EXPLANATORY STATEMENT

 

Select Legislative Instrument 2009 No. 369

 

Health Insurance Act 1973

 

Health Insurance Amendment Regulations 2009 (No. 6)

 

Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides, in part, 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 Act 1973 (the Act) and its regulations set the conditions under which diagnostic imaging services are eligible for Medicare benefits. Section 16EA coupled with the provisions in Division 5 of Part IIB, cover the conditions for the Diagnostic Imaging Accreditation Scheme (the Scheme). Specific provisions of the Scheme are incorporated in regulations and other subordinate legislation. The Scheme is designed to ensure that all Medicare Benefits Schedule funded diagnostic imaging services are provided from an accredited site.

 

The Regulations remove Regulation 12AA from the Health Insurance Regulations 1975 (the Principal Regulations). Regulation 12AA currently operates to exclude certain types of diagnostic imaging services from the first stage of the Scheme which commenced on

1 July 2008. This is because prior to 1 July 2008 there was a formal agreement between the Commonwealth and the radiology profession to implement an accreditation scheme for radiology services linked to the payment of Medicare benefits. Around 84 per cent of the total number of diagnostic imaging services performed annually under Medicare, are radiology services.

 

The remaining 16 per cent of diagnostic imaging services, namely cardiac ultrasound and cardiac angiography, obstetric and gynaecological ultrasound, and nuclear medicine imaging services (non-radiology services) are included in the Stage II Scheme which commences on

1 July 2010. This requires the repeal of Regulation 12AA.

 

Paragraph 16EA(1)(a) of the Act provides that unless the Minister otherwise directs, a Medicare benefit is not payable in respect of a diagnostic imaging service rendered by or on behalf of a medical practitioner unless the procedure is carried out at diagnostic imaging premises that are, or at a base for mobile diagnostic imaging equipment that is, accredited for that procedure under a diagnostic imaging accreditation scheme. Pursuant to

paragraphs 16EA(1)(b) and (c) respectively, similar restrictions apply in relation to the use of diagnostic imaging equipment (mobile or otherwise) ordinarily located at accredited premises.

 

Subsection 16EA(2) of that Act provides that this restriction does not apply in relation to a diagnostic imaging service prescribed by the regulations for the purposes of that subsection. For the purposes of subsection 16EA(2), regulation 12AA of the Principal Regulations prescribes that the following kinds of non-radiology diagnostic imaging services were exempt from the accreditation requirements of subsection 16EA(1) from 1 July 2008:

·      Cardiac Ultrasound (Group I1, Subgroup 2; Items 55113-55135);

·      Cardiac Angiography (Group I3, Subgroup 13; Items 59903, 59912, 59925, 59971, 59972 and 59973. Subgroup 16; Items 60918 and 60927);

·      Obstetric and Gynaecological Ultrasound (Group I1, Subgroup 5; Items 55700-55774); and

·      Nuclear Medicine Imaging (Group I4; Items 61302-61650).

 

The Regulations repeal regulation 12AA so that from 1 July 2010 the

Stage II Scheme includes practices providing non-radiology diagnostic imaging services. Accordingly, for the purposes of Medicare eligibility, all diagnostic imaging services, both radiology and non-radiology services, listed in the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 (the DIST Regulations) are required to be rendered from premises or a base accredited under the Scheme.

 

A separate Minute recommends that the DIST Regulations be amended to extend the Scheme to include non-radiology services so that all diagnostic imaging services are required to be rendered from premises or a base accredited under the Scheme as of 1 July 2010.

 

Since the Minister for Health and Ageing agreed to broaden the scope of the Diagnostic Imaging Accreditation Scheme (the Scheme) from 1 July 2010 to include the non-radiology services of cardiac ultrasound and angiography; obstetric and gynaecological ultrasound; and nuclear medicine imaging services, the Department has written to and met with members of the professional bodies representing the providers of non-radiology services.

 

A broad range of groups were consulted including the Royal Australian and New Zealand College of Obstetricians & Gynaecologists; Cardiac Society of Australia and New Zealand and the Australian and New Zealand Association of Physicians in Nuclear Medicine (ANZAPNM). The Department also released an Information Paper outlining the decision to broaden the scope of the Scheme and proposals for transitioning providers of non-radiology services into the Scheme by 1 July 2010. The Information Paper has been provided to around 30 professional and industry organisations representing providers of both radiology and non-radiology services.

 

In addition to advising stakeholders about the intention to broaden the Scheme, the Department undertook a review of services contained in Determinations made under subsection 3C(1) of the Health Insurance Act 1973. Where the services would need to be provided by a facility accredited under the Scheme, the Department assessed the appropriateness of maintaining or revoking the related Determinations. The transfer of two nuclear medicine imaging items permanently to the DIST Regulations is machinery in nature and does not impose any changes to the current conditions of service. The ANZAPNM has been consulted about the decision to broaden the scope of the Scheme to include nuclear medicine imaging services.

 

The Act specifies no conditions that need to be met 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 2010.