EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Patient Episode Initiation) Revocation Determination 2012
Issued by the Authority of the Minister for Health
Authority
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by writing, determine that a health service not listed in the pathology services table shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. The pathology services table is set out in the Health Insurance (Pathology Services Table) Regulations, which are remade each year.
Purpose
The purpose of this Determination is to revoke Health Insurance (Patient Episode Initiation) Determination 2011 (No. 1) (the 2011 Determination) made on 25 November 2011.
Background
Three tissue pathology services relating to biopsy complexity levels were listed in the pathology services table; item 72838 commenced on 1 November 2007 (Health Insurance (Pathology Services Table) Regulations 2007), and items 72827 and 72828 commenced on 1 November 2008 (Health Insurance (Pathology Services Table) Regulations 2008). At the time of the respective commencement of those items, benefits were payable for the initiation of patient episodes for services, which were provided in the circumstances specified by the item descriptors in Group P10 of the pathology services table. It was envisaged that these specified circumstances would include, amongst others, circumstances consisting of where a health service listed in items 72838, 72827 or 72828 was provided. It was also envisaged that, from 1 November 2009 onwards, bulk billing incentives would be payable for episodes consisting of the health services described in items 72838, 72827 or 72828 where those items were bulk billed. To facilitate bulk billing incentives, Group P13 was inserted into the pathology services table.
Due to an oversight, no reference was made to items 72838, 72827 or 72828 in either Group P10 or Group P13. Thus the inadvertent effect of the omission was that no benefits were payable for the initiation of patient episodes for the health services described in items 72838, 72827 and 72828 and no bulk billing incentives were payable where those health services were provided under bulk billing arrangements.
In order to correct this oversight the 2011 Determination created new health services, which consist of the initiation of patient episodes of the services described in items 72838, 72827 and 72828 of the pathology services table, to enable benefits to be payable in those circumstances. The 2011 Determination also specified that bulk billing incentives are payable for episodes consisting of the new health services which were created by that Determination.
The Health Insurance (Pathology Services Table) Amendment Regulation 2012 (No. 1) registered on the Federal Register of Legislative Instruments on 20 April 2012 and with a date of effect of 1 May 2012 will allow benefits for services performed on and after that date to be paid. The entitlement to benefits for services performed prior to 1 May 2012 established by the 2011 Determination will remain for the specified periods.
Consultation
No consultation has been undertaken. The drafting oversight in the pathology services table that led to the making of the 2011 Determination has now been fixed, and the 2011 Determination is therefore redundant.
The Act specifies no conditions that need to be satisfied before the power to make the Determination may be exercised.
This Determination commences on 1 May 2012.
The Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.