EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Accreditation – Approved Accreditors) Instrument 2010
Issued by the authority of the Minister for Health and Ageing
AUTHORITY
The instrument to which this explanatory statement relates is made under subsection 23DZZIAA(1) of the Health Insurance Act 1973 (the Act).
The instrument is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
PURPOSE AND OPERATION
The purpose of the instrument is to approve and name the accreditors who are to receive and make decisions on applications by proprietors seeking accreditation of diagnostic imaging premises and bases for mobile diagnostic imaging equipment (diagnostic imaging practices) in accordance with the Health Insurance (Diagnostic Imaging Accreditation) Instrument 2010.
The Act provides a legislative framework for the introduction and operation of an accreditation scheme for practices providing diagnostic imaging services under medicare. Subsection 23DZZIAA(1) provides that the Minister may, by one or more legislative instruments, establish one or more schemes for the accreditation of diagnostic imaging practices, and may approve one or more persons (approved accreditors) to accredit premises and bases under the scheme(s).
Pursuant to subsection 16EA(1) of the Act, and unless the Minister otherwise directs, diagnostic imaging practices rendering diagnostic imaging services must be accredited for the service to be eligible for medicare benefits.
The scheme is being implemented in stages to ensure diagnostic imaging practices are accredited incrementally and have continued access to medicare benefits. The first stage of the scheme was established by the Minister under the Health Insurance (Diagnostic Imaging Accreditation) Determination 2008 (Stage I Scheme). It commenced on 1 July 2008 and covers all radiology services in the Diagnostic Imaging Services Table (DIST) of the Medicare Benefits Scheme (MBS). The Stage I Scheme does not cover cardiac ultrasound, cardiac angiography, obstetric and gynaecological ultrasound, and nuclear medicine imaging (non-radiology services). The Stage I Scheme will conclude on 30 June 2010.
The second stage of the Scheme (Stage II Scheme) will be established by a separate legislative instrument made under subsection 23DZZIAA(1) of the Act, the Health Insurance (Diagnostic Imaging Accreditation) Instrument 2010. From 1 July 2010, scheme coverage will be extended to all diagnostic imaging services as a consequence of the repeal of Regulation 12AA of the Health Insurance Regulations 1975 (which is to have effect from this date). This means that both radiology and non-radiology services will be subject to the same accreditation standards. All diagnostic imaging practices will need to be accredited for diagnostic imaging procedures by an approved accreditor in order to retain medicare eligibility.
This instrument specifies the approved accreditors who can receive and make decisions on applications from proprietors seeking accreditation of diagnostic imaging practices.
It is intended that deemed accreditation arrangements under the Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2010 (the 2010 Act) will apply in relation to diagnostic imaging practices that provide non-radiology services and are not covered by the Stage I Scheme.
Consultation
Since the commencement of the Stage I Scheme on 1 July 2008, the Department of Health and Ageing (Department) has continued its consultative approach for developing ongoing accreditation arrangements for diagnostic imaging practices. Two consultation papers seeking feedback on proposals for implementing the Stage II Scheme were released for comment in early 2009. A consultant was also engaged to evaluate the impacts of the Stage I Scheme and to gather feedback on expectations for the future. Key findings from the research and feedback from submitters indicate broad support for including all diagnostic imaging services in the Stage II Scheme and the proposed arrangements for implementing the Stage II Scheme. Diagnostic imaging practices providing diagnostic imaging services will be advised of the new arrangements when the arrangements are approved.
Organisations were invited to apply for approval as a potential accreditor and designated person through an Invitation to Apply (ITA) process conducted by the Department in late October 2009. Applications received by the Department were assessed to identify preferred accreditors that were submitted to the Minister for her consideration.
Commencement
The instrument commences on the earlier of:
immediately after the commencement of Schedule 1 to the 2010 Act; or
the start of the day on 1 July 2010.
This is to align with the commencement of relevant provisions of the Health Insurance (Diagnostic Imaging Accreditation) Instrument 2010.
Overview
The Health Insurance (Diagnostic Imaging Accreditation – Approved Accreditors) Instrument 2010 was enacted under subsection 23DZZIAA(1) of the Health Insurance Act 1973. This instrument serves to address the need for a comprehensive accreditation scheme for diagnostic imaging practices to ensure they meet the necessary standards for eligibility under the Medicare Benefits Scheme. The instrument was issued by the authority of the Minister for Health and Ageing, and its policy objective is to facilitate the accreditation of diagnostic imaging practices incrementally, ensuring that both radiology and non-radiology services are subject to the same accreditation standards. The instrument came into effect on 1 July 2010, aligning with the commencement of relevant provisions of the Health Insurance (Diagnostic Imaging Accreditation) Instrument 2010, and it specifies the approved accreditors who can receive and process applications from proprietors seeking accreditation for their diagnostic imaging practices. This approach was developed through consultation with relevant stakeholders and aims to ensure continued access to Medicare benefits for accredited diagnostic imaging services.
Scope and Application
The Health Insurance (Diagnostic Imaging Accreditation – Approved Accreditors) Instrument 2010 applies to the approval of accreditors who will oversee the accreditation of diagnostic imaging practices, ensuring they meet the standards set forth under the Health Insurance Act 1973. The Act mandates that diagnostic imaging practices must be accredited to be eligible for Medicare benefits, with the accreditors named in this instrument authorised to make decisions on applications from diagnostic imaging practice proprietors. The geographic reach of this legislation is nationwide, as it applies across Australia, ensuring a uniform standard of accreditation for diagnostic imaging services. This instrument does not specify exclusions but operates under the broader framework of the Health Insurance Act, which outlines the necessary accreditation for eligibility of services under Medicare. The instrument extends the application of the Act through subordinate instruments, such as the Health Insurance (Diagnostic Imaging Accreditation) Instrument 2010, which details the accreditation standards and procedures for diagnostic imaging practices.
Key Provisions
The Health Insurance (Diagnostic Imaging Accreditation – Approved Accreditors) Instrument 2010, made under section 23DZZIAA(1) of the Health Insurance Act 1973, is designed to approve and name the accreditors who will handle applications for the accreditation of diagnostic imaging premises and mobile diagnostic imaging equipment bases. This instrument is an essential component of the Health Insurance (Diagnostic Imaging Accreditation) Instrument 2010, which establishes the framework for accrediting diagnostic imaging practices to ensure their services are eligible for medicare benefits. Specifically, Section 16EA(1) of the Act mandates that diagnostic imaging practices must be accredited unless otherwise directed by the Minister. This accreditation requirement ensures that diagnostic imaging services are delivered to a consistent standard, thereby maintaining the integrity of the medicare system.
The obligations imposed by this instrument on the parties it governs are primarily centred around the accreditation process for diagnostic imaging practices. Accreditors, once approved, must receive and evaluate applications from proprietors seeking accreditation. This includes ensuring that diagnostic imaging practices meet the necessary standards and criteria set forth in the Health Insurance (Diagnostic Imaging Accreditation) Instrument 2010. Accreditors must adhere to these standards to verify that the services provided by diagnostic imaging practices are of a high quality and meet the requirements for medicare eligibility. Furthermore, diagnostic imaging practices must submit comprehensive applications that detail their facilities, equipment, and processes to the accreditors for review.
Failure to comply with the requirements set out in this instrument can lead to significant consequences. Under the Health Insurance Act 1973, any diagnostic imaging practice that does not obtain accreditation from an approved accreditor risks losing eligibility for medicare benefits. This means that services provided by unaccredited practices will not be reimbursable under the Medicare Benefits Scheme (MBS). Additionally, there are potential administrative penalties for non-compliance, although the specifics of these penalties are not detailed in the explanatory statement. Accredited practices that fail to maintain the required standards may also face scrutiny and could be subject to reassessment or revocation of their accreditation status, further impacting their ability to provide services under the MBS.
The implementation of this instrument is carefully staged to ensure a smooth transition for diagnostic imaging practices. The first stage of the accreditation scheme, which covers radiology services, began on 1 July 2008 and will conclude on 30 June 2010. The second stage, which will commence on 1 July 2010, extends the accreditation requirement to all diagnostic imaging services, including non-radiology services. This staged approach ensures that practices have sufficient time to meet the new accreditation standards and maintain continuity of services under the MBS. Diagnostic imaging practices will be informed of these changes and the new requirements as they are implemented, ensuring they have the opportunity to prepare and comply with the accreditation process.