Health Insurance (1999-2000 Pathology Services Table) Amendment Regulations 2000 (No. 1) 2000 No. 61
EXPLANATORY STATEMENT
STATUTORY RULES 2000 No. 61
Issued by the Authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance (1999-2000 Pathology Services Table) Amendment Regulations 2000 (No. 1)
Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations prescribing matters for the purpose of the Act.
The Act provides for the payment of professional services through Medicare benefits to all eligible persons.
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 (1999-2000 Pathology Services Table) Regulations 1999, which commenced on 1 November 1999, prescribes such a table.
A number of changes have been incorporated in the Health Insurance (1999-2000 Pathology Services Table) Amendment Regulations 2000. Changes to the Regulations include a restructure of thrombophilia items, minor amendments to five items and the inclusion of a new histopathology complexity level.
The changes to the 1999-2000 Pathology Services Table have been developed in cooperation with the two peak pathology professional bodies, the Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices, through the Pathology Services Table Committee (PSTC).
These changes have no major financial implications and will be incorporated within the expenditure targets for 1999/2000 as set under the pathology Quality and Outlays Agreement for 1999/2000-20012002.
Details of the Regulations are set out in the attachment.
The Regulations commenced on 1 May 2000.
ATTACHMENT
Regulation 1 cites the regulations as the Health Insurance (1999-2000 Pathology Services Table) Amendment Regulations 2000 (No. 1).
Regulation 2 prescribes a commencement date of 1 May 2000.
Regulation 3 provides for the Health Insurance (1999-2000 Pathology Services Table) Regulations 1999 to be amended as set out in Schedule 1.
The changes under Regulation Schedule 1 are:
* a restructure of thrombophilia items including the deletions of items 65138 and 65141 and the introduction of a series of new haematology items for the characterisation of the genotype of patients and their first degree relatives in the investigation of proven venous thrombosis or pulmonary embolism. This will lead to a new testing algorithm to further assist in the identification of patients at higher risk of thrombosis who may benefit from prevention and improved treatment strategies (items 1, 2 and 3);
* amendment from 3 measurements to 2 measurements of blood glucose required for oral glucose tolerance test item 66542 as there was limited evidence to support the 1 hour measurement (item 1);
* amendments to microbiology item 69324 to accurately reflect the intent of the item and microbiology item 69336 to ensure consistency with other related items (item 1);
* minor amendments to cytology items 73049 and 73051 to remove ambiguity in the item descriptors (item 1); and
* amendment to the histopathology complexity levels with the inclusion of a new specimen type entry for skin, eyelid, wedge resection (item 4).
Overview
The Health Insurance (1999-2000 Pathology Services Table) Amendment Regulations 2000 (No. 1) were enacted in 2000 to amend the 1999-2000 Pathology Services Table under the Health Insurance Act 1973. This Act, enacted by the Australian Parliament, provides for the payment of professional services through Medicare benefits to eligible persons. The purpose of these regulations was to implement changes to the pathology services table in line with advancements in pathology services and to ensure that the fees for these services are accurately reflected. The changes were developed in consultation with key professional bodies and were designed to have no major financial implications, fitting within the expenditure targets for the period.
These amendments, which took effect on 1 May 2000, included a restructuring of thrombophilia items, minor amendments to several pathology service items, and the introduction of a new histopathology complexity level. The changes were made in cooperation with the Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices, aiming to better align the services with current medical practices and to improve the accuracy and efficiency of pathology services provided under Medicare.
Scope and Application
The Health Insurance (1999-2000 Pathology Services Table) Amendment Regulations 2000 (No. 1) amends the Health Insurance (1999-2000 Pathology Services Table) Regulations 1999 under the Health Insurance Act 1973. These Regulations are pertinent to eligible persons who receive pathology services covered under Medicare, as well as the pathology service providers who offer these services. The regulations apply to the specified medical services, particularly pathology services, and seek to ensure that Medicare benefits are accurately calculated and fairly disbursed in accordance with the fees outlined in the amended table. The amendments were developed in consultation with relevant professional bodies, including the Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices, ensuring that the changes reflect current medical practices and standards. The regulations came into effect on 1 May 2000, and they have no significant financial implications, aligning with the expenditure targets under the pathology Quality and Outlays Agreement for 1999/2000-2002. This amendment primarily affects pathology services in Australia, operating within the Commonwealth jurisdiction as per the Health Insurance Act 1973.
Key Provisions
The Health Insurance (1999-2000 Pathology Services Table) Amendment Regulations 2000 (No. 1) (Regulations) are amendments to the existing 1999-2000 Pathology Services Table under the Health Insurance Act 1973. These Regulations, which commenced on 1 May 2000, include a restructure of thrombophilia items, minor amendments to several items, and the inclusion of a new histopathology complexity level. Regulation 1 names the regulations, Regulation 2 sets the commencement date, and Regulation 3 details the amendments to the 1999-2000 Pathology Services Table.
The Regulations impose specific obligations on entities involved in pathology services under the Health Insurance Act 1973. These entities must adhere to the new fee structures and service descriptions provided in the amended table. For instance, pathology providers must now follow the new testing algorithm for thrombophilia items, which involves assessing the genotype of patients and their relatives for venous thrombosis or pulmonary embolism. Additionally, they must adjust their billing practices to reflect the reduced number of blood glucose measurements required for the oral glucose tolerance test, as well as other minor amendments to ensure clarity and consistency in service descriptions.
Breach of these Regulations may not necessarily result in specific offences as outlined in the text, but non-compliance with the amended fee structures and service descriptions could lead to disputes regarding Medicare benefits payments. While the explanatory statement does not explicitly detail penalties for non-compliance, it is likely that incorrect billing or non-adherence to the stipulated fee structures could result in financial penalties or legal action under the Health Insurance Act 1973. The exact penalties would depend on the nature and severity of the breach, but they could include financial penalties or other enforcement actions taken by the relevant authorities.