Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) AMENDMENT REGULATIONS 2001 (NO. 1) 2001 NO. 78

STATUTORY RULES 2001 No. 78

Issued by the Authority of the Minister for Health and Aged Care

Health Insurance Act 1973

Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2001 (No. 1)

Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations prescribing matters for the purposes of the Act.

The Act provides for payments to eligible persons for professional services by way of Medicare benefits.

Section 4AA of the Act provides that the table of diagnostic imaging services may be prescribed by the Regulations. The Health Insurance (Diagnostic Imaging Services Table) Regulations 2000 prescribe such a table.

Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services (including diagnostic imaging services) set out in the table which includes the Diagnostic Imaging Services Table (the Table).

The purpose of the proposed Regulations is to make a number of changes to the Table, as part of the ongoing management of the Table:

The Regulations incorporate the following changes to the Table:

•       two new musculoskeletal ultrasound items will be added; 55852 and 55854, for R-type and NR-type paediatric spine ultrasound. These will restore the Medicare rebate lost as an unintended consequence of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000, and

•       explanatory notes will be added to the Medicare benefits schedule to aid practitioners with interpretation of these new items;

The changes have been developed in consultation, where required, with the Musculoskeletal Subgroup. This group is comprised of representatives from the Royal Australian and New Zealand College of Radiologists, the Royal Australian College of General Practitioners, the Health Insurance Commission, the Australian College of Sports Physicians, the Australian Rheumatology Association, the Australian Sonographers Association and the Australian and New Zealand Association of Physicians in Nuclear Medicine.

Details of the Regulations are in the attachment.

The regulations commence on gazettal.

ATTACHMENT A

Details of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2001

Regulation 1 provides that the name of the regulations will be the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2001 (No. 1).

Regulation 2 provides for the regulations to commence on 1 May 2001.

Regulation 3 provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000 will be amended by Schedule 1 of the proposed Regulations.

The May 2001 Diagnostic Imaging Services Table differs from the previous tables in the following way:

The May 2001 Diagnostic Imaging Services Table differs from the previous tables in introducing two new item numbers. These are item numbers 55852 and 55854 pertaining to Musculoskeletal Ultrasound. Item number 55852 covers ultrasound scanning, on referral by a medical practitioner W, and 55854 will cover scanning in a situation where the patient has not been referred by a medical practitioner 'NR.

The aim of these inclusions is to ensure that paediatric spine, spinal cord and overlying subcutaneous tissue ultrasound services are recognised in the Medicare Benefits Schedule. Advice from the profession was that the items introduced by the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000 were sufficient for all current valid clinical applications. However, since then it has been recognised that there are valid clinical reasons for performing paediatric spinal ultrasounds, for which there are currently no item numbers. These additional items are a remedy for this situation.