Health Insurance (Pathology Services) Amendment Act 1991

Administered by Department of Health, Disability and Ageing

Legislation au C2004A04132 In force Act

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Health Insurance (Pathology Services) Amendment Act 1991

No. 57 of 1991

An Act to amend certain provisions of the Health Insurance Act 1973 relating to pathology services, and for related purposes

[Assented to 24 April 1991]

The Parliament of Australia enacts:

Short title etc.

1. (1) This Act may be cited as the Health Insurance (Pathology Services) Amendment Act 1991.

(2) In this Act, “Principal Act” means the Health Insurance Act 19731.

Commencement

2. (1) Subject to subsection (2), this Act commences on the day on which it receives the Royal Assent.

(2) Each of the provisions of subsections 4 (1) and 5 (1) is taken to have commenced on the day, or at the time, shown by the note in italics at the foot of that provision.

Interpretation

3. Unless the contrary intention appears, a word or expression:

(a)     defined in the Principal Act for the purposes of that Act; and

(b)     used in this Act;

has in this Act the same meaning as it has in the Principal Act.

Schedule 1

4. (1) Schedule 1 to the Principal Act is amended:

(a) by inserting in each of items 1345 and 1346 in the table of medical services “(other than a microbiological or tissue antigen or antibody)” after “substance”;

Commencement: 1 January 1980.

(b) by adding at the end of the rules for the interpretation of the table of medical services the following rules:

“A.1. If a particular service falls within both:

(a)     the description of service in an item that describes the service in general terms; and

(b)     the description of service in an item that describes the service in specific terms;

only the item that describes the service in specific terms is taken to relate to the service.

“A.2. If:

(a)     a particular service falls within the description of service in 2 or more items; and

(b)     rule A.1 does not apply;

the item that specifies the lower or lowest fee is taken to be the item that relates to the service.”;

Commencement: 1 January 1980.

(c) by inserting each of the following items in its appropriate numerical position in the table of medical services:

2294(3)

Enzyme-linked immunosorbent assay (ELISA)— one test (SP)

15.40

15.40

15.40

15.40

15.40

15.40

2294(4)

Each test referred to in the above item in excess of one (SP)

8.20

8.20

8.20

8.20

8.20

8.20

2295(3)

Enzyme-linked immunosorbent assay (ELISA)— one test (OP)

11.55

11.55

11.55

11.55

11.55

11.55

2295(4)

Each test referred to in the above item in excess of one (OP)

6.15

6.15

6.15

6.15

6.15

6.15

Commencement: 1 March 1984.

(d) by omitting from the table of medical services items 2294 (3), 2294 (4), 2295 (3) and 2295 (4) and substituting the following items:

2294 (3)

Enzyme-linked immunosorbent assay (ELISA)— one test (SP)

16.60

16.60

16.60

16.60

16.60

16.60

2294 (4)

Each test referred to in the above item in excess of one (SP)

8.80

8.80

8.80

8.80

8.80

8.80

2295 (3)

Enzyme-linked immunosorbent assay (ELISA)— one test (OP)

12.45

12.45

12.45

12.45

12.45

12.45

2295 (4)

Each test referred to in the above item in excess of one (OP)

6.60

6.60

6.60

6.60

6.60

6.60

Commencement: 15 June 1984.

(e) by inserting each of the following items in its appropriate numerical position in the table of medical services:

2294 (3)

Enzyme-linked immunosorbent assay (ELISA)— one test (SP)

17.20

17.20

17.20

17.20

17.20

17.20

2294 (4)

Each test referred to in the above item in excess of one (SP)

9.20

9.20

9.20

9.20

9.20

9.20

2295 (3)

Enzyme-linked immunosorbent assay (ELISA)— one test (OP)

12.90

12.90

12.90

12.90

12.90

12.90

2295 (4)

Each test referred to in the above item in excess of one (OP)

6.90

6.90

6.90

6.90

6.90

6.90

Commencement: Immediately after the commencement of Statutory Rules 1985 No. 149 on 1 July 1985.

(f) by omitting from the table of medical services items 2294 (3), 2294 (4), 2295 (3) and 2295 (4) and substituting the following items:

2294 (3)

Enzyme-linked immunosorbent assay (ELISA) for a microbiological or tissue antigen or antibody where that antigen or antibody is not specified elsewhere in the Schedule— one test (SP)

17.20

17.20

17.20

17.20

17.20

17.20

2294 (4)

Each test referred to in the above item in excess of one (SP)

9.20

9.20

9.20

9.20

9.20

9.20

2295(3)

Enzyme-linked immunosorbent assay (ELISA) for a microbiological or tissue antigen or antibody where that antigen or antibody is not specified elsewhere in the Schedule— one test (OP)

12.90

12.90

12.90

12.90

12.90

12.90

2295 (4)

Each test referred to in the above item in excess of one (OP)

6.90

6.90

6.90

6.90

6.90

6.90

Commencement: 14 March 1986.

(2) Similar amendments to the amendments made by paragraph (1) (a) are taken to have been made to each table of medical services that:

(a)     was prescribed for the purposes of subsection 4 (2) of the Principal Act; and

(b)    had effect (under subsection 4 (3) of that Act) as if it had been set out in Schedule 1 to that Act;

after 1 January 1980 and before 1 August 1986.

(3) The rules added to the table of medical services in Schedule 1 to the Principal Act are taken to have been added to each table of medical services that:

(a)     was prescribed for the purposes of subsection 4 (2) of that Act; and

(b)    had effect (under subsection 4 (3) of that Act) as if it had been set out in that Schedule;

after 1 January 1980 and before 1 August 1986.

(4) If:

(a)     after an item was inserted in the table of medical services in Schedule 1 to the Principal Act by a paragraph of subsection (1); and

(b)     before that item was omitted by another paragraph of that subsection;

another table of medical services was prescribed for the purposes of subsection 4 (2) of that Act and had effect (under subsection 4 (3) of that Act) as if it had been set out in that Schedule in the place of the first-mentioned table, that other table is taken to have had effect as if that item had been inserted in it.

Schedule 1a

5. (1) Schedule 1a to the Principal Act is amended:

(a) by inserting in each of items 1345 and 1346 in the pathology services table “(other than a microbiological or tissue antigen or antibody)” after “substance”;

Commencement: Immediately after the commencement of section 52 of the Health Legislation Amendment Act 1986 on 1 August 1986.

(b) by adding at the end of the rules for interpretation of the pathology services table the following rules:

“A.1. If a particular service falls within both:

(a)     the description of service in an item that describes the service in general terms; and

(b)     the description of service in an item that describes the service in specific terms;

only the item that describes the service in specific terms is taken to relate to the service.

“A.2. If:

(a)     a particular service falls within the description of service in 2 or more items; and

(b)     rule A.1 does not apply;

the item that specifies the lower or lowest fee is taken to be the item that relates to the service.”;

Commencement: Immediately after the commencement of section 52 of the Health Legislation Amendment Act 1986 on 1 August 1986.

(c) by inserting each of the following items in its appropriate numerical position in the pathology services table:

2294 (3)

Enzyme-linked immunosorbent assay (ELISA) for a microbiological or tissue antigen or antibody where that antigen or antibody is not specified elsewhere in the Schedule— one test (SP)

17.20

17.20

17.20

17.20

17.20

17.20

2294 (4)

Each test referred to in the above item in excess of one (SP)

9.20

9.20

9.20

9.20

9.20

9.20

2295 (3)

Enzyme-linked immunosorbent assay (ELISA) for a microbiological or tissue antigen or antibody where that antigen or antibody is not specified elsewhere in the Schedule— one test (OP)

12.90

12.90

12.90

12.90

12.90

12.90

2295 (4)

Each test referred to in the above item in excess of one (OP)

6.90

6.90

6.90

6.90

6.90

6.90

Commencement: Immediately after the commencement of section 52 of the Health Legislation Amendment Act 1986 on 1 August 1986.

(2) Similar amendments to the amendments made by paragraph (1) (a) are taken to have been made to each pathology services table that:

(a)     was prescribed for the purposes of subsection 4a (2) of the Principal Act; and

(b)     had effect (under subsection 4a (3) of that Act) as if it had been set out in Schedule 1a to that Act;

after 1 August 1986 and before 1 August 1989.

(3) The rules added by paragraph (1) (b) to the pathology services table in Schedule 1a of the Principal Act are taken to have been added:

(a) to each pathology services table that:

(i) was prescribed for the purposes of subsection 4a (2) of the Principal Act; and

(ii) had effect (under subsection 4a (3) of that Act) as if it had been set out in that Schedule;

after 1 August 1986 and before the commencement of this subsection; and

(b) to the pathology services table that was substituted for the table then in that Schedule by the Community Services and Health Legislation Amendment Act 1989.

(4) The items inserted by paragraph (1) (c) in the pathology services table in Schedule 1a of the Principal Act are taken to have been inserted in each pathology services table that:

(a)     was prescribed for the purposes of subsection 4a (2) of the Principal Act; and

(b)     had effect (under subsection 4a (3) of that Act) as if it had been set out in that Schedule;

after 1 August 1986 and before 1 August 1989.

Transitional

6. (1) Where:

(a)     before the commencement of this section, a person made a claim for payment of a benefit in respect of a service by reference to an item that, because of the retrospective operation of a provision of section 4 or 5, did not relate to the service; and

(b)    the person has been paid in respect of the service a benefit calculated by reference to the fees specified in that item;

the person is taken to have been entitled to receive in respect of the service the amount of benefit that was paid.

(2) Where:

(a)     before the commencement of this section, a person made a claim for payment of a benefit in respect of a service by reference to an item that, because of the retrospective operation of a provision of section 4 or 5, related to the service; and

(b)     the person has been paid in respect of the service a benefit calculated by reference to the fees specified in another item;

the person is taken to be entitled to receive in respect of the service the higher of:

(c)     the amount of the benefit payable in respect of the service; and

(d)     the amount of benefit that was paid.

(3) Where:

(a)     before the commencement of this section, a person made a claim for payment of a benefit in respect of a service by reference to an item that, because of the retrospective operation of a provision of section 4 or 5, did not relate to the service; and

(b)    the person has been paid in respect of the service a benefit calculated by reference to the fees specified in the item that, because of the retrospective operation of a provision of section 4 or 5, related to the service;

the person is taken to have been entitled to receive in respect of the service the amount of benefit that was paid.

(4) Where:

(a)     before the commencement of this section, a person made a claim for payment of a benefit in respect of a service by reference to an item that, because of the retrospective operation of a provision of section 4 or 5, did not relate to the service; and

(b)     subsection (3) does not apply to the person; and

(c)     the person has been paid in respect of the service a benefit calculated by reference to the fees specified in another item;

the person is taken to be entitled to receive the higher of:

(d)     the amount of the benefit payable in respect of the service; and

(e)     the amount of benefit that was paid.

(5) If, apart from this subsection, an amount to which a person is taken to be, or to have been, entitled under this section, would not be an amount payable by the Commonwealth under Part II of the Principal Act, that amount is taken, for the purposes of section 125 of that Act, to be an amount payable by the Commonwealth under that Part.

Saving

7. This Act does not affect the liability of any person to pay or repay an amount to the Commonwealth under Part V of the Principal Act.

NOTE

1. No. 42, 1974, as amended. For previous amendments, see No. 58, 1975; Nos. 59, 91, 101, 109 and 157, 1976; No. 75, 1977; Nos. 36, 89 and 133, 1978; Nos. 53 and 123, 1979; No. 132, 1980; Nos. 118 and 176, 1981; Nos. 49, 80 and 112, 1982; Nos. 54 and 139, 1983; Nos. 15, 46, 63, 120, 135 and 165, 1984; Nos. 24, 65, 70, 95 and 167, 1985; Nos. 28, 75 and 94, 1986; Nos. 44, 131, 132 and 141, 1987; Nos. 85, 87, 99 and 155, 1988; Nos. 59, 84. 95 and 164, 1989; Nos. 3, 106 and 141, 1990; and No. 6, 1991.

[Minister’s second reading speech made in—

House of Representatives on 11 April 1991

Senate on 17 April 1991]

Overview

The Health Insurance (Pathology Services) Amendment Act 1991, enacted by the Parliament of Australia, was introduced to amend specific provisions of the Health Insurance Act 1973 relating to pathology services. The principal aim of this Act was to address gaps in the existing framework regarding the provision and reimbursement of pathology services under the Medicare system. The amendments primarily focused on clarifying the definitions and fee structures for certain pathology services, ensuring that the services were accurately classified and compensated. The Act also introduced new rules for interpreting the tables of medical services to avoid ambiguity in service descriptions and fees, thereby ensuring fair and consistent application of benefits.

Scope and Application

The Health Insurance (Pathology Services) Amendment Act 1991 amends the Health Insurance Act 1973 to update provisions relating to pathology services. This Act applies to all persons and entities that fall under the purview of the Health Insurance Act 1973, particularly those providing or claiming benefits for pathology services. It affects the medical services and pathology services tables within the Principal Act, ensuring that services are accurately described and fees are correctly applied. The Act does not introduce any new exclusions or exemptions but modifies existing rules and fee structures for specified tests. The amendments extend to all tables of medical services and pathology services that were in effect after 1 January 1980 and before 1 August 1989. The Act does not affect the liability of any person under Part V of the Principal Act, which pertains to the payment or repayment of amounts to the Commonwealth.

Key Provisions

The Health Insurance (Pathology Services) Amendment Act 1991 (referred to as the Act) amends certain provisions of the Health Insurance Act 1973, specifically relating to pathology services. Section 4(1) of the Act amends Schedule 1 of the Principal Act, which includes the table of medical services, to exclude certain microbiological or tissue antigen or antibody services from specified items, and adjusts the fees for particular services, such as Enzyme-linked immunosorbent assay (ELISA) tests. It also introduces new rules for interpreting the table of medical services, including rules for determining which item applies when a service falls under multiple descriptions, and which applies when a service falls under multiple items (Section 4(1)(b)). Section 5 similarly amends Schedule 1a of the Principal Act, which includes the pathology services table, to reflect these changes and introduces the same new rules for interpretation. The Act imposes obligations on healthcare providers and patients to ensure that claims for pathology services are made according to the updated fee schedule and interpretation rules. It also outlines the circumstances under which a person may be entitled to a benefit for a service, even if the fee schedule has been retrospectively amended (Section 6). For example, if a service was claimed under an item that no longer related to the service due to retrospective amendments, but the person was paid according to the fees specified in that item, they are considered to have been entitled to receive the amount paid. There are no explicit offences, penalties, or civil/criminal consequences stated in the Act for breaches of its provisions. However, given the nature of the amendments, any non-compliance with the updated fee schedule or interpretation rules could potentially lead to disputes over the amount of benefits payable or refundable, with implications for both healthcare providers and patients. The Act ensures that any retrospective changes do not unfairly disadvantage those who have already been paid for services rendered under the old fee schedule (Section 6). Additionally, the Act clarifies that it does not affect the liability of any person to pay or repay an amount to the Commonwealth under Part V of the Principal Act (Section 7).

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