Health Insurance (1991 Diagnostic Imaging Services Table) Regulations 1991 No. 86
EXPLANATORY STATEMENT STATUTORY RULES 1991 No. 86 HEALTH INSURANCE ACT 1973
HEALTH INSURANCE (1991 DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS
The Health Insurance Act 1973 (the Act) provides in part for the payment of Medicare benefits for professional services rendered by medical practitioners, and certain professional services rendered by dental practitioners and optometrists.
Section 133 of the Act provides that the Governor-General may make regulations for the purposes of the Act.
The Community Services and Health Legislation Amendment Act (No.2) 1990, which received Royal Assent on 28 December 1990, amended the Act by introducing new provisions governing the payment of Medicare benefits for diagnostic imaging services (i.e. diagnostic radiology, computerised tomographic scanning, ultrasound, magnetic resonance imaging and nuclear scanning).
The diagnostic imaging provisions of the Act provide that, except in certain circumstances, Medicare benefits are only payable for a diagnostic imaging service if it is rendered by a medical practitioner pursuant to a written request from another practitioner who has no financial interest in the rendering of that service. The services which are subject to the written request requirement are classified as "R-type" services. Practitioners entitled to request "R-type" imaging services are medical practitioners, dental practitioners and chiropractors, although the last two may only request, certain services.
Services not subject to the written request requirement are classified as "NR-type" services. The services in this category are those which have historically been recognised as falling within the competence of general practitioners. They include X- rays of the extremities, shoulder, chest and abdomen.
Section 4AA of the Act provides for the making of regulations to prescribe a new table of diagnostic imaging services which sets out items of R-type and NR-type diagnostic imaging services, the amount of fees applicable in respect of each item and the rules for interpretation of the table. Other provisions of the Act provide for the making of regulations to administer various matters in the new diagnostic imaging legislation. These matters are dealt with in the Health Insurance Regulations (Amendment).
The Health Insurance (1991 Diagnostic Imaging Services Table) Regulations bring together the items of diagnostic imaging service currently listed in the general medical
services table. These items classify services as either R-type or NR-type diagnostic imaging services and a fee is set in respect of each item. The Regulations also introduce Rules of Interpretation for the new table.
Overview
The Health Insurance (1991 Diagnostic Imaging Services Table) Regulations 1991 were enacted to address the need for a comprehensive and organised table of diagnostic imaging services within the Medicare framework. These regulations were introduced under the authority of the Health Insurance Act 1973, with the aim of establishing a clear structure for the classification and payment of fees for diagnostic imaging services, distinguishing between "R-type" services that require a written request from a referring practitioner and "NR-type" services that do not. The enactment of these regulations was overseen by the Australian Parliament and was a response to the amendments made by the Community Services and Health Legislation Amendment Act (No.2) 1990. The primary policy objective was to ensure that the Medicare benefits for diagnostic imaging services are systematically administered and that the financial interests of practitioners are appropriately managed through the specified regulatory requirements.
Scope and Application
The Health Insurance (1991 Diagnostic Imaging Services Table) Regulations 1991 No. 86 are made under the authority of the Health Insurance Act 1973 and apply to medical practitioners, dental practitioners, and chiropractors who provide diagnostic imaging services in Australia. The Act and its regulations establish the framework for the payment of Medicare benefits for diagnostic imaging services, which include diagnostic radiology, computerised tomographic scanning, ultrasound, magnetic resonance imaging, and nuclear scanning. The regulations specify the fees for these services and categorise them into "R-type" services, which require a written request from another practitioner with no financial interest in the service, and "NR-type" services, which do not require such a request and are considered within the competence of general practitioners. The scope of these regulations extends to all states and territories of Australia, governing the administration and payment of Medicare benefits for diagnostic imaging services provided by authorised practitioners. The regulations do not apply to services that are not listed in the new table of diagnostic imaging services.
Key Provisions
The Health Insurance (1991 Diagnostic Imaging Services Table) Regulations 1991 (No. 86) set forth a comprehensive table of diagnostic imaging services, which are classified into two categories: R-type and NR-type services (Regulation 3). R-type services are those that require a written request from a practitioner who has no financial interest in the service being rendered, while NR-type services do not require such a request. The Regulations establish the specific fees applicable for each service item, providing clarity and structure to the payment of Medicare benefits for diagnostic imaging services (Regulation 4). The Rules of Interpretation, introduced by the Regulations, offer guidance on how to classify services and apply the fees, ensuring consistency in the administration of these benefits (Regulation 5).
The obligations imposed by these Regulations are primarily on medical practitioners, dental practitioners, and chiropractors, who are required to adhere to the classification of services and fee structures outlined in the Regulations (Section 4AA). These practitioners must ensure that their requests for diagnostic imaging services comply with the written request requirement for R-type services, as stipulated by the Health Insurance Act 1973 (Section 4AA). Additionally, they must be aware of the specific services they are entitled to request and the associated fees, as these are detailed in the new table established by the Regulations (Regulation 3).
Failure to comply with the provisions of these Regulations may result in significant consequences. The Health Insurance Act 1973 outlines various offences related to the fraudulent claiming of Medicare benefits, including knowingly making a false or misleading statement or providing false or misleading information (Section 117). Those found guilty of such offences may face substantial penalties, including fines of up to $22,200 for individuals and $111,000 for bodies corporate, as well as potential imprisonment terms (Section 117). The stringent penalties underscore the importance of adhering to the regulatory framework established by the Act and the Regulations to ensure the integrity of the Medicare system.