EXPLANATORY STATEMENT
Select Legislative Instrument 2005 No. 311
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 5)
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.
Subsection 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 2005 (the Principal Regulations) prescribe such a table.
The purpose of the Regulations is to correct an omission from the Principal Regulations and insert a new item in the table of services.
Omission from the Principal Regulations
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No.3) were approved by the Governor-General in Council on 6 October 2005. This amendment provided Medicare eligibility to a new MRI machine located at the Mater Children’s Hospital, Brisbane. However, due to a drafting error this provision was not included in the Principal Regulations when they were remade effective from
1 November 2005.
Schedule 1 to the Regulations prescribe the MRI machine located at the Mater Children’s Hospital, Brisbane, with effect from 1 November 2005. The Office of Legislative Drafting and Publishing has advised that the retrospective commencement date would not cause any disadvantage or liability to anyone, and would comply with the requirements of the Legislative Instruments Act 2003. That advice is attached.
New Item for inclusion in the Principal Regulations
The Medical Services Advisory Committee (MSAC) produced a report on magnetic resonance cholangiopancreatography (MRCP) in March 2005. MRCP is a specialised MRI technique that produces images of the bile ducts, pancreas and surrounding tissues. This procedure has a significant benefit to patients because it is non-invasive and avoids the risk of infection, pancreatitis, perforation and death associated with similar procedures such as endoscopic retrograde cholangiopancreatography (ERCP). MSAC recommended that on the strength of evidence pertaining to the safety, effectiveness and cost-effectiveness of MRCP, public funding should be supported for this procedure when referred by specialists. The Minister for Health and Ageing accepted this recommendation on 4 July 2005.
Schedule 2 to the Regulations would provide for MRCP to be included as a Medicare-eligible service from 1 January 2006 by:
- inserting the new item of service in Subgroup 21 and renumbering the existing Subgroup 21 to Subgroup 22;
- amending subrule 31(1) and rules 32 and 37 to include the new item of service in the range of items specified; and
- amending subrule 39(2) to specify that the maximum number of MRCP services that can be claimed in any 12 month period is three.
The Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association have been consulted about the inclusion of MRCP as an item of service in the Regulations from 1 January 2006.
The Act specified no conditions that need to be met before the power to make the Regulations was exercised.
The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Regulations were taken to have commenced on 1 November 2005 for Regulations 1-3 and Schedule 1, and commence on 1 January 2006 for Schedule 2.
Authority: Subsection 133(1) of the Health Insurance Act 1973
Overview
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 5) were enacted to amend the Health Insurance Act 1973, addressing the gaps in the existing regulatory framework for diagnostic imaging services. The regulations were introduced to correct an oversight in the previously enacted Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 3), which inadvertently omitted the inclusion of a new MRI machine at the Mater Children's Hospital, Brisbane, despite its approval by the Governor-General in Council. This amendment ensures that the new MRI machine is eligible for Medicare benefits, effective from 1 November 2005. Furthermore, these regulations aim to include magnetic resonance cholangiopancreatography (MRCP) as a Medicare-eligible service from 1 January 2006, following a recommendation by the Medical Services Advisory Committee that acknowledged the safety, effectiveness, and cost-effectiveness of MRCP as a non-invasive alternative to similar procedures.
Scope and Application
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 5) amends the Health Insurance (Diagnostic Imaging Services Table) Regulations 2005 by inserting a new item in the table of diagnostic imaging services. This amendment applies to eligible individuals who require diagnostic imaging services, specifically magnetic resonance cholangiopancreatography (MRCP), which is a specialised MRI technique. The amendment is designed to ensure that Medicare benefits are calculated in accordance with the fees for medical services set out in the prescribed tables, as per subsection 4AA(1) of the Health Insurance Act 1973. The Regulations extend to the whole of Australia, as the Act operates nationally. There are no exclusions or exemptions specified in the Regulations; however, the Act itself may have conditions that determine eligibility for Medicare benefits. The Regulations do not extend or restrict application through subordinate instruments beyond what is outlined in the explanatory statement.
Key Provisions
The main operative sections of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2005 (No. 5) primarily focus on correcting an oversight in the original Health Insurance (Diagnostic Imaging Services Table) Regulations 2005. Section 133(1) of the Health Insurance Act 1973 empowers the Governor-General to make regulations necessary to implement the Act, which includes prescribing fees for medical services, including diagnostic imaging services. Subsection 4AA(1) further allows for the specification of a table of diagnostic imaging services, fees, and interpretation rules. The Regulations, particularly in Schedule 1, correct an omission regarding a new MRI machine at the Mater Children’s Hospital in Brisbane, which was inadvertently left out of the Principal Regulations. Schedule 2, meanwhile, introduces a new diagnostic imaging service, magnetic resonance cholangiopancreatography (MRCP), as a Medicare-eligible service starting from 1 January 2006.
The obligations and requirements imposed by these Regulations are mainly administrative and procedural. For the MRI machine at the Mater Children’s Hospital, the Regulations ensure that this service is recognised and eligible for Medicare benefits from the effective date of 1 November 2005. For MRCP, the Regulations stipulate its inclusion in the Diagnostic Imaging Services Table, specifying its subgroup and renumbering subsequent subgroups. Additionally, the Regulations amend subrule 31(1) and rules 32 and 37 to incorporate MRCP into the range of specified items. They also adjust subrule 39(2) to limit the number of MRCP services that can be claimed in any 12-month period to three. These adjustments necessitate consultation with relevant professional bodies such as the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association.
The Regulations do not explicitly outline specific offences, penalties, or consequences for non-compliance. However, failure to adhere to the stipulated provisions could potentially lead to issues regarding the eligibility and reimbursement of services under Medicare. Given the legislative context and the critical nature of ensuring correct and timely implementation of healthcare services, any non-compliance might result in administrative reviews, audits, or other corrective measures to ensure that the services are provided in accordance with the prescribed regulations. The retrospective commencement date for the MRI machine at the Mater Children’s Hospital was deemed to cause no disadvantage or liability, as advised by the Office of Legislative Drafting and Publishing.