EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Capital Sensitivity) Amendment Determination 2012 (No.2)
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) Regulations (the DIST Regulations) which are remade each year.
Purpose
This Determination amends the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011 (the Principal Determination) by including six new items which mirror the new items in the DIST Regulation. These items extend magnetic resonance imaging (MRI) requesting rights to medical practitioners (other than a specialist or a consultant physician) for children under the age of 16 years for a set of clinically appropriate indications (such as MRI scans of the head, spine, knee, hip, elbow and wrist).
This Determination also introduces capital sensitivity items for MRI services by granting partial Medicare eligibility to compliant existing or planned MRI equipment located in metropolitan areas by an eligible provider. These items include existing MRI items for the staging of treatment of rectal and cervical cancer and the screening of breast cancer in women less than 50 years of age, as well as the six new MRI services for children under the age of 16 years.
This Determination also makes technical amendments including changes in the way a number of clauses are referred to in the DIST Regulation.
Background
The Principal Determination introduced new services eligible for Medicare benefits to align with the ‘Changes to fees for fully depreciated diagnostic imaging equipment’ or Capital Sensitivity 2009-10 Budget measure. This measure is about improving 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 introduced a new service with 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.
Details of the Determination are set out in the Attachment.
The Determination commences on 1 November 2012.
The Determination is a legislative instrument for the purposes of the
Legislative Instruments Act 2003.
Consultation
The extension of requesting rights to GPs has been implemented under the Better Access to Magnetic Resonance Imaging measure which forms part of the the Diagnostic Imaging Review Reform Package. Extensive consultation has been undertaken with the sector with regard to the introduction of the six new MRI items for children under the age of 16 years.
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (DIAGNOSTIC IMAGING CAPITAL SENSITIVITY) AMENDMENT DETERMINATION 2012 (No. 2)
Section 1 – Name of Determination
Section 1 provides that the title of the Determination is the Health Insurance (Diagnostic Imaging Capital Sensitivity) Amendment Determination 2012 (No.2) (the Determination).
Section 2 – Commencement
Section 2 provides that the Determination commences on 1 November 2012.
Section 3 – Amendment of Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011
Section 3 provides that the Schedule of the Determination amends the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011 (the Principal Determination).
Schedule Amendments
Item 1
Schedule 1 to the Principal Determination provides for (NK) items. Subsection 6(1) provides that
an (NK) item applies to a service which is performed using:
- diagnostic imaging equipment with an age that exceeds the new effective life age
specified for that type of equipment which has not been upgraded; or
- upgraded diagnostic imaging equipment with an age that exceeds the maximum extended life age specified for that type of equipment.
Item 1 inserts a new subdivision E containing six (NK) items (items 63508, 63511, 63514, 63517, 63520 and 63523) into Schedule 1 of the Principal Determination. These items provide for MRI services for children under the age of 16 years that would be requested by a medical practitioner other than a specialist or a consultant physician for a small set of clinically appropriate indications (such as MRI scans of the head, spine, knee, hip, elbow and wrist). As the MRI items included in the DIST Regulation need to be mirrored into the Principal Determination in order to give effect to (NK) items, Subdivision E has now been added to Division 2.5.
Item 2
The tables in Schedule 2 of the Principal Determination sets out the provisions of regulations made under the Act which are taken to have effect as if they were included references to the (NK) items.
Item 2 substitutes three new tables into Schedule 2 of the Principal Determination to give effect to amendments made in the DIST Regulations, including the inclusion of the MRI services for children under the age of 16 years that would be requested by a medical practitioner other than a specialist or a consultant physician for a small set of clinically appropriate indications, and the inclusion of capital sensitivity items for MRI services granted partial Medicare eligibility.
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 Determination 2012 (No. 2)
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) Determination 2011 (the Principal Determination) enables the payment of Medicare benefits for certain diagnostic imaging services performed on aged diagnostic imaging equipment, referred to as (NK) items. 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.
The Health Insurance (Diagnostic Imaging Capital Sensitivity) Amendment Determination 2012 (No. 2) (the Determination) amends the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011 (the Principal Determination) by including six new items which mirror the new items in the DIST Regulation. These items extend magnetic resonance imaging (MRI) requesting rights to medical practitioner’s (other than a specialist or a consultant physician) for children under the age of 16 years for a small set of clinically appropriate indications (such as MRI scans of the head, spine, knee, hip, elbow and wrist). The Determination provides for the inclusion of capital sensitivity items for MRI services granted partial Medicare eligibility. In additional there are technical amendments including changes in the way a number of clauses are referred to in the DIST Regulation.
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.
Right to Social Security
The right to social security is contained in article 9 of the ICESCR. The right requires that a country must, within its maximum available resources, ensure access to a social security scheme that provides a minimum essential level of benefits to all individuals and families that will enable them to acquire at least essential health care. Countries are obliged to demonstrate that every effort has been made to use all resources that are at their disposal in an effort to satisfy, as a matter of priority, this minimum obligation.
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.
The Committee has also stated that with respect to the right to social security that the qualifying conditions for benefits must be reasonable, proportionate and transparent.
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 has a positive effect on human rights issues.
Richard Bartlett
First Assistant Secretary
Medical Benefits Division
Department of Health and Ageing