EXPLANATORY STATEMENT

 

Select Legislative Instrument 2008 No. 113

 

Health Insurance Act 1973

 

Health Insurance (Pathology Services Table) Amendment Regulations 2008 (No. 2)

 

Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides, in part, 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 2007 (the Principal Regulations) currently prescribe such a table.

 

The purpose of these Regulations is to amend the table in the Principal Regulations to implement part of the 2008-2009 Federal Budget savings measures.

 

These amendments remove three items (2 chemical and 1 microbiology); to introduce (add) one new patient episode initiation (PEI) fee for collection centres that are co-located with an approved pathology laboratory - to take account of the lesser costs of collecting on site; and to amend one item to incorporate the new PEI item. A PEI fee is the fee Pathologists are paid for the collection of pathology samples to cover overhead costs such as specimen collection, storage, transportation, reporting and the raising of accounts. The items that are removed are the following high volume, highly automated basic chemical/microbiology tests. These three items no longer be able to be claimed through the Medicare Benefits Schedule:

 

·                66515 - a test for six or more electrolytes (sodium, potassium, etc), kidney and liver function;

·                66710 - a test for six or more of a variety of hormones and associated proteins; and

·                69399 - a test for six or more antibodies to infections eg bacteria or viruses.

 

The item to be added is:

·                73920 – a new fee for a PEI where the approved collection centre is co-located with an approved pathology laboratory.

 

Pathologists are paid for the collection of pathology samples through the PEI in addition to the actual test fee. The PEI fees vary depending on the location and circumstances in which the specimen is collected. This measure will reduce the amount paid (in the private sector) from $17.40 to $2.40 in a collection centre co-located with a pathology laboratory.

Item 73928 is the initiation of a patient episode by collection of a specimen for one or more services collected in an approved collection centre. This item has been amended to incorporate the new item 73920.

 

Details of the Regulations are included in the Attachment.

 

As this is a Budget-related initiative, no external consultations were undertaken in developing this measure.

 

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 commence on 1 July 2008.

 

 

ATTACHMENT

 

 

DETAILS OF THE HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) AMENDMENT REGULATIONS 2008 (NO. 2)

 

Regulation 1 – Name of Regulations

 

This regulation provides for the Regulations to be referred to as the Health Insurance (Pathology Services Table) Amendment Regulations 2008 (No. 2).

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on 1 July 2008.

 

Regulation 3 – Amendment of the Health Insurance (Pathology Services Table) Regulations 2007

 

This regulation provides that Schedule 1 amends the Health Insurance (Pathology Services Table) Regulations 2007, the Principal Regulations.

 

Schedule 1 – Amendments

 

Schedule 1 sets out a number of changes to the following provisions in Schedule 1 to the Principal Regulations:

§         Part 2 – Rules of interpretation;

§         Part 3 – Services and fees.

 

Part 2 - Rules of interpretation

 

Items [1] to [3] of the Regulations incorporate the following changes:

 

Items [1] and [3], subrules 4(1) and 16(3) are amended to remove the reference to item 66515 that has been deleted.

 

Item [2], paragraph 4(3)(e) is amended to omit item 66515 and include item 66512 which is now the highest ladder item for these type of tests.

 

Part 3 – Services and fees

Items [4] to [11]

 

Items 66515, 66710 and 69399 is deleted by items [5], [7] and [9], respectively.

 

Items 66512 at item [4], 66707 at item [6] and 69396 at item [8] are amended to change 5 tests to 5 or more tests with no impact on patients or providers.

 

A new item 73920 is added by item [10] to provide a PEI fee for pathology collection centres, which are co-located with an Approved Pathology Laboratory.

 

Item 73928 has been amended by item [11] to reflect the reference to the new item 73920.