EXPLANATORY STATEMENT
Select Legislative Instrument 2006 No. 319
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2006 (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.
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 2006 (the Principal Regulations) prescribe such a table.
The purpose of the Regulations is to amend the Principal Regulations to enable Medicare benefits to be paid for magnetic resonance imaging (MRI) services conducted using specified equipment at Orana Radiology in Dubbo, NSW.
The conditions under which Medicare benefits will be paid in respect of the MRI unit specified above will differ from those in respect of the MRI units currently prescribed in the Principal Regulations. The conditions negotiated with Orana Radiology include bulk-billing concessional card holders only. Persons who are not concessional card holders may be charged up to the schedule fee. This will ensure the financial viability of the service.
Details of the Regulations are set out 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 funded MRI services are managed through the 2003-2008 Radiology Quality and Outlays Memorandum of Understanding 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 and the Australian Diagnostic Imaging Association).
Authority: Subsection 133(1) of the Health Insurance Act 1973
ATTACHMENT
Details of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2006 (No. 6)
Regulation 1 – Name of Regulations
This regulation provides that the title of the Regulations is the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2006 (No. 6).
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 2006
This regulation provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006 (the Principal Regulations) are amended as set out in Schedule 1.
Schedule 1 – Amendments
Item [1]
Item 1, Schedule 1, Part 2, subrule 31(1) will insert reference to new subrule 31(2A), which is inserted by item [2] below.
Item [2]
Item 2 will insert into Schedule 1, Part 2, after subrule 31(2) a new subrule 31 (2A) which will include a reference to new paragraph 36(e) of Part 2 of Schedule 1 which is inserted by item [6] below.
New subrule 31(2A) will provide that a Medicare benefit will only be payable for an MRI service performed with the specified equipment under the following circumstances:
- services to patients who are concessional beneficiaries will be bulk-billed; or
- patients who are not concessional beneficiaries will be charged up to the Medicare Schedule fee for the services provided.
Item [3]
For Schedule 1, Part 2, subrule 31(3), the reference to ‘For subrule (2)’ will be replaced by inserting ‘In this rule’ as this subrule will now refer to subrule (2) and subrule (2A).
Item [4]
Item 4 will insert a definition of concessional beneficiary into Schedule 1, Part 2,
subrule 31(3).
Item [5]
Item 5 will insert a reference to the eligible equipment as inserted by item [7] below into Schedule 1, Part 2, subrule 34(2).
Item [6]
Item 6 will make a grammatical change to allow item [7] to be inserted.
Item [7]
Item 7 will insert a new paragraph 36(e) into Part 2 of Schedule 1 to the Principal Regulations. This amendment will provide that the new specified piece of equipment will be Medicare eligible if the equipment:
(a) is located at the place specified in the regulations;
(b) has a magnet strength of 1.5T; and
(c) forms part of a comprehensive radiology department at the relevant location that provides, at a minimum, x-ray, computed tomography and ultrasound services; and
(d) is available for use from 9 am to 5 pm each Monday to Friday (excluding public holidays) for routine services, except for periods reasonably required for necessary maintenance, repairs and upgrades; and
(e) is available for use at all times for emergency services, except for periods reasonably required for necessary maintenance, repairs and upgrades.
Overview
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2006 (No. 6) were enacted to address a specific problem in the provision of magnetic resonance imaging (MRI) services at Orana Radiology in Dubbo, NSW, under the Health Insurance Act 1973. The Act, which governs the payment of Medicare benefits for medical services, including diagnostic imaging, was supplemented by these regulations to ensure the financial viability of MRI services provided at Orana Radiology. The regulations allow for differentiated conditions for Medicare benefits for MRI services, specifically bulk-billing concessional card holders while permitting non-concessional card holders to be charged up to the schedule fee. This amendment was enacted by the Minister for Health and Ageing under the authority provided by subsection 133(1) of the Health Insurance Act 1973 and is intended to ensure that the service remains viable while still providing access to essential diagnostic services for eligible patients. The regulations were developed in consultation with relevant stakeholders, including the Department of Health and Ageing, the Royal Australian and New Zealand College of Radiologists, and the Australian Diagnostic Imaging Association, and they commenced on the day after their registration on the Federal Register of Legislative Instruments.
Scope and Application
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2006 (No. 6) applies to the administration and payment of Medicare benefits for diagnostic imaging services, specifically for magnetic resonance imaging (MRI) services conducted using specified equipment at Orana Radiology in Dubbo, NSW. The Regulations amend the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006, which set out the fees and conditions for the provision of diagnostic imaging services under the Health Insurance Act 1973. The Act applies to the persons and entities eligible to receive Medicare benefits and those providing medical services, including diagnostic imaging services, in Australia. The Regulations establish specific conditions for the payment of Medicare benefits for MRI services conducted with the specified equipment at Orana Radiology, such as the requirement to bulk-bill concessional card holders and the ability to charge non-concessional card holders up to the Medicare Schedule fee. The Regulations are made under the authority of subsection 133(1) of the Health Insurance Act 1973 and commence on the day after they are registered on the Federal Register of Legislative Instruments. The Regulations do not specify any exclusions or exemptions, and their application is limited to the specified MRI equipment at the specified location. The Regulations extend the application of the Principal Regulations by introducing new conditions for the payment of Medicare benefits for MRI services conducted with the specified equipment at Orana Radiology.
Key Provisions
The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2006 (No. 6) amend the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006 to enable the payment of Medicare benefits for magnetic resonance imaging (MRI) services conducted using specified equipment at Orana Radiology in Dubbo, NSW (regulation 3). The regulations specify the new conditions under which Medicare benefits will be paid for MRI services using the specified equipment (subrule 31(2A), inserted by item [2] of Schedule 1). The new conditions include bulk-billing concessional card holders and charging non-concessional card holders up to the Medicare Schedule fee (subrule 31(2A), inserted by item [2] of Schedule 1). A concessional beneficiary is defined as a person who holds a Commonwealth concessional entitlement card or a card issued by the State or Territory government under a reciprocal agreement with the Commonwealth (subrule 31(3), inserted by item [4] of Schedule 1). The specified equipment must meet certain criteria, including being located at Orana Radiology in Dubbo, NSW, having a magnet strength of 1.5T, forming part of a comprehensive radiology department, and being available for use from 9 am to 5 pm each Monday to Friday (excluding public holidays) for routine services and at all times for emergency services, except for periods reasonably required for necessary maintenance, repairs and upgrades (subrule 36(e), inserted by item [7] of Schedule 1). The regulations also make a grammatical change to allow the insertion of the new specified equipment (item [6] of Schedule 1) and insert a reference to the eligible equipment into Schedule 1, Part 2, subrule 34(2) (item [5] of Schedule 1).
The regulations impose obligations on parties and entities governed by them, including the requirement to bulk-bill concessional card holders for MRI services conducted using the specified equipment and charge non-concessional card holders up to the Medicare Schedule fee (subrule 31(2A), inserted by item [2] of Schedule 1). The regulations also require the specified equipment to meet certain criteria, including being located at Orana Radiology in Dubbo, NSW, having a magnet strength of 1.5T, forming part of a comprehensive radiology department, and being available for use from 9 am to 5 pm each Monday to Friday (excluding public holidays) for routine services and at all times for emergency services, except for periods reasonably required for necessary maintenance, repairs and upgrades (subrule 36(e), inserted by item [7] of Schedule 1).
The Act does not provide for any specific offences, penalties, or civil or criminal consequences for breach of the regulations. However, any breach of the regulations may be subject to the general provisions of the Administrative Appeals Tribunal Act 1975 and the Administrative Decisions ( Judicial Review) Act 1977, which provide for review and appeal of administrative decisions, including decisions made under the Act. In addition, any person who makes a false or misleading statement in a document or application made under the Act may be subject to criminal penalties under section 126 of the Act, which provides for imprisonment for up to two years or a fine of up to 10,000 penalty units, or both.