EXPLANATORY STATEMENT
Select Legislative Instrument 2009 No. 60
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (No. 1)
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.
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 2008 (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 for Magnetic Resonance Imaging (MRI) services conducted using specified equipment at seven locations in New South Wales, Victoria, Queensland and Western Australia and set out the conditions under which Medicare benefits are paid for these MRI services.
The Regulations also clarify an existing item to enable Medicare benefits to be paid for MRI services used in the diagnosis of breast cancer in asymptomatic women less than 50 years of age with a high risk of developing breast cancer.
The Department of Health and Ageing undertook a competitive application process to select the specified equipment being granted Medicare-eligibility. The Department consulted with the seven successful applicants about the requirements for the MRI units to be granted Medicare-eligibility in order to finalise the amendments to the Principal Regulations. The relevant local communities are keen to see the introduction of Medicare-eligible MRI services at the seven locations as soon as possible.
The Department consulted with the Royal Australian and New Zealand College of Radiologists, the Australian Diagnostic Imaging Association, and the National Breast and Ovarian Cancer Centre regarding the patient eligibility requirements prior to the introduction of Medicare benefits for breast MRI services for certain women from February 2009.
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 the day after registration on the Federal Register of Legislative Instruments.
ATTACHMENT
Details of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (No. 1)
Regulation 1 – Name of Regulations
This regulation provides that the title of the Regulations is the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (No. 1).
Regulation 2 - Commencement
This Regulation provides for the Regulations to commence on the day after registration on the Federal Register of Legislative Instruments.
Regulation 3 – Amendment of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008
This regulation provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008 (the Principal Regulations) are amended as set out in Schedule 1.
Schedule 1 – Amendments
Item [1]
This item inserts a reference to new subrule 31(2B) into Schedule 1, Part 2, subrule 31(1). The new subrule 31(2B) is inserted by item [2] below.
Item [2]
This item inserts into Schedule 1, Part 2, a new subrule 31(2B) which includes a reference to:
- (i) Monash Medical Centre, Clayton, Victoria;
- (ii) Suite 1, 38-40 Urunga Parade, Miranda, New South Wales;
- (iii) Bundaberg Mater Misericordiae Hospital, Bundaberg, Queensland;
- (iv) Radiology Department of the Royal Melbourne Hospital, Parkville, Victoria;
- (v) Suite 1, Maitland Specialist Centre, Maitland Private Hospital, East Maitland,
New South Wales;
- (vi) SKG Radiology Kelmscott, Kelmscott, Western Australia; and
- (vii) SKG Radiology Duncraig, Duncraig, Western Australia..
New subrule 31(2B) provides that a Medicare benefit is only payable for an MRI service performed with the specified equipment under the following circumstances:
- for services to patients who are concessional beneficiaries or children under 16 – the maximum charge is the sum of the medicare benefit and any private health insurance benefit payable for the service; and
- where all of the conditions of the agreement, set out in the table, that applies to the eligible equipment are met.
Item [3]
This item inserts a reference to a new paragraph 36(1)(f) into Schedule 1, Part 2, subrule 34(2). The new paragraph 36(1)(f) is inserted by item [6] below.
Item [4]
For Schedule 1, Part 2, rule 36, the reference to ‘For rule 31’ is replaced by a reference to
‘(1) For rule 31’ as a result of the inclusion of a new subrule 36(2). The new subrule 36(2) is inserted by item [7] below.
Item [5]
This item makes a grammatical change to allow item [6] to be inserted.
Item [6]
This item inserts a new paragraph 36(1)(f) into rule 36, Schedule 1, Part 2 of the Principal Regulations. This amendment provides that each of the seven new specified pieces of equipment, set out in item [8] below, are Medicare eligible if the equipment:
(a) is located at the place specified in the regulations;
(b) is described by reference to the manufacturer, scanner model and magnet strength in the regulations;
(c) forms part of a comprehensive radiology department, or a medical practice, at the relevant location that provides x-ray, computed tomography and ultrasound services; and
(d) is available for use at least from 9 am to 5 pm each Monday to Friday (excluding public holidays), except for periods reasonably required for necessary maintenance, repairs and upgrades.
Item [7]
This item inserts a new subrule 36(2) into rule 36, Schedule 1, Part 2 of the Principal Regulations, which defines the term “medical practice”. This term is used in the new paragraph 36(1)(f) being inserted by item [6] above.
Item [8]
This item inserts the details of the seven new MRI units into a new table (referred to as ‘Table 3 Eligible equipment - paragraph 36 (1)(f)) in rule 36 of Schedule 1, Part 2 to the Principal Regulations.
The new Table 3 in subrule 36(1) of Schedule 1, Part 2 describes: (i) the locations of the seven new MRI units; (ii) the manufacturer and scanner model of the MRI units; and (iii) the magnet strength of the seven new MRI units. The conditions under which Medicare benefits are paid for the seven new MRI units prescribed in Table 3 are set out in item [2] and item [6] above.
Item [9]
This item clarifies in the descriptor for item 63464 that the MRI service applies to asymptomatic women.
Item [10]
This item amends the following rules as a consequence of the inclusion of new subrule 36(2) by item [7] above:
(i) subrule 31(2), 31(2A) and 34(1) of Schedule 1, Part 2 of the Principal Regulations; and
(ii) Table 1 and Table 2 of rule 36 of Schedule 1, Part 2 of the Principal Regulations.