Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2007 (No. 4)

EXPLANATORY STATEMENT

Select Legislative Instrument 2007 No. 188

Subject:     Health Insurance Act 1973

   Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2007  
  (No. 4)

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.  Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006 (the Principal Regulations) prescribes such a table.

The purpose of the Regulations is to:

• amend the Principal Regulations to enable Medicare benefits to be paid, from the day after the Regulations are registered, for certain magnetic resonance imaging (MRI) services conducted using specified equipment at Blacktown Hospital, Blacktown NSW; and
• replace two items for Computed Tomography of Colon (CTC) listed on an interim basis under items 56549 and 56551 in the Diagnostic Imaging Services Table (DIST) and replace the items with new items 56552 and 56554.

New MRI Equipment

On 23 July 2006, the Minister for Health and Ageing announced ten additional Medicare-eligible MRI machines across Australia.  The Blacktown Hospital, has ordered its new unit and expects the new machine to be operational by 1 July 2007. 

Paragraph 36(d) of Schedule 1 to the Principal Regulations sets out the conditions under which the equipment in question will be regarded as ‘eligible equipment’.

CTC Items

The Australian Government (as represented by the Department of Health and Ageing) manages Medicare funding for diagnostic imaging services through four agreements known as the 2003-2008 Quality and Outlays Memoranda of Understanding.   The amendments to the Principal Regulations affect services covered by the Radiology Memoranda of Understanding (MoU).  The MoU is managed by the Radiology Management Committee (RMC) comprised of representatives from the Department of Health and Ageing, the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association.

The two new items for CTC, 56552 and 56554, were developed by the RMC and followed the Medical Services Advisory Committee (MSAC) report of March 2006 that recommended public funding for CTC be supported under certain circumstances.  The MSAC report was endorsed by the Minister for Health and Ageing on 24 August 2006.  The two new items include provisions for new referral arrangements, clear conditions of service and adjusted fees.  The new conditions allow the CTC services to be ordered by any eligible medical practitioner in clearly defined circumstances.  The new item descriptors also clarify the required clinical indicators and the details of the indicators that must be included on the request.  The fees for the services will be adjusted to better reflect the complexity of the service.

The MSAC recommended that items 56549 and 56551 be omitted and replaced rather than amending their descriptors because of the number of changes required to the item descriptor.  It was thought that amending the descriptors could confuse requesters and providers and may result in inappropriate claiming of the items.

Details of the Regulations are provided in the Attachment.

The Act does not specify any 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 as follows:

(a)    on the day after they are registered – regulations 1 to 3 and Schedule 1, amendments for certain MRI services conducted at Blacktown Hospital; and

(b)   on 1 July 2007 – Schedule 2, amendments pertaining to CTC services.

ATTACHMENT

Details of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2007 (No. 4)

Regulation 1 – Name of Regulations

This regulation provides that the title of the Regulations is the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2007 (No. 4).

Regulation 2 - Commencement

This regulation provides for Schedule 1 of the Regulations to commence on the day after they are registered and for Schedule 2 to commence on 1 July 2007.

Regulation 3 – Amendment to 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 and

Schedule 2.

Schedule 1 – Amendment commencing the day the Regulations are registered

Item 1

This item inserts the details of the new MRI unit at Blacktown Hospital in Blacktown, NSW into Table 2 at rule 36 of Part 2 of Schedule 1 to the Principal Regulations.

Rule 31 of the Principal Regulations allows a Medicare benefit to be paid for an MRI service performed with the specified equipment where the patient is bulk-billed in respect of the fee for service.

Pursuant to paragraph 36(d) of Schedule 1, Part 2, the new specified piece of equipment is  ‘eligible equipment’ only if the equipment:

(a)    is located at the place in Table 2 for that equipment; and

(b)   forms part of a comprehensive radiology department at the relevant location that provides, at a minimum, x-ray, computed tomography and ultrasound services; and

(c)    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 

(d)   is available for use at all times for emergency services, except for periods reasonably required for necessary maintenance, repairs and upgrades.

Schedule 2 – Amendments commencing 1 July 2007

Item 1

This item removes interim items 56549 and 56551 which pertain to Computed Tomography of Colon (CTC) services.  These items are replaced with two new items 56552 and 56554. 

Item 2

This item inserts two new items 56552 and 56554 into the Diagnostic Imaging Services Table.  The new items pertain to CTC services.  Item 56552 requires that investigations in symptomatic or high risk patients to exclude colorectal neoplasia can only be undertaken where an incomplete colonoscopy has been performed in the previous 3 months.  Item 56554 requires that investigations in symptomatic or high risk patients to exclude colorectal neoplasia can only be undertaken where there are contraindications to colonoscopy.