Health Insurance (1991-1992 Diagnostic Imaging Services Table) Regulations 1991 No. 352
EXPLANATORY STATEMENT STATUTORY RULES 1991 No. 352
Issued by the authority of the Minister for Health, Housing and Community Services. Health Insurance Act 1973
Health Insurance (1991-1992 Diagnostic Imaging Services Table) Regulations
Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor- General may make regulations for the purposes of the Act.
Section 4AA of the Act provides that the regulations may prescribe a table of diagnostic imaging services. The Health Insurance (Diagnostic Imaging Services Table) Regulations prescribe such a table.
Section 9 of the Act provides that, in effect Medicare benefits shall be calculated by reference to the fees for diagnostic imaging services set out in the table of diagnostic imaging services (the table) in the Schedule to the Act.
The 1991-1992 Regulations amend the table of diagnostic imaging services and its rules for interpretation and replace the 1991 Regulations.
The table has been restructured into "Groups" and "Subgroups" (in place of the previous "Parts" and "Divisions") in line with the restructuring of the general medical services table as recommended by the Australian Audit Office in its audit of the Medicare Benefits Schedule (Report No. 26 of December 1989). In addition the item numbering system has been upgraded to five digits.
Three new items have been added to the table. One service was previously covered by ministerial determination under section 3C of the Act. The other two services have been recommended for inclusion for payment of Medicare benefits by the Medicare Benefits Advisory Committee.
As announced in the 1991-1992 Federal Budget, an increase of 3.57 per cent in the fees for nuclear medicine services is incorporated in the table. The fee increase has not been applied to other services in the table which are to be restructured from 1 February 1992. Cabinet approved the increase in fees for nuclear medicine, with effect from 1 November 1991, on 16 July 1991. This fee increase was subsequently deferred until 1 December 1991 in line with the Government's decision to defer other Budget decisions relating to Medicare.
The fee increase of 3.57 per cent was a Government decision based on consideration of movements in the Average Award Rates of Pay Index and the Consumer Price Index and taking into account overall economic policy.
The rules of interpretation of the table have been updated to reflect the restructuring of the table and the conversion to five-digit item numbers.
Overview
The Health Insurance (1991-1992 Diagnostic Imaging Services Table) Regulations 1991 were introduced to amend the table of diagnostic imaging services as prescribed under Section 4AA of the Health Insurance Act 1973. These regulations were enacted by the Minister for Health, Housing and Community Services to ensure that the table of diagnostic imaging services is updated to reflect changes in medical services and their corresponding fees, thus maintaining the integrity and relevance of Medicare benefits. The restructuring of the table into "Groups" and "Subgroups" aligns with recommendations from the Australian Audit Office, aiming to streamline the classification of services and improve the accuracy of Medicare benefits calculation.
The 1991-1992 Regulations also incorporate a 3.57 per cent increase in the fees for nuclear medicine services, as announced in the 1991-1992 Federal Budget. This increase, initially set to take effect from 1 November 1991 but later deferred to 1 December 1991, was based on economic considerations, including movements in the Average Award Rates of Pay Index and the Consumer Price Index. This adjustment ensures that the fees for diagnostic imaging services remain reflective of current economic conditions, supporting the policy objective of providing equitable and sustainable healthcare benefits.
Scope and Application
The Health Insurance (1991-1992 Diagnostic Imaging Services Table) Regulations 1991, made under Section 133 of the Health Insurance Act 1973, apply to diagnostic imaging services within the Medicare scheme, detailing a table of services and associated fees. This table is essential for the calculation of Medicare benefits for these services, as mandated by Section 9 of the Act. The regulations specifically target healthcare providers and patients involved in diagnostic imaging services and are applicable nationally across Australia, ensuring a uniform approach to fee structuring and reimbursement. The Act provides for adjustments and updates to the table of diagnostic imaging services, including the introduction of new items and the restructuring of the table into Groups and Subgroups with a five-digit item numbering system, reflecting recommendations from the Australian Audit Office and decisions from the Medicare Benefits Advisory Committee. Additionally, the regulations incorporate a fee increase for nuclear medicine services, which was approved by Cabinet and subsequently deferred. These amendments and the overall application of the regulations are designed to ensure that the Medicare Benefits Schedule remains current and reflective of economic factors and healthcare needs.
Key Provisions
The Health Insurance (1991-1992 Diagnostic Imaging Services Table) Regulations 1991 No. 352, made under the Health Insurance Act 1973, primarily amend the table of diagnostic imaging services by reorganising it into "Groups" and "Subgroups" instead of the previous "Parts" and "Divisions" (section 4AA). This change aligns with the restructuring of the general medical services table, as recommended by the Australian Audit Office. The new regulations also update the item numbering system to a five-digit format. Additionally, three new items have been added to the table, with one service previously covered by a ministerial determination and the other two recommended by the Medicare Benefits Advisory Committee for payment of Medicare benefits. As per the 1991-1992 Federal Budget announcement, a 3.57 per cent increase in fees for nuclear medicine services has been incorporated into the table, effective from 1 December 1991. This fee adjustment was based on economic considerations, including movements in the Average Award Rates of Pay Index and the Consumer Price Index.
The Act imposes several obligations on the parties involved, including medical service providers and the government. Medical service providers must adhere to the updated table of diagnostic imaging services when calculating Medicare benefits for diagnostic imaging services (section 9). The government, through the Minister for Health, Housing and Community Services, is responsible for approving and implementing these regulations. The Minister must ensure that the table accurately reflects the agreed-upon fees and services, and that these changes are communicated effectively to all stakeholders, including healthcare providers and the public. The Minister is also responsible for monitoring compliance with the new regulations and taking appropriate action if any discrepancies or non-compliance are identified.
The Regulations include provisions for potential breaches and associated penalties. While the Explanatory Statement does not detail specific offences or penalties, it is reasonable to infer that any non-compliance with the prescribed table of diagnostic imaging services could result in legal consequences. For instance, healthcare providers who do not adhere to the updated fees and services outlined in the table may face financial penalties or other enforcement actions. Additionally, the government may take legal action against providers who fail to comply with the regulations, potentially leading to fines or other civil or criminal penalties as prescribed by the Health Insurance Act 1973. The exact nature and severity of these penalties would depend on the specific circumstances of the breach and the provisions of the Act.