Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1998 (No. 1) 1998 No. 373
EXPLANATORY STATEMENT
STATUTORY RULES 1998 No. 373
Issued by the Authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1998 (No. 1)
Section 133 of the Act provides that the Governor-General may make regulations prescribing matters for the purposes of the Act.
Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services (including pathology services) set out in the table.
Section 4A of the Act provides that a table of pathology services may be prescribed. The Health Insurance (199899 Pathology Services Table) Regulations 1998 prescribe such a table.
The regulations make an amendment to the Health Insurance (1998-99 Pathology Services Table) Regulations 1998 by restoring reference to two cytology item numbers for Pap smear testing (items 73053 and 73055) which were inadvertently omitted from Rule 19(1)(d)(i) of Part 1 - Rules of Interpretation. The Health Insurance (1998-99 Pathology Services Table) Regulations 1998 came into effect on 1 November 1998.
Rule 19(1)(d)(i) exempts certain items from the application of the episode cone. The episode cone is brought into effect by Rule 19 which places an upper Emit on the number of items for which Medicare benefits are payable in a patient episode. Under this arrangement, where four or more items of pathology testing services are ordered for a particular patient on the same day, the Medicare benefits payable will be equivalent to those for the three items with the highest schedule fees.
The episode cone applies to services requested by general practitioners for their non-hospitalised patients. Pathology services requested for hospital in-patients, or ordered by specialists are not subject to these arrangements. A number of services are exempt from the episode cone, including the two Pap smear items 73053 and 73055.
The Regulations commenced on 1 November 1998. The earlier commencement date for the Regulations does not disadvantage any person in respect of their rights or create a liability which would be imposed on a person (other than the Commonwealth or an authority of the Commonwealth) and does not contravene subsection 48(2) of the Acts Interpretation Act 1901.
Overview
The Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1998 (No. 1) were enacted to correct an oversight in the initial regulations concerning the Health Insurance (1998-99 Pathology Services Table) Regulations 1998. These regulations were made under the authority of the Minister for Health and Aged Care pursuant to the Health Insurance Act 1973. The purpose of these amendments was to reinstate the reference to two cytology item numbers for Pap smear testing, which were mistakenly omitted from the original regulations. This adjustment was necessary to ensure the proper application of Medicare benefits for pathology services, particularly addressing the episode cone which limits the number of items for which Medicare benefits are payable in a patient episode. The regulations aim to rectify this error without creating any disadvantage or liability for individuals, thereby maintaining the integrity of the Medicare system.
Scope and Application
The Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1998 (No. 1) amends the Health Insurance (1998-99 Pathology Services Table) Regulations 1998 to correct an oversight by reinstating the reference to two cytology item numbers for Pap smear testing (items 73053 and 73055), which were inadvertently omitted from the table. These regulations apply to the calculation of Medicare benefits for pathology services, as stipulated by Section 9 of the Health Insurance Act 1973. They specifically pertain to services provided by general practitioners for non-hospitalised patients, and exclude services for hospital in-patients or those ordered by specialists. These regulations came into effect on 1 November 1998, ensuring that the adjustments do not adversely affect any rights or impose new liabilities on individuals, consistent with subsection 48(2) of the Acts Interpretation Act 1901.
Key Provisions
The Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1998 (No. 1) provide amendments to the Health Insurance (1998-99 Pathology Services Table) Regulations 1998, primarily by correcting an oversight regarding the inclusion of certain Pap smear testing item numbers in the table of pathology services. Specifically, the regulations restore reference to cytology item numbers 73053 and 73055, which were inadvertently omitted from Rule 19(1)(d)(i) of Part 1 - Rules of Interpretation. This amendment ensures that these items are explicitly acknowledged and exempt from the episode cone, as intended by the original regulations.
The obligations and requirements imposed by these regulations are primarily administrative in nature. They necessitate the correction of a regulatory oversight to ensure that the intended exemptions for certain pathology services are accurately reflected in the legislative framework. Specifically, these regulations mandate that the two cytology item numbers for Pap smear testing (items 73053 and 73055) be included in the list of services exempt from the episode cone. This ensures that these items are not subject to the limitations imposed by the episode cone, which caps the number of pathology testing items for which Medicare benefits are payable during a patient episode.
There are no explicit offences, penalties, or consequences for breach outlined in the Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1998 (No. 1). The primary focus of these regulations is to rectify a technical error in the original regulations. As such, the main consequence of failing to comply with these amended regulations would be the continued oversight of the incorrect exclusion of the specified Pap smear items from the episode cone, potentially leading to administrative discrepancies in the calculation and payment of Medicare benefits for these services. The regulations themselves do not introduce new penalties or legal consequences beyond the requirement to correct the identified error.