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Legislative amendments relating to pathology and diagnostic imaging services

Changes have been made to legislation relating to pathology and diagnostic imaging services provided under Medicare.

Amendments to the Health Insurance Act 1973 (the Act) relating to pathology and diagnostic imaging services funded under Medicare came into effect on 1 March 2008. The changes were introduced in the Health Insurance Amendment (Inappropriate and Prohibited Practices and Other Measures) Act 2007.

Inappropriate and Prohibited Practices amendments

The majority of the changes clarify and strengthen previous provisions in the Act that aim to prevent inducements or threats that may lead to referrals for pathology or diagnostic imaging services. A new range of criminal and civil penalties has also been included in the amendments.

The changes are explained in the Frequently Asked Questions and Explanatory Guide to the Health Insurance Amendment (Inappropriate and Prohibited Practices and Other Measures) Act 2007 (PDF 179 KB)

In November 2007, a brochure outlining the changes was circulated to all those that might possibly be affected by the changes, i.e. anyone who can request a Medicare-funded pathology or diagnostic imaging services (requesters) and anyone who can provide those services (providers).
Brochure - Changes to legislation relating to Pathology and Diagnostic Imaging (PDF 158 KB)

Supporting legislation

The amendments allow for legislative instruments to be made to support the prohibited practices provisions in the Act.

In December 2007, the Department released two Discussion Papers for comment relating to the proposed content of the supporting legislation.
Prohibited Pathology Practices - Discussion Paper (PDF 110 KB)
Prohibited Diagnostic Imaging Practices - Discussion Paper (PDF 102 KB)
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After comments on the discussion papers were taken into account, the Minister for Health and Ageing, the Hon Nicola Roxon MP, approved two Determinations – one for diagnostic imaging and one for pathology. The Determinations set out benefits that providers of pathology or diagnostic imaging services are permitted to provide to requesters, and the conditions under which they are permitted. The Determinations supplement the list of permitted benefits that are set out in the Act.
Health Insurance (Permitted benefits – diagnostic imaging services) Determination 2008

Health Insurance (Permitted benefits – pathology services) Determination 2008

Under the Act, payments for property, goods or services are permitted, provided that the payments are not substantially different from the market value of the property, goods or services exchanged. Regulations are being developed which will clarify the concept of ‘substantially different from the market value’. Further details on the regulations will be circulated to all those that might be affected when they are finalised later this year.

Market Value Regulations

New Regulations to support the Health Insurance Amendment (Inappropriate and Prohibited Practices and Other Measures) Act 2007 have recently been made. Theses Regulations [Health Insurance Amendment Regulations 2009 (No.2)] are referred to as the ‘Market Value Regulations’.

The purpose of the Regulations is to amend the Health Insurance Regulations 1975 to set out a method for determining the amount that is to be the market value of property, goods or services and a method of working out whether the amount of a payment or of consideration for property, goods or services is substantially different from the market value of the property, goods or services.

The changes are explained in a communication brochure titled “Changes to Laws Relating to Pathology and Diagnostic Imaging (PDF 454 KB)”. This brochure is a summary of the key issues and responsibilities for health practitioners who can request or provide pathology or diagnostic imaging services.
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An HTML version of the above document is being prepared. If you are having problems accessing this document please contact legislativeamendments@health.gov.au

It is important to familiarise yourself with the new legislation and review any arrangements that may be affected. You may wish to seek independent legal advice to clarify the change in legislation and how it might impact your practice.

Other measures

The changes in the Act also allow the Minister for Health and Ageing to set out in a legislative instrument what formal qualifications and experience are necessary in order to become an approved pathology practitioner.

A Discussion Paper on the proposed content of the Ministerial Determination has been released for comment. Anyone wishing to submit comments should provide them to legislativeamendments@health.gov.au. Comments received by 20 June 2008 will be considered.

Discussion Paper – Ministerial Determination on the Formal Qualifications and Experience Needed to Become an Approved Pathology Practitioner (73 KB)
Attachment A: APP undertaking – August 2005 (109 KB)
Attachment B: Health Insurance (Accredited Pathology Laboratories – Approval) Principles 2002
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