EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Amendment Determination 2013 (No.1)
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by writing, determine that a health service not listed in the pathology services table (the Table) shall, in specified circumstance and for specified statutory provisions, be treated as if it were so listed. This Table is set out in the Health Insurance (Pathology Services Table) Regulation which is remade each year. The Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Amendment Determination 2012 (No. 1) (the Determination) amends the Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination HS/01/06 (the Principal Determination) to reduce the fees of the diabetes monitoring pathology tests in the Principal Determination.
The Principal Determination enables Medicare benefits to be payable for two point of care pathology diagnostic tests (quantitation of glycosolated haemoglobin and urine albumin:creatinine ratio) used for the monitoring of diabetes in Aboriginal and Torres Strait Islander primary health care sites. The Principal Determination allows these tests to be provided in Aboriginal and Torres Strait Islander communities where pathology testing may otherwise may not be possible. The standard pathology provider eligibility requirements under the Act require pathology services to be provided at an accredited pathology laboratory by an approved pathology provider. As most Aboriginal Medical Services and Aboriginal Controlled Community Health Services would not meet these requirements, they have been removed for the two point of care tests.
To ensure quality of testing, the Principal Determination includes a requirement that a practitioner performing the test, or the organisation for which the practitioner works, must participate in the Quality Assurance in Aboriginal and Torres Strait Islander Medical Services Program (the QAAMS Program), an external quality assurance program.
The QAAMS Program is funded by the Australian Government Department of Health and Ageing. The aim of the QAAMS Program is to provide education, training, quality assurance, quality control, and ongoing support services for point of care testing in Aboriginal Community Controlled Health Services and Aboriginal Medical Services.
The Pathology Funding Agreement (PFA) between the Commonwealth, the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices and the National Coalition of Public Pathologists governs the Australian Government outlays for pathology services. The PFA sets out agreed maximum and minimum Government outlays for each year of the agreement.
In December 2012, there was an Amendment Determination that amended the Principal Determination to reflect the changes to the pathology services table and the amounts payable through Medicare for items 73840 and 73844. The fee for item 73840 will be reduced from $17.10 to $17.00, and the fee for item 73844 will be reduced from $20.50 to $20.35.
The Determination amends the cessation date of the Principal Determination from 30 June 2013 to 30 June 2016, which was not revised by the last amendment Determination. This will ensure the continued access to Medicare benefits for those Aboriginal and Torres Strait Islander health services enrolled in the QAAMS program.
Consultation
The decrease in fees for items in Groups 1 to 11 of the PST was negotiated with the other signatories to the PFA, namely the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices and the National Coalition of Public Pathologists.
The Department of Human Services was consulted concerning the revised cessation date to consider any impact of the changes on their business operations, which was considered to be minimal given this is a longstanding program.
This Determination commences on the day after it is registered.
This determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Overview
The Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Amendment Determination 2013 (No. 1) was enacted to address the issue of ensuring continued access to Medicare benefits for diabetes monitoring pathology tests in Aboriginal and Torres Strait Islander primary health care sites. This legislation amends the Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination HS/01/06 to reduce the fees of these tests and to extend the cessation date of the Principal Determination from 30 June 2013 to 30 June 2016. This ensures ongoing eligibility for Medicare benefits for services enrolled in the Quality Assurance in Aboriginal and Torres Strait Islander Medical Services Program. The determination was made under subsection 3C(1) of the Health Insurance Act 1973 by the Minister for Health and Ageing, with the policy objective of maintaining and improving the quality of healthcare services in Aboriginal and Torres Strait Islander communities.
Scope and Application
The Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Amendment Determination 2013 (No.1) pertains to the amendment of the Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination HS/01/06, which facilitates the provision of Medicare benefits for specific diabetes monitoring pathology tests in Aboriginal and Torres Strait Islander primary health care sites. These sites often operate in communities where conventional pathology testing is not feasible, hence the necessity for point-of-care testing. The determination specifically applies to the quantitation of glycosolated haemoglobin and urine albumin:creatinine ratio tests, which are essential for monitoring diabetes in these settings. To ensure the quality and reliability of the testing, the legislation mandates that practitioners performing these tests, or the organisations they represent, must participate in the Quality Assurance in Aboriginal and Torres Strait Islander Medical Services Program (QAAMS Program). The Amendment Determination also reduces the fees associated with these tests, reflecting changes in the pathology services table and the amounts payable through Medicare, while extending the cessation date of the Principal Determination to 30 June 2016. This amendment ensures continued access to Medicare benefits for health services participating in the QAAMS program, thereby supporting the delivery of essential health services in Aboriginal and Torres Strait Islander communities.
Key Provisions
The Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Amendment Determination 2013 (No. 1) amends the Principal Determination HS/01/06, which allows for the provision of two specific point-of-care pathology diagnostic tests for monitoring diabetes in Aboriginal and Torres Strait Islander primary health care sites (sections 3C(1) and HS/01/06). These tests are the quantitation of glycosolated haemoglobin and the urine albumin:creatinine ratio. This amendment reduces the fees associated with these tests, effective from the date of the determination. Specifically, the fee for item 73840 will be reduced from $17.10 to $17.00, and the fee for item 73844 will be reduced from $20.50 to $20.35. Additionally, the cessation date of the Principal Determination is extended from 30 June 2013 to 30 June 2016 to ensure continued access to Medicare benefits for eligible services.
The amendment imposes obligations on parties involved in the provision of these tests. It requires that any practitioner performing these tests or the organisation for which they work must participate in the Quality Assurance in Aboriginal and Torres Strait Islander Medical Services Program (QAAMS Program) (section HS/01/06). This program is designed to ensure the quality of point-of-care testing by providing necessary education, training, quality assurance, quality control, and ongoing support services. The aim is to ensure that the testing meets the required standards and is conducted in a manner that is reliable and effective for the target population.
Failure to comply with the provisions of the Health Insurance Act 1973, as amended by this determination, could result in civil or criminal consequences. However, the explanatory statement does not specify the exact nature of these consequences. It is important to note that the fees are subject to the Pathology Funding Agreement (PFA) between the Commonwealth and other relevant bodies, including the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices, and the National Coalition of Public Pathologists. The decrease in fees was negotiated with these parties, and the revised cessation date was also considered by the Department of Human Services, which found the impact on their operations to be minimal. This determination is a legislative instrument under the Legislative Instruments Act 2003, and it comes into effect on the day after its registration.