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.3)
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).
The purpose of this determination is to correct a drafting error in the description of item 63514. The current wording of the item descriptor does not include the annotations which authorise the claiming of Medicare benefits for the anaesthetic and contrast components of the service. Contrast is a substance (such as a solution of iodine or suspension of barium sulphate) which is comparatively opaque to X-rays, that is introduced into the body to contrast an internal part with its surrounding tissue in radiographic visualisation. Therefore, this amendment clarifies that the use of anaesthetic and contrast is permissible where a General Practitioner requests an MRI knee scan for a child under the age of 16 years.
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 Regulations, 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.
The Determination commences on 1 January 2013.
The Determination is a legislative instrument for the purposes of the
Legislative Instruments Act 2003.
Consultation
No consultation was undertaken in relation to this regulation as the change is a minor amendment to correct an omission in the previous amendment.
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. 3)
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. 3) (the Determination) corrects a drafting error in the description of item 63514. The current wording of the item descriptor does not include the annotations which authorise the claiming of Medicare benefits for the anaesthetic and contrast components of the service. Contrast is a substance (such as a solution of iodine or suspension of barium sulphate) which is comparatively opaque to X-rays that is introduced into the body to contrast an internal part with its surrounding tissue in radiographic visualisation. Therefore, this amendment clarifies that the use of anaesthetic and contrast is permissible where a General Practitioner requests an MRI knee scan for a child under the age of 16 years.
Human rights implications
This Legislative Instrument does not engage any of the applicable rights or freedoms.
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 and Ageing
Overview
The Health Insurance (Diagnostic Imaging Capital Sensitivity) Amendment Determination 2012 (No.3) amends the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011 to correct a drafting error in the description of item 63514, which concerns MRI knee scans for children under the age of 16 years. This determination, enacted by the Minister for Health, rectifies an omission in the previous amendment, ensuring that the use of anaesthetic and contrast is authorised when a General Practitioner requests such a scan. The amendment aligns with the policy objective of improving the quality and safety of diagnostic imaging services through the replacement or upgrading of aged equipment, thereby encouraging providers to use newer technology. This legislative instrument is compatible with human rights as it does not engage any of the applicable rights or freedoms, as outlined in the Human Rights (Parliamentary Scrutiny) Act 2011.
Scope and Application
The Health Insurance (Diagnostic Imaging Capital Sensitivity) Amendment Determination 2012 (No.3) amends the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011, addressing a drafting error in the description of item 63514 within the diagnostic imaging services table. This correction allows for the claiming of Medicare benefits for the anaesthetic and contrast components of certain diagnostic imaging services, specifically MRI knee scans requested by General Practitioners for children under 16 years of age. The amendment is designed to ensure that the use of anaesthetic and contrast, which are substances used to enhance the visibility of internal body parts in radiographic imaging, are correctly authorised for Medicare claims under the specified circumstances. This legislative instrument applies to medical practitioners and diagnostic imaging service providers who perform these services using older diagnostic imaging equipment. The amendment is effective from 1 January 2013 and is a legislative instrument under the Legislative Instruments Act 2003. No consultation was undertaken as the change is considered a minor correction of an omission in the previous amendment. This determination aligns with human rights, as it does not engage any applicable rights or freedoms as recognised under the Human Rights (Parliamentary Scrutiny) Act 2011.
Key Provisions
The Health Insurance (Diagnostic Imaging Capital Sensitivity) Amendment Determination 2012 (No. 3) (the Determination) amends the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011 (the Principal Determination). The main operative sections of the Determination (subsection 3C(1) of the Health Insurance Act 1973) provide 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. This amendment corrects a drafting error in the description of item 63514, ensuring that the use of anaesthetic and contrast is permissible where a General Practitioner requests an MRI knee scan for a child under the age of 16 years.
The Determination imposes specific obligations on the parties involved in the provision and claiming of Medicare benefits for diagnostic imaging services. The Principal Determination enabled the payment of Medicare benefits for certain diagnostic imaging services performed on aged diagnostic imaging equipment, referred to as (NK) items. This was intended to improve the quality and safety of diagnostic imaging services by encouraging providers to replace or upgrade aged equipment. The Amendment Determination ensures that the use of anaesthetic and contrast is clarified and authorised for the specified service.
The Determination does not introduce new offences, but it does clarify existing provisions to ensure that the correct services are eligible for Medicare benefits. The Principal Determination introduced a new service with a 50 per cent reduced Medicare Benefit Schedule Fee for specified equipment ages. Any breach of these provisions could potentially lead to incorrect claiming of Medicare benefits, which could result in civil or criminal penalties under the Health Insurance Act 1973 or other related legislation. However, the specific penalties for such breaches are not detailed in the Determination itself.
The legislative instrument is compatible with human rights, as confirmed in the Statement of Compatibility with Human Rights. The Amendment Determination does not engage any of the applicable rights or freedoms and does not raise any human rights issues. This compatibility statement is prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011. The Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003 and commenced on 1 January 2013.