EXPLANATORY STATEMENT
Select Legislative Instrument 2005 No. 67
Issued by the Authority of the Minister for Ageing
Health Insurance Act 1973
Health Insurance (Pathology Services Table) Amendment Regulations 2005 (No. 1)
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 table. The Health Insurance (Pathology Services Table) Regulations 2004 (the Principal Regulations) currently prescribe such a table.
The purpose of the Regulations is to amend the current table of pathology services by making the following changes, as part of the ongoing management of the table:
- amendments to 28 existing items;
- the creation of a new rule; and
- amendments to 2 existing rules.
The changes have been developed with the co-operation and support of the two peak pathology bodies - the Royal College of Pathologists of Australasia (RCPA) and the Australian Association of Pathology Practices (AAPP) - through the Pathology Services Table Committee.
Details of the Regulations are set out in the Attachment.
The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised.
The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Regulations commence on 1 May 2005.
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) AMENDMENT REGULATIONS 2005 (NO. 1)
Regulation 1 provides for the Regulations to be referred to as the Health Insurance (Pathology Services Table) Amendment Regulations 2005 (No. 1).
Regulation 2 provides for the Regulations to commence on 1 May 2005.
Regulation 3 provides for Schedule 1 to amend the Health Insurance (Pathology Services Table) Regulations 2004.
Schedule 1 - Amendments
The word ‘episode’ is defined in the rules of interpretation of the table. It is also used, in a different application, in the descriptions of items which have restrictors to limit the number of times that the item is applicable to any particular patient in a specified period of time.
The Regulations remove the word ‘episode’ from the item descriptors, to avoid any ambiguity that may arise by having two applications of the word ‘episode’. A new rule is created, which applies to the items which currently have restrictors. The new rule preserves the restrictions unchanged, but avoids the use of the word ‘episode’.
The changes related to the word ‘episode’ and to the new rule are detailed in items [3] to [4] and [6] to [20], below.
Item [1]
This item amends rule 4 (1) (a) to clarify that the items to which this rule applies may be claimed on each of the 6 occasions that a specimen may be taken.
Item [2]
Rule 19 defines certain terms relating to Hepatitis C antibodies. This item amends
rule 19 to provide that rule 19 does not apply to items 69442 and 69445, as the terms defined by rule 19 are not contained in these items.
Item [3]
This item inserts new rule 25. Rule 25 applies to 17 items which have restrictors to limit the number of times that the item is applicable to any particular patient in a specified period of time.
Rule 25 provides that items 66539, 69442, 71075, 71127, 71135 and 71137 are applicable not more than twice in a 12 month period; item 66626 is applicable not more than 36 times in a 12 month period; items 66655, 66659, 69443 and 69444 are applicable not more than once in a 12 month period; item 66750 is applicable not more than once in a pregnancy; item 69336 is applicable not more than once in a period of 7 days; items 69445, 71079 and 73523 are applicable not more than 4 times in a 12 month period and item 71077 is applicable not more than 6 times in a 12 month period.
Item [4]
This item amends the description of item 65072 to remove the word ‘episode’ from the item description.
Item [5]
This item amends the description of items 66518 and 66519 to provide that these items apply to laboratory procedures that use blood specimens (plasma, serum or whole blood) for the quantitative measurement of creatine kinase isoenzymes, troponin or myoglobin.
The current descriptions of items 66518 and 66519 preclude the methods which use whole blood. The amendments allow the use of whole blood, as the technology for the examination of whole blood has become common.
Items [6] to [12]
These items amend the descriptions of items 66539, 66626, 66655, 66659, 66669, 66670, 66672, 66673 and 66750 to remove the word ‘episode’. The items also provide that new rule 25 applies to items 66539, 66626, 66655, 66659 and 66750 (see item [3], above).
Item [13]
This item amends the description of item 69336 to clarify that in order to claim
item 69336 the laboratory must use a technique that concentrates the sample before performing microscopy, staining or antigen detection. It also provides that new rule 25 applies to item 69336 (see item [3], above).
Item [14]
This item amends the descriptions of items 69378, 69381, 69382 to remove the word ‘episode’.
Item [15]
This item amends the descriptions of items 69442, 69443, 69444 and 69445 to provide that new rule 25 applies to those items (see item [3], above).
It also provides that rule 19 does not apply to items 69442 and 69445 (see item [2], above).
Item [16]
This item amends the description of item 71073 to remove the word ‘episode’.
Items [17] to [20]
These items amend the descriptions of items 71075, 71077, 71079, 71127, 71135, 71137 and 73523 to remove the word ‘episode’. The items also provide that new rule 25 applies to items 71075, 71077, 71079, 71127, 71135, 71137 and 73523 (see item [3], above).