Commonwealth Numbered Regulations - Explanatory Statements
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HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2011 (SLI NO 185 OF 2011)
EXPLANATORY STATEMENT
Select Legislative Instrument 2011 No. 185
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Regulations 2011
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.
Section 4AA of the Act provides that the regulations may prescribe a table of diagnostic imaging services that sets out items of R-type and NR-type diagnostic imaging services, the amount of fees applicable in respect of each item, and rules for interpretation of the diagnostic imaging services table. The Health Insurance (Diagnostic Imaging Services Table) Regulations 2010 (the 2010 Regulations) currently prescribe such a table.
Subsection 4AA(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4AA(1) cease to be in force and are taken to have been repealed on the day after the fifteenth sitting day of the House of Representative after the end of the period 12 months, commencing on the day on which the regulations are notified on the Federal Register of Legislative Instruments. The 2010 Regulations were registered on the Federal Register of Legislative Instruments on 28 October 2010 and commenced on 1 November 2010.
The Regulations repeal the 2010 Regulations and prescribe a new diagnostic imaging services table for the 12 month period commencing 1 November 2011. The Regulations set out items of diagnostic imaging services that are eligible for Medicare benefits, the amount of fees applicable for each item and rules for interpretation of the table. The new table reproduces the table contained in the 2010 Regulations with some amendments to the rules and schedule of services, including:
* Removing a number of requirements for positron emission tomography (PET) facilities including covered walkways between buildings, neurology facilities and accreditation for advanced training. Consultations with the diagnostic imaging industry have indicated that these three requirements are unnecessarily onerous and do not contribute to the quality of PET services.
* End-dating paragraph 2.4.3 (1)(b), which allows practitioners who have provided more than 400 PET services to continue to provide Medicare-eligible services without credentialing by the Joint Nuclear Medicine Credentialing and Accreditation Committee.
* Removing all references to nurse practitioners from items 55768 and 55770. These items provide for pregnancy related ultrasound scans after 22 weeks of gestation and are outside the scope of services that nurse practitioners can request.
As part of the ongoing management of the table, items 64990 and 64991 (which provide for additional bulk billing payments for diagnostic imaging services) are indexed to take effect from 1 November 2011.
Details of the Regulations are set out in the Attachment.
In January 2010 and again in December 2010, the Department of Health and Ageing wrote to diagnostic imaging peak bodies and key cancer organisations seeking their views on the current PET requirements. Through the consultation process, stakeholders indicated that certain requirements are unnecessarily onerous and do not contribute to the quality of PET services. The amendments were also supported by the Diagnostic Imaging Services Table Committee, which comprised a variety of representatives of diagnostic imaging, including representatives from the Australian and New Zealand Association of Physicians in Nuclear Medicine.
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 November 2011.
Authority: Subsection 133(1) of the
Health Insurance Act 1973
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2011
Regulation 1 - Name of Regulations
This regulation provides for the Regulations to be referred to as the Health Insurance (Diagnostic Imaging Services Table) Regulations 2011.
Regulation 2 - Commencement
This regulation provides for the Regulations to commence on 1 November 2011.
Regulation 3 - Repeal
This regulation repeals the Health Insurance (Diagnostic Imaging Services Table) Regulations 2010 (the 2010 Regulations).
Regulation 4 - Dictionary
This regulation provides that for the purpose of the Regulations, the dictionary at the end of the Regulations defines certain words and expressions.
Regulation 5 - Diagnostic Imaging Service Table
This regulation provides that the table of diagnostic imaging services (the Table) in Schedule 1 is prescribed for the purpose of subsection 4AA(1) of the Act.
Schedule 1 - Table of diagnostic imaging services
Schedule 1 sets out a diagnostic imaging service table which is similar to the Table in the 2010 Regulations except with changes to the following provisions:
* Part 1 - Preliminary; and
* Part 2 - Services and fees.
Part 1 - Preliminary
Schedule 1, Part 1, Division 1.2, Clause 1.2.5
This clause is amended to remove the note in subclause (4) that references the Health Insurance (Indium-labelled Octreotide Study) Determination HS/09/2006. The Determination has been revoked and item 61369 is now listed in the Table.
Part 2 - Services and fees
Schedule 1, Part 2, Division 2.1 Group I1 - Ultrasound
Clause 2.1.1, which specifies the exemptions to the reporting requirements for ultrasound services, is removed as it duplicates subclause 1.2.3(2) and is not required. The remaining clauses within this Division are renumbered.
References to subclause 2.1.5(2) in items 55718 and 55723 are removed for consistency. Other items listed in the subclause do not contain this reference.
All references to nurse practitioners in items 55768 and 55770 (which provide for pregnancy related ultrasound scans) are removed. Requesting rights for nurse practitioners were introduced on 1 November 2010. These changes are consequential to amendments to the Health Insurance Regulations 1975 which removed nurse practitioner requesting rights to item 55768. In addition and for consistency, all paragraphs in item 55770 are reordered to match all paragraphs in item 55768.
Schedule 1, Part 2, Division 2.2 Group I2 - Computed tomography
Clause 2.2.7, which specifies the exemptions to the reporting requirements for computed tomography services, are removed as it duplicates subclause 1.2.3(2) and is not required.
Schedule 1, Part 2, Division 2.3 Group I3 - Diagnostic radiology
Clauses 2.3.1, 2.3.3, 2.3.4 and 2.3.7, which specify the exemptions to the reporting requirements for certain diagnostic radiology services, are removed as they duplicate subclause 1.2.3(2) and are not required. The remaining clauses within this Division are renumbered.
Schedule 1, Part 2, Division 2.4 Group I4 - Nuclear medicine imaging
In the 2010 Regulations, subclause 2.4.2(1) provides that positron emission tomography (PET) services must be performed on a person at an accredited site. An accredited site means a site accredited by the Australian and New Zealand Association of Physicians in Nuclear Medicine (ANZAPNM) as a site for advanced training in PET. The reference to accredited site is removed from this subclause as this requirement is not necessary for the provision of quality PET services.
Subclause 2.4.2(1) is amended so that the range of PET items referenced is 61523 to 61610. This is a consequential amendment to the removal of item 61613.
An additional subparagraph is added to paragraph 2.4.3(1)(b) so that all requirements under this paragraph are met prior to 1 November 2011. This addition prevents any possibility of new, uncredentialed practitioners becoming eligible to provide PET services.
Currently, paragraph 2.4.5(1)(b) provides that owners or operators of PET equipment must provide a statutory declaration that includes information about whether the PET services are provided at an accredited site. This is removed as it is no longer a requirement for PET services to be performed at an accredited site.
Item 61613, which is for the evaluation of metastatic squamous cell carcinoma with catheterisation of the bladder, is removed. Items that include catheterisation are anomalous. Catheterisation is regularly performed without being mentioned in item descriptors.
Schedule 1, Part 2, Division 2.6 Group I6 - Management of bulk-billed services
Paragraph 2.6.1(4) currently references the Australian Standard Geographical Classification (ASGC) in relation to item 64991. This is updated to reflect the current standard. The ASGC 2010 can be found on the Australian Bureau of Statistics website. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1216.0July%202010?OpenDocument
The fees and benefits for items 64990 and 64991, following indexation, are amended as follows: item 64990 - new fee of $6.90; and item 64991 - new fee of $10.45.
Dictionary
The definition of (Anaes.) is updated to reference Clause 2.43.5 of Schedule 1 to the general medical services table. This provides a clearer definition of (Anaes.).
The entire definition of accredited site is removed as it is no longer a requirement for PET services to be provided at a site accredited by ANZAPNM as a site for advanced training in PET.
Clause 2.4.2 provides that PET services must be provided in a comprehensive facility. The definition of comprehensive facility is amended so that it is not a requirement for buildings within the facility to be linked via a covered pedestrian walkway. In addition, the requirement for a facility to perform neurology services is removed. These requirements are unnecessarily onerous for PET providers.
The note in the definition of non-metropolitan hospital referencing the ASGC is updated to reflect the current standard. The ASGC 2010 can be found on the Australian Bureau of Statistics website. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1216.0July%202010?OpenDocument
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