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Health Insurance Amendment (Pathology Requests) Bill 2010

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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.