Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2001 (No. 3) 2001 No. 141
EXPLANATORY STATEMENT
STATUTORY RULES 2001 No. 141
Issued by the Authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2001 (No. 3)
Section 133 of the Health Insurance Act 1973 ('the Act') provides that the Governor-General may make regulations prescribing matters for purposes of the Act.
The Act provides for payments to eligible persons for professional service by way of Medicare benefits.
Section 4AA of the Act provides that the table of diagnostic imaging services may be prescribed by the Regulations. The Health Insurance (Diagnostic Imaging Services Table) Regulations 2001 prescribe such a table.
Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services (including diagnostic imaging services) set out in a table which included the Diagnostic Imaging Services Table (the Table).
A number of changes to the Regulations have been made as part of the ongoing management of the Table. The Regulations incorporate the following changes to the Table:
• a restructure and fee reduction to cardiac ultrasound items, including the deletion of one item, the introduction of three new items replacing the deleted item thus providing more detailed monitoring information, and the amendment of item descriptors to three items;
• the restructure of cardiac angiography items, with the deletion of six items, the introduction of five new items to reflect current clinical practice, and an update to the descriptors for two items. Capital sensitivity for equipment older than ten years has also been introduced;
• the deletion of two radiological preparation items, and updates to the remaining two items' descriptors.
The changes and reforms have been developed, initially in consultation with the Cardiac Society of Australia and New Zealand (CSANZ), and more recently with the Diagnostic Imaging Management Committee (DIMC).
Details of the Regulations are in Attachment A.
The Regulations came into effect from 1 July 2001.
ATTACHMENT A
Details of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2001
Regulation 1 provides that the name of the regulations is the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2001 (No. 3).
Regulation 2 provides for the regulations to commence on 1 July 2001.
Regulation 3 provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2001 will be amended by Schedule 1 of the proposed Regulations.
Changes to the Table
The July 2001 Diagnostic Imaging Services Table differs from the previous tables in the following way:
Cardiac Ultrasound:
• A Schedule Fee reduction of five percent (5%) is to be applied to all cardiac ultrasound items as an initial step towards more sustainable financing of the high-growth of services on these items. The fee reduction is modest, and takes into account the impact on bulk billing and patient contributions.
• Item number 55112, the main cardiac ultrasound item, is to be deleted and replaced with three (3) new items, being 55113, 55114 and 55115. The introduction and use of the new items will allow the clinical reasons for the high growth of services to be identified and monitored,
• Amendments to the descriptors of items 55116 and 55117 have been applied to cover an oversight in the November 2000 changes, where the standard subgroup restrictions were inadvertently left off these two items.
Cardiac Angiography:
• The deletion of items 59900, 59906, 59915, 59918,59921, and 59924. This is a decision seen by the medical profession to be long overdue, and brings the Schedule in line with current clinical practice.
• A restriction has been introduced between item 59903 and item 59912 so that they can no longer be claimed simultaneously. However, both items will continue to be claimed individually. The descriptors for items 59903 and 59902 have been updated to reflect changes made to other services used in association with these two items.
• A new item, 59925, has been introduced to replace the previous practice of simultaneously claiming the above items, being 59903 and 59912, when both services are required to be performed on the same patient on the same day. The new item, 59925, will attract a fee 14% less than when the two services were claimed in tandem (this fee reduction is a reflection of the time and effort saved when performing the combined service).
Cardiac Angiography (continued):
New items have been introduced to apply capital sensitivity to Cardiac Angiography services. The new items, 59971, 59972, 59973 and 59974 are to be claimed in place of items 59903, 59912, 59925 and 59970 when the equipment used to perform the service is greater than ten (10) years old.
The introduction of capital sensitivity to Cardiac Angiography services will discontinue the situation where the Commonwealth unnecessarily pays the capital component of cardiac angiography services long after the equipment itself has been paid for. This arrangement is similar to that which has been successfully applied to computed tomography (CT) services.
Preparation Items for Radiological Procedures:
• Deletion of items 60903 and 60915 to bring the Schedule in line with current clinical .practice.
• Minor wording changes to the remaining two item descriptors, being items 60918 and 60927, have been applied in order to reflect the changes to item numbers in the Cardiac Angiography restructure (above).
Explanatory notes for all new item numbers are to be incorporated in the Medicare benefits schedule, to aid practitioners with interpretation.