EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Capital Sensitivity Amendment and Repeal) Determination 2013
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides, in part, that the Minister may determine in writing that a health service not listed in the diagnostic imaging services table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. The Table is set out in the Health Insurance (Diagnostic Imaging Services Table) Regulation (the DIST Regulation) which is remade each year.
The Health Insurance (Diagnostic Imaging Capital Sensitivity Amendment and Repeal) Determination 2013 (the Determination) amends the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011 (the Principal Determination) to create four new reduced-fee Magnetic Resonance Imaging (MRI) services for use on fully depreciated diagnostic imaging equipment. The Determination also repeals the Principal Determination with effect from the cessation of the current DIST Regulation as part of the annual remake.
These new MRI items (items 63552, 63555, 63558, 63561) allow medical practitioners, other than specialists and consultant physicians, to request MRI services for patients 16 years and over for particular prescribed indications (eg. unexplained seizure or chronic headache). These items, identified by the symbol ‘(NK)’, have a Medicare Benefit Schedule fee set at half the fee of corresponding items 63551, 63554, 63557 and 63560, for use on newer imaging equipment. Items 63551, 63554, 63557 and 63560 will take effect from 1 November 2013, requiring the creation of corresponding (NK) items in the Principal Determination.
The capital sensitivity measure, under which diagnostic imaging services provided on older, depreciated equipment attracts reduced Medicare benefit, is intended to improve the quality of diagnostic imaging services by encouraging diagnostic imaging service providers to upgrade and replace, as appropriate, aged equipment. For each relevant service in the current DIST Regulation, the Principal Determination provides for a 50 per cent reduced Medicare Benefit Schedule fee which applies where the equipment used to perform the service is older than:
- if the equipment has not been upgraded, the ‘new effective life age’; or
- if the equipment has been upgraded, the ‘maximum effective life age’.
Section 7 of the Determination applies relevant rules in the DIST Regulation relating to MRI services to (NK) items 63552, 63555, 63558 and 63561:
- the items can be provided by an using equipment recognised as ‘eligible equipment’ or ‘partial eligible equipment’ for Medicare purposes;
- the items must be reported by, and provided under the professional supervision of, a specialist in diagnostic radiology who satisfies the Chief Executive Medicare that he or she is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program, unless the service is provided in an emergency or must be provided in a remote location due to medical necessity;
- requests must be in writing and specify the clinical indications for the service;
- an MRI scan must include a minimum of 3 sequences; and
- the items cannot be claimed more than three times for a particular patient in a 12 month period.
As part of the annual remake of the DIST Regulation, all items currently included in the Principal Determination will be transferred directly to the new DIST Regulation. The Principal Determination will be obsolete and can be repealed.
Sections 1 to 4 and Schedule 1 of the Determination, which will provide for the creation of the four new MRI items, commence on 1 November 2013. Schedule 2 of the Determination, which repeals the Principal Determination, commences on the cessation or earlier repeal of the current DIST Regulation, the Health Insurance (Diagnostic Imaging Services Table) Regulation 2012. In accordance with section 4AA of the Act, the Health Insurance (Diagnostic Imaging Services Table) Regulation 2012 will cease on the fifteenth sitting day of the House of Representatives after a period of 12 months from registration, unless earlier repealed.
The Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Consultation
There has been significant consultation with the relevant craft groups in the development of these measures under the Diagnostic Imaging Reform Package through the Diagnostic Imaging Advisory Committee (DIAC). Stakeholders who have been consulted include the Royal Australian and New Zealand College of Radiologists, the Australian Medical Association, the Australian Institute of Radiography, the Rural Doctors Association of Australia, the Australian Medical Association, the Royal Australian College of General Practitioners, the Australian College of Rural and Remote Medicine and the Australasian Association of Nuclear Medicine Specialists.
No consultation has been undertaken in relation to the repeal of the Principal Determination. The Principal Determination operates so that services specified in the Determination are treated as if they were listed in the DIST Regulation. The DIST Regulation replacing the current Regulation will directly list the services currently in the Principal Determination. Medicare benefits will continue to be paid for these services by virtue of their transfer to the DIST Regulation and the Principal Determination will be redundant.
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Health Insurance (Diagnostic Imaging Capital Sensitivity Amendment and Repeal) Determination 2013
This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Legislative Instrument
The Health Insurance (Diagnostic Imaging Capital Sensitivity Amendment and Repeal) Determination 2013 (the Determination):
- amends the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011 (the Principal Determination) to create four new Medicare-eligible Magnetic Resonance Imaging (MRI) services from 1 November 2013; and
- repeals the Principal Determination on the cessation or earlier repeal of the Health Insurance (Diagnostic Imaging Services Table) Regulation 2012 (the current DIST Regulation).
The four new MRI items (items 63552, 63555, 63558, 63561) allow medical practitioners, other than specialists and consultant physicians, to request Medicare-eligible MRI services for patients 16 years and over for particular prescribed indications (eg. unexplained seizure or chronic headache). These items, identified by the symbol ‘(NK)’, have a Medicare Benefit Schedule fee set at half the fee of corresponding items 63551, 63554, 63557 and 63560, for use on newer imaging equipment. Items 63551, 63554, 63557 and 63560 will take effect from 1 November 2013, requiring the creation of corresponding (NK) items in the Principal Determination.
The capital sensitivity measure, under which diagnostic imaging services provided on older, depreciated equipment attracts reduced Medicare benefit, is intended to improve the quality of diagnostic imaging services by encouraging diagnostic imaging service providers to upgrade and replace, as appropriate, aged equipment. For each relevant service in the current DIST Regulation, the Principal Determination provides for a 50 per cent reduced Schedule Fee which applies where the equipment used to perform the service is older than:
- if the equipment has not been upgraded, the ‘new effective life age’; or
- if the equipment has been upgraded, the ‘maximum effective life age’.
This is a quality measure. It is intended to improve the quality and safety of diagnostic imaging services for patients by encouraging providers of Medicare eligible diagnostic imaging services to replace or upgrade as appropriate aged equipment.
Relevant rules in the DIST Regulation relating to MRI services have been applied to items 63552, 63555, 63558 and 63561:
- the items can be provided by an using equipment recognised as ‘eligible equipment’ or ‘partial eligible equipment’ for Medicare purposes;
- the items must be reported by, and provided under the professional supervision of, a specialist in diagnostic radiology who satisfies the Chief Executive Medicare that he or she is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program, unless the service is provided in an emergency or must be provided in a remote location due to medical necessity;
- requests must be in writing and specify the clinical indications for the service;
- an MRI scan must include a minimum of 3 sequences; and
- the items cannot be claimed more than three times for a particular patient in a 12 month period.
The Health Insurance Act 1973 provides for the DIST Regulation to remain in force a maximum of 15 sitting days in the House of Representatives after a period of 12 months from its registration. The DIST Regulation is therefore remade annually. As part of the upcoming annual remake of the Regulation, all items currently included in the Principal Determination will be transferred directly to the new Regulation. The Principal Determination will be redundant and can be repealed.
Human rights implications
The right to health
The right to health – the right to the enjoyment of the highest attainable standard of physical and mental health – is contained in article 12(1) of the International Covenant on Economic, Social and Cultural Rights (ICESCR). The UN Committee on Economic, Social and Cultural Rights (the Committee) has stated that health is a ‘fundamental human right indispensable for the exercise of other human rights’, and that the right to health is not to be understood as a right to be healthy, but rather entails a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.
The Committee has stated that the notion of ‘the highest attainable standard of health’ takes into account both the conditions of the individual and the country’s available resources. The right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs and conditions necessary for the realisation of the highest attainable standard of health.
MRI services for these indications are currently available to patients over the age of 16 years through request by a specialist and consultant physician. These services will now available through request by other medical practitioners such as GPs. In November 2012, equivalent services that can be requested by GPs were introduced for children under the age of 16 years.
The initiative was developed to ensure that patients have access to affordable and convenient services that reflect best clinical practice. As these items can be requested by GPs, patients will have better access to MRI services and faster diagnosis, as they will not be required to be referred to a specialist or consultant physician in order to get a Medicare funded MRI service.
There is no incompatibility with the right to health or social security because the legislation is for a legitimate objective and reasonable, necessary and proportionate in the circumstances.
Conclusion
This Legislative Instrument is compatible with human rights as it does not raise any human rights issues.
Richard Bartlett
First Assistant Secretary
Medical Benefits Division
Department of Health