EXPLANATORY STATEMENT
STATUTORY RULES 1984 NO. 6
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (PATHOLOGY SERVICES) REGULATION AMENDMENT
Sub-section 133(1) of the Health Insurance Act 1973 (‘the Act’) provides that the Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or which are necessary or convenient to be prescribed for carrying out or giving effect to the Act.
An approved pathology practitioner is defined in sub-section 3(1) of the Act to mean, in addition to the Commonwealth, the Northern Territory, and statutory authorities specified in writing by the Minister, a person in respect of whom there is in force an undertaking accepted by the Minister under section 16C of the Act.
Sub-section 16A(1) of the Act provides that a Commonwealth medical benefit is not payable in respect of a pathology service unless a practitioner determined the service was necessary, and certain other requirements are met. Sub-section 16A(1), from 1 February 1984, applies similarly to medicare benefit. Arising from paragraph 16A(1)(a) of the Act, pathology services required to be referred to an approved pathology practitioner to be
rendered must be referred by means of a request made in writing as prescribed, or if made otherwise than in writing, subsequently confirmed in writing as prescribed. Such a request would be made by the practitioner originally determining the service to be necessary or by another approved pathology practitioner.
Particulars for the purposes of paragraph 16A(1)(a) of the Act to be specified in a request or confirmation of a request to an approved pathology practitioner for the rendering of a pathology service are prescribed in Regulation 5 of the Health Insurance (Pathology Services) Regulations. Regulation 5 was extensively amended by Statutory Rules No. 254 with effect from 1 February 1984. Arising from this amendment, paragraph (d) of Regulation 5 required a request or confirmation of a request to specify.
“the service to which the instrument relates by means of a description sufficient to identify the item that relates to that service and the number of that item”.
During the course of administrative preparations for the implementation of the amendments of Regulation 5, it became evident that it was impracticable to require, as well as a description of services, the specification of
item numbers, being items in the Medical Benefits Schedule, on all requests. The Statutory Rules therefore omit the words “and the number of that item” from paragraph (d) of Regulation 5.
The proposed Statutory Rules came into operation on 2 February 1984.
Overview
The Health Insurance (Pathology Services) Regulation Amendment of 1984 was issued under the authority of the Minister for Health, addressing a specific issue arising from the implementation of amendments to Regulation 5 of the Health Insurance (Pathology Services) Regulations. This regulation is a part of the broader Health Insurance Act 1973, which aims to regulate the provision of medical benefits and pathology services under the Medicare system. The policy objective is to ensure that pathology services are appropriately referred and documented while maintaining the flexibility necessary for practical administration. The amendment was necessitated by the discovery that it was unfeasible to require the specification of item numbers on all requests, thereby omitting those words from the regulation to facilitate smoother administrative processes.
Scope and Application
The Health Insurance (Pathology Services) Regulation Amendment issued under the Health Insurance Act 1973 aims to refine the regulatory framework governing pathology services, particularly in relation to the necessary details that must be specified in requests for such services. The Act applies to approved pathology practitioners, which include the Commonwealth, the Northern Territory, and any statutory authorities specified by the Minister, as well as any individuals holding an undertaking accepted by the Minister. The regulations govern the conduct of these practitioners in providing pathology services, ensuring that services deemed necessary for Commonwealth or Medicare benefits are properly documented and referred according to the Act’s stipulations. The amendment to Regulation 5, effective from 1 February 1984, exempts the requirement to specify item numbers from requests, recognising the impracticality identified during administrative preparations. These regulations apply nationally, impacting the healthcare industry and ensuring compliance with the Health Insurance Act's provisions regarding pathology services.
Key Provisions
The key provisions of the Health Insurance (Pathology Services) Regulation Amendment under the Health Insurance Act 1973 include changes to Regulation 5, which specifies the particulars required in requests or confirmations of requests for pathology services. Regulation 5 was amended by Statutory Rules No. 254, effective from 1 February 1984, to mandate that requests or confirmations for pathology services must describe the service and include the item number from the Medical Benefits Schedule. However, subsequent administrative assessments indicated that this requirement was impractical, leading to further amendments by Statutory Rules No. 6, which took effect on 2 February 1984. These amendments removed the necessity to specify the item numbers in the requests, allowing only a description of the service to be required.
The amendment imposes specific obligations on parties involved in the provision of pathology services under the Health Insurance Act. Practitioners who determine that a pathology service is necessary must ensure that the service is referred to an approved pathology practitioner. This referral must be made in writing as prescribed by Regulation 5, or if made otherwise, it must be confirmed in writing. The amendment to Regulation 5 by Statutory Rules No. 254 originally required the inclusion of item numbers, but this was later omitted by Statutory Rules No. 6, leaving only the requirement for a description of the service. This change alleviates the burden on practitioners to include item numbers, which were found to be impractical to specify in all requests.
The Act and its regulations do not explicitly state specific offences or penalties for non-compliance with the requirements of the amended Regulation 5. However, non-compliance with the provisions of the Health Insurance Act or the regulations made under it could potentially lead to administrative penalties or other legal consequences. These could include the denial of Commonwealth medical benefits for services that do not comply with the prescribed requirements, which could result in financial loss for the provider or the patient. Additionally, repeated or significant non-compliance might attract scrutiny from regulatory bodies, leading to further investigation or enforcement actions.