Health Insurance (1995-96 Pathology Services Table) Regulations (Amendment) 1995 No. 301
EXPLANATORY STATEMENT STATUTORY RULES 1995 No. 301
Issued by the Authority of the Minister for Human Services and Health
Health Insurance Act 1973
Health Insurance (1995-96 Pathology Services Table) Regulations (Amendment)
Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor- General may make regulations for the purposes of the Act.
Section 9 of the Act provides, in effect, that Medicare benefits shall be calculated by reference to the fees for medical services (including pathology services) set out in the table (which includes the pathology services table) in Schedule 1A to the Act.
Section 4A of the Act provides, among other things, that the regulations may prescribe a table of pathology services setting out fees applicable to items of pathology services and rules for interpreting the table. The Health Insurance (1995-96 Pathology Services Table) Regulations (the principal regulations) prescribe such a table.
The Regulations have been developed with the co-operation and support of the two peak pathology professional bodies, the Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices.
Details of the Regulations are as follows:
Regulation 3.1 amends item 66201 to exclude the use of "tablets" to measure the substances listed.
In Regulations 3.2, 3.3, 3.4 and 3.6, amendments have been made to items 66241, 66329, 66417 and 69241 to clarify their meaning so as to make them easier to use and to enforce.
Regulation 3.5 contains new item 66421 covering testing for reducing substances in faeces. This test used to be included in item 66217, but on 1 November 1994 this item was replaced by 66221 which did not mention reducing substances. New item 66421 remedies this omission.
Regulation 3.7 amends item 73529 so as to exclude the use of latex, membrane, strip or other simple pregnancy testing kits which attract a lesser fee under item 73806.
Regulation 3.8 increases the fees for forty items in the Table. It has been agreed that a general Medicare Benefits Schedule fee increase of 1.8 per cent will take effect from
1 November 1995. In the Pathology Services Table, an amount equivalent to an overall increase of 1.8% in pathology schedule fees has been allocated to forty specific items to improve fee relativities. This is consistent with the 1995-96 Budget pathology package.
These Regulations will have effect from 1 November 1995.
Overview
The Health Insurance (1995-96 Pathology Services Table) Regulations (Amendment) 1995 No. 301, issued under the authority of the Minister for Human Services and Health, amend the existing Health Insurance (1995-96 Pathology Services Table) Regulations. Enacted pursuant to Section 133 of the Health Insurance Act 1973, these amendments aim to address specific issues within the Medicare benefits framework by refining the pathology services table and associated fees. The policy objective is to ensure that Medicare benefits are calculated accurately and to provide clarity and fairness in the application of pathology service fees, aligning with the broader 1995-96 Budget pathology package. The amendments were developed in collaboration with key professional bodies to ensure that the changes meet the needs of the pathology services sector. These Regulations will come into effect from 1 November 1995.
Scope and Application
The Health Insurance (1995-96 Pathology Services Table) Regulations (Amendment) 1995 No. 301 applies to all persons and entities involved in the provision of pathology services in Australia, as well as to the conduct and transactions associated with these services. The regulations fall under the purview of the Health Insurance Act 1973 and are designed to update and refine the fees and rules for pathology services provided under Medicare. The amendments primarily affect healthcare providers, including pathology laboratories and practitioners, as well as the Department of Human Services and Health which administers the Medicare benefits. The geographic reach of these regulations is nationwide, as they apply across Australia in accordance with the Commonwealth jurisdiction. The regulations specify adjustments to fee structures and the inclusion of new tests, ensuring the Medicare Benefits Schedule remains current and reflective of medical advancements and practices. There are no stated exclusions or exemptions, but the application of these regulations may be further defined through subordinate instruments that may be issued under the Act.
Key Provisions
The Health Insurance (1995-96 Pathology Services Table) Regulations (Amendment) 1995 No. 301 primarily modifies the fees for specific pathology services listed in the Schedule 1A of the Health Insurance Act 1973 (the Act). Regulation 3.1 modifies item 66201 to exclude the use of "tablets" for measuring listed substances, ensuring that these services are conducted using specified methods. Regulations 3.2, 3.3, 3.4, and 3.6 clarify items 66241, 66329, 66417, and 69241, respectively, to enhance their usability and enforceability. Regulation 3.5 introduces a new item 66421 for testing reducing substances in faeces, addressing an oversight where this test was omitted from item 66221. Regulation 3.7 excludes the use of certain pregnancy testing kits under item 73529, aligning with the fee structure set out under item 73806. Finally, Regulation 3.8 increases fees for forty specific pathology items, consistent with a general Medicare Benefits Schedule fee increase of 1.8% effective from 1 November 1995.
The obligations imposed by these regulations are primarily administrative, requiring pathology service providers to adhere to the new fee structures and testing methods specified. Providers must ensure that their practices comply with the amendments, particularly in the measurement of substances and the use of specific testing kits. The regulations necessitate clear documentation and adherence to the specified methods to avoid any discrepancies in service delivery and fee calculations.
Breaches of these regulations may result in civil and criminal consequences. Providers who fail to comply with the specified methods and fee structures could face penalties under the Health Insurance Act 1973. While the specific penalties are not detailed in the explanatory statement, it is understood that non-compliance could lead to financial penalties or other legal actions. Given the regulatory nature of the amendments, any significant deviations from the prescribed methods and fees could result in enforcement actions, including potential prosecution under the Act.