Health Legislation Amendment Act 1986

Overview

The Health Legislation Amendment Act 1986 No. 75, enacted on 24 June 1986 by the Parliament of Australia, amends various health-related laws to address gaps and improve the regulatory framework for health services in Australia. The Act seeks to refine the administration and oversight of medical services, particularly focusing on pathology services and the qualifications and conduct of practitioners involved in providing these services. By amending the Health Insurance Act 1973, the Act introduces new provisions for the approval and supervision of pathology services, including the establishment of a Pathology Services Advisory Committee to oversee these services. It also introduces criteria for the personal supervision of pathology services by approved pathology practitioners and the conditions under which Medicare benefits may be payable for such services. Additionally, the Act addresses the regulation of accredited pathology laboratories and the oversight of pathology services to ensure they are necessary and not excessive. The objective is to enhance the quality and integrity of pathology services provided under the Medicare scheme while ensuring that benefits are appropriately allocated and that practitioners adhere to professional standards.

Scope and Application

The Health Legislation Amendment Act 1986 is a Commonwealth Act that amends various health-related laws, including the Health Insurance Act 1973, the Health Insurance Commission Act 1973, the National Health Act 1953, and the States Grants (Nurse Education Transfer Assistance) Act 1985. The Act applies to individuals and entities involved in the provision of health services, specifically focusing on pathology services. It mandates that pathology services rendered on behalf of an approved pathology practitioner must be under the personal supervision of the practitioner, who must exercise a reasonable level of control and have personal responsibility for the service. The Act also introduces new categories of pathology services, such as pathologist-determinable services and prescribed pathology services, which can be specified by the Minister through written determinations. Furthermore, it establishes a Pathology Services Advisory Committee to advise the Minister on matters such as the specification of treatments in the pathology services table and the fees associated with these services. The Minister has the authority to vary the pathology services table based on recommendations from this committee. The Act sets out provisions for the approval of pathology practitioners and authorities, including the giving and acceptance of undertakings, the period of effect of these undertakings, and the process for their termination. It also outlines the procedures for handling breaches of undertakings and the initiation of excessive pathology services, including the establishment of Medicare Participation Review Committees to make determinations in such cases. Additionally, the Act governs the accreditation of pathology laboratories and specifies the fees for various pathology services in different states and territories. The Act's provisions extend to the regulation of fees for pathology services, the assignment of Medicare benefits, and the establishment of a framework for committees to review and make recommendations on matters related to the rendering of pathology services, including the payment of increased fees for complex cases and the disallowance of Medicare benefits for services rendered by disqualified practitioners. The Act also incorporates amendments to other Acts, such as the introduction of a new Schedule 1a to the Health Insurance Act 1973, which lists specific pathology services and their corresponding fees. The amendments to the National Health Act 1953 and the States Grants (Nurse Education Transfer Assistance) Act 1985 include updates to definitions and the insertion of new headings, among other changes.

Key Provisions

• The Health Legislation Amendment Act 1986 amends several key pieces of legislation, primarily focusing on the Health Insurance Act 1973, the Health Insurance Commission Act 1973, the National Health Act 1953, and the States Grants (Nurse Education Transfer Assistance) Act 1985. Under the Health Insurance Act, the Act introduces new categories of pathology services, including pathologist-determinable services, prescribed pathology services, and excessive pathology services. It specifies that pathology services must be rendered under the personal supervision of an approved pathology practitioner (section 3aaa), and sets out the process for determining which services fall into these categories (sections 4ba and 4bb). The Act also outlines the requirements for the approval of pathology services tables by the Minister, either on the recommendation of the Pathology Services Advisory Committee or otherwise (section 8). Additionally, it modifies the criteria for Medicare benefits in relation to pathology services, stipulating that such benefits are not payable unless certain conditions are met, including the necessity of the service, the involvement of approved pathology practitioners and pathology authorities, and the rendering of services in accredited pathology laboratories (section 16a).
• The Act imposes various obligations on parties involved in pathology services. Approved pathology practitioners and authorities must provide undertakings that the services they render will be under their personal supervision, will not be excessive, and will comply with the approved forms (section 23dc). They must also retain request forms and confirmation forms for pathology services for 18 months (section 23dk). The Minister has the authority to approve forms of undertaking and determine the period for which these undertakings are in effect (section 23db). Furthermore, approved pathology practitioners and authorities must not breach their undertakings or initiate excessive pathology services without reasonable cause (sections 23dl and 23dm). The Minister is also tasked with establishing the Pathology Services Advisory Committee, which is responsible for making recommendations on the pathology services table, the payment of Medicare benefits for pathology services, and the conduct of approved pathology practitioners and authorities (section 78c). Approved pathology authorities must apply for and obtain approval to operate as accredited pathology laboratories (section 23dn).
• The Act imposes criminal and civil penalties for breaches of its provisions. For instance, an approved pathology practitioner who contravenes the requirements regarding the retention and production of request forms and confirmation forms is guilty of an offence and can be fined up to $1,000 (section 23dp). Similarly, an approved pathology practitioner or authority who provides non-compliant pathology request forms is liable for a penalty of $1,000 (section 23dp). There are also provisions concerning the disqualification of practitioners and authorities from participating in Medicare if they commit relevant offences or are reasonably believed to have done so (sections 124f and 124fc). The Act allows for the establishment of Medicare Participation Review Committees to investigate breaches of undertakings and to make various determinations, including revocation of undertakings and suspension of Medicare benefits (sections 124fb, 124fc, and 124fd). These committees can impose sanctions such as counselling, reprimand, revocation of undertakings, and suspension of the right to receive Medicare benefits for a specified period (sections 124fb and 124fc). The Act further provides for the review of decisions by the Administrative Appeals Tribunal and the publication of determinations by the Minister (sections 42 and 43). It also contains provisions for the establishment, functions, and composition of the Pathology Services Advisory Committee, including the appointment of members, their remuneration, and the process for terminating their appointments (sections 78d to 78h).

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Health Law

Consumer Law

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Act

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Definitions & Interpretation

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Licensing & Registration

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Regulatory Standards