Key changesAll changes are stated in the Health Insurance Amendment Inappropriate and Prohibited Practices and Other Measures Act 2007, but collectively they are expected to:
- increase consumer choice
- discourage inducement or threat
- protect patient rights.
- increase patient choice by removing restrictions on the selection of pathology and diagnostic imaging providers
- prohibit inappropriate commercial relationships between requesters and providers of pathology and diagnostic imaging services
- discourage the delivery of pathology or diagnostic imaging services as a result of inducement or threat
- require that a branded pathology or diagnostic imaging request form is available for use by requesting practitioners and includes a ‘patient advisory statement’.
Key pathology legislation
- Health Insurance Act 1973
- Health Insurance Amendment Regulation 2012 (No. 2)
- Health Insurance (Pathology Services) Amendment Regulation 2012 (No. 1)
- Health Insurance Amendment (Pathology Requests) Act 2010
- Health Insurance (Accredited Pathology Laboratories—Approval) Principles
- Health Insurance (Eligible Collection Centres) Approval Principles
Key diagnostic imaging legislation
- Health Insurance Act 1973
- Health Insurance Regulations 1975
- Health Insurance (Diagnostic Imaging Services Table) Regulations 2014
- Health Insurance (Diagnostic Imaging Accreditation) Instrument 2010
Why is this important?The changes to the Health Insurance Act 1973 seek to ensure that referrals are made on the basis of patient clinical-need that is in the best interest of the patient and not as a result of commercial arrangements that may be either illegal or unethical and that may jeopardise best patient outcomes or result in over-servicing.
What hasn’t changed?There remains a legislative requirement that a request for a pathology/diagnostic imaging service be made, but it is no longer a requirement that the request be made to a particular pathology/diagnostic imaging practitioner except if the requester specifies (for clinical reasons) a particular practitioner/authority.
Who is affected?The amended law affects anyone who can request or provide Medicare-eligible pathology or diagnostic imaging services such as GPs, medical specialists, dental practitioners, podiatrists, physiotherapists, osteopaths and chiropractors.
Amendments detailsA branded request form is one that is produced and distributed by or on behalf of a diagnostic imaging or pathology provider and that displays corporate/business details of that or another provider. Since August 2012, it has been a requirement that a branded pathology or diagnostic imaging provider request form must include a patient advisory statement.
Wording options for branded pathology or diagnostic imaging request forms‘Request forms for diagnostic imaging services must include a statement that informs the patient that they may obtain the services from a provider of their choice and are not restricted to the provider named on the request form’. See section 19 of the Health Insurance Regulations 1975
Your doctor has recommended that you use (insert name of pathology provider). You are free to choose your own pathology provider. However, if your doctor has specified a particular pathology on clinical grounds, a Medicare rebate will only be payable if that pathologist performs the service. You should discuss this with your doctor.
Your treating practitioner has recommended that you use (insert name of pathology provider). You are free to choose your own provider. However, if your treating practitioner has specified a particular provider on clinical grounds, a Medicare rebate will only be payable if that provider performs the service. You should discuss this with your treating practitioner.
- Frequently Asked Questions and Answers about legislative amendments.