Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1997-98 DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS1997 NO. 297

STATUTORY RULES 1997 No. 297

Issued by the authority of the Minister for Health and Family Services

Health Insurance Act 1973

Health Insurance (1997-98 Diagnostic Imaging Services Table) Regulations

The Health Insurance Act 1973 (the Act) provides in pan for the payment of Medicare benefits for professional services rendered by medical practitioners and for certain professional services rendered by dental practitioners and optometrists.

Section 133 of the Act provides that the Governor-General may make regulations, for the purposes of the Act.

Section 4AA of the Act provides that regulations may prescribe a table of diagnostic imaging services (the table) and the Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations currently prescribe such a table. The Act provides that, if not sooner repealed, regulations made under section 4AA cease to have effect on the day after the 15th sitting day of the House of Representatives after the end of the twelve month period commencing from the date of Gazettal. The date of Gazettal of the current regulations was 30 October 1996.

Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for diagnostic imaging services set out in the table.

The purpose of the Regulations is to prescribe a new table of diagnostic imaging services and rules of interpretation which incorporate new services, the deletion of obsolete services and amendments to services and fees for other services. The Regulations also provide for the repeal of the Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations as amended.

Details of the Regulations are set out in the Attachment,

The Regulations came into effect from 1 November 1997.

ATTACHMENT

DETAILS OF THE HEALTH INSURANCE (1997-98 DIAGNOSTIC, IMAGING SERVICES TABLE) REGULATIONS,

Regulation 2 provides for the Regulations to commence on 1 November 1997.

Regulation 3 provides for the repeal of the Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations. as amended.

Regulation 4 prescribes a new table of diagnostic imaging services and rules of interpretation.

RULES OF INTERPRETATION

Amended rules have been introduced for the purpose of interpreting the table. These are as follows:

Rule 2 of the previous rules* has been amended by adding a further two items which are items from the General Medical Services Table. The items are referred to in the Diagnostic Imaging Services Table item descriptions and the amendment explains that they are items in the General Medical Services Table.

Rule 9 of the previous rules* has been amended by deleting reference to NR-type items for the purposes of defining a medical practitioner who may request the services set out in the Rule. As a written request is not required for NR-type items, reference to these items in the Rule is not necessary.

Rule 10 of the previous rules* has been amended by deleting reference to an item that has been deleted from the table and by increasing the value of the amount set out for the remaining item to reflect the effect of the general fee increase of 1.7 percent.

Rule 11 of the previous rules* has been amended by deleting reference to the preparation items that have been deleted from the table and by varying the reference for the remaining preparation items of the items with which they are associated.

Rule 13 of the previous rules* has been amended to reflect the deletion of item 61503. The item range would then read 61302 to 61499 (inclusive).

Rule 14 of the previous rules* has been amended by increasing the value of the amount set out for the item to reflect the effect of the general fee increase of 1.7 percent.

TABLE OF SERVICES AND FEES

Schedule fees for all items have been increased by 1.7 percent following a decision in the 1997-98 Budget.

Vascular Ultrasound Items

Previously existing items have been replaced by revised items.

The vascular section of ultrasound services has been restructured to provide itemisation by anatomical area rather than the present "catch-all" items. This would provide better information on the clinical use of vascular ultrasound and better information on which to undertake a further review. The restructure of these items has been undertaken on a cost neutral basis prior to the application of the 1.7 percent fee increase. The changes have the support of the Royal Australasian College of Radiologists, the Vascular Section of the Royal Australian College of Surgeons and the Australian and New Zealand Association of Physicians in Nuclear Medicine.

Computerised Tomography Items

Minor amendments have been made for computerised tomography items to clarify that, in some items, scans taken prior to intravenous contrast injection relate to scans of the region for the item.

The amendments have the support of the Royal Australasian College of Radiologists.

Diagnostic Radiology Items

The changes to diagnostic radiology items involve amendments to items, new items to better identify services and item deletions.

The amendments are for items that deal with soft tissues, where contrast media are used with X-rays. The descriptions and fees for the prime X-ray items were amended so that both the X-rays and preparation items are now combined into a single item., Where it was common practice for plain X-rays to be taken as part. of these studies, these have also been incorporated into the descriptions and fees for the prime item.

There are two new items for radiographic examination of breasts in conjunction with a surgical procedure (such as biopsy) and one for the X-ray of excised breast tissue following pre-operative localisation. Preparation items for angiography (by film technique) have been retained but will be restricted to angiography items.

The review of diagnostic radiology was conducted on a cost neutral basis by subgroup prior to the application of the 1.7 percent fee increase. The amendments have the support of the Royal Australasian College of Radiologists

Nuclear Medicine Imaging-Services

There are minor amendments to myocardial perfusion studies where reference to specific radiopharmaceuticals has been deleted. This follows the availability of additional radiopharmaceuticals.

A new item was introduced for scans of two or more body regions acquired separately for a whole, body study using gallium, Previously, itemisation made no distinction between one or more scans for whole body studies using gallium.

The "previous rules" or "previous rule" refers to rules current under the Health Insurance (1996-97 Diagnostic Imaging Services Table) Regulations.