Health Insurance (1993-1994 Diagnostic Imaging Services Table) Regulations 1993 No. 271
EXPLANATORY STATEMENT STATUTORY RULES 1993 No. 271
Issued by the authority of the Minister for Health Health Insurance Act 1973
Health Insurance (1993-1994 Diagnostic Imaging Services Table) Regulations
The Health Insurance Act 1973 (the Act) provides for payments by way of Medicare benefits, payments for hospital services and payments tor 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). The Health Insurance (Diagnostic Imaging Services Table) Regulations, Statutory Rules 1992 No. 337 and 1993 No. 152 currently prescribe such a table.
Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for diagnostic imaging services sat out in the table.
The regulations replace and amend the current table (Statutory Rules 1992 No. 337, and 1993 No. 152) by introducing a new service, amending the descriptions of other services and adjusting the fees for all services in the table.
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.
Details of the regulations are as follows.
Regulation 2 provides for the regulations to commence on 1 November 1993.
Regulation 3 repealed Statutory Rules 1992 No. 337 and 1993 No. 152 which authorised the current table of diagnostic imaging services.
Regulation 4 prescribes a new table of diagnostic imaging services and rules of interpretation. The rules and table have been amended as follows:
Rules of interpretation:
The dollar amounts quoted in rules 9, 10, 14 and 15 have been amended to reflect the
1.09 per cent general fee increase. The remaining rules are unchanged.
Table of Services and Fees
The table of services and tees has been amended as follows:
(a) a new service (item 55303) has been introduced to enable monitoring of transrectal ultrasound services performed by certain practitioners on their own patients (that is nonreferred patients). The description of the existing transrectal ultrasound service (item 55300) has been amended so as to restrict the item to patients who have been assessed by another practitioner;
(b) the general ultrasound services (items 55028 to 55057 Inclusive) were amended with effect from 1 July 1993 (Statutory Rules 1993 No 1521 so as to describe the Services on an anatomical basis. An unforeseen consequence of this restructure was the prevention of payment of benefits for ultrasound scans on more than one area at the same attendance. The regulations reinstate the payment of benefits where such examinations are necessary;
(c) the fees for all services listed in the table have been Increased by 1.09 per cent.
(d) the descriptions of all other services are unchanged.
The Regulations come into effect on 1 November 1993.
Overview
The Health Insurance (1993-1994 Diagnostic Imaging Services Table) Regulations 1993 No. 271 were enacted to address the need for an updated table of diagnostic imaging services under the Health Insurance Act 1973. This Act provides for payments by way of Medicare benefits, payments for hospital services and payments for matters concerning related committees and tribunals. Authorised by the Minister for Health, these regulations were made under the authority of the Governor-General, as provided for in Section 133 of the Act, and serve to replace and amend the existing diagnostic imaging services table to ensure it reflects current medical practice. The primary policy objective of these regulations is to maintain the accuracy and relevance of the diagnostic imaging services table, thereby ensuring that Medicare benefits are calculated correctly according to the latest medical standards and practices. This update includes the introduction of new services, amendments to service descriptions, and adjustments to fees to accommodate a general fee increase of 1.09 per cent.
Scope and Application
The Health Insurance (1993-1994 Diagnostic Imaging Services Table) Regulations 1993 No. 271, issued under the Health Insurance Act 1973, are designed to regulate the table of diagnostic imaging services and their associated fees. These regulations apply to all entities and practitioners involved in the provision of diagnostic imaging services in Australia, ensuring that Medicare benefits are accurately calculated and paid in accordance with the fees specified in the table. The regulations establish a new table, replacing and amending the existing one, and they come into effect on 1 November 1993. The changes primarily stem from reviews by the Medicare Benefits Consultative Committee to align the table with current medical practices, particularly focusing on ultrasound services. The table has been updated to include a new service for monitoring transrectal ultrasound services, adjustments to existing ultrasound services, and a general fee increase of 1.09% for all listed services. The amendments ensure that benefits are appropriately paid for multiple area ultrasound scans and clarify the descriptions of services on an anatomical basis.
Key Provisions
The Health Insurance (1993-1994 Diagnostic Imaging Services Table) Regulations 1993 No. 271 primarily focus on updating the table of diagnostic imaging services under the Health Insurance Act 1973 (s. 133). Regulation 4 prescribes this updated table, which includes new services, revised descriptions, and adjusted fees for existing services (Reg. 4). The new service introduced, item 55303, allows for monitoring of transrectal ultrasound services performed by certain practitioners on their own patients (Reg. 4(a)). Additionally, the description of the existing transrectal ultrasound service, item 55300, has been restricted to patients who have been assessed by another practitioner (Reg. 4(a)). The general ultrasound services, items 55028 to 55057, have been restructured to describe the services on an anatomical basis, with the regulations now reinstating the payment of benefits where examinations on more than one area are necessary (Reg. 4(b)).
These regulations impose specific obligations on parties involved in diagnostic imaging services under Medicare. Health service providers must adhere to the updated descriptions and fees outlined in the table to ensure compliance with Medicare benefits regulations (s. 9). The changes necessitate that practitioners and service providers update their billing and record-keeping practices to reflect these amendments. This includes ensuring that the correct service descriptions are used and that the appropriate fees are charged in accordance with the new table (Reg. 4).
Breaches of these regulations can result in civil or criminal consequences. While the specific penalties are not detailed in the explanatory statement, it is known that failure to comply with Medicare regulations can lead to penalties under the Health Insurance Act 1973. These penalties may include fines or other sanctions for incorrect billing practices, misrepresentation of services, or non-compliance with the updated table of diagnostic imaging services. The exact penalties would depend on the nature and severity of the breach, but they are intended to enforce adherence to the regulatory framework established by the Act and its associated regulations.