Health Insurance (Pathologist-determinable Services) Amendment Determination (No. 2) 2020

I, RENAYE LUCCHESE, delegate of the Minister for Health, make the following Determination.

Dated 23 April 2020

Renaye Lucchese

Contents

1  Name

2  Commencement

3  Authority

4  Schedules

Schedule 1— Amendments

1  Name

  This instrument is the Health Insurance (Pathologist-determinable Services) Amendment Determination (No. 2) 2020.

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.

 Note: This table relates only to the provisions of this instrument as originally made.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 subsection 4BA of 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  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1— Amendments

Health Insurance (Pathologist-determinable Services) Determination 2015

1.       Subsection 5(b)(iii) (table)

Repeal and replace:

Note: Items 72860, 73332, 73336, 73337, 73341, 73342 and 73344 are specified in a determination made under subsection 3C(1) of the Act.

1.        Paragraph 5(c)

Repeal and replace:

(c) a pathology service that is mentioned in items 69316, 69317, 69319, 69494, 69495, 69496, 69497 or 69498 of the pathology services table and:

 (i) is rendered, by or on behalf of, an approved pathology practitioner who is a recognised pathologist; and

 (ii) is a service that the approved pathology practitioner determines to be necessary on the basis of:

(A) information provided by a treating practitioner in relation to a pathology service mentioned in items 69303, 69306, 69312, 69318, 69321 or 69345 of the pathology services table, that was rendered to the patient by, or on behalf of, the approved pathology practitioner pursuant to a request that complied with paragraph 16A(4)(a) or (b) of the Act; or

(B) the nature or appearance of the pathology specimen collected for a pathology service mentioned in items 69303, 69306, 69312, 69318, 69321 or 69345 of the pathology services table, that was rendered to the patient by, or on behalf of, the approved pathology practitioner pursuant to a request that complied with paragraph 16A(4)(a) or (b) of the Act; or

(C) information learned from a pathology service mentioned in items 69303, 69306, 69312, 69318, 69321 or 69345 of the pathology services table, that was rendered to the patient by, or on behalf of, the approved pathology practitioner pursuant to a request that complied with paragraph 16A(4)(a) or (b) of the Act.

1.        Section 5 (after paragraph 5(c))

Insert:

(d) a pathology service that is mentioned in item 72860, which is specified in a determination made under subsection 3C(1) of the Act and:

1.                  An initial service that is described in an item in Group P5 (other than item 72860), P6 or P7 of the pathology services table was rendered in a patient episode for the patient by, or on behalf of, the approved pathology practitioner pursuant to a request that complied with paragraph 16A(4) (a) or (b) of the Act; and
2.                Following the initial service, the treating practitioner determines that a service described in an item in Group P7 (the subsequent P7 service) is clinically necessary; and
3.              following a request from the treating practitioner, the pathologist who rendered the initial service, determines they are unable to perform the subsequent P7 service and consequently determines a service described under item 72860 is required to select appropriate tissue samples for referral to a different accredited pathology laboratory for performance of the subsequent P7 service; and
4.              the subsequent P7 service and a service under item 72860 are rendered in a different accredited pathology laboratory, by or on behalf of, an approved pathology practitioner who is a recognised pathologist.