EXPLANATORY STATEMENT
Select Legislative Instrument 2005 No. 178
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table)
Amendment Regulations 2005 (No. 2)
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) prescribe such a table.
On 9 June 2004, the Minister for Health and Ageing announced that the Government would provide additional funding to extend Medicare eligibility to two existing MRI machines in children’s hospitals in Perth and Adelaide, and to a children’s hospital in Brisbane, upon purchase and installation of an MRI machine. The Royal Children’s Hospital, Brisbane (the hospital) has purchased an MRI machine, and it is expected the machine will be installed and operational from 8 August 2005.
The purpose of the Regulations is to enable the MRI machine located in the hospital to provide Medicare eligible services.
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 are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Regulations commence on the day after they are registered on the Federal Register of Legislative Instruments.
Consultation
Medicare Benefits Schedule (MBS) funded MRI services are managed through the 2003-2008 Radiology Quality and Outlays Memorandum of Understanding (MoU) between the Commonwealth (as represented by the Department of Health and Ageing) and the radiology profession (as represented by the Royal Australian and New Zealand College of Radiologists (RANZCR) and the Australian Diagnostic Imaging Association (ADIA)). The RANZCR and the ADIA have been consulted about this matter as part of the ongoing management process for the Radiology MoU.
ATTACHMENT
Details of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 2)
Regulation 1 – Name of Regulations
This regulation provides that the title of the Regulations is the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 2).
Regulation 2 – Commencement
This regulation provides for the Regulations to commence on the day after they are registered on the Federal Register of Legislative Instruments.
Regulation 3 – Amendment of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2004
This regulation provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2004 (the Principal Regulations) are amended as set out in the Schedule.
Schedule – Amendment
Item [1] – rule 36
This item amends rule of interpretation 36 (MRI and MRA - eligible equipment) by inserting new item 3 in the table in paragraph 36(c)(i) to prescribe the MRI unit located in the Royal Children’s Hospital, Brisbane as eligible MRI equipment.
Overview
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 2) were enacted to address the need for expanding Medicare eligibility to cover diagnostic imaging services provided by a newly acquired MRI machine in the Royal Children’s Hospital, Brisbane. Authorised by subsection 133(1) of the Health Insurance Act 1973, these regulations were issued by the Minister for Health and Ageing, aiming to facilitate the inclusion of the new MRI unit in the schedule of eligible equipment under the Health Insurance Act. This legislative action ensures that the hospital can offer Medicare-subsidised MRI services, thereby enhancing healthcare access for eligible patients. The policy objective is to extend Medicare coverage for diagnostic imaging services in children’s hospitals, promoting equitable healthcare delivery across different regions in Australia.
Scope and Application
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 2) applies to the diagnostic imaging services provided by the MRI machine installed at the Royal Children's Hospital in Brisbane, which has been extended Medicare eligibility. The Act itself applies to the calculation of Medicare benefits for diagnostic imaging services, as prescribed by the fees set out in the relevant tables. The amendments made by these Regulations are specifically designed to facilitate the provision of Medicare-eligible services through the new MRI machine in the children's hospital. The Regulations extend the eligibility of MRI services under Medicare to this specific equipment, thus impacting the healthcare services provided to eligible patients in Queensland. The jurisdictional reach of these Regulations is national, as they are made under the authority of the Commonwealth Government, with the specific intent to modify the existing Health Insurance (Diagnostic Imaging Services Table) Regulations 2004. These Regulations do not specify any exclusions or thresholds apart from the eligibility of the MRI machine in question. The application of these Regulations can potentially be extended or further defined through additional subordinate instruments as required.
Key Provisions
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 2) amend the Health Insurance (Diagnostic Imaging Services Table) Regulations 2004 to include an MRI unit located in the Royal Children’s Hospital, Brisbane, as eligible equipment for the provision of Medicare-funded services (Regulation 3). Specifically, this amendment adds a new entry in rule 36, which defines the types of equipment eligible to provide MRI and MRA services under Medicare (Schedule, Item [1]). These Regulations are made under the authority of subsection 133(1) of the Health Insurance Act 1973 (the Act) and are designed to facilitate the provision of Medicare benefits for diagnostic imaging services rendered using the MRI unit at the specified hospital.
These Regulations impose specific obligations on the hospital and the relevant professional bodies, such as the Royal Australian and New Zealand College of Radiologists (RANZCR) and the Australian Diagnostic Imaging Association (ADIA). The hospital must ensure that the MRI unit meets all the criteria set out in the amended rule 36 and is capable of providing services eligible for Medicare benefits. The professional bodies are responsible for ensuring that the services provided using this equipment comply with the standards and guidelines set out in the Radiology Quality and Outlays Memorandum of Understanding (MoU) between the Commonwealth and the radiology profession. The Department of Health and Ageing, on behalf of the Commonwealth, retains oversight responsibilities to ensure adherence to these standards and the proper application of Medicare benefits.
Failure to comply with the provisions of these Regulations or the overarching Act could result in significant consequences. While the Regulations themselves do not explicitly state penalties for non-compliance, breaches of the Health Insurance Act 1973 can result in civil or criminal penalties. Under section 136 of the Act, individuals or entities found guilty of providing false or misleading information to obtain Medicare benefits may face fines of up to $21,000 for individuals and $105,000 for bodies corporate. Furthermore, under section 138, more severe penalties, including imprisonment, may apply for serious or repeated offences. These provisions underscore the importance of strict compliance with the Act and the Regulations to avoid potential legal repercussions.