{"id":"F2024L01221","name":"Health Insurance (Section 3C Pathology Services – Point-of-Care Testing Services) Determination 2024","slug":"health-insurance-section-3c-pathology-services-point-of-care-testing-services-determination-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":105385,"registerId":"commonwealth-F2024L01221-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name","content":"#### 1 Name\n\n  This instrument is the Health Insurance (Section 3C Pathology Services – Point‑of‑Care Testing Services) Determination 2024.","sortOrder":0},{"sectionNumber":"3","sectionType":"section","heading":"Authority","content":"#### 3 Authority\n\n  This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":1},{"sectionNumber":"4","sectionType":"section","heading":"Definitions","content":"#### 4 Definitions\n\n> Note: A number of expressions used in this instrument are defined in definitions section of the Act, including the following:\n\n    (a) item;\n    (b) professional service;\n    (c) schedule fee.\n  In this instrument:\n\n> Act means the Health Insurance Act 1973.\n\n> eligible Aboriginal and Torres Strait Islander health practitioner has the same meaning as in the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024.\n\n> eligible Aboriginal and Torres Strait Islander health worker has the same meaning as in the Health Insurance (Section 3C General Medical Services – Allied Health and other Primary Health Care Services) Determination 2024.\n\n> general medical services table means the table prescribed under subsection 4(1) of the Act.\n\n> health professional means a practice nurse, eligible Aboriginal and Torres Strait Islander health practitioner or eligible Aboriginal and Torres Strait Islander health worker.\n\n> medical practitioner has the same meaning as subsection 3(1) of the Act.\n\n> Modified Monash 6 area has the same meaning as in the general medical services table.\n\n> Modified Monash 7 area has the same meaning as in the general medical services table.\n\n> pathology service has the same meaning as subsection 3(1) of the Act.\n\n> pathology services table means the table prescribed under subsection 4A(1) of the Act.\n\n> practice nurse has the same meaning as in the general medical services table.\n\n> relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health Act 1953, relating to pathology services, professional services or items.\n\n> relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.\n\n> Schedule means a Schedule to this instrument.\n\n> (1) Unless the contrary intention appears, a reference in this instrument to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.","sortOrder":2},{"sectionNumber":"5","sectionType":"section","heading":"Treatment of relevant services","content":"#### 5 Treatment of relevant services\n\n  (1) For subsection 3C(1) of the Act, a relevant service provided in accordance with this instrument is to be treated, for the relevant provisions, as if:\n    (a) it were both a professional service and a pathology service; and\n    (b) there were an item in Group P9 of the pathology services table that:\n    (i) related to the service; and\n    (ii) specified for the service a fee in relation to each State, being the fee specified in Schedule 1 in relation to the service.\n\n> Note: For this Determination, an internal Territory is deemed to form part of the State of New South Wales – see subsection 3C(7) of the Act.","sortOrder":3},{"sectionNumber":"6","sectionType":"section","heading":"Application of items","content":"#### 6 Application of items\n\n  (1) Item 73813 applies to a service only if:\n    (a) the service is rendered at, or from, a practice location in:\n    (i) a Modified Monash 6 area; or\n    (ii) a Modified Monash 7 area;\n    (b) the medical practitioner providing the service, or the health professional providing the service on behalf of a medical practitioner, is employed by an organisation that:\n    (i) delivers health services; and\n    (ii) is participating in the First Nations Molecular Point‑of‑Care (PoC) Testing Program;\n    (c) the service is provided in accordance with the Program referred to in subparagraph (b)(ii);\n    (d) the service is conducted by a medical practitioner, or on behalf of a medical practitioner by a health professional, who has achieved competency as a PoC operator by the First Nations Molecular PoC Testing Program for the test(s) performed;\n    (e) the PoC test(s) gives valid patient result(s).","sortOrder":4}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"The instrument extends how the Act applies to point-of-care molecular tests by treating specified Program services as both professional and pathology services and by effectively creating corresponding Group P9 fee items for those services (s5). It simultaneously narrows who may claim the item by imposing geographic (Modified Monash 6–7), organisational participation (First Nations Molecular PoC Testing Program) and operator competency and result-validity conditions (s6)."},"complexity_factors":["Cross-references to multiple statutes and regulations (Health Insurance Act 1973, National Health Act 1953 and associated regulations) increase legal interdependence (see Authority and Definitions).","Extensive reliance on external definitions and another Determination for key terms (eg. 'eligible Aboriginal and Torres Strait Islander health practitioner/worker' and 'practice nurse'), requiring readers to consult multiple instruments (Definitions).","Treatment mechanism: the instrument treats specified services as both 'professional services' and 'pathology services' and creates an implied pathology table item rather than directly amending the pathology services table — a non-standard drafting approach that requires mapping to the Act's item structure (s5).","Geographic eligibility tied to Modified Monash 6 and 7 classifications narrows scope and requires matching practice locations to those classifications (s6(1)(a)).","Program participation requirement: services must be provided by organisations participating in the First Nations Molecular PoC Testing Program, creating dependency on an external program's rules and enrolment (s6(1)(b)–(c)).","Operator competency and validity conditions: providers must be accredited PoC operators under the Program and produce valid patient results, creating training, certification and quality-assurance obligations (s6(1)(d)–(e)).","State-specific fee specification via Schedule 1 and deeming rules (internal Territories treated as NSW) add administrative complexity to fee application and payment processing (s5 note and s5(1)(b)).","Limited scope of application of a single listed item (73813) within detailed eligibility constraints increases conditionality and compliance risk (s6)."],"plain_english_summary":"This Determination treats certain point-of-care molecular pathology tests as both professional and pathology services under s3C and links them to Group P9 fees (Schedule 1). Item 73813 is limited to tests done in Modified Monash 6–7 areas under the First Nations Molecular PoC Testing Program. It affects medical practitioners and authorised health professionals employed by participating organisations; Medicare funds the items, and providers must be accredited PoC operators who produce valid patient results, imposing training and compliance requirements (ss5–6)."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a new instrument with focused scope. It implements a specific program (First Nations Molecular Point-of-Care Testing Program) in defined remote areas. The scope is tightly constrained to this particular initiative and does not appear to have expanded beyond its original purpose of enabling Medicare rebates for rapid testing in remote Indigenous communities."},"complexity_factors":["13 defined terms in section 4, with 7 terms cross-referenced to other instruments or legislation","Nested eligibility conditions in section 6(1) with 5 cumulative requirements (location, employer, program participation, competency, valid results)","Incorporation by reference of external documents (First Nations Molecular PoC Testing Program requirements)","Dual classification of services (both professional service AND pathology service) requiring understanding of two different Medicare payment frameworks","Geographic restrictions using Modified Monash classification system (special remoteness categories)","Delegated authority structure - relies on definitions from parent Act and two other Determinations"],"plain_english_summary":"This law creates a new Medicare rebate for molecular point‑of‑care testing in the most remote Indigenous communities (Modified Monash 6–7). It lets trained doctors, nurses and Aboriginal health workers employed under the First Nations Molecular Point‑of‑Care Testing Program claim payments for on‑the‑spot diagnostic tests, improving timely detection and treatment of infectious diseases where lab access is limited."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-pathology-services-point-of-care-testing-services-determination-2024","history":"/api/acts/health-insurance-section-3c-pathology-services-point-of-care-testing-services-determination-2024/history","analysis":"/api/acts/health-insurance-section-3c-pathology-services-point-of-care-testing-services-determination-2024/analysis","conflicts":"/api/acts/health-insurance-section-3c-pathology-services-point-of-care-testing-services-determination-2024/conflicts","importantCases":"/api/acts/health-insurance-section-3c-pathology-services-point-of-care-testing-services-determination-2024/important-cases","documents":"/api/acts/health-insurance-section-3c-pathology-services-point-of-care-testing-services-determination-2024/documents"}}