EXPLANATORY STATEMENT
Select Legislative Instrument 2009 No. 306
Health Insurance Act 1973
Health Insurance Amendment Regulations 2009 (No. 4)
Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides, in part, that the Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Regulation 11 of the Health Insurance Regulations 1975 (the Principal Regulations) outlines the diagnostic imaging services that allied health professionals (AHPs) (chiropractors, osteopaths, physiotherapists) may request.
The Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 (the DIST Regulations) contain x-ray items that cover the four areas of the spine, being the cervical, thoracic, lumbosacral and sacrococcygeal regions. They allow a health professional to request a single or multi-region (being two, three or four region) x-ray for diagnostic purposes. There is some evidence to suggest that AHPs are requesting excessive and unnecessary numbers of three and four region spinal x-rays.
The Regulations aim to reduce unnecessary patient exposure to radiation by limiting the number of three and four region spinal x-rays that can be requested by AHPs for a particular patient in a calendar year.
The Regulations remove from regulation 11 of the Principal Regulations, requesting rights for AHPs for items 58108 (four region spinal x-ray) and 58115 (three region spinal x-ray) and replace them with references to two new items, 58120 and 58121 to be inserted into the DIST Regulations. These items will only be provided to a patient once in a calendar year, which limits requesting rights of AHPs to either one three region (58121) or one four region (58120) spinal x-ray per patient each calendar year.
Radiology stakeholders have previously raised concerns about inappropriate requesting of multi-region spinal x-rays by Allied Health Professionals (AHPs – chiropractors, physiotherapists, osteopaths).
Anecdotal evidence of over requesting of items 58108 (four region spinal x-ray) and 58115
(three region spinal x-ray) was provided from the Royal Australian and New Zealand College of Radiologists; the Australian Diagnostic Imaging Association; the Western Australian Department of Health and Diagnostic Imaging Pathways Project; and the Australian Radiation Protection and Nuclear Safety Authority.
This specific proposal was not subject to wide spread consultation because of Budget and Cabinet confidentiality requirements.
The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised.
The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Regulations commence on 1 January 2010.
Overview
The Health Insurance Amendment Regulations 2009 (No. 4) were enacted to address concerns regarding the excessive and unnecessary requests for multi-region spinal x-rays by allied health professionals, including chiropractors, osteopaths, and physiotherapists, under the Health Insurance Act 1973. This was primarily driven by the need to reduce unnecessary patient exposure to radiation, as identified by various stakeholders such as the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association. The Regulations aim to limit the number of three and four region spinal x-rays that allied health professionals can request for a particular patient in a calendar year. This is achieved by removing the existing rights for requesting items 58108 (four region spinal x-ray) and 58115 (three region spinal x-ray) from the Principal Regulations and introducing new items 58120 and 58121 in the DIST Regulations, which restrict the number of such x-rays to one per patient per year. These amendments were made under the authority of the Governor-General and are intended to be effective from 1 January 2010.
Scope and Application
The Health Insurance Amendment Regulations 2009 (No. 4) pertain to the Health Insurance Act 1973 and primarily focus on allied health professionals, specifically chiropractors, osteopaths, and physiotherapists, who are authorised to request diagnostic imaging services for their patients. These regulations address the issue of excessive and unnecessary requests for three and four region spinal x-rays, aiming to mitigate patient exposure to radiation by limiting the number of such x-rays that can be requested by allied health professionals in a calendar year. The regulations introduce new items, 58120 and 58121, which replace previous items 58108 and 58115, and restrict allied health professionals to requesting either one three region or one four region spinal x-ray per patient annually. These measures are designed to ensure that diagnostic imaging services are requested appropriately and only when necessary. The regulations apply nationally, aligning with the scope and jurisdiction of the Health Insurance Act 1973, and they do not specify exclusions or exemptions, except for the limitations on the frequency of x-ray requests outlined in the regulations. The provisions are enacted through subordinate legislation, consistent with the authority granted under subsection 133(1) of the Health Insurance Act 1973.
Key Provisions
The main operative sections of the Health Insurance Amendment Regulations 2009 (No. 4) relate to the alteration of diagnostic imaging services that allied health professionals can request under the Health Insurance Regulations 1975 (Principal Regulations). Specifically, Regulation 11 of the Principal Regulations, which outlines the diagnostic imaging services that allied health professionals (AHPs) can request, is amended by the removal of the items 58108 (four region spinal x-ray) and 58115 (three region spinal x-ray). These are replaced with references to two new items, 58120 and 58121, which are to be inserted into the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 (DIST Regulations). The new items, 58120 and 58121, limit the number of three and four region spinal x-rays that can be requested by AHPs for a particular patient in a calendar year to one of each type.
The Regulations impose specific obligations on AHPs, including chiropractors, osteopaths, and physiotherapists, regarding the requesting of diagnostic imaging services. AHPs are now limited to requesting one three region spinal x-ray (item 58121) or one four region spinal x-ray (item 58120) per patient per calendar year. This restriction aims to mitigate the unnecessary exposure of patients to radiation by curbing the excessive and potentially unnecessary requests for multi-region spinal x-rays. These changes necessitate that AHPs adhere to the updated limits when requesting such diagnostic imaging services under the Medicare Benefits Schedule.
The Regulations do not explicitly detail specific offences, penalties, or consequences for breach within the text provided. However, under the general provisions of the Health Insurance Act 1973, breaches of regulations made under the Act can lead to civil or criminal penalties. Civil penalties can include fines, while criminal penalties can result in imprisonment, depending on the severity and intent behind the breach. The precise penalties would be determined by the courts when considering specific instances of non-compliance with the Regulations. The overarching objective of these potential penalties is to ensure adherence to the legislative intent of reducing unnecessary radiation exposure to patients.