EXPLANATORY STATEMENT
Select Legislative Instrument 2010 No. 68
Health Insurance Act 1973
Health Insurance (Pathology Services Table) Amendment Regulations 2010 (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 pathology services table. The Health Insurance (Pathology Services Table) Regulations 2009 (the Principal Regulations) currently prescribe such a table.
The Regulations amend the current table of pathology services in the Principal Regulations, as part of the ongoing management of the table. The changes are necessary to reflect the current state of pathology in Australia as both a science and an industry.
The Regulations introduce five new items specifically targeted to the use of particular genetic technologies in particular clinical circumstances. These technologies are currently all rebated under two general items on the Schedule 1 to the Principal Regulations. The introduction of the five new items and amendments to the wording of the two existing items provide a more tailored fee structure, such that fees better reflect the costs of the different technologies and could be more easily adjusted in the future to reflect changes in technology and medical practice.
These changes have been developed with the co-operation and support of the three peak pathology bodies, the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices and the National Coalition of Public Pathology, through the Pathology Services Table Committee.
Details of the Regulations are set out in the Attachment.
These changes have been developed with the co-operation and support of the three peak pathology bodies, the Royal College of Pathologists of Australasia, the Australian Association of Pathology Practices and the National Coalition of Public Pathology, through the Pathology Services Table Committee. 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.
The Act specifies no conditions that need to be satisfied 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 2010.
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) AMENDMENT REGULATIONS 2010 (NO. 1)
Regulation 1 – Name of Regulations
This regulation provides for the Regulations to be referred to as the Health Insurance (Pathology Services Table) Amendment Regulations 2010 (No. 1).
Regulation 2 – Commencement
This regulation provides for the Regulations to commence on 1 May 2010.
Regulation 3 – Amendment of the Health Insurance (Pathology Services Table) Regulations 2009
This regulation provides that Schedule 1 amends the Health Insurance (Pathology Services Table) Regulations 2009 (the Principal Regulations).
Schedule 1 – Amendment
Schedule 1 sets out a change to Part 3 – Services and fees – in Schedule 1 to the Principal Regulations.
Part 3 – Services and fees
Item [1] – Schedule 1, Part 3, items 73287 and 73289
This item substitutes seven items for two existing items on Schedule 1 to the Principal Regulations.
Existing item 73287, which indicates a fee for chromosome studies of any tissue except blood, are amended to require that every chromosome must be studied and that the fee provided includes a service described in new item 73293, if performed.
Existing item 73289, which indicates a fee for chromosome studies of blood, are also amended to require that every chromosome must be studied. It also indicates that the fee provided includes a service described in new item 73294, if performed.
New item 73290 is introduced, to provide a specific item for chromosome studies of blood or bone marrow to diagnose or monitor haematological malignancy. It also indicates that the fee provided includes a service described in item 73287 or 73289, if performed.
New item 73291 is introduced, to provide a specific item for chromosome studies for developmental delay.
New item 73292 is introduced, to provide a specific item for chromosome studies for developmental delay, intellectual disability, autism or other congenital abnormalities, specifically requiring the use of genome-wide microarray technology. (Microarray is a scientific technique that allows many genes to be analysed at once). It also indicates that the fee provided includes a service described in items 73287, 73289 or 73291, if performed.
New item 73293 is introduced to provide a specific item for chromosome studies for specific constitutional genetic abnormalities in diagnostic studies of the products of conception.
New item 73294 is introduced to provide a specific item for the analysis of the PMP22 gene for constitutional genetic abnormalities causing peripheral neuropathy in either affected persons or their relatives. The term “relative” in this context has an accepted meaning in the professional geneticist community as referring to a person(s) who shares genetic material with the person in question.