (Variation of Fees and Medical Services) (No. 4) Regulations (being that schedule as amended by the Health Insurance (Variation of Fees and Medical Services) (No. 5) Regulations) is amended as set out in the Schedule to these Regulations.

              

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* Notified in the Commonwealth of Australia Gazette on 31 October 1977.

SCHEDULE

AMENDMENTS OF THE SCHEDULE TO THE HEALTH INSURANCE (VARIATION OF FEES AND MEDICAL SERVICES) (No. 4) REGULATIONS

AMENDMENTS OF THE RULES FOR THE INTERPRETATION OF THE TABLE OF MEDICAL SERVICES

1. Omit paragraph 5a (e), substitute the following paragraph:

“ (e) in the rendering of which—

(i) any pathology equipment of a recognized hospital or a laboratory included in a prescribed class of laboratories is used; or

(ii) any member of the staff of a recognized hospital or a laboratory included in a prescribed class of laboratories participates.”.

2 Omit rules 5c and 5d, substitute the following rules:

“ 5c. Where an item in Part 7 includes the symbol ‘ (HP) ’, the item shall be taken to relate to a pathology service—

(a) to which paragraph 16a (1) (a) or (b) applies when rendered—

(i) in the case of a service to which paragraph 16a (1) (a) applies—in pursuance of a request made in respect of a person who was, at the time that the request was made, a private patient in a recognized hospital; or

(ii) in the case of a service to which paragraph 16a (1) (b) applies—in respect of a patient who is a private patient in a recognized hospital; and

(b) in the rendering of which—

(i) any pathology equipment of a recognized hospital or a laboratory included in a prescribed class of laboratories is used; or

(ii) any member of the staff of a recognized hospital or a laboratory included in a prescribed class of laboratories participates.

“ 5d. For the purposes of rules 5a and 5c, each of the following classes of laboratories is a prescribed class of laboratories:

(a) laboratories operated by the Commonwealth;

(b) laboratories operated by the Capital Territory Health Commission;

(c) laboratories operated by a State or an authority of a State;

(d) laboratories operated by an Australian university.

“ 5e. Where an item in Part 7 includes the symbol ‘ (OP) ’, the item shall be taken to relate to a pathology service to which paragraph 16a (1) (a) or (b) applies other than a service included in an item that includes the symbol ‘ (SP) ’ or ‘ (HP) ’,

“5f. Each item in Division 9 of Part 7 shall be taken to relate to a pathology service to which paragraph 16a (1) (c) applies.”.

3. Omit rules 10a and 10b, substitute the following rules:

“ 10a. Where—

(a) a procedure of one of 2 or more kinds of procedure described in an item in Part 7 (being an item that is expressed to apply in relation to one procedure) that includes the symbol ‘ (SP) ’;

(b) a procedure of one of 2 or more kinds of procedure described in an item in Part 7 (being an item that is expressed to apply in relation to one procedure) that includes the symbol ‘ (HP) ’; or

(c) a procedure of one of 2 or more kinds of procedure described in an item in Part 7 (being an item that is expressed to apply in relation to one procedure) that includes the symbol ‘ (OP) ’,

is rendered in respect of a person by or on behalf of an approved pathology practitioner in pursuance of a request, made on a day, addressed to that approved pathology practitioner (in this rule referred to as ‘ the first-mentioned approved pathology practitioner ’)—

(d) by the practitioner who determined that the procedure was necessary; or

(e) by another approved pathology practitioner who is not the practitioner who determined that the procedure was necessary,

SCHEDULE—continued

being the only such request in respect of a procedure of that kind, or any other kind described in that item, made on that day in respect of that person to the first-mentioned approved pathology practitioner by that practitioner or that other approved pathology practitioner, that procedure shall be treated as one service consisting of that procedure.

“ 10b. Where—

(a) 2 or more procedures each of which is a procedure of one of 2 or more kinds of procedure described in an item in Part 7 (being an item that is expressed, whether directly or indirectly, to apply to that number of procedures) that includes the symbol ‘ (SP) ’;

(b) 2 or more procedures each of which is a procedure of one of 2 or more kinds of procedure described in an item in Part 7 (being an item that is expressed, whether directly or indirectly, to apply to that number of procedures) that includes the symbol ‘ (HP) ’; or

(c) 2 or more procedures each of which is a procedure of one of 2 or more kinds of procedure described in an item in Part 7 (being an item that is expressed, whether directly or indirectly, to apply to that number of procedures) that includes the symbol ‘ (OP) ’,

are rendered in respect of a person by or on behalf of an approved pathology practitioner in pursuance of a request, or requests made on the one day, addressed to that approved pathology practitioner—

(d) by the practitioner who determined that the procedures were necessary; or

(e) by another approved pathology practitioner who is not the practitioner who determined that the procedures were necessary,

those procedures shall, unless the contrary intention appears, be treated as one service consisting of those procedures.”.

4. Insert in rule 10c “ or ‘ (HP) ’ ” after “ the symbol ‘ (OP) ’ ”,

5. Insert in rule 10d “ or ‘ (HP) ’ ” after “ the symbol ‘ (OP) ’ ”.

AMENDMENTS OF THE TABLE OF MEDICAL SERVICES

1. Omit items 1010 and 1011, substitute the following items:
“ 1010 Blood count consisting of erythrocyte count, erythrocyte sedimentation rate, hematocrit estimation, haemoglobin estimation, platelet count or leucocyte count —two procedures (excluding blood count consisting of haemoglobin estimation or erythrocyte sedimentation rate when not referred by another medical practitioner) (HP) .. ..	3.15	3.15	3.15	3.15	3.15	3.15
“ 1011 Three or more procedures to which item 1006 applies, including calculation of erythrocyte indices where done (SP) .. ..	7.50	7.50	6.90	6.30	6.30	6.30
“ 1012 Three or more procedures to which item 1007 applies, including calculation of erythrocyte indices where done (OP) .. ..	5.65	5.65	5.20	4.75	4.75	4.75
“ 1013 Three or more procedures to which item 1010 applies, including calculation of erythrocyte indices where done (HP) .. ..	3.75	3.75	3.75	3.75	3.75	3.75 ”.
2. After item 1015, insert the following item: “ 1016 Blood film, examination of—including erythrocyte morphology, differential count by one or more methods and the qualitative estimation of platelets (HP) ..	3.10	3.10	3.10	3.10	3.10	3.10 ”.

SCHEDULE—continued

3. Omit items 1112 and 1113, substitute the following items:
“ 1111 Compatibility testing (by saline, papain, albumin or indirect Coombs techniques), including auto-crossmatch and donor group check where performed—testing involving one or two units of blood (SP) .. ..		25.00	25.00	23.00	21.00	21.00	21.00
“ 1112 Compatibility testing (by saline, papain, albumin or indirect Coombs techniques), including auto crossmatch and donor group check where performed—testing involving one or two units of blood (OP) .. ..		18.75	18.75	17.25	15.75	15.75	15.75
“ 1113 Compatibility testing (by saline, papain, albumin or indirect Coombs techniques), including auto crossmatch and donor group check where performed—testing involving one or two units of blood (HP) .. ..		12.50	12.50	12.50	12.50	12.50	12.50 ”.
4. After item 1116, insert the following item:
“ 1117 Compatibility testing (by saline, papain, albumin or indirect Coombs techniques), including auto crossmatch and donor group check where performed—each unit of blood tested in excess of two (HP) .. .. ..		4.70	4.70	4.70	4.70	4.70	4.70 ”.
5. Omit items 1301 and 1302, substitute the following items:
“ 1301 Estimation by any method of— albumin, alkaline phosphatase, ALT, AST, bicarbonate, bilirubin (direct), bilirubin (indirect), calcium, chloride, cholesterol, CK, creatinine, GGTP, globulin, glucose, HBD, LD, phosphate, potassium, protein (total), sodium, triglycerides, urate or urea or estimation of a substance referred to in any other item in this Division other than items 1302 and 1303 where the estimation is performed on a multichannel analyser—one estimation (SP) .. ..	9.40		9.40	8.60	7.90	7.90	7.90
“ 1302 Estimation by any method of— albumin, alkaline phosphatase, ALT, AST, bicarbonate, bilirubin (direct), bilirubin (indirect), calcium, chloride, cholesterol, CK, creatinine, GGTP, globulin, glucose, HBD, LD, phosphate, potassium, protein (total), sodium, triglycerides, urate or urea or estimation of a substance referred to in any other item in this Division other than items 1301 and 1303 where the estimation is performed on a multichannel analyser—one estimation (OP) .. ..	7.05		7.05	6.45	5.95	5.95	5.95

SCHEDULE—continued

“ 1303 Estimation by any method of albumin, alkaline phosphatase, ALT, AST, bicarbonate, bilirubin (direct), bilirubin (indirect), calcium, chloride, cholesterol, CK, creatinine, GOT?, globulin, glucose, HIM, LD, phosphate, potassium, protein (total), sodium, triglycerides, urate or urea or estimation of a substance referred to in any other item in this Division other than items 1301 and 1302 where the estimation is performed on a multichannel analyser-one estimation (HP)	4.70	4.70	4.70	4.70	4.70	4.70 ”.
6. Omit items 1306, 1307, 1309 and 1310, substitute the following items:
“ 1306 Two estimations of a kind specified in item 1303 (HP) .. ..	6.25	6.25	6.25	6.25	6.25	6.25
“ 1307 Three to five estimations of a kind specified in item 1301 (SP) ..	15.60	15.60	14.40	13.20	13.20	13.20
“ 1308 Three to five estimations of a kind specified in item 1302 (OP) ..	11.70	11.70	10.80	9.90	9.90	9.90
“ 1309 Three to five estimations of a kind specified in item 1303 (HP) ..	7.80	7.80	7.80	7.80	7.80	7.80
“ 1310 Six or more estimations of a kind specified in item 1301 (SP) ..	17.20	17.20	17.20	15.80	15.80	15.80
“ 1311 Six or more estimations of a kind specified in item 1302 (OP) ..	12.90	12.90	12.90	11.85	11.85	11.85
“ 1312 Six or more estimations of a kind specified in item 1303 (HP) ..	8.60	8.60	8.60	8.60	8.60	8.60 ”.
7. After item 1610, insert the following item:
“ 1611 Cultural examination of a specimen other than urine for aerobic micro - organisms (including fungi) with, where indicated, the use of relevant stains, selective media or sensitivity testing or any two or more of those procedures (HP) .. .. ..	7.90	7.90	7.90	7.90	7.90	7.90 ”.
8. After item 1616, insert the following item:
“ 1618 Cultural examination of a specimen Other than blood or urine for aerobic and anaerobic microorganisms, using an anaerobic atmosphere for the culture of anaerobes, with, where indicated, the use of relevant stains, selective media or sensitivity testing or any two or more of those procedures (HP) .. .. ..	11.85	11.85	11.85	11.85	11.85	11.85 ”.
9. After item 1634, insert the following item:
“ 1636 Blood culture, including sub-culture, using both aerobic and anaerobic media, with, where indicated, the use of relevant stains or sensitivity testing, or relevant stains and sensitivity testing, but not involving organism identification—each set of cultures to a maximum of three sets (HP) ..	9.40	9.40	9.40	9.40	9.40	9.40 ”.

SCHEDULE—continued

10. After item 1674, insert the following item:
“ 1676 Microscopical examination of urine, with cell count, relevant stains (if indicated), cultural examination and colony count of microorganisms (not being a service to which item 1682 or 1683 applies) with sensitivity testing (where indicated) and general examination for one or more of pH, specific gravity, blood, albumin, urobilinogen, sugar, acetone and bile pigments (HP) .. 8.70	8.70	8.70	8.70	8.70	8.70 ”.