EXPLANATORY STATEMENT
Select Legislative Instrument 2012 No. 295
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Amendment Regulation 2012 (No. 1)
Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides that the
Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Part II of the Act provides for the payment of Medicare benefits for professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services set out in the table.
Subsection 4AA(1) of the Act provides that the regulations may prescribe a table of diagnostic imaging services that describes the services, the fees applicable for each item, and rules for interpreting the table. The Health Insurance (Diagnostic Imaging Services Table) Regulation 2012 (the Principal Regulation) currently prescribes such a table.
The purpose of the regulation is to correct a drafting error in the description of item 63513. 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 agents, such as Gadolinium, are substances introduced into the body to improve the visibility of internal body structures in magnetic resonance imaging (MRI). 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.
The Act specifies no conditions which need to be met before the power to make the regulation may be exercised.
The regulation is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The regulation commences the day after it is registered.
Consultation
Although no consultation was undertaken in relation to this regulation as the change is a minor amendment to correct an omission in the Principal Regulation, following the announcement of the Diagnostic Imaging Reform Package 2010-11 Budget announcements there was significant consultation with the relevant craft groups in the development of the initiative. The Review involved extensive formal and informal consultation with the diagnostic imaging industry and profession including the establishment of a Diagnostic Imaging Review Consultation Committee (DIRCC). These items were developed with assistance from an Expert Group of General Practitioners and Radiologists, including representatives from the Royal Australian and New Zealand College of Radiologists (RANZCR), and the Royal Australian College of General Practitioners (RACGP).
Authority: Subsection 133(1) of the
Health Insurance Act 1973
Overview
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulation 2012 (No. 1) is a legislative instrument introduced to amend the Health Insurance (Diagnostic Imaging Services Table) Regulation 2012, which was itself made under the authority of the Health Insurance Act 1973. This amendment was enacted to correct a drafting error in the description of item 63513, ensuring that the item descriptor includes the necessary annotations to permit the claiming of Medicare benefits for the anaesthetic and contrast components of the service, particularly for General Practitioner-requested MRI knee scans for children under 16 years of age. The regulation was made under subsection 133(1) of the Health Insurance Act 1973, empowering the Governor-General to make regulations not inconsistent with the Act to prescribe matters necessary for its operation. No specific conditions are required to be met before exercising this power. The regulation commenced on the day after it was registered and is subject to the Legislative Instruments Act 2003. While no direct consultation was undertaken for this specific amendment, broader consultation had occurred in the development of the Diagnostic Imaging Reform Package as announced in the 2010-11 Budget, involving extensive engagement with the diagnostic imaging industry and profession.
Scope and Application
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulation 2012 (No. 1) applies to entities and individuals involved in the provision of diagnostic imaging services within the framework of the Health Insurance Act 1973. Specifically, it pertains to the clarification of item 63513, which concerns the claiming of Medicare benefits for the anaesthetic and contrast components of MRI scans for children under 16 years. The regulation rectifies a drafting error in the Principal Regulation by ensuring that these components are appropriately acknowledged, thereby enabling General Practitioners to claim Medicare benefits for these services when requested. The jurisdictional reach of this regulation is confined to the Commonwealth of Australia, as it is an amendment to the federal legislation. The regulation does not introduce new exclusions or exemptions; rather, it clarifies existing provisions to ensure proper application and compliance with the Act. The regulation may be further extended or restricted through subordinate instruments as necessary, although no such extensions or restrictions are outlined in this particular legislative instrument.
Key Provisions
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulation 2012 (No. 1) amends the Diagnostic Imaging Services Table to correct a drafting error in the description of item 63513. Specifically, the amendment clarifies that the use of anaesthetic and contrast agents is permissible when a General Practitioner requests an MRI knee scan for a child under the age of 16 years (subsection 4AA(1)). The regulation rectifies the omission in the Principal Regulation, ensuring that the necessary annotations for claiming Medicare benefits for these components are included.
This regulation imposes obligations on General Practitioners and diagnostic imaging providers to ensure that the correct fees are billed and that the use of anaesthetic and contrast agents are properly authorised when conducting MRI scans on children under 16 years of age. This ensures that eligible services are correctly claimed and reimbursed under the Medicare benefits scheme.
There are no explicit offences or penalties outlined in the explanatory statement for breaching this regulation. However, the Health Insurance Act 1973 provides for a range of civil and criminal penalties for non-compliance with Medicare regulations. For example, section 124 of the Act allows for fines and imprisonment for fraudulent claims, and section 126 provides for financial penalties for incorrect or misleading statements. The penalties can include fines of up to $22,200 for individuals and $111,000 for bodies corporate, as well as potential imprisonment terms.
Given the amendment's purpose is to correct an oversight in the Principal Regulation, compliance is essential to avoid discrepancies in billing and reimbursement for diagnostic imaging services. The amendment ensures that all relevant parties are aware of and correctly interpret the requirements for claiming Medicare benefits in this specific context.