Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 2000 (No. 2) 2000 No. 147
EXPLANATORY STATEMENT
STATUTORY RULES 2000 NO. 147
Issued by the Authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 2000 (No. 2)
Section 133 of the Health Insurance Act 1973 ('the Act') provides that the Governor-General may make regulations prescribing matters for purposes of the Act.
The Act provides for payments to eligible persons for professional services by way of Medicare benefits.
Section 4AA of the Act provides that the table of diagnostic imaging services may be prescribed by the Regulations. The Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999 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 a table which included the Diagnostic Imaging Services Table (the Table)
This Regulation incorporates the following change to the Table:
9 amendment to a rule for professional supervision for ultrasound.
In September 1999 a professional supervision rule for diagnostic ultrasound was added to the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999. This provision aimed to promote quality and appropriate ultrasound services by ensuring that these services are provided where a medical specialist is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient.
The 1999 regulation provides exemption for two categories of practitioners to continue to provide W (referred) type ultrasounds. However, these exempt practitioners did not have to meet the requirement of being available to monitor and influence the examination or personally attend the patient, where the service is performed on their behalf
As a result of consultation with providers of ultrasound through the Ultrasound Group, the regulation has been amended to require these 'grand-fathered' practitioners to meet the same supervision requirements as specialists.
This regulation will enhance the quality of ultrasound services provided by "grand-fathered" practitioners and ensure that there is consistency in the standard of care rendered by a specialist, consultant physician or a general practitioner who qualifies under the exemptions.
This change has been developed in consultation with the Australian and New Zealand Association of Physicians in Nuclear Medicine, Royal Australian and New Zealand College of Radiologists, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australian College of General Practitioners, the Australian College of Rural and Remote Medicine, the Urological Society of Australia, the Royal Australasian College of Surgeons, the Australian Society of Ultrasound in Medicine, and the Australian Sonographers Association.
Details of the Regulations are in the attachment.
The regulations commence on 1 July 2000.
ATTACHMENT
Details of the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 2000
Regulation 1 provides that the name of the regulations will be the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 2000 (No. 2).
Regulation 2 provides for the regulations to commence on 1 July 2000.
Regulation 3 provides that the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999 will be amended by Schedule 1 of the proposed Regulations.
Changes to the Table
Schedule 1 item 1 will substitute a new rule I OAA in Schedule 1, Part 1.
Overview
The Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 2000 (No. 2) were enacted to address a gap identified in the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999, specifically concerning the professional supervision required for diagnostic ultrasound services. These regulations were introduced to ensure consistent quality and appropriate delivery of diagnostic imaging services by requiring 'grandfathered' practitioners to meet the same supervision requirements as specialists, thereby enhancing the standard of care provided. The regulations were developed in consultation with various medical associations and professional bodies to ensure the changes would be practical and effective.
The regulations were issued under the authority of the Minister for Health and Aged Care, pursuant to Section 133 of the Health Insurance Act 1973, which empowers the Governor-General to make regulations prescribing matters for the purposes of the Act. The policy objective of these amendments is to maintain high standards of care in diagnostic imaging services by aligning the supervision requirements for all practitioners involved in the provision of ultrasound services. The Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 2000 (No. 2) commenced on 1 July 2000, with the changes to be incorporated into the existing table of diagnostic imaging services.
Scope and Application
The Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 2000 (No. 2) applies to medical practitioners and entities providing diagnostic imaging services, particularly ultrasound services, under the Health Insurance Act 1973. The Act itself is a Commonwealth statute that provides for the payment of Medicare benefits to eligible persons for professional services, with diagnostic imaging services being a key component of these benefits. The regulations amend the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999 to ensure that "grandfathered" practitioners, who were previously exempt from certain professional supervision requirements, now must meet the same standards as medical specialists, consultant physicians, or general practitioners who qualify under exemptions. These amendments aim to maintain the quality and appropriateness of ultrasound services by ensuring that all practitioners adhere to the same professional supervision rules, thereby promoting consistency in the standard of care.
The regulations have a national reach as they are made under the authority of the Health Insurance Act 1973, a Commonwealth Act. The changes outlined in these regulations do not specify any exclusions or exemptions beyond what is stipulated in the original 1999 regulations, but they do modify existing rules to enhance the quality of diagnostic services. The regulations will come into effect on 1 July 2000, and further details of the amendments are provided in the attached schedule.
Key Provisions
The main operative sections of these Regulations, specifically Section 4AA and Section 9 of the Health Insurance Act 1973 (the Act), pertain to the amendment of the Diagnostic Imaging Services Table. Section 4AA of the Act allows the Governor-General to prescribe the table of diagnostic imaging services through regulations, which was previously done by the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999. Section 9 of the Act mandates that Medicare benefits be calculated using the fees for medical services, including those listed in the Diagnostic Imaging Services Table. These Regulations specifically amend the rules regarding professional supervision for ultrasound services, enhancing the quality and consistency of care provided by "grandfathered" practitioners.
The obligations and requirements imposed by these Regulations primarily focus on ensuring that all practitioners providing diagnostic ultrasound services adhere to the same professional supervision standards. This includes requiring "grandfathered" practitioners, who were previously exempt from certain supervision requirements, to now meet the same standards as specialists. This change aims to ensure that all practitioners providing ultrasound services are subject to the same quality control measures, promoting appropriate and high-quality diagnostic services. These amendments reflect the collaborative efforts of various medical associations and professional bodies, indicating a broad consensus on the need for these changes.
In terms of civil or criminal consequences for breaches, the Regulations do not explicitly state any specific offences or penalties. However, any non-compliance with the amended regulations would likely result in the practitioner not being eligible for Medicare benefits for the services provided. Additionally, failure to adhere to the professional supervision requirements could potentially lead to other regulatory actions by the relevant health authorities, including possible sanctions or penalties under other relevant legislation governing medical practice and professional conduct.
These Regulations are designed to improve the quality and consistency of diagnostic imaging services within the Medicare framework. By amending the Diagnostic Imaging Services Table to include stricter supervision requirements for ultrasound services, the Regulations aim to ensure that all practitioners, regardless of their category, meet the necessary standards to provide safe and effective care. The consultation process involving various medical associations underscores the importance of these changes in maintaining high standards within the medical community.