EXPLANATORY STATEMENT
Select Legislative Instrument 2012 No. 297
Health Insurance Act 1973
Health Insurance (Pathology Services Table) Amendment Regulation 2012 (No. 4)
Subsection 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 necessary or convenient to be prescribed for carrying out or giving effect to the Act.
The Act provides, in part, for payments of Medicare benefits in respect of professional services rendered to 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 prescribed tables.
Section 4A of the Act provides that the regulations may prescribe a table of pathology services that sets out items of pathology services, the amount of fees applicable in respect of each item, and rules for interpretation of the pathology services table. The Health Insurance (Pathology Services Table) Regulation 2012 (the Principal Regulation), recently amended, currently prescribes such a table.
The regulation decreases the fees for all the items in Groups P1 to P11 of the pathology services table to recover the amount of 2011/12 expenditure incurred over the agreed 2011/12 funding cap in the Pathology Funding Agreement. The Pathology Funding Agreement governs the Australian Government outlays for pathology services and specifies the action to be taken when the yearly caps are exceeded or not achieved. The Pathology Funding Agreement’s signatories, the Australian Government (represented by the Department of Health and Ageing), the Australian Association of Pathology Practices, the Royal College of Pathologists of Australasia and the National Coalition of Public Pathology agreed to the percentage decrease that would apply to the fees in the table.
The Act specifies no conditions that need to be satisfied before the power to make the regulation may be exercised.
The regulation is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The regulation commences on 1 January 2013.
Consultation
These changes relate to the ongoing maintenance of the Pathology Services Table (PST) to reflect evidence-based best practice and appropriate funding.
The decrease in fees for Groups 1 to 11 of the PST was negotiated between the signatories of the Pathology Funding Agreement; the Australian Government (represented by the Department of Health and Ageing), 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 impact of the changes on their business operations. The Department of Veterans’ Affairs was advised of the changes to ensure that their schedule of benefits for veterans could be amended if necessary.
It has been concluded that the changes will have minimal impact on pathology practice in terms of costs to business and will lead to a closer correspondence between Medicare benefit structure and pathology practice.
Authority: Subsection 133(1) of the
Health Insurance Act 1973
This material is provided to persons who have a role in Commonwealth legislation, policy and programs as general guidance only and is not to be relied upon as legal advice. Commonwealth agencies subject to the Legal Services Directions 2005 requiring legal advice in relation to matters raised in connection with this template must seek that advice in accordance with the Directions.
Overview
The Health Insurance (Pathology Services Table) Amendment Regulation 2012 (No. 4) was introduced to address the issue of exceeding the agreed funding cap for pathology services in the 2011/12 financial year. Enacted under subsection 133(1) of the Health Insurance Act 1973 by the Governor-General, this regulation aims to adjust the fees for pathology services to align with the Pathology Funding Agreement. The policy objective is to ensure that Medicare benefits for pathology services are calculated accurately and in accordance with evidence-based best practice, whilst managing expenditure within agreed caps. The regulation, which involves a decrease in fees for specified groups of pathology services, was developed through consultation with relevant stakeholders, including the Australian Government, the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices, and the National Coalition of Public Pathology. The changes are intended to have minimal impact on pathology practices, while ensuring a closer correspondence between Medicare benefits and pathology practice.
Scope and Application
The Health Insurance (Pathology Services Table) Amendment Regulation 2012 (No. 4) applies to all parties involved in the provision of pathology services in Australia and the determination of Medicare benefits associated with these services. This regulation pertains specifically to the fees set out in the Pathology Services Table under Section 9 of the Health Insurance Act 1973, which governs the calculation of Medicare benefits for medical services, including pathology services. The regulation adjusts these fees to align with the expenditure incurred during the 2011/12 financial year, as stipulated in the Pathology Funding Agreement. This agreement is an arrangement between the Australian Government, represented by the Department of Health and Ageing, and various professional bodies, including the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices, and the National Coalition of Public Pathology. The regulation's adjustments are intended to ensure that the Medicare benefit structure accurately reflects the agreed funding levels and best practices in pathology services. The regulation operates across the Commonwealth and applies to all entities and individuals involved in the provision and billing of pathology services to Medicare beneficiaries.
Key Provisions
The Health Insurance (Pathology Services Table) Amendment Regulation 2012 (No. 4) pertains to the Health Insurance Act 1973 and specifically amends the fees for pathology services outlined in the Pathology Services Table (PST) (section 4A). This regulation modifies the fees for all items in Groups P1 to P11 of the PST to reflect the 2011/12 expenditure that exceeded the agreed funding cap in the Pathology Funding Agreement. The agreement, signed by the Australian Government (represented by the Department of Health and Ageing), the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices, and the National Coalition of Public Pathology, dictated the percentage decrease applied to the fees. This adjustment aims to ensure that Medicare benefits align with the agreed-upon funding parameters and evidence-based best practice.
The obligations imposed by this regulation are primarily directed towards the entities involved in pathology services, ensuring they adhere to the revised fee structures as set out in the amended table. These entities must now comply with the new fee schedule when claiming Medicare benefits for pathology services. The Department of Human Services and the Department of Veterans' Affairs were both consulted and informed about the changes to ensure smooth implementation and to allow for any necessary adjustments to their respective schedules of benefits.
The regulation does not explicitly outline offences or penalties for non-compliance. However, any breaches of the Health Insurance Act 1973 or the terms of the Pathology Funding Agreement could potentially lead to legal consequences. Such breaches might result in civil or criminal penalties, depending on the nature and severity of the infringement. The specific penalties would be determined in accordance with the provisions of the Health Insurance Act 1973 and any related legislation, which could include fines or other corrective measures. It is essential for all parties to comply with the amended fees to avoid any potential legal repercussions.