Health Insurance (Diagnostic Imaging Accreditation - Approved Accreditors) Determination 2009

Administered by Department of Health, Disability and Ageing

Legislation au F2009L02407 Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Issued by the authority of the Minister for Health and Ageing

 

Health Insurance Act 1973

 

Health Insurance (Diagnostic Imaging Accreditation – Approved Accreditors) Determination 2009

 

This Determination is made under subsection 23DZZIAA(1) of the Health Insurance Act 1973 (‘the Act’).

 

The Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007 amended the Act to establish a legislative framework for the introduction of an accreditation Scheme for practices providing diagnostic imaging services under Medicare other than:

  • Cardiac Ultrasound;
  • Cardiac Angiography;
  • Obstetric and Gynaecological Ultrasound; and 
  • Nuclear Medicine Imaging.

 

Paragraph 16EA(1)(a) of the Act provides that unless the Minister otherwise directs, a Medicare benefit is not payable in respect of a diagnostic imaging service rendered by or on behalf of a medical practitioner unless the procedure is carried out at a diagnostic imaging premises that are, or at a base for mobile diagnostic imaging equipment that is, accredited for that procedure under a diagnostic imaging accreditation scheme. Pursuant to paragraphs 16EA(1)(b) and (c) respectively similar restrictions apply in relation to use of diagnostic imaging equipment (mobile or otherwise) ordinarily located at accredited premises.

 

Subsection 23DZZIAA(1) of the Act allows the Minister to establish, by legislative instrument, a diagnostic imaging accreditation scheme or schemes and approve persons (accreditors) who will be able to accredit practices for the purposes of the scheme.

 

The Health Insurance (Diagnostic Imaging Accreditation – Approved Accreditors) Determination 2008 (the Previous Determination) sets out: (i) the designated persons with whom certain notices are to be lodged for registration of diagnostic imaging premises and bases for mobile diagnostic imaging equipment (‘diagnostic imaging practices’) for deemed accreditation; and (ii) the approved accreditors who are to receive and make decisions on applications by proprietors of diagnostic imaging practices seeking actual accreditation of their practices in accordance with the Health Insurance (Diagnostic Imaging Accreditation) Determination 2008.   

 

From 1 July 2008, diagnostic imaging premises or bases for mobile diagnostic imaging equipment were required to be accredited for diagnostic imaging procedures in order to retain Medicare eligibility (subject to deemed accreditation arrangements discussed below).  The Diagnostic Imaging Accreditation Scheme (which may comprise one or more Schemes relating to accreditation of diagnostic imaging practices) was established by the Minister under paragraph 23DZZIAA(1)(a) of the Act.  Accreditation was undertaken by persons approved by the Minister (approved accreditors) under paragraph 23DZZIAA(1)(b).

 

 

Deemed accreditation

Proprietors of existing diagnostic imaging practices who lodged their notice of registration for accreditation of their diagnostic imaging practices for diagnostic imaging procedures before 1 July 2008, were deemed to be accredited (deemed accreditation) under the Scheme for the procedures.  Proprietors were required to lodge their notice with a person designated by the Minister under subitem 12(5) of Schedule 1 of the Act (designated person).  In order to retain Medicare eligibility proprietors with deemed accreditation are required to apply for actual accreditation under the Scheme before 1 July 2009.

 

Actual accreditation

One or more legislative instruments made by the Minister under paragraph 23DZZIAA(1)(a) of the Act may establish one or more Schemes for actual accreditation of diagnostic imaging practices.  An actual accreditation expires on a date and time depending on the terms of any particular accreditation decision.

 

Reason for the Determination

The purpose of this Determination is to:

(i)                 delete the name of an approved accreditor, in the Previous Determination, due to the approved accreditor transferring to a new legal entity;

(ii)               insert the name of the new approved accreditor who is to accredit the diagnostic imaging practices in accordance with paragraph 23DZZIAA(1)(a) of the Act; and    

(iii)            delete references to designated persons with whom certain notices were to be lodged for registration of diagnostic imaging premises and diagnostic imaging practices for deemed accreditation, given that notices for application for deemed accreditation no longer apply after 1 July 2008.

 

Consultation

Section 18 of the Legislative Instruments Act 2003 (LIA) specifically provides for circumstances where consultation may not be necessary or appropriate. 

 

Because this Determination is revoking and remaking the Previous Determination to:

(i) delete the name of an approved accreditor due to the approved accreditor transferring to a new legal entity;

(ii) include the name of a new approved accreditor who is to accredit the diagnostic imaging practices in accordance with paragraph 23DZZIAA(1)(a) of the Act; and    

(iii) delete references to designated persons with whom certain notices were to be lodged for registration of diagnostic imaging premises and diagnostic imaging practices for deemed accreditation;

the amendments to the Determination do not substantially alter existing arrangements and will have minimal or no impact on stakeholders or consumers.  Therefore no consultation was undertaken. 

 

Details of the Determination are set out in the Attachment.

 

The Determination commences on the day after it is registered and ceases to have effect at the end of 30 June 2010.

 

This Determination is a legislative instrument for the purpose of the Legislative Instruments Act 2003.

 

Authority: subsection 23DZZIAA(1) of the Health Insurance Act 1973


ATTACHMENT

 

DETAILS OF THE HEALTH INSURANCE (DIAGNOSTIC IMAGING ACCREDITATION – APPROVED ACCREDITORS) DETERMINATION 2009.

 

Section 1 – Name of Determination

 

This section provides that the name of the Determination is the Health Insurance (Diagnostic Imaging Accreditation- Approved Accreditors) Determination 2009.

 

Section 2 – Purpose of Determination

 

This section explains the purpose of the Determination which is to approve accreditors who are to receive and make decisions to accredit based on applications by proprietors of diagnostic imaging practices seeking actual accreditation of their practices. 

 

Section 3 – Commencement and Revocation

 

This section provides that the Determination commences on the day after registration.

 

This section also provides that the Determination revokes the Health Insurance (Diagnostic Imaging Accreditation- Approved Accreditors) Determination 2008.

 

Section 4 – Cessation

 

This section provides that the Determination will cease to have effect at the end of 30 June 2010.

 

Section 5 – Interpretation

 

Subsection 5(1) defines words and phrases used in the Determination.  These are as follows.

 

"Act" refers to the Health Insurance Act 1973.

 

"actual accreditation" refers to accreditation of a diagnostic imaging practice based on its compliance with criteria provided in a legislative instrument establishing a diagnostic imaging accreditation Scheme under paragraph 23DZZIAA(1)(a) of the Act.  The definition notes that actual accreditation is distinguished from deemed accreditation for which item 12 of Schedule 1 of the Act provides. 

 

"diagnostic imaging practice" is a convenient term to cover a "diagnostic imaging premises" and a "base for mobile diagnostic imaging equipment".  These two terms are in turn defined in the Act and are explained below.

 

Subsection 5(2) explains that a reference to "item 12" means item 12 of Schedule 1 of the Act and a reference to "subitem” has a corresponding meaning.

 

Subsection 5(3) of the Determination provides that a word or phrase used in this Determination that is defined in this section or in the Act is preceded by an asterisk in the Determination.  It alerts the reader to the need to consult the definitions. 

 

The notes following subsection 5(3) of this Determination refer to definitions of words and phrases used in the Determination that are defined in the Act.  These are as follows.

 

"approved accreditor" is said in section 3(1) of the Act to have the meaning in paragraph 23DZZIAA(1)(b) of the Act.  This is a person or persons approved by the Minister in one or more legislative instruments to accredit premises and bases under the Scheme. 

 

"base for mobile diagnostic imaging equipment" is said in subsection 3(1) of the Act to have the meaning given by section 23DZL.  Section 23DZL describes a base for mobile diagnostic imaging equipment as premises where diagnostic imaging equipment is ordinarily located when not in use and where the diagnostic imaging procedures carried out using the equipment are not carried out at the premises, or are frequently carried out off the premises.  The diagnostic imaging procedures must be carried out using a single business name.

 

"deemed accreditation" is defined in subitem 12(2) of Schedule 1 of the Act.  It arose where the proprietor of a diagnostic imaging practice lodged               a notice under subitem 12(1) of Schedule 1 of the Act before 1 July 2008 registering the practice for one or more diagnostic imaging procedures.  The diagnostic imaging practice is, for the purposes of section 16EA of the Act, taken to be accredited under a diagnostic imaging accreditation Scheme for the procedures specified in the proprietor's notice.  Subitem 12(3) requires a proprietor with deemed accreditation for any procedure to apply for actual accreditation for that procedure before 1 July 2009 or before another day if such a day is specified in a diagnostic imaging accreditation Scheme for this purpose (the application deadline day).  Subitem 12(4) deals with the cessation of deemed accreditation.  Under that subitem deemed accreditation ceases on the application deadline day if the proprietor has not applied for actual accreditation for the procedure before that day.  Where the proprietor has sought actual accreditation for the procedure before the application deadline day and accreditation has been granted then deemed accreditation ceases on the day that the actual accreditation takes effect.  If the proprietor seeks actual accreditation for the procedure before the application deadline day and the approved accreditor refuses accreditation for that procedure then deemed accreditation ceases on the day after the proprietor's rights to reconsideration are exhausted or expire.

 

"diagnostic imaging premises" is said in subsection 3(1) of the Act to have the meaning given by section 23DZM.  Section 23DZM states that diagnostic imaging premises are a building, or part of a building, at which diagnostic imaging procedures are carried out under a single business name.  Subsection 23DZM(2) emphasises that a base for mobile diagnostic imaging equipment is not diagnostic imaging premises.

 

"proprietor" is defined in subsection 3(1)(b) of the Act by reference to section 23DZO of the Act.  In essence the proprietor of a diagnostic imaging practice is the person or government agency that has effective control of the premises or the base, the use of the diagnostic imaging equipment used at or ordinarily located at the premises and the employment of staff connected with the premises or the base. 

 

Section 6 – Approval of persons to accredit diagnostic imaging practices

 

Subsection 6(1) of this Determination provides that the approved accreditors who are to accredit diagnostic imaging practices under the scheme set up pursuant to paragraph 23DZZIAA(1)(a) of the Act are:

  (a) Health and Disability Auditing Australia Pty Ltd (ACN 134 482 625);

  (b) National Association of Testing Authorities, Australia (ACN 004 379 748);

  (c) Quality in Practice Pty Ltd (ACN 094 965 590); and

  (d) The Australian Council on Healthcare Standards Limited (ACN 008 549 773).

 

The persons named as approved accreditors under subsection 6(1) of this Determination are designated for the period from the day following the date of registration of the Determination until the end of the day on 30 June 2010.

 

The detailed duties and other arrangements associated with the performance of the functions of the designated persons and approved accreditors are set out in Deeds of Agreement signed by Commonwealth representatives and the designated persons and approved accreditors. 

 

Subsection 6(1) of this Determination has been amended to delete the previous approved accreditor Health and Disability Auditing New Zealand Limited (ARBN 124 747 468), trading as Health and Disability Auditing Australia (Queensland BN 20355610) and replacing it with a new approved accreditor Health and Disability Auditing Australia Pty Ltd (ACN 134 482 625).

 

Overview

The Health Insurance (Diagnostic Imaging Accreditation – Approved Accreditors) Determination 2009 was made under subsection 23DZZIAA(1) of the Health Insurance Act 1973, establishing a legislative framework for the accreditation of diagnostic imaging practices providing services under Medicare, excluding specific imaging types. The determination was enacted by the Minister for Health and Ageing to ensure that diagnostic imaging services rendered by medical practitioners are performed at accredited premises, thereby maintaining Medicare eligibility. This was introduced to address the need for quality assurance in diagnostic imaging services provided under the Medicare scheme, ensuring they meet specified standards. The determination identifies approved accreditors who are authorised to accredit diagnostic imaging practices. It revokes the previous determination, updates the list of approved accreditors, and removes references to deemed accreditation which no longer applies post-1 July 2008. The policy objective of this determination is to streamline the accreditation process for diagnostic imaging practices, ensuring they adhere to the required standards for Medicare eligibility.

Scope and Application

The Health Insurance (Diagnostic Imaging Accreditation – Approved Accreditors) Determination 2009 applies to the entities approved to accredit diagnostic imaging practices under the Health Insurance Act 1973, specifically within the Medicare system for diagnostic imaging services. This Determination pertains to the accreditation of practices providing diagnostic imaging services, with exclusions for cardiac ultrasound, cardiac angiography, obstetric and gynaecological ultrasound, and nuclear medicine imaging. It is a legislative instrument made under the authority of the Minister for Health and Ageing, with the purpose of approving specific accreditors who will receive and make decisions on applications from proprietors of diagnostic imaging practices seeking accreditation. The Determination revokes the previous accreditation scheme and re-establishes it with updated accreditors, effective from the day after registration and continuing until the end of 30 June 2010. The approved accreditors named in the Determination are responsible for accrediting diagnostic imaging practices based on compliance with the criteria set out in the relevant legislative instruments. This Determination does not substantially alter existing arrangements and, therefore, no consultation was undertaken before its establishment.

Key Provisions

The Health Insurance (Diagnostic Imaging Accreditation – Approved Accreditors) Determination 2009 primarily serves to approve specific entities as accreditors under the diagnostic imaging accreditation scheme established under the Health Insurance Act 1973. These accreditors are responsible for accrediting diagnostic imaging practices, ensuring that they meet the required standards for Medicare eligibility (Section 6). This Determination also revokes and replaces the 2008 version, updating the list of approved accreditors and removing references to deemed accreditation, which no longer applies after 1 July 2008. The approved accreditors listed in the Determination are Health and Disability Auditing Australia Pty Ltd, National Association of Testing Authorities, Australia, Quality in Practice Pty Ltd, and The Australian Council on Healthcare Standards Limited (subsection 6(1)). These entities have been designated to accredit diagnostic imaging practices from the day following the registration of the Determination until 30 June 2010. The Determination imposes specific obligations on the approved accreditors. They must adhere to the criteria and standards outlined in the legislative instruments that establish the diagnostic imaging accreditation scheme. These accreditors are required to evaluate applications from diagnostic imaging practice proprietors and decide whether to grant actual accreditation based on compliance with the established criteria (subsection 6(1)). Furthermore, the accreditors must ensure that the practices they accredit meet the necessary standards to retain Medicare eligibility for diagnostic imaging services. The accreditors are also expected to comply with any Deeds of Agreement signed with Commonwealth representatives, which detail the duties and arrangements associated with their accreditation functions. The Determination does not explicitly outline specific offences, penalties, or consequences for breach within its text. However, under the broader framework of the Health Insurance Act 1973, non-compliance with accreditation requirements could lead to a diagnostic imaging service not being eligible for a Medicare benefit. Such non-compliance could result in the service provider losing their eligibility to claim Medicare benefits for diagnostic imaging services rendered. Additionally, the Act and related legislation might impose other civil or administrative penalties for failure to comply with accreditation standards or other related requirements. The specific penalties would depend on the nature and severity of the breach, as well as any other applicable laws and regulations.

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