EXPLANATORY STATEMENT

 

Select Legislative Instrument 2009 No. 236

 

Health Insurance Act 1973

 

Health Insurance (Pathology Services Table) Regulations 2009

 

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 pathology services table. The Health Insurance (Pathology Services Table) Regulations 2008 (the 2008 Regulations) currently prescribe such a table.

 

Subsection 4A(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4A(1) cease to be in force and are taken to have been repealed on the day after the 15^th sitting day of the House of Representatives after the end of the period of

12 months, commencing on the day on which the regulations are notified on the Federal Register of Legislative Instruments. The 2008 Regulations were registered on the Federal Register of Legislative Instruments on 21 October 2008 and commenced on 1 November 2008.

 

The purpose of the Regulations is to repeal the 2008 Regulations and prescribe a new pathology services table for the 12 month period commencing on 1 November 2009. The Regulations set out items of pathology services which are eligible for Medicare benefits, the amount of fees applicable in respect of each item and rules for interpretation of the table. The new table reproduces the table contained in the 2008 Regulations with some changes to the rules of interpretation and to the schedule of services and fees.

 

The following changes to the table have been approved through the 2009/10 Budget process and are recommended to take effect from 1 November 2009:

 

·        fees are be reduced for certain Pathology Episode Initiation items;

·        a new group of items (Group P13) are added to the schedule to provide a bulk billing incentive; and

·        consequential rule changes are made to reflect the above.

 

Details of the Regulations are set out in the Attachment.

 

These changes were developed through internal-to-government Budget processes and have reached the form of the current proposal as a result of a Cabinet decision. These processes were Budget-in-Confidence and thus stakeholders could not be engaged in them. However, submissions to the 2009/10 Budget emerged from a Strategic Review of Pathology and Diagnostic Imaging Services conducted by the Department of Health and Ageing in the

12 months prior. This Review included broad and extensive consultation with key stakeholders, including the Royal College of Pathologists of Australasia, the National Coalition of Public Pathology and the Australian Association of Pathology Practices. Approximately 30 submissions were received and considered.

 

The Act specifies no conditions that need to be satisfied 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 November 2009.

 

 

 

ATTACHMENT

 

 

DETAILS OF THE HEALTH INSURANCE (PATHOLOGY SERVICES TABLE) REGULATIONS 2009

 

Regulation 1 – Name of Regulations

 

This regulation provides for the Regulations to be referred to as the Health Insurance (Pathology Services Table) Regulations 2009.

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on 1 November 2009.

 

Regulation 3 – Repeal

 

This regulation repeals the Health Insurance (Pathology Services Table) Regulations 2008 (as amended).

 

Regulation 4 – Definitions

 

This regulation provides that for the purpose of the Regulations, Act means the Health Insurance Act 1973 and this table means the Regulations.

 

Regulation 5 – Pathology Services Table

 

This regulation provides that the table of pathology services in Schedule 1 is prescribed for the purposes of subsection 4A(1) of the Act.

 

Schedule 1 – Table of pathology services

 

Schedule 1 sets out a pathology services table which is similar to the table in the Health Insurance Table (Pathology Services Table) Regulations 2008 but with changes to the following provisions:

·        Part 2 – Rules of interpretation; and

·        Part 3 – Services and fees;

 

Part 2 – Rules of interpretation

 

Rule 18A of Part 2 is changed. Paragraph (3)(b) is amended to include a reference to Group P13 (bulk billing incentive for episodes including a P10 service). This makes the new group of bulk billing incentive items exempt from the pathology coning rule, which limits the number of items that can be claimed within a pathology episode. This rule otherwise limits the potential for these items to be claimed in combination with other items and thus prevent them from operating effectively.

 

Part 3 – Services and fees

 

Four Pathology Episode Initiation (PEI) items have their fees reduced:

·        Item 73928, for collection at an approved collection centre, has its fee reduced from $17.40 to $6.00.

·        Item 73930, for collection from a hospital in-patient, has its fee reduced from $17.70 to $6.00.

·        Item 73936, for collection by the patient, has its fee reduced from $9.80 to $6.00.

·        Item 73938, for collection by a treating practitioner, has its fee reduced from $9.80 to $8.00.

 

This is a Budget measure from the 2009/10 Budget and is intended to save money to the Medicare Benefits Schedule.

 

A new group of items is created. Titled “Group P13 – Bulk billing incentive for episodes consisting of a P10 service,” comprises eight items. The fees for these new items range from $1.60 to $4.00. The item to be claimed depends on the PEI item claimed for the episode, which varies the incentive depending on the context. These items can only be claimable when a whole episode is bulk billed.