Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1999 (No. 2) 1999 No. 109
EXPLANATORY STATEMENT
STATUTORY RULES 1999 No. 109
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 1999 (No. 2)
Section 133 of the Health Insurance Act 1973 (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 (1998-99 Pathology Services Table) Regulations 1998, which commenced on 1 November 1998, prescribes such a table.
The amendment Regulations removes the episode limit restrictions on two HIV viral RNA load test items. The changes are in response to further representation from the Australian National Council on AIDS and Related Diseases and to concerns raised by medical practitioners treating HIV seropositive patients.
The changes to the 1998-99 Pathology Services Table have been developed through the Pathology Services Table Committee, in cooperation with the two peak pathology professional bodies, The Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices.
The changes have no major financial implications and are incorporated within the expenditure targets for 1999100 as set under the Pathology Quality and Outlays Agreement.
Details of the Regulations are set out in the attachment.
The Regulations commenced on 1 July 1999.
ATTACHMENT
Regulation 1 cites the regulations as the Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1999 (No. 2).
Regulation 2 prescribes a commencement date of 1 July 1999.
Regulation 3 prescribes the amendments to the Health Insurance (1998-99 Pathology Services Table) Regulations 1998.
The changes under Regulation 3, Schedule 1 are:
Item 1 deletes Rule 20 which provided a global limit on the number of test episodes allowed in a 12 month period for two HIV viral RNA items (items 69378 and 69381).
Items 2 and 3 amended the HIV viral RNA items (items 69378 and 69381) by removal of the episode limit restriction.
Overview
The Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1999 (No. 2) were enacted to address the episode limit restrictions on two HIV viral RNA load test items, specifically items 69378 and 69381. These regulations were introduced in response to representations from the Australian National Council on AIDS and Related Diseases and concerns raised by medical practitioners treating HIV seropositive patients. The amendment was made under the authority of the Minister for Health and Aged Care and in accordance with the Health Insurance Act 1973, which mandates the Governor-General to make regulations prescribing matters for the purposes of the Act. The objective of these regulations is to ensure that the medical needs of HIV patients are met without unduly restrictive limits on pathology services. The changes have been developed through the Pathology Services Table Committee, in cooperation with the relevant professional bodies, and have been incorporated within the expenditure targets for 1999-2000, ensuring there are no major financial implications. The regulations commenced on 1 July 1999.
Scope and Application
The Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1999 (No. 2) apply to the fees for pathology services, specifically addressing the Medicare benefits for HIV viral RNA load tests. This regulation is a direct amendment to the Health Insurance (1998-99 Pathology Services Table) Regulations 1998, altering the restrictions on episode limits for certain pathology services. The amendment, effective from 1 July 1999, responds to feedback from the Australian National Council on AIDS and Related Diseases, as well as concerns raised by medical practitioners treating HIV seropositive patients. The changes were developed in consultation with relevant professional bodies and are incorporated within the financial targets set for the Pathology Quality and Outlays Agreement. The amendments specifically remove the episode limit restrictions for two HIV viral RNA load test items, which are now allowed without the previous global limit on the number of test episodes allowed in a 12-month period.
Key Provisions
The Health Insurance (1998-99 Pathology Services Table) Amendment Regulations 1999 (No. 2) (the Regulations) amend the Health Insurance (1998-99 Pathology Services Table) Regulations 1998 (the Principal Regulations) by removing episode limit restrictions on two specific HIV viral RNA load test items. Under Section 133 of the Health Insurance Act 1973 (the Act), the Governor-General has the authority to make regulations that prescribe matters necessary to carry out the Act's provisions. The Regulations are designed to address concerns raised by the Australian National Council on AIDS and Related Diseases and medical practitioners treating HIV seropositive patients. These changes are reflected in Regulation 3 of the Regulations, which specifies the amendments to the Principal Regulations.
The Regulations impose specific obligations on medical service providers and health insurance entities. For example, medical service providers must now be able to provide the two specified HIV viral RNA load tests without the previous restrictions on the number of episodes per patient per year. Health insurance entities are obligated to process claims for these tests without applying the episode limit restrictions. The changes are intended to facilitate better access to essential pathology services for patients with HIV, ensuring that these services are available when medically necessary. The Pathology Services Table Committee, in cooperation with The Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices, developed these changes to ensure they align with professional standards and requirements.
Failure to comply with the Regulations may lead to civil or criminal consequences. While the explanatory statement does not explicitly outline penalties, breaches of regulations under the Health Insurance Act 1973 can result in significant penalties. For example, under Section 122 of the Act, an individual or entity can be fined up to 50 penalty units ($9,900 as of 2023) for each offence if found guilty of contravening the Act or regulations. Additionally, corporations can face penalties of up to 500 penalty units ($99,000 as of 2023) for each offence. These penalties underscore the importance of adhering to the Regulations and ensuring that pathology services are provided in accordance with the amended table.