Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (No. 4)

Administered by Department of Health, Disability and Ageing

Legislation au F2009L03534 Regulations Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

Select Legislative Instrument 2009 No. 286

 

Health Insurance Act 1973

 

Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (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. 

 

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 2009 (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 located at Bankstown Hospital, New South Wales.

 

The Regulations also amend the ‘manufacturer and scanner model’ of the specified MRI equipment located at the Monash Medical Centre, Clayton, Victoria, due to the replacement of the existing specified equipment with a new model.

 

The Regulations further makes a technical amendment to one Rule to remove the ambiguity of the current wording and clarify the eligibility criteria for one existing breast MRI item.

 

Details of the Regulations are set out in the Attachment.

 

The Department of Health and Ageing undertook a competitive application process to select the specified equipment being granted Medicare-eligibility at Bankstown Hospital.  The Department then consulted with the successful applicant about the process for the MRI unit to be granted Medicare-eligibility.

 

Due to the replacement of the existing specified equipment at Monash Medical Centre, Clayton, it was also necessary for the Department to consult with the service operator about the process for the transfer of Medicare-eligibility from the existing MRI unit to the replacement MRI unit.

 

Prior to the introduction of Medicare benefits for breast MRI services for certain women from 1 February 2009, 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 criteria.  No further consultations were required for the clarifying amendment to the eligibility criteria, nor for the technical amendment to Rule 31 which removes ambiguity in the wording.

 

The Act specifies no conditions that need to be satisfied 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.

 

Most of the provisions in the Regulations commence on 9 November 2009.  The amendment clarifying the eligibility criteria for the existing item commences on 1 January 2010, to allow the change to be incorporated into bulk changes to the Medicare Benefits Schedule, but the existing intention of the item are not affected by the amendment.

 

 

      


ATTACHMENT

 

Details of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (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 2009 (No. 4).

 

Regulation 2 - Commencement

 

This regulation provides for amendment items [1] to [4] of Schedule 1 to commence on
9 November 2009 and amendment item [1] of Schedule 2 to commence on 1 January 2010.

 

Regulation 3 – Amendment of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009

 

This regulation provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 (the Principal Regulations) are amended as set out in Schedules 1 and 2.

 

Schedule 1 – Amendments commencing on 9 November 2009

 

Item [1]

This item substitutes the current wording of Schedule 1, Part 2, subrule 31(1)(a) with new wording that removes current ambiguity and requires that Medicare-eligible MRI scans must be at the request of a specialist or consultant physician.

 

Item [2]

This item inserts terms of agreement details for the new specified equipment at the Bankstown Hospital, New South Wales, into Schedule 1, Part 2, paragraph 31(2B)(b).

 

Item [3]

This item  substitutes the description of the ‘manufacturer and scanner model’ of the  specified equipment located at the Monash Medical Centre, Clayton, Victoria, in Schedule 1, Part 2, Table 3 - Eligible equipment in paragraph 36(1)(f) of the Principal Regulations.

 

Item [4]

This item inserts the details of the new MRI unit at the Bankstown Hospital, New South Wales into Schedule 1, Part 2, Table 3 - Eligible equipment in paragraph 36(1)(f) of the Principal Regulations.

 

Schedule 2 – Amendments commencing on 1 January 2010

 

Item [1]

This item substitutes the wording of the patient eligibility criteria for Medicare Benefits Schedule item 63464 to remove current ambiguity and clarify eligibility requirements for this service.

 

Overview

The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (No. 4) were enacted by the Governor-General under the authority granted by the Health Insurance Act 1973. The primary purpose of these regulations is to address specific gaps in the provision of Medicare benefits for diagnostic imaging services, particularly magnetic resonance imaging (MRI). The Health Insurance Act 1973 mandates the payment of Medicare benefits for professional services rendered to eligible persons, and the regulations provide a table of diagnostic imaging services and the applicable fees. These amendments enable Medicare benefits to be paid for MRI services conducted using specified equipment at Bankstown Hospital in New South Wales and update the equipment details at Monash Medical Centre in Victoria. Additionally, the regulations clarify the eligibility criteria for certain breast MRI services, ensuring that Medicare benefits are correctly applied according to the intended policy objectives. The Department of Health and Ageing undertook a competitive application process and consultations with relevant stakeholders to ensure the appropriate implementation of these amendments.

Scope and Application

The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (No. 4) amends the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009, which are subsidiary legislation under the Health Insurance Act 1973. The Act primarily concerns the administration of payments for Medicare benefits for professional services rendered to eligible persons, and the Regulations further define the scope and application of these benefits in relation to diagnostic imaging services. The Regulations apply to specified diagnostic imaging services, particularly magnetic resonance imaging (MRI) services, and to the entities operating the MRI equipment at Bankstown Hospital in New South Wales and Monash Medical Centre in Victoria. The amendments enable these services to be eligible for Medicare benefits by updating the table of diagnostic imaging services to include the new MRI equipment at Bankstown Hospital and adjusting the details of the MRI equipment at Monash Medical Centre following its replacement. The Regulations also clarify the eligibility criteria for a particular breast MRI service. The changes made by the Regulations are limited to these specific amendments and do not impose any new conditions or thresholds for eligibility beyond those already specified in the Act and the Principal Regulations. The amendments commence on different dates, with most effective from 9 November 2009, and one clarification of eligibility criteria effective from 1 January 2010.

Key Provisions

The Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2009 (No. 4) primarily make amendments to the existing Diagnostic Imaging Services Table under the Health Insurance Act 1973 (the Act). These amendments, as outlined in Schedule 1 and Schedule 2, enable Medicare benefits to be paid for magnetic resonance imaging (MRI) services at Bankstown Hospital, New South Wales, and update the details of MRI equipment at Monash Medical Centre, Clayton, Victoria, following a replacement of specified equipment (Reg. 3). Regulation 2 sets the commencement dates for these amendments, with most provisions coming into effect on 9 November 2009 and a specific technical amendment on 1 January 2010 (Reg. 2). These Regulations impose specific obligations on healthcare providers and patients. For providers, it is necessary to ensure that MRI services are conducted using equipment listed in the amended table to be eligible for Medicare benefits. For patients, eligibility criteria must be met as specified in the updated regulations, particularly for breast MRI services, which now require the scan to be at the request of a specialist or consultant physician (Reg. 3, Sched. 1, Item [1]). Additionally, the new MRI unit at Bankstown Hospital must adhere to the terms of agreement outlined in the regulations (Reg. 3, Sched. 1, Item [2]). Under the Health Insurance Act 1973, there are potential consequences for non-compliance with these regulations. While the explanatory statement does not explicitly mention penalties, breaches of the regulations could lead to denial of Medicare benefits for services not provided by listed equipment or under the specified terms. There could also be administrative or legal actions taken against providers who fail to comply with the updated equipment descriptions and terms of agreements (Reg. 3, Sched. 1, Items [2] and [4]). For patients, failure to meet the clarified eligibility criteria could result in their services not being covered under Medicare, potentially leading to out-of-pocket expenses (Reg. 3, Sched. 1, Item [1]).

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