EXPLANATORY STATEMENT
Issued by authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Prescribed Pathology Services) Determination 2011
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’.
The Health Insurance (Prescribed Pathology Services) Determination 2011 (‘the Determination’) revokes and remakes the Health Insurance (Prescribed Pathology Services) Determination 2000 (‘the Previous Determination’), which commenced on 1 November 2000, as amended by the Health Insurance (Prescribed Pathology Services) Amendment Determination 2010 (No 1), which commenced on 1 November 2010.
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 which are specified in a determination made under section 4BB of the Act. The Previous Determination specified that simple basic pathology tests listed in Group P9 of the pathology services table were prescribed pathology services. The previous determination was amended by the Health Insurance (Prescribed Pathology Services) Amendment Determination 2010 (No 1) to also specify that simple basic pathology tests rendered by participating nurse practitioners were prescribed pathology services. This amendment was made as part of the implementation of a wider measure to enable participating midwives and participating nurse practitioners to access Medicare services, and was intended to allow participating nurse practitioners to provide certain basic pathology tests as Medicare services. Due to an oversight, no arrangements were made for the rendering of prescribed pathology services by participating nurse practitioners to be ‘professional services’ within the meaning of the Act; thus the services were still not Medicare eligible. The Health Insurance (Midwife and Nurse Practitioner) Determination 2011 rectifies this problem and, in doing so, new pathology items are created with respect to participating nurse practitioners. The purpose of the Determination is to update the prescribed pathology services for participating nurse practitioners to reflect those new items. In other words, the Determination carries out a consequential change.
The Determination commences retrospectively from 1 November 2010 to align with the commencement date of the Health Insurance (Midwife and Nurse Practitioner) Determination 2011. Making the Determination retrospective will enable the payment of Medicare benefits for those prescribed pathology services provided by participating nurse practitioners since 1 November 2010, where the associated claim has yet to be submitted. The Commonwealth will be the only party who is adversely affected by the retrospective making of this Determination, thus subsection 12(2) of the Legislative Instruments Act 2003 will not be offended.
Details of the Determination are set out in the Attachment.
The Act specifies no conditions that need to be satisfied before the power to make the Determination may be exercised.
The Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Consultation
There has been no consultation for the Determination as it is a consequential change.
ATTACHMENT
Details of the Health Insurance (Prescribed Pathology Services) Determination 2011
Section 1 Name of Determination
This section provides that the name of the Determination is the Health Insurance (Prescribed Pathology Services) Determination 2011 (‘the Determination’).
Section 2 Commencement and Revocation
This section provides that the Determination is taken to have commenced on 1 November 2010 and revokes the Health Insurance (Prescribed Pathology Services) Determination 2000, which commenced on 1 November 2000, as amended by the Health Insurance (Prescribed Pathology Services) Amendment Determination 2010 (No 1), which commenced on 1 November 2010.
Section 3 Definition
This section provides that reference to Act in the Determination means the Health Insurance Act 1973.
Section 4 Prescribed Pathology Services
This section provides that for paragraph 4BB(a) of the Act, a pathology service specified in an item in Group P9 of the pathology services table is a prescribed pathology service for the purposes of that Act.
Section 5 Prescribed Pathology Services Rendered by Nurse Practitioners
This section provides that subsection 16A(7A) of the Act applies to the prescribed pathology services in the range 73828 – 73837 listed in the Health Insurance (Midwife and Nurse Practitioner) Determination 2011, where the service is rendered by a participating nurse practitioner. Section 5 of the Determination is changed from the Previous Determination to reflect these new items.
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.