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.
Overview
The Health Insurance (Patient Episode Initiation) Revocation Determination 2012, issued under the authority of the Minister for Health, revokes the Health Insurance (Patient Episode Initiation) Determination 2011 (No. 1). This revocation was necessary due to an oversight in the Health Insurance (Pathology Services Table) Regulations, where three tissue pathology services related to biopsy complexity levels were listed without appropriate references in Group P10 and Group P13 of the pathology services table. This oversight resulted in no benefits being payable for the initiation of patient episodes or bulk billing incentives for services described in items 72838, 72827, and 72828. The 2011 Determination was introduced to correct this issue by creating new health services to enable benefits to be payable in those circumstances. However, with the Health Insurance (Pathology Services Table) Amendment Regulation 2012 (No. 1), which came into effect on 1 May 2012, the drafting oversight has been rectified, rendering the 2011 Determination redundant. This revocation ensures that benefits for services performed on and after 1 May 2012 will be paid as per the corrected regulations.
Scope and Application
The Health Insurance (Patient Episode Initiation) Revocation Determination 2012 pertains to the Health Insurance Act 1973 and aims to revoke the Health Insurance (Patient Episode Initiation) Determination 2011 (No. 1), which was made to address an oversight in the pathology services table. The Act applies to health services listed in the pathology services table, specifically to tissue pathology services related to biopsy complexity levels, including items 72838, 72827, and 72828. The revocation determination affects those who provide or are eligible to receive benefits for these services under the Health Insurance Act, including healthcare providers and patients. Geographically, the Act applies throughout Australia as it is a Commonwealth Act, impacting the national health insurance scheme. The Determination does not specify any exclusions or exemptions but focuses on correcting a prior legislative oversight that affected the payment of benefits and incentives for certain pathology services. The authority to make this Determination is granted under Subsection 3C(1) of the Health Insurance Act 1973, and it comes into effect on 1 May 2012.
Key Provisions
The Health Insurance (Patient Episode Initiation) Revocation Determination 2012 (subsection 3C(1) of the Health Insurance Act 1973) revokes the Health Insurance (Patient Episode Initiation) Determination 2011 (No. 1). The 2011 Determination was made to address an oversight in the pathology services table, which omitted references to certain items (72838, 72827, and 72828) and thus prevented benefits from being payable for the initiation of patient episodes for these services. The 2012 Determination is effective from 1 May 2012 and removes the need for the 2011 Determination as the oversight has been corrected in the Health Insurance (Pathology Services Table) Amendment Regulation 2012 (No. 1).
The Act imposes several obligations on parties involved in the health insurance framework, including the Minister for Health, who has the authority to determine that specific health services not listed in the pathology services table can be treated as listed under certain circumstances. This power is exercised to ensure that benefits and incentives are correctly aligned with the intended services. Additionally, the Act requires that the pathology services table be updated annually, which includes rectifying any errors such as the one addressed by the 2011 Determination.
The revocation of the 2011 Determination means that any entitlements established by that Determination for services performed prior to 1 May 2012 remain valid for the specified periods. However, for services performed on and after 1 May 2012, the corrected regulations will apply, and the 2011 Determination will no longer be in effect.
There are no specific offences or penalties mentioned in the Determination itself. However, under the broader framework of the Health Insurance Act 1973, there are potential civil and criminal consequences for non-compliance with the Act's provisions. Penalties can vary depending on the nature and severity of the breach but may include fines and other legal actions. The exact penalties would be determined based on the specific circumstances and the relevant provisions of the Act.