EXPLANATORY STATEMENT

 

Select Legislative Instrument 2008 No. 110

 

Health Insurance Act 1973

 

Health Insurance Amendment Regulations 2008 (No. 1)

 

Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides that the

Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.

 

The Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007 (DIAA) enacted the framework for a Diagnostic Imaging Accreditation Scheme (the Scheme). The Scheme will provide accreditation for all radiology services listed in the Diagnostic Imaging Services Table (DIST) from 1 July 2008. The DIST is prescribed by the Health Insurance (Diagnostic Imaging Services Table) Regulations 2007 pursuant to subsection 4AA(1) of the Act. The Scheme will not cover cardiac ultrasound and cardiac angiography; obstetric and gynaecological ultrasound; or nuclear medicine imaging.

 

Amendments made to the Act by the DIAA provide that after 1 July 2008, Medicare benefits will only be payable for diagnostic imaging services where the diagnostic imaging procedure performed as part of the service is carried out at premises (or using equipment from a base for mobile diagnostic imaging equipment) accredited under the Scheme.

 

The purpose of the Regulations is to amend the Health Insurance Regulations 1975 (the Principal Regulations) to give effect to a number of provisions which are incidental to the introduction of the Scheme.

 

Specifically, the Regulations :

 

(1)       exempt diagnostic imaging services that are outside the scope of the Scheme from the accreditation requirement;

(2)       prescribe the information about the accreditation that is required when applying for registration on the Diagnostic Imaging Register maintained by Medicare Australia when the premises or base is accredited at the time of the application; and

(3)       prescribe certain information about the accreditation status of diagnostic imaging premises and bases for mobile diagnostic imaging equipment to be recorded on the Diagnostic Imaging Register.

 

Details of the Regulations are set out in the Attachment.

 

Consultation on the Scheme commenced in August 2006. The Department consulted widely with approximately 168 organisations, the principal parties during the initial phase of consultation being the RANZCR and ADIA representing practice owners. The views of diagnostic imaging stakeholders who contributed to the consultation process were generally supportive of the accreditation scheme but were concerned about the cost of accreditation; the impact on businesses and healthcare consumers; and the implementation timetable. In direct response to stakeholder feedback, the Scheme will be introduced in two stages. These Regulations are to be implemented as ancillary to Stage 1 of the Scheme (which comprises of implementing entry level practice requirements).

The Act specifies no conditions that need to be satisfied before the power to make the Regulations may be exercised.

 

The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

The Regulations commence on 1 July 2008.

 

ATTACHMENT

 

Details of the Health Insurance Amendment Regulations 2008 (No. 1)

 

1 Name of Regulations

This regulation provides that the Regulations are the Health Insurance Amendment Regulations 2008 (No. 1).

 

2 Commencement

This regulation provides that the Regulations commence on 1 July 2008.

 

3 Amendment of Health Insurance Regulations 1975

This regulation provides that Schedule 1 amends the Health Insurance Regulations 1975.

 

Schedule 1 Amendments

 

Item 1

For subsection 16EA (2) of the Act, item 1 inserts a new regulation 12AA to prescribe those diagnostic imaging services that fall outside the scope of the diagnostic imaging accreditation scheme and are therefore excluded from the accreditation requirement of subsection 16EA(1). The diagnostic imaging services prescribed in regulation 12 AA are those in:

(a) subgroup 2 of Group I1 (cardiac ultrasound) of the Diagnostic Imaging Services Table;

(b) subgroup 5 of Group I1 (obstetric and gynaecological ultrasound) of the Diagnostic Imaging Services Table;

(c) subgroup 16 of Group I3 (cardiac procedure) of the Diagnostic Imaging Services Table;

(d) Group I4 (nuclear medicine imaging) of the Diagnostic Imaging Services Table;

(e) items 59903–59925 (inclusive) (cardiac angiography) of the Diagnostic Imaging Services Table; and

(f) items 59971–59973 (inclusive) (cardiac angiography) of the Diagnostic Imaging Services Table.

 

Currently, Medicare outlays for services in the Diagnostic Imaging Services Table are managed under four separate agreements. The agreement covering radiology services includes a commitment to introduce an accreditation scheme linked to the payment of Medicare benefits. The three other agreements covering cardiac ultrasound and angiography, obstetric and gynaecological ultrasound, and nuclear medicine imaging did not include a commitment to establish an accreditation scheme linked to the payment of Medicare benefits. Accordingly, the services covered by the three latter agreements are excluded for the accreditation requirements.

 

Item 2

Item 2 makes minor amendments to subparagraph 20A (b) (iv) to enable the inclusion of the new paragraph 20A (c) (see item 3 below).

Item 3

Item 3 inserts a new paragraph 20A (c) to prescribe the information about the accreditation that is required in an application for registration on the Diagnostic Imaging Register. The information about the accreditation is only necessary if the premises or base is accredited under a diagnostic imaging accreditation scheme at the time of the application.

 

Item 4

 

Item 4 makes a minor amendment to the format of regulation 20B to allow for the inclusion of new subregulation 20B (2) (see item 5 below).

 

Item 5

Item 5 inserts a new subregulation 20B (2). Subregulation 20B (2) ,pursuant to subsections 23DZZIAB(1) and (2) of the Act, prescribes the information to be included on the Diagnostic Imaging Register in relation to accredited diagnostic imaging premises or accredited bases for mobile diagnostic imaging equipment. The information is the same as the accreditation details of the premises or base provided on the application for registration. The required information is the name of the approved accreditor; the commencement date for the accreditation; the diagnostic imaging procedures for which the premises are, or base is, accredited or is not accredited; and the expiry date for the accreditation.