Contents
Part 1—Preliminary 1
1............ Name............................................................................................................................. 1
2............ Commencement............................................................................................................. 1
3............ Authority....................................................................................................................... 1
4............ Schedules...................................................................................................................... 1
5............ Definitions..................................................................................................................... 1
Part 2—Requirements for requests for pathology services 3
6............ Purposes of this Part..................................................................................................... 3
7............ Information about requesting practitioner...................................................................... 3
8............ Information about patient............................................................................................... 3
9............ Information about pathology service............................................................................. 4
10.......... Requirements applying to requests that specify an approved pathology practitioner..... 4
11.......... Requirements applying to further requests.................................................................... 4
Part 3—Terminating undertakings 5
12.......... Terminating undertakings.............................................................................................. 5
Schedule 1—Repeals 6
Health Insurance (Pathology Services) Regulations 1989 6
Part 1—Preliminary
1 Name
This instrument is the Health Insurance (Pathology Services) Regulations 2018.
2 Commencement
(1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.
| Commencement information |
| Column 1 | Column 2 | Column 3 |
| Provisions | Commencement | Date/Details |
| 1. The whole of this instrument | The day after this instrument is registered. | 9 March 2018 |
Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.
(2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.
3 Authority
This instrument is made under the Health Insurance Act 1973.
4 Schedules
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
5 Definitions
Note: A number of expressions used in this instrument are defined in the Act, including the following:
(a) hospital;
(b) item;
(c) out‑patient service;
(d) private patient;
(e) public patient;
(f) recognised hospital.
In this instrument:
Act means the Health Insurance Act 1973.
group of practitioners means 2 or more practitioners who are taken to constitute a group of practitioners under subsection 16A(9) or (10) of the Act.
treating practitioner, in relation to a pathology service, has the same meaning as in section 16A of the Act.
Part 2—Requirements for requests for pathology services
6 Purposes of this Part
This Part is made for the purposes of paragraph 16A(4)(b) of the Act.
7 Information about requesting practitioner
(1) A request for a pathology service must include the following information in relation to the treating practitioner or approved pathology practitioner who makes the request (the requesting practitioner):
(a) either:
(i) the surname and the initials of the given names of the requesting practitioner; or
(ii) if the requesting practitioner is a member of a group of practitioners and another member of the group has the same surname and initials as the requesting practitioner—the surname and such of the given names of the requesting practitioner as would distinguish him or her from the other members of the group;
(b) the address of a place of practice of the requesting practitioner;
(c) the provider number mentioned in subsection (3).
(2) If the request is made from a place of practice of the requesting practitioner, the address included under paragraph (1)(b) must be the address of that place.
(3) For the purposes of paragraph (1)(c), the requesting practitioner must have a provider number (within the meaning of the Health Insurance Regulations 1975) in respect of his or her place of practice at the address included in the request under paragraph (1)(b).
8 Information about patient
(1) A request for a pathology service must, subject to subsection 11(3), include the following information in respect of the person in relation to whom the service is requested:
(a) the name of the person;
(b) the address of the person;
(c) whether the person is a public patient in relation to a hospital;
(d) whether the person is a private patient in relation to a hospital;
(e) whether the request is made in the course of the provision in relation to the person of an out‑patient service at a recognised hospital.
(2) If the person is a private patient in relation to a hospital, the request may, with the consent of the person, include the following information:
(a) the name of the person’s private health insurer (if any);
(b) the membership number or other unique identifier allocated to the person by the insurer.
(3) If the person does not consent to the inclusion of the information mentioned in subsection (2):
(a) the request must not include the information; and
(b) the person’s failure to consent does not affect any entitlement the person may have to a medicare benefit, or a benefit payable by a private health insurer, in respect of the service.
9 Information about pathology service
A request for a pathology service must, subject to subsection 11(3), include the following information in respect of the service:
(a) a description of the service in terms or symbols that:
(i) would be generally understood by practitioners; and
(ii) are sufficient to identify the service for the purpose of ascertaining the item (if any) in which the service is specified;
(b) the date on which the service was determined to be necessary;
(c) whether the service is a pathology service that:
(i) relates to a bodily specimen obtained from a person while the person was an in‑patient of a hospital; and
(ii) is to be performed after the person has ceased to be such a patient.
10 Requirements applying to requests that specify an approved pathology practitioner
If a treating practitioner specifies an approved pathology practitioner on a request for a pathology service, the request must include:
(a) the clinical grounds for specifying an approved pathology practitioner; or
(b) a statement that the specification is on clinical grounds.
11 Requirements applying to further requests
(1) This section applies if:
(a) a treating practitioner makes a request (the first request) for a pathology service; and
(b) the first request is received by an approved pathology practitioner (the referring pathologist); and
(c) the referring pathologist makes a request (the further request) for the service.
(2) The further request must, subject to subsection (3), include the information relating to the treating practitioner that was included in the first request under section 7.
(3) The further request is not required to comply with sections 8 and 9 and subsection (2) of this section if:
(a) the further request relates only to the pathology service to which the first request relates; and
(b) the first request is attached to the further request.
Part 3—Terminating undertakings
12 Terminating undertakings
For the purposes of sections 23DE and 23DH of the Act, a notice of termination must be sent:
(a) by pre‑paid post to the Minister at the Department of Human Services, PO Box 1001, Tuggeranong, ACT 2901; or
(b) electronically to the Minister at the email or other electronic address specified by the Chief Executive Medicare for the purposes of this paragraph on the website of the Human Services Department.