EXPLANATORY STATEMENT
Issued by authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Prescribed Pathology Services) Amendment Determination 2010 (No. 1)
Section 4BB of the Health Insurance Act 1973 (the Act) provides that the Minister may determine in writing that a pathology service, or class of pathology services, specified in the determination is a prescribed pathology service.
From 1 November 2010, new arrangements for participating midwives and participating nurse practitioners will enable them to provide Medicare services, refer patients to consultant physicians and specialists, and request pathology and diagnostic imaging services. The proposed Health Insurance (Prescribed Pathology Services) Amendment Determination 2010 (No. 1) (Determination) is part of the implementation of these new arrangements.
Generally, Medicare eligible pathology services must be provided in an accredited pathology laboratory by an approved pathology practitioner. However, there is an exception for ‘prescribed pathology services’ specified in a determination made under section 4BB of the Act. The purpose of the Determination is to amend the Health Insurance (Prescribed Pathology Services) Determination 2000 to allow participating nurse practitioners to render certain simple basic pathology services for which Medicare benefits are payable.
Details of the proposed Determination are set out in the Attachment.
The Act specifies no conditions that need to be satisfied before the power to make the proposed Determination may be exercised.
The proposed Determination would be a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Consultation regarding implementation of the arrangements for access by patients to midwife and nurse practitioner Medicare services and PBS prescribing occurred via advisory groups established to advise on specific issues and technical aspects. The advisory groups included practitioners from relevant medical and health professions, with experience in midwifery, nursing, general practice, obstetrics, and representatives from registration bodies, state and territory health services, regional and remote health services, Indigenous populations, and consumers. Advice included advice on Medicare and PBS eligibility, collaborative arrangements with medical professionals, authorisation as PBS prescribers, and medicines suitable for PBS prescribing.
ATTACHMENT
Details of the Health Insurance (Prescribed Pathology Services) Amendment Determination 2010 (No. 1)
Section 1 Name of Determination
This section provides that the name of the Determination is the Health Insurance (Prescribed Pathology Services) Amendment Determination 2010 (No. 1).
Section 2 Commencement
This section provides that the Determination commences on 1 November 2010.
Section 3 Amendment of Health Insurance (Prescribed Pathology Services) Determination 2000
This section provides that Schedule 1 of the Determination amends the Health Insurance (Prescribed Pathology Services) Determination 2000 (the Principal Determination).
Schedule 1 Amendments
Item [1] – Section 3
This item substitutes a new section 3 in the Principal Determination, which provides that ‘Act’ means the Health Insurance Act 1973.
Item [2] – Section 4
This item removes the term ‘Health Insurance Act 1973’ and replaces with the term ‘Act’ in section 4 of the Principal Determination. This is a minor technical amendment to improve drafting.
Item [3] – After section 4
This item inserts a new section 5 in the Principal Determination. This new section 5 provides that subsection 16A(7A) of the Act applies to a the prescribed pathology services in the range 73801 – 73810 of the Health Insurance Diagnostic Imaging Services Table, where the service is rendered by a participating nurse practitioner.
Where subsection 16A(7A) of the Act applies to a prescribed pathology service rendered by a participating nurse practitioner who is also the patient’s treating practitioner, the prohibition on the payment of Medicare benefit for that pathology service if it is not provided by a approved pathology provider in an accredited pathology laboratory does not apply. This amendment will enable participating nurse practitioners to provide simple basic pathology tests such as pregnancy testing by immunochemical methods, testing for blood in faeces, examining semen for the presence of sperm and microscopy study to determine the presence of fungi in skin, hair or nails as Medicare eligible services.