Health Insurance (1992-1993 Diagnostic Imaging Services Table) Regulations (Amendment) 1993 No. 152
EXPLANATORY STATEMENT STATUTORY RULES 1993 No. 152
Issued by the authority of the Minister for Health Health Insurance Act 1973
Health Insurance (1992-1993 Diagnostic Imaging Services Table) Regulations (Amendment)
The Health Insurance Act 1973 (the Act) provides for payments by way of Medicare benefits, payment for hospital services and payments for matters concerning related committees and tribunals.
Section 133 of 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 table), in accordance with the form of table set out in Schedule 1 and that, upon commencement of a regulation prescribing the table, it has effect as if it were set out in Schedule 1 in place of the table in that Schedule. The Health Insurance (1992-1993 Diagnostic Imaging Services Table) Regulations currently prescribe such a table for the purposes of section 4AA.
Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for diagnostic imaging services set out in the table.
The Regulations amend the current table (Statutory Rules 1992 No. 337) by introducing new services, deleting some existing services and amending the descriptions and/or fees of other services.
Changes to the table result largely from ongoing reviews by the Medicare Benefits Consultative Committee designed to ensure that it reflects current medical practice. The major area reviewed was ultrasound services. The restructure of ultrasound resulted in services being defined on an anatomical basis.
Details of the regulations are as follows.
Subregulation 1.1 provided for the Regulations to commence on 1 July 1993.
Subregulation 2.1 provided for the Health Insurance (Diagnostic Imaging Services Table) Regulations to be amended as set out below.
Subregulation 3.1 introduced an amendment to rule 7 of the Rules of Interpretation by amending the item range to read 55028 to 61109 (inclusive). This consequential
amendment was necessary because of the restructure of ultrasound services and the consequent renumbering of items.
Subregulations 3.2 to 3.4 implement a restructure of the general, cardiac and vascular subgroups of the ultrasonic group of items in the table.
Subregulation 3.5 inserted a new subgroup - urological - into the ultrasonic group of items, containing a single item for an ultrasound examination of the prostate.
Subregulations 3.6 and 3.7 amended the description of items in the angiography and report subgroup of the diagnostic radiology group of items in the table. The new descriptions and fees reflect a trend in the storage of angiograms away from film and towards disc or tape.
The Regulations come into effect on 1 July 1993.
Overview
The Health Insurance (1992-1993 Diagnostic Imaging Services Table) Regulations (Amendment) 1993 No. 152 were enacted to address the need for updates in the diagnostic imaging services table under the Health Insurance Act 1973. This legislation was introduced to reflect contemporary medical practices and ensure that the fees and services listed in the table accurately represent the current state of diagnostic imaging services. The Act provides for Medicare benefits, hospital service payments, and related committee and tribunal matters, with the amendments aimed at aligning the diagnostic imaging services table with these evolving practices. The regulations were issued under the authority of the Minister for Health and include changes such as the introduction of new services, the removal of outdated services, and adjustments to the descriptions and fees of existing services, primarily driven by the restructuring of ultrasound services on an anatomical basis.
The policy objective behind these amendments is to maintain the integrity and relevance of the diagnostic imaging services table, ensuring it serves as an accurate and up-to-date reference for calculating Medicare benefits. The changes were largely the result of ongoing reviews by the Medicare Benefits Consultative Committee, aimed at ensuring the table reflects the most current medical practices. The amendments to the table, including the introduction of a new urological subgroup and updates to the angiography and report subgroup, ensure that the services and fees listed are reflective of technological advancements and shifts in medical storage methods, such as the transition from film to digital formats for angiograms.
Scope and Application
The Health Insurance (1992-1993 Diagnostic Imaging Services Table) Regulations (Amendment) 1993 No. 152 amends the Health Insurance (Diagnostic Imaging Services Table) Regulations, which are made under the Health Insurance Act 1973. These Regulations apply to the calculation of Medicare benefits for diagnostic imaging services, impacting entities such as healthcare providers and patients who are eligible for Medicare benefits. The amendment to the table of diagnostic imaging services reflects changes in medical practice, particularly in ultrasound services, ensuring the table remains current and relevant. The scope of the amendments extends to the introduction of new services, the deletion of some existing services, and the modification of descriptions and fees for other services. These changes are effective from 1 July 1993 and are applicable across Australia, aligning with the national application of the Health Insurance Act 1973. The Act itself provides for payments by way of Medicare benefits, payment for hospital services, and payments for matters concerning related committees and tribunals.
Key Provisions
The Health Insurance (1992-1993 Diagnostic Imaging Services Table) Regulations (Amendment) 1993 No. 152 modifies the current table set out in Statutory Rules 1992 No. 337. It introduces new diagnostic imaging services, removes some existing services, and updates the descriptions and/or fees of other services to reflect contemporary medical practices. The primary amendments are due to the ongoing reviews by the Medicare Benefits Consultative Committee, with a significant focus on the restructuring of ultrasound services. This restructuring redefines services on an anatomical basis, resulting in changes to the table.
Under Section 4AA of the Health Insurance Act 1973, the Governor-General is empowered to make regulations for the purposes of the Act, including prescribing a table of diagnostic imaging services. The current table, which is set out in the Health Insurance (Diagnostic Imaging Services Table) Regulations, is amended to reflect the new services and changes. Section 9 of the Act stipulates that Medicare benefits are to be calculated based on the fees for diagnostic imaging services set out in this amended table.
The Regulations impose obligations on providers of diagnostic imaging services to ensure their services and fees comply with the updated table. This includes the necessity to realign their billing practices and descriptions of services to match the new entries and any changes in descriptions or fees. The Regulations also require the Minister for Health and relevant authorities to review and update the table periodically to ensure it remains reflective of current medical practices.
Failure to comply with the provisions of the Regulations may result in financial implications for service providers. While the specific civil or criminal consequences are not detailed in the explanatory statement, non-compliance could potentially lead to disputes over Medicare benefits payments, audits, and penalties for incorrect billing. The precise penalties for non-compliance would be determined in accordance with the broader framework of the Health Insurance Act 1973 and other relevant laws.