Health Insurance (1998-99 Diagnostic Imaging Services Table) Amendment Regulations 1999 (No. 1) 1999 No. 20
EXPLANATORY STATEMENT
STATUTORY RULES 1999 No. 20
Issued by the Authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance (1998-99 Diagnostic Imaging Services Table) Amendment Regulations 1999 (No. 1)
The Health Insurance Act 1973 ("the Act") provides for payments to eligible persons for professional services by way of medicare benefits.
Section 133 of the Act provides that the Governor-General may make regulations prescribing matters for the purposes of the Act.
Section 4AA of the Act provides that the table of diagnostic imaging services may be prescribed by the Regulations. The Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1998 prescribe such a table.
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 the table which includes the Diagnostic Imaging Services Table (the Table).
The changes to the Table include the implementation of amendments concerning the introduction of different scale of fees for computed tomography (CT), the introduction of professional supervision requirements for CT and Mammography, amending six CT items to exclude thoracic CT for coronary/artery calcification, the removal of item 55055 from the Diagnostic Imaging Services Table and consequent editorial amendments and minor editorial changes.
The changes for incorporation in the Table have been developed with the cooperation and support of the Royal Australasian College of Radiologists and the Australian and New Zealand Association of Physicians in Nuclear Medicine through the Consultative Committee on Diagnostic Imaging.
Details of the Regulations are in the attachment.
The regulations came into effect from 1 March 1999.
ATTACHMENT
Regulation 1 provides that the name of the regulations will be the Health Insurance (1998-99 Diagnostic Imaging Services Table) Amendment Regulations 1999. (No. 1)
Regulation 2 provides for the regulations to commence on 1 March 1999.
Regulation 3 provides that the Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1998 will be amended by Schedule 1 of the proposed Regulations.
Changes to the Regulations detailed in Schedule 1
General Definitions.
Item 1 provides new definitions for "computed tomography", "CT equipment" and "remote location".
Item 5 provides for a reference in subgroup 18(b)(ii) to "remote or rural location to be changed to "remote location" which is defined in item 1.
Items 6 and 9 provide for all references to "computerised tomography" to be updated to "computed tomography".
Different Scale of Fees for Computed Tomography (CT)
Item 3 (new rule 9A) and item 10 provide for the introduction of a differential scale of fees for computed tomography (CT). All existing CT items are being revised to include a "(K)" qualifier, and new items are to be introduced mirroring the revised items except for an "(NK)" qualifier and reduced fees. The intent of these changes is to provide for reduced medicare benefits for CT services provided using equipment that is more than 10 years old, so as to promote appropriate practice and use of up to date technology, and to ensure the Commonwealth is not making a capital contribution to already fully depreciated equipment.
The schedule fee for the new (NK) items is 50% of the corresponding (K) item. As required by sections 9 and 10 of the Health Insurance Act 1973, the benefits payable for (K) and (NK) items are calculated from the Schedule fees for the corresponding (K) and (NK) items respectively at the 75% in-hospital and 85% out of hospital rates (unless affected by maximum gap provisions) as with other diagnostic imaging items.
Rule 9A allows a reduced rate of benefit to apply to services rendered on CT equipment installed more than ten years before the date of the service. The draft rule distinguishes between CT equipment first installed and used as new equipment at any site in Australia and equipment which is imported as pre-used. The date from when the ten year period begins to run is:
* In the case of CT equipment first installed and used as new equipment at any site in Australia - ten years from the earliest date the CT equipment (or any component thereof) was first installed; and
* In the case of imported, pre-used CT equipment - ten years from the earliest date of manufacture of any component.
Services rendered in remote locations are exempt from the application of new rules 9A and 9B for CT. A definition for "remote location" has been developed and is defined in item 1 of Schedule 1.
Professional Supervision for CT and Mammography
Item 3 (new rule 9B) and item 4 provide for the introduction of professional supervision requirements for CT and mammography. The intent of this provision is to promote quality and appropriate diagnostic imaging services by seeking to ensure that CT and mammography services are provided in a situation where a specialist in diagnostic radiology is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient.
Professional supervision was introduced in September 1998 as a requirement for the eligible provision of magnetic resonance imaging services under the medicare Benefits Schedule arrangements.
Services rendered in remote locations are exempt from the professional supervision requirement for CT and mammography in cases where there is medical necessity. Remote location is defined in item 1.
Removal of Item 55055
Item 8 provides for item 55055 to be removed from the Diagnostic Imaging Services Table. Item 55055 is not considered to be a true diagnostic imaging service and as such it would be more appropriately placed in the Health Insurance (1998-1999 General Medical Services Table) Regulations 1998. A replacement item (item number 11240) has been separately developed for inclusion in the Health Insurance (1998-1999 General Medical Services Table) Regulations 1998.
Items 2 and 7 provide for all references to item 55055 to be deleted and replaced by a reference to item 11240.
Other Amendments
Item 10 introduces the new W and 'NK' items for CT.
Item 10 also introduces an amendment to CT items 56301, 56307, 56801, 56807, 57001 and 57007 to exclude thoracic CT for coronary/artery calcification.
Item 11 provides for a reference to item 57200 to be updated to item 57201 because item 57200 has been replaced by item 57201.
Item 12 provides for the amendment of the heading for MR1 Subgroup 26 to correct a minor error in the description of that subgroup.