EXPLANATORY STATEMENT
Select Legislative Instrument 2005 No. 219
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 3)
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(1) 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.
The Minister for Health and Ageing gave policy approval, for services provided, using a Magnetic Resonance Imaging (MRI) unit, located at the Mater Misericordiae Health Services Brisbane Limited, known as the Mater Children’s Hospital, Brisbane, to be granted Medicare eligibility.
The purpose of the amendment Regulations is to provide Medicare eligibility for magnetic resonance imaging (MRI) scans conducted at the Mater Children’s Hospital. This would be achieved by inserting a new item 4 in the table in paragraph 36(c).
Following consultation, the Queensland State Government recommended that Medicare eligibility be granted to the Royal Children's Hospital, Brisbane. During 2005, consultation with the Mater Children's Hospital, Brisbane, revealed that it was the only tertiary children's hospital in Australia without direct access to a Medicare eligible MRI unit. Unlike x-ray and computed tomography, MRI does not use ionising radiation. This is especially important for children who face far greater risks from radiation than adults.
The Regulations enables the MRI machine located in the Mater Children’s Hospital to provide Medicare eligible services.
The Regulations commence on the day after they are registered on the Federal Register of Legislative Instruments.
Overview
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 3) were enacted to address a specific gap in Medicare eligibility for diagnostic imaging services, particularly magnetic resonance imaging (MRI) scans, at the Mater Children’s Hospital in Brisbane. This legislative instrument was introduced under the authority of Subsection 133(1) of the Health Insurance Act 1973, which empowers the Governor-General to make regulations necessary for the effective implementation of the Act. The policy objective of these amendments was to ensure equitable access to Medicare benefits for MRI services at the Mater Children's Hospital, which, at the time, was the only tertiary children's hospital in Australia without direct access to a Medicare-eligible MRI unit. The amendment facilitates the inclusion of a new item in the Diagnostic Imaging Services Table, thereby providing the necessary Medicare eligibility for MRI services conducted at this hospital. The Regulations were approved by the Minister for Health and Ageing, following recommendations from the Queensland State Government and consultations with the Mater Children's Hospital.
Scope and Application
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 3) amends the Health Insurance (Diagnostic Imaging Services Table) Regulations 2004, which prescribe a table of diagnostic imaging services for which fees are payable under the Health Insurance Act 1973. The Regulations apply to the Commonwealth of Australia and are made under subsection 133(1) of the Act, which allows for the Governor-General to make regulations to carry out or give effect to the Act. The Regulations specifically address the eligibility of magnetic resonance imaging (MRI) services provided at the Mater Children’s Hospital in Brisbane, aiming to provide Medicare benefits for these services. This amendment is significant as it grants Medicare eligibility to the only tertiary children's hospital in Australia without direct access to a Medicare-eligible MRI unit. The Regulations insert a new item into the prescribed table to reflect this eligibility and will come into effect on the day after they are registered on the Federal Register of Legislative Instruments.
Key Provisions
The main operative sections of these regulations, particularly sections 36(c) and 4AA(1) under the Health Insurance Act 1973, permit the insertion of a new item, specifically item 4, into the Diagnostic Imaging Services Table. This new item provides Medicare eligibility for magnetic resonance imaging (MRI) scans conducted at the Mater Children’s Hospital in Brisbane. The insertion of this new item is intended to address the unique needs of children, who are more susceptible to the risks posed by ionising radiation compared to adults. By including MRI scans within the Medicare scheme, the regulations ensure that children at the Mater Children’s Hospital have access to this essential diagnostic service without incurring out-of-pocket expenses.
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 impose specific obligations on the Mater Children’s Hospital and the Minister for Health and Ageing. The hospital must ensure that its MRI services meet the standards and criteria set by Medicare for eligibility. The Minister, on the other hand, must ensure that the new item is correctly and effectively incorporated into the Diagnostic Imaging Services Table, thus enabling the hospital to provide these services with the appropriate Medicare benefits. The regulations also necessitate consultation with relevant stakeholders, including the Queensland State Government and the Mater Children’s Hospital, to align the amendments with broader healthcare policies and needs.
Failure to comply with these regulations may result in civil or criminal consequences. While the specific penalties are not outlined in the explanatory statement, breaches of the Health Insurance Act 1973 generally can lead to significant penalties. For instance, under section 133 of the Act, individuals or entities may face fines or other civil penalties for non-compliance. In more serious cases, criminal charges could be pursued, potentially leading to imprisonment. The exact penalties depend on the severity and nature of the breach, but they underscore the importance of adhering to the regulations to maintain the integrity of the Medicare system.