Commonwealth of Australia Explanatory Memoranda Commonwealth of Australia Explanatory Memoranda[Index] [Search] [Download] [Bill] [Help]
2010
THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA
SENATE
HEALTH INSURANCE AMENDMENT (PATHOLOGY REQUESTS) BILL 2010
REVISED EXPLANATORY MEMORANDUM
(Circulated by authority of the Minister for Health and Ageing,
the Hon. Nicola Roxon, MP)
THIS MEMORANDUM TAKES ACCOUNT OF AMENDMENTS MADE BY
THE HOUSE OF REPRESENTATIVES
TO THE BILL AS INTRODUCED
HEALTH INSURANCE AMENDMENT (PATHOLOGY REQUESTS)
BILL 2010
OUTLINE
The Health Insurance Amendment (Pathology Requests) Bill 2010 (the Bill)
will amend the Health Insurance Act 1973 (the Act) to improve patient
choice in respect of pathology services.
The Bill amends the Act to remove the legislative requirement that, with
the exception of a pathologist-determinable service, in order for a
Medicare benefit to be payable for a pathology service rendered by or on
behalf of an approved pathology practitioner, a request for the service
must be made to that approved pathology practitioner or to the approved
pathology authority who is the proprietor of the laboratory in which the
service is rendered. There will still be a legislative requirement for a
request to be made, but there will no longer be a requirement that the
request be made to a particular approved pathology practitioner or
authority. However , if for clinical reasons a requesting practitioner
chooses to specify a particular approved pathology practitioner on a
request, that approved pathology practitioner must render the service for
Medicare benefit to be payable.
Increased patient choice is intended to encourage pathology providers to
compete on price and convenience for patients.
This new arrangement will commence on the day after Royal Assent.
Financial Impact Statement
$140,000 was allocated to this measure in the 2009-10 Budget, with $40,000
available in 2010-11. This includes funding for a communications strategy.
HEALTH INSURANCE AMENDMENT (PATHOLOGY REQUESTS) BILL 2010
NOTES ON CLAUSES
Clause 1 - Short Title
This clause provides for the Bill, once enacted, to be cited as the Health
Insurance Amendment (Pathology Requests) Act 2010.
Clause 2 - Commencement
This clause provides that the Act commences on the day after Royal Assent.
Clause 3 - Schedule(s)
This clause provides that each Act that is specified in a Schedule to this
Bill is amended or repealed as set out in the applicable items in the
Schedule concerned, and any other item has effect according to its terms.
In this Bill Schedule 1 amends the Health Insurance Act 1973 (the Act).
SCHEDULE 1-AMENDMENT OF THE HEALTH INSURANCE ACT 1973
The amendments made by Schedule 1 will have the effect of allowing a
patient to take a request for a Medicare eligible pathology service to the
pathology provider of the patient's choice, except where a particular
pathology provider has been specified on the request for clinical reasons.
Item 1 - Subsection 3(1) (subparagraph (d)(ii) of the definition of
professional service)
Subsection 3(1) defines certain terms used in the Act. The definition of
professional service currently includes, at paragraph (d), a pathology
service rendered by or on behalf of an approved pathology practitioner
pursuant to a request made in accordance with subsection 16A(4) by either:
. a patient's treating practitioner (subparagraph (d)(i)); or
. another approved pathology practitioner to whom the treating practitioner
has made a request for the service (subparagraph (d)(ii)).
This item removes the reference in subparagraph (d)(ii) to another approved
pathology practitioner "to whom the treating practitioner has made a
request for the service", and replaces it with a reference to another
approved pathology practitioner "who received a request for the service
made by the treating practitioner".
This amendment is consequential to the amendments made to subsection 16A(3)
(items 2 and 3 refer).
As a result of the amended wording, paragraph (d) of the definition of
professional service will include a pathology service, rendered by or on
behalf of an approved pathology practitioner, pursuant to a request made by
another approved pathology practitioner who received a request for the
service made by the treating practitioner.
Items 2 and 3 - Subsection 16A(3)
Subsection 16A(3) currently provides that a Medicare benefit is not payable
in respect of a pathology service (other than a pathologist-determinable
service) that has been rendered by or on behalf of an approved pathology
practitioner unless the service was rendered pursuant to a request made to
the approved pathology practitioner by:
. the treating practitioner (paragraph 16A(3)(a)); or
. another approved pathology practitioner to whom the treating
practitioner made a request for the service (paragraph 16A(3)(b)).
Item 2 repeals current subsection 16A(3), removing the requirement for a
request for a pathology service to be made "to the approved pathology
practitioner" who rendered the service.
Item 2 substitutes a new subsection 16A(3), which provides that a Medicare
benefit is not payable in respect of a pathology service (other than a
pathologist-determinable service) rendered by or on behalf of an approved
pathology practitioner unless the service was provided pursuant to a
request:
. made by the patient's treating practitioner and, if that practitioner has
specified an approved pathology practitioner on the request, the service
is provided by that practitioner (paragraph 16A(3)(a)); or
. made by another approved pathology practitioner who themselves received
the request from the patient's treating practitioner, and the request
from the treating practitioner did not specify a particular approved
pathology practitioner (paragraph 16A(3)(b)).
The effect of this amendment is that, for a Medicare benefit to be payable
in respect of a pathology service (other than a pathologist-determinable
service) rendered by or on behalf of an approved pathology practitioner,
there will no longer be a general requirement that the request be made to
the approved pathology practitioner who rendered the service. However,
where a patient's treating practitioner specifies a particular approved
pathology practitioner on a request, that practitioner is required to
render the pathology service to enable Medicare benefits to be claimed.
Item 2 also inserts a new subsection 16A(3A), which provides that for the
purposes of new subsection 16A(3), a treating practitioner is only able to
specify a particular approved pathology provider on a request based on
clinical grounds.
Item 4 - Subsection 16A(4)
Subsection 16A(4) currently sets out the requirements for a valid request
for a pathology service, for the purposes of subsection 16A(3). The
request, made to or by an approved pathology practitioner, must be made:
. in writing, or otherwise confirmed in writing within 14 days from the
date the request is made (paragraph 16A(4)(a)); and
. in accordance with the regulations, if any (paragraph 16A(4)(b)).
This item removes the reference in subsection 16A(4) to a request being
made "to or by an approved pathology practitioner for a pathology service".
This amendment is consequential to the amendments made to subsection
16A(3) (items 2 and 3 refer).
The amended subsection applies the requirements in paragraphs 16A(4)(a) and
(b) simply to a request for a pathology service, rather than to a request
which has been made to a particular approved pathology practitioner for a
pathology service.
Item 5 - Subsection 16A(5)
Subsection 16A(5) provides that if a request to or by an approved pathology
practitioner for a pathology service is made other than in writing and is
not confirmed in writing within 14 days from the date the request is made
(subparagraph 16A(4)(b) refers), then the request is deemed, for the
purposes of subsection 16A(3), never to have been made.
This item removes the reference in subsection 16A(5) to a request being
made "to or by an approved pathology practitioner for a pathology service".
This amendment is consequential to the amendments made to subsection
16A(3) (items 2 and 3 refer).
The amended subsection will provide that any request for a pathology
service which is made other than in writing and is not confirmed in writing
within 14 days from the date the request is made will be deemed, for the
purposes of subsection 16A(3), never to have been made.
Items 6 and 7 - Subsection 16A(5AA)
Subsection 16A(5AA) provides that a Medicare benefit is not payable in
respect of a pathology service that has been rendered by or on behalf of an
approved pathology practitioner (the rendering pathologist) pursuant to a
request made to the rendering pathologist by:
. the treating practitioner (paragraph 16A(5AA)(a)); or
. another approved pathology practitioner to whom the treating practitioner
has made a request for that service (paragraph 16A(5AA)(b));
unless the pathology specimen provided for the rendering of the pathology
service was collected from the patient by prescribed persons (e.g. the
patient or the treating practitioner) at prescribed locations (e.g. the
patient's residence or an approved collection centre).
Item 6 removes the reference in subsection 16A(5AA) to a request being made
"to the rendering pathologist".
Item 7 removes the reference in paragraph 16A(5AA)(b) to another approved
pathology practitioner "to whom the treating practitioner has made a
request for that service", and replaces it with a reference to another
approved pathology practitioner "who received a request for the service
made by the treating practitioner".
The amendments at items 6 and 7 are consequential to the amendments made to
subsection 16A(3) (items 2 and 3 refer).
The amended subsection will apply the specimen collection requirements in
paragraphs 16A(5AA)(c), (d) and (e) to a pathology service that is rendered
by or on behalf of an approved pathology practitioner, where the request
for the service is made by the patient's treating practitioner or by
another approved pathology practitioner who received a request for the
service made by the treating practitioner.
Items 8 and 9 - Paragraph 16A(5A)(a)
Subsection 16A(5A) provides that a Medicare benefit is not payable in
respect of a pathology service that has been rendered by or on behalf of an
approved pathology practitioner if the request for the service was made:
. to the approved pathology practitioner by the treating practitioner (the
requesting practitioner) (subparagraph 16A(5A)(a)(i)); or
. by another approved pathology practitioner (the requesting practitioner)
to whom the treating practitioner made the request (subparagraph
16A(5A)(a)(ii));
and the request was made as a result of conduct for which the approved
pathology practitioner or the requesting practitioner:
. has been convicted of an offence under Division 3 of Part IIBA of the Act
(subparagraph 16A(5A)(b)(i)); or
. has been ordered to pay a pecuniary penalty under Part VIA of the Act
(subparagraph 16A(5A)(b)(ii)).
Item 8 removes the reference in subparagraph 16A(5A)(a)(i) to a request for
a pathology service being made "to the approved pathology practitioner"
(that is, the approved pathology practitioner who renders the service).
Item 9 removes the reference in subparagraph 16A(5A)(a)(ii) to another
approved pathology practitioner "to whom the treating practitioner made the
request", and replaces it with a reference to another approved pathology
practitioner "who received a request for the service made by the treating
practitioner".
The amendments at items 8 and 9 are consequential to the amendments made to
subsection 16A(3) (items 2 and 3 refer).
The amended subsection will refer to a request for a pathology service that
is made by a treating practitioner or by an approved pathology practitioner
(other than the rendering approved pathology practitioner) who received a
request for the service made by the treating practitioner. There will no
longer be any reference in the subsection to a request being made to a
particular approved pathology practitioner.
Item 10 - Subsection 16A(8)
Subsection 16A(8) sets out the circumstances when a request for a pathology
service that is made to an approved pathology authority (i.e. the
proprietor of an accredited pathology laboratory) rather than to the
approved pathology practitioner who renders the service, will be deemed,
for the purposes of subsections 16A(3) and (5AA), to have been made to that
approved pathology practitioner.
This item repeals subsection 16A(8) as it is no longer relevant. The
requirement that a request for a pathology service that is rendered by or
on behalf of an approved pathology practitioner must be made to that
approved pathology practitioner has been removed from section 16A by other
items in this Bill. Therefore there is no need for a provision that deems
a request made to an approved pathology authority to have been made to the
rendering approved pathology practitioner.
Items 11 and 12 - Subsection 23DK(2)
Subsection 23DK(2) provides that, where an approved pathology practitioner
receives a written request for a pathology service from a patient's
treating practitioner, and that approved pathology practitioner makes a
request to another approved pathology practitioner for the service, the
first mentioned approved pathology practitioner must retain the written
request (or written confirmation of the request) for 18 months.
Item 11 removes from paragraph 23DK(2)(a) the words "to an approved
pathology practitioner (in this section referred to as the relevant
pathologist)". This amendment removes the reference to a request for a
pathology service being made to a particular approved pathology
practitioner. This change is consequential to the amendments made to
subsection 16A(3) (items 2 and 3 refer).
Item 12 amends paragraph 23DK(2)(c) by deleting the words "relevant
pathologist" and substituting the words "approved pathology practitioner
who received the request (the relevant pathologist)". This minor change is
consequential to the amendment to paragraph 23DK(2)(a) (item 11 refers).
Item 13 - Subsection 23DK(5)
Subsection 23DK(5) provides that where a practitioner makes a request for a
pathology service to an approved pathology practitioner otherwise than in
writing, and a Medicare benefit may become payable in respect of the
service, the practitioner must confirm the request in writing within 14
days (commencing on the day of the request).
This item removes the reference in this subsection to a request being made
"to an approved pathology practitioner". This amendment is consequential
to the amendments made to subsection 16A(3) (items 2 and 3 refer).
Item 14 - Subsection 23DK(11)
Subsection 23DK(11) provides that any reference to a request made to an
approved pathology practitioner in section 23DK includes a reference to a
request which is deemed, for the purposes of section 16A of the Act, to
have been made to that approved pathology practitioner.
This item repeals subsection 23DK(11) as it is no longer relevant.
Subsection 16A(8) of the Act, which provides for certain requests to be
deemed to be made to an approved pathology practitioner, is repealed by
item 10.
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