Health Insurance (1995-96 Pathology Services Table) Regulations (Amendment)
1996 No. 10
EXPLANATORY STATEMENT
STATUTORY RULES 1996 No. 10
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 1995-96 Budget contained a package of measures designed to reduce the high level of growth in pathology outlays under Medicare. While the principal initiatives took effect took effect on 1 July 1995, the package included savings to be achieved through a measure to be developed with the peak pathology bodies in the latter half of 1995, and introduced from 1 February 1996.
This measure, which is embodied in the proposed regulations, comprises reductions in the Schedule Fees for certain items in the Pathology Services Table called Patient Episode Initiation items (PEIs). It is anticipated that it will result in savings in Medicare pathology outlays of $5.2 million in 1995/1996, and $12.5 million in 1996/1997.
This proposal was developed by the Pathology Consultative Committee which includes representatives of the two peak pathology professional bodies, the Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices, and the Department of Human Services and Health, and the Health Insurance Commission,
Details of the Regulations are as follows:
Regulation 1 prescribes a commencement date of 1 February 1996 for the new regulations.
Regulation 2 provides that the 1995-96 Pathology Services Table is amended as set out in the new regulations.
Subregulation 3.1 reduces the fee for item 73901 from $7.85 to $7.10.
Subregulation 3.2 reduces the fee for item 73903 from $14.15 to $13.40.
Subregulation 3.3 reduces the fee for item 73905 from $7.85 to $7.10,
Subregulation 3.4 reduces the fees for items 73907 and 73909 from $16.25 to $15.50.
Subregulation 3.5 reduces the fees for items 73911, 73913 and 73915 from $10.00 to $9.25.
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.
These Regulations will have effect from 1 February 1996.
Overview
The Health Insurance (1995-96 Pathology Services Table) Regulations (Amendment) 1996 No. 10 was enacted under the authority of the Minister for Human Services and Health, pursuant to Section 133 of the Health Insurance Act 1973. These regulations were introduced to address the issue of excessive growth in pathology outlays under Medicare, a problem that had been highlighted in the 1995-96 Budget. The policy objective of these amendments was to implement cost-saving measures while maintaining the integrity of the healthcare system. The regulations were developed in consultation with key stakeholders, including the Pathology Consultative Committee, which comprises representatives from the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices, and the Department of Human Services and Health. The principal changes introduced by the regulations involve reductions in the fees for certain pathology services, specifically the Patient Episode Initiation items (PEIs), aiming to achieve significant savings in Medicare pathology outlays.
Scope and Application
The Health Insurance (1995-96 Pathology Services Table) Regulations (Amendment) 1996 No. 10 amends the Health Insurance (1995-96 Pathology Services Table) Regulations to implement measures aimed at reducing the growth in pathology outlays under Medicare. These Regulations apply to pathology services and specifically to the fees set out in the Pathology Services Table, which is a part of the Schedule in the Health Insurance Act 1973. The Regulations are designed to affect entities involved in providing pathology services, including pathology laboratories, medical practitioners, and potentially the patients who receive these services. The amendment is a Commonwealth regulation, reflecting its jurisdictional reach across Australia. The changes in fees will be applicable to specified pathology service items, reducing the fees for certain Patient Episode Initiation items as of 1 February 1996, with the intent to achieve savings in Medicare outlays. The Regulations do not specify exclusions or exemptions but rather focus on adjusting the fees for particular pathology services to meet budgetary measures.
Key Provisions
The main operative sections of the Health Insurance (1995-96 Pathology Services Table) Regulations (Amendment) 1996 No. 10 (the Regulations) concern amendments to the fees for specific pathology services listed in the Pathology Services Table under the Health Insurance Act 1973 (the Act). Regulation 1 establishes the commencement date of the Regulations as 1 February 1996. Regulation 2 amends the 1995-96 Pathology Services Table, with specific reductions to fees for certain items detailed in subregulations 3.1 to 3.5. For instance, subregulation 3.1 reduces the fee for item 73901 from $7.85 to $7.10, and subregulation 3.2 reduces the fee for item 73903 from $14.15 to $13.40. These changes aim to address the high growth in pathology outlays under Medicare as part of the measures outlined in the 1995-96 Budget.
The Regulations impose obligations on parties governed by the Act, specifically the providers of pathology services. These providers must comply with the amended fees set out in the Regulations, ensuring that they charge the updated fees for the specified items from the commencement date of 1 February 1996. The Regulations also mandate that the new fees be reflected in the calculation of Medicare benefits for pathology services, as per Section 9 of the Act. Compliance with these fee adjustments is essential for providers to remain eligible for Medicare rebates.
The Act does not explicitly state any offences or penalties for non-compliance with the Regulations. However, failure to adhere to the amended fees could potentially result in financial discrepancies and audits by Medicare. Such non-compliance might lead to investigations and corrective actions by the Department of Human Services and Health. While specific penalties are not detailed in the Act or the Regulations, the consequences for not complying with Medicare regulations could include financial penalties, repayments of overpaid benefits, and potential exclusion from the Medicare program.