EXPLANATORY STATEMENT

 

 

Select Legislative Instrument 2009 No. 370

 

Health Insurance Act 1973

 

Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (No. 6)

 

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 Act provides, in part, for payments of Medicare benefits in respect of professional services rendered to eligible persons. 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 prescribed tables.

 

Subsection 4AA(1) of the Act provides that the regulations may prescribe a table of diagnostic imaging services, the amount of fees applicable in respect of each item and the rules for interpretation of the table. Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 (the Principal Regulations) currently prescribe such a table.

 

From 1 July 2010, the Regulations insert two new nuclear medicine items, item 61369 and item 61650, into Schedule 1 to the Principal Regulations. Originally, these nuclear medicine imaging items were set out in separate 3C Determinations made under subsection 3C(1) of the Act for the purpose of monitoring and evaluating the volume of use and cost to the Medicare outlays. Since the introduction of public funding for these nuclear medicine items, usage has been low. There is no longer a need for these items to be managed in this way.

 

Inserting item 61369 and item 61650, (currently contained in the Health Insurance

(Indium-labelled Octreotide Study) Determination HS/09/2006; and the Health Insurance (LeukoScan) Determination HS/08/2006 respectively), into Schedule 1 to the Principal Regulations means that these items are captured under the Diagnostic Imaging Accreditation Scheme (the Scheme) and are required from 1 July 2010 to be rendered from an accredited practice to be eligible for a Medicare benefit.

 

The Act contains the framework for the Scheme, including the approval of persons to accredit. In the Act, section 16EA coupled with the provisions in Division 5 of Part IIB, cover the conditions for the Scheme. The Scheme is being introduced in stages.

 

The Stage 2 Scheme commences on 1 July 2010 and covers all diagnostic imaging items of service prescribed in the Principal Regulations. The Stage 1 Scheme commenced on 1 July 2008 and covers practices providing radiology services. The Stage 2 Scheme will continue the arrangements for practices providing radiology services and commence the arrangements for practices providing only non-radiology services or a combination of radiology and non-radiology services, not accredited under the Scheme.

 

Details of the Regulations are set out in the Attachment.

 

Consultation

 

In February 2009, the Minister for Health and Ageing, the Hon Nicola Roxon MP agreed that from 1 July 2010 the scope of the Diagnostic Imaging Accreditation Scheme be broadened to include all diagnostic imaging services, both radiology and non-radiology services, listed in the Diagnostic Imaging Services Table of the Medicare Benefits Schedule (MBS). The Department of Health and Ageing (the Department) commenced consultation about the decision to broaden the scope of the Scheme in early March 2009. The Department wrote to peak representative organisations for providers of non-radiology services including the Australian and New Zealand Association of Physicians in Nuclear Medicine, the Cardiac Society of Australia and New Zealand and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Also during that month, the Department met with members of the Executive of each of these organisations to discuss the implementation arrangements.

 

In April 2009, the Department released its consultation paper “Broadening the Scope of the Accreditation Scheme” 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 was provided to all State and Territory Health Departments and around 30 professional and industry organisations representing all providers of services. Consultation with non-radiology providers focused on enabling their incremental participation and keeping the compliance burden to a minimum.

 

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 2010.

 

 

ATTACHMENT

 

DETAILS OF THE HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) AMENDMENT REGULATIONS 2009 (No. 6)

 

Regulation 1 – Name of Regulations

 

Regulation 1 provides that the title of the Regulations is the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (No. 6).

 

Regulation 2 – Commencement

 

Regulation 2 provides for the Regulations to commence on 1 July 2010.

 

Regulation 3 – Amendment of Health Insurance (Diagnostic Imaging Services Table) Regulations 2009

 

Regulation 3 provides that the Principal Regulations are amended as set out in
Schedule 1.

 

Schedule 1 – Amendments to Services and Fees

 

Item [1] Schedule 1, Part 3, after item 61368

Item 1 inserts into Schedule 1, Part 3, after item 61368, the nuclear medicine imaging item 61369 – Indium-labelled Octreotide Study. This item sets out the service and assign to the service the applicable item number, item descriptor and fee.

Item [2] Schedule 1, Part 3, item 61505, note

Item 2 removes the note at the end of item 61505 in Schedule 1, Part 3 that refers to item 61650 as being taken as an item in the table for the purpose of the Health Insurance (LeukoScan) Determination HS/08/2006, given that this Determination will be repealed on 1 July 2010.

 

Item [3] Schedule 1, Part 3, after item 61505, in Group I4

Item 3 insert into Schedule 1, Part 3, after item 61505, in Group I4, the nuclear medicine imaging item 61650 – LeukoScan Study. This item sets out the service and assign to the service the applicable item number, item descriptor and fee.