Explanatory Statement
Issued by the Authority of the Minister for Health
Health Insurance Act 1973
Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service) Amendment Determination 2012 (No. 1)
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by writing, determine that a health service not listed in the diagnostic imaging services table (the Table) shall, in specified circumstance and for specified statutory provisions, be treated as if it were so listed. This Table is set out in the Health Insurance (Diagnostic Imaging Services Table) Regulations, which is remade each year.
Purpose
The Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service) Amendment Determination 2012 (No. 1) (the Determination) amends the Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service) Determination 2009 (the Principal Determination) to:
- ensure the continued payment of Medicare benefits for MRI services performed using a mobile MRI unit at the premises of the Mater Misericordiae Hospital Rockhampton, the Mater Misericordiae Hospital Gladstone or the Friendly Society Private Hospital in Bundaburg; and
- apply the new 100% bulk-billing incentive applying to MRI services in the Table to the services in the Principal Determination.
Background
The Table currently sets out a number of different classes of MRI providers able to perform medicare-eligible MRI services (‘eligible providers’) and equipment on which medicare-eligible MRI services can be performed (‘eligible equipment’), with different requirements applying to each different class. Under the current arrangements a mobile MRI unit based at the Mater Misericordiae Hospital Rockhampton and servicing that hospital, the Mater Misericordiae Hospital Gladstone and the Friendly Society Private Hospital in Bundaburg (‘the Mater unit’) is ‘eligible equipment’. An MRI scan performed using the equipment is therefore capable of generating medicare benefits.
The Table is being amended from 1 July 2012 to replace the various different classes of eligible providers and eligible equipment with a single set of requirements applicable to all providers and equipment.
Under the new arrangements, for MRI equipment to be ‘eligible equipment’ it must be located at premises of a ‘comprehensive practice’, being a medical practice or a hospital radiology department that provides x-ray, ultrasound and computed tomography (CT) services.
The Mater unit is mobile MRI unit mounted on a specifically built semi-trailer. Accordingly, it is not located in the radiology department of the Mater Misericordiae Hospital Rockhampton, Mater Misericordiae Hospital Gladstone or Friendly Society Private Hospital Bundaburg.
To ensure that the Mater unit is able to keep providing Medicare eligible services, the Determination amends the Principal Determination to give the Mater unit access to the MRI items in the Principal Determination.
The items in the Principal Determination reflect the items in the Table, and patients accessing services performed using the Mater unit will not see any change to the kinds of MRI services they may receive or the levels of Medicare benefit they are able to receive.
Details of this Determination are set out in the Attachment.
Commencement
This Determination commences 1 May 2012, to coincide with the amendments to the Table.
Consultation
The decision enter into a standardised Deed of Undertaking with diagnostic imaging providers who provide MRI Medicare eligible services arose from a review of diagnostic imaging which was announced in the 2009-2010 Budget, and which took place from late 2009 to mid 2011. Extensive formal and informal consultation occurred with the diagnostic testing industry and profession during this period, including the establishment of a Diagnostic Imaging Review Consultation Committee. Membership of this committee included representatives from professional organisations, requestors, providers, consumers, regulatory authorities and training providers of diagnostic imaging services. The outcomes of the review are part of the 2011-2012 Budget.
A determination made under subsection 3C(1) of the Act is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Attachment
Details of the health insurance (GIPPSLAND AND SOUTH EASTERN NEW SOUTH WALES MOBILE MRI SERVICE) AMENDMENT determination 2012 (NO. 1)
Section 1 Name of Determination
Section 1 provides that the name of the Determination is the Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service) Amendment Determination 2012 (No. 1).
Section 2 Commencement
Section 2 provides that the Determination will commence on 1 May 2012.
Section 3 Amendment of Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service) Determination 2009
Section 3 provides that the Schedule to the Determination amends the Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service) Determination 2009, the Principal Determination.
Schedule Amendments
Item 1 Name of determination
Item 1 amends section 1 of the Principal Determination to rename it the Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service and Rockhampton, Bundaburg and Gladstone Mobile MRI Service) Determination 2009.
Item 2 Subsection 4(1), Interpretation, eligible provider
Item 2 makes a minor technical amendment to the definition of ‘eligible provider’ to reflect the integration of Medicare Australia into the Department of Human Services on 1 July 2011. As a result of the integration the position of ‘Medicare Australia CEO’ was replaced by the position of ‘Chief Executive Medicare’.
Item 3 Subsection 4(1), Interpretation, funding agreement
Item 3 deletes the definition for ‘funding agreement’. To clarify that the funding agreement is an agreement between Regional Imaging Pty Ltd (RIL) and the Commonwealth, the definition is being amended to ‘RIL funding agreement’ (see item 5) and the list of definitions in subsection 4(1) re-ordered accordingly.
Item 4 Subsection 4(1), Interpretation, before item
Item 4 inserts a new definition of ‘LSPN’. An LSPN is a ‘location specific practice number’. An identifying LSPN is allocated under section 23DXQ of the Act to each diagnostic imaging premises or base for mobile diagnostic imaging registered on the Diagnostic Imaging Register.
Item 5 Subsection 4(1), Interpretation, after relevant service
Item 5 inserts the new definition of the ‘RIL funding agreement’.
Item 6 Subsection 4(2), Interpretation, paragraph (c)
Item 6 makes a minor technical amendment to correct an earlier error in drafting.
Item 7 Section 5, Circumstances where this Determination applies
Item 7 substitutes a new title for section 5 of the Principal Determination and new paragraphs 5(1)(a) and (b). These amendments provide that where an MRI service is provided using mobile diagnostic imaging equipment based at the Latrobe Regional Hospital at Traralgon West in Victoria (the Gippsland and South Eastern New South Wales Mobile MRI service offered by RIL) the Principal Determination will apply in the circumstances set out in that section.
These amendments are necessary because the circumstances in which the Principal Determination applies to mobile MRI services performed using the Mater unit are different to those applying in the case of the services provided by RIL.
Item 8 After section 5
Item 8 inserts a new section 5AA. This new section sets out the circumstances in which the Principal Determination will apply to mobile MRI services performed using the Mater unit.
Subsection 5AA(1) provides that the circumstances are:
- for items 63002 to 63483, the MRI service is provided pursuant to a request that is in accordance with subsection 5AA(2); and
- the MRI service must be performed under the professional supervision of an ‘eligible provider’ available to monitor and influence the examination, including attending on the patient if necessary, and the service must be reported by an ‘eligible provider’. An eligible provider’ is defined in subsection 4(1) of the Principal Determination as a specialist in diagnostic radiology who had satisfied the Chief Executive Medicare he or she participates in the Royal Australian and New Zealand College of Radiologists’ Quality Assurance Program. However, a service is not required to meet the professional supervision and reporting requirements if it is performed in an emergency. This reflects requirements applying to MRI services in the Table; and
- the equipment used to perform the service must be operated at a location specified in the Table to the section. These locations are the Mater Misericordiae Hospital Rockhampton, the Mater Misericordiae Hospital Gladstone or the Friendly Society Private Hospital in Bundaburg; and
- the equipment used to perform the service must be a General Electric scanner model Signa Echo Speed, have a strength of 1.5 Tesla and be mounted on a specifically built semi-trailer.
Subsection 5AA(2) provides that the request for the service must be made in writing by a specialist, consultant physician or a dentist and must identify the clinical indications for the service. This reflects general request requirements applying to MRI services in the Table.
Subsection 5AA(3) clarifies that operating diagnostic imaging equipment at the relevant hospitals will include operating the equipment within the grounds of the hospitals. The Mater unit provides MRI services from a purpose built semi trailer separate from hospital buildings but within hospital grounds.
Item 9 Bulk billing incentive
Item 9 substitutes a new section 5A which extends the new 100% bulk billing incentive applicable to all MRI services in the Table from 1 July 2012 to the services in the Principal Determination.