EXPLANATORY STATEMENT

 

Select Legislative Instrument 2007 No. 339

 

Subject: Health Insurance Act 1973

Health Insurance (Pathology Services Table) Amendment

Regulations 2007 (No. 3)

 

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 table. The Health Insurance (Pathology Services Table) Regulations 2005 (the Principal Regulations) currently prescribe such a table.

 

The purpose of the Regulations is to amend the current table of pathology services in the Health Insurance (Pathology Services Table) Regulations 2006 by making the following changes, as part of the ongoing management of the table.

 

The amendment is to correct an error made in the amendments to the table which commenced on 1 May 2007. Rule 18A is amended to reinstate an exemption to coning for items 73053 and 73055, which was omitted in the 1 May 2007 amendments. Under the coning rules, Medicare benefits are only paid for the three most expensive items in a patient episode. Rule 18 specifies those items which are exempt from this rule. This exemption is backdated to 1 May 2007 to ensure continuity of the exemption and to ensure no patients are disadvantaged.

 

The changes have been developed with the co-operation and support of the three peak pathology bodies - the Royal College of Pathologists of Australasia, the National Coalition of Public Pathology and the Australian Association of Pathology Practices - through the Pathology Services Table Committee.

 

The Act specifies no conditions that need to be met 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 are taken to have commenced on 1 May 2007.