EXPLANATORY STATEMENT
STATUTORY RULES 2004 No. 384
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2004 (No. 6)
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.
The Act provides, in part, for payments of Medicare benefits in respect of 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, including diagnostic imaging services, set out in prescribed tables.
Section 4AA of the Act provides that the regulations may prescribe a table of diagnostic imaging services, the amount of fees applicable in respect of each item and the rules for interpretation of the table. The Health Insurance (Diagnostic Imaging Services Table) Regulations 2004 (the Principal Regulations) currently prescribe such a table.
The Minister for Health and Ageing announced on 9 June 2004 that the Government would extend MBS eligibility to additional Magnetic Resonance Imaging (MRI) units. The Department of Health and Ageing has undertaken a MRI Invitation to Apply (ITA) to select around twenty additional MRI units for Medicare eligibility. The ITA was widely distributed through the print media. The MRI units selected through the ITA will be invited to register under the ‘2004 MRI Additional Units Eligibility Scheme’ (the 2004 Scheme). The 2004 Scheme was published in the Gazette on 29 November 2004.
The purpose of the Regulations is to enable the MRI units registered under the 2004 Scheme to provide Medicare eligible services.
The Regulations also amend the definition of ‘eligible provider’. This clarifies that ‘eligible provider’ includes providers who use either of the two MRI units in children’s hospitals that are already recognised as eligible equipment in rule 36 of the Principal Regulations, and providers of Medicare eligible MRI or Magnetic Resonance Angiography (MRA) services under the 2004 Scheme. MRA is a form of MRI which uses the same unit, but examines the cardiovascular system rather than a particular region of the body.
Details of the Regulations are provided in the Attachment.
The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised.
The Regulations commence on 1 January 2005.
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) AMENDMENT REGULATIONS 2004 (NO. 6)
Regulation 1 provides for the Regulations to be referred to as the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2004 (No. 6).
Regulation 2 provides for the Regulations to commence on 1 January 2005.
Regulation 3 provides for Schedule 1 to amend the Health Insurance (Diagnostic Imaging Services Table) Regulations 2004 (the Principal Regulations).
Schedule 1 - Amendments
Part 2 of Schedule 1 to the Principal Regulations – Rules of interpretation
Item [1]
This item amends subrule 31(2) to replace the reference to paragraph 36(b) with a reference to paragraph 36(c). This consequential amendment is needed because item [3] (below) renumbers paragraph 36(b) as paragraph 36(c).
Item [2]
This item amends rule of interpretation 34 (MRI and MRA services – eligible provider). The current rule 34 is renumbered as new subrule 34(1), and is amended to specify that the subrule applies to services performed with equipment to which rule 35 or paragraph 36(a) applies.
This item inserts new subrule 34(2) which specifies that the requirements that a provider of MRI services must satisfy in order to be an ‘eligible provider’ for the purposes of providing a service on the equipment specified in new paragraphs 36(b) and (c). New paragraphs 36(b) and (c) specify, respectively, the MRI units registered under the ‘2004 MRI Additional Units Eligibility Scheme’ (the 2004 Scheme) and the MRI units at two children’s hospitals (see item [3], below).
Item [3]
This item amends rule of interpretation 36 (MRI and MRA services – eligible equipment) by renumbering existing paragraph 36(b) as 36(c), and adding new paragraph 36(b).
New paragraph 36(b) provides that the MRI units that are registered under the 2004 MRI Additional Units Eligibility Scheme (the 2004 Scheme) are eligible equipment.
New Note 2 to this item clarifies that the 2004 Scheme is the scheme that was published in the Gazette on 29 November 2004.
Overview
The Health Insurance Act 1973 was enacted to provide for payments of Medicare benefits in respect of professional services rendered to eligible persons. One of the key components of this Act is the provision for Medicare benefits to be calculated by reference to fees for medical services, including diagnostic imaging services, as set out in prescribed tables. To facilitate this, the Act allows for regulations that prescribe these tables, the applicable fees, and the rules for their interpretation. The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2004 (No. 6) were introduced to amend the existing diagnostic imaging services table, thereby enabling additional Magnetic Resonance Imaging (MRI) units to be eligible for Medicare benefits. These regulations were enacted by the Minister for Health and Ageing to address the gap in MRI services availability under the Medicare Benefits Schedule (MBS). The policy objective of these regulations was to extend MBS eligibility to additional MRI units, enhancing access to diagnostic imaging services for the public. The regulations came into effect on 1 January 2005, providing a clear framework for the inclusion of new MRI units in the MBS.
Scope and Application
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2004 (No. 6) applies to the regulation of Medicare benefits concerning diagnostic imaging services, specifically Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) services, under the Health Insurance Act 1973. The Act applies to eligible persons who receive Medicare benefits and the entities or providers who deliver these diagnostic imaging services. The geographic reach of the Act is national, as it is a Commonwealth Act. The Act extends its application to additional MRI units through subordinate instruments such as these regulations. The Regulations specifically extend eligibility to additional MRI units selected through the 2004 MRI Additional Units Eligibility Scheme and to MRI units at two children’s hospitals. The Regulations do not specify any exclusions or thresholds, but rather provide a framework for the inclusion of additional eligible equipment and providers to ensure broader access to Medicare-subsidised diagnostic imaging services. The Regulations clarify the definition of ‘eligible provider’ to include providers who use the specified MRI units, thereby facilitating the provision of Medicare-eligible services under the amended table.
Key Provisions
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2004 (No. 6) primarily amend the Health Insurance (Diagnostic Imaging Services Table) Regulations 2004 by expanding the scope of eligible providers and equipment for Magnetic Resonance Imaging (MRI) services under the Medicare Benefits Schedule (MBS). Regulation 3 of the Amendment Regulations amends the Principal Regulations by adjusting the rules of interpretation to include additional MRI units under the '2004 MRI Additional Units Eligibility Scheme'. Specifically, Schedule 1, Item [3] renumbers existing paragraph 36(b) to 36(c) and introduces new paragraph 36(b), which recognises MRI units selected through the 2004 Scheme as eligible equipment. Additionally, Item [2] modifies rule 34 to clarify that MRI services performed with equipment specified in the new paragraphs 36(b) and (c) are eligible for MBS benefits, provided the service provider meets the specified requirements to be an 'eligible provider'.
Under these Regulations, parties or entities governed by them are required to comply with the new rules and interpretations regarding eligible equipment and providers. Eligible providers must ensure that their MRI units are registered under the 2004 Scheme or are one of the specified units at children's hospitals to qualify for Medicare benefits. Additionally, the Regulations mandate that service providers adhere to the updated rules of interpretation concerning eligible equipment, ensuring that only recognised MRI units can be used for services eligible under the MBS.
Failure to comply with these Regulations may not explicitly outline specific offences, penalties, or civil/criminal consequences within the provided text. However, breaches of regulations governing Medicare eligibility could potentially lead to financial penalties or legal action, as the Health Insurance Act 1973 allows for enforcement measures against non-compliance with Medicare provisions. The extent of penalties would depend on the nature and severity of the breach, but typically could involve financial penalties or other corrective actions deemed necessary to ensure compliance with the Act.