EXPLANATORY STATEMENT
Select Legislative Instrument 2012 No. 57
Health Insurance Act 1973
Health Insurance Legislation Amendment Regulation 2012 (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 10(2) provides for the amount of medicare benefits payable in respect of a service. Under paragraph 10(2)(aa) of the Act, a benefit in respect of a service can be an amount equal to 100 per cent of the Schedule fee if the regulations prescribe the particular service, and the service is not already covered by paragraph 10(2)(a), which deals with services provided as part of an episode of hospital treatment or hospital-substitute treatment.
Subsection 4AA(1) of the Act provides that the regulations may prescribe a table of diagnostic imaging services, setting out the items for R-type and NR-type 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 2011 (the DIST Regulations) prescribes such a table.
The amendments to the DIST Regulations and the Health Insurance Regulations 1975 (the HI Regulations), increase the bulk billing incentive for Magnetic Resonance Imaging (MRI) services to 100 per cent of the Schedule fee mentioned in the table when the MRI service is bulk billed and provided out of hospital.
The amendments to the DIST Regulations also remove the various current categories of ‘eligible provider’ and ‘eligible equipment’ for MRI and introduce a single set of consistent requirements in order for Medicare benefits to be payable for services provided using the equipment. They also introduce a requirement for owners/lessees of such equipment to enter into a deed with the Commonwealth. The purpose of the deed is to identify the owner/lessee of the eligible equipment and to provide a record of the location and specifications of that equipment. The eligible equipment must also be located in a comprehensive practice that is either a medical practice, or a radiology department of a hospital, that provides a range of diagnostic imaging services.
The decision to make adjustments to the current arrangements for MRI services arose from a review of diagnostic imaging which was announced in the 2009-10 Budget, and which took place from late 2009 to mid 2011. The outcomes of the review, including the decision to increase the existing bulk billing incentive to 100 per cent for MRI services, and to standardise eligibility requirements was announced as part of the 2011-12 Budget.
Details of the regulation are set out in the Attachment.
Consultation
The decision to increase the bulk billing incentive for MRI services arose from a review of diagnostic imaging which was announced in the 2009-10 Budget, and which took place from late 2009 to mid 2011.
Extensive formal and informal consultation occurred with the diagnostic imaging industry and profession during this period, including through 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 2011-12 Budget.
The Act specifies no conditions that need to be met before the power to make the regulation may be exercised.
The regulation is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The regulation commences on 1 May 2012.
Authority: Subsections 4AA(1) and133(1) of the Health Insurance Act 1973
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE LEGISLATION AMENDMENT REGULATION 2012 (No. 1)
Section 1 – Name of Regulation
This section provides for the regulation to be referred to as the Health Insurance Legislation Amendment Regulation 2012 (No. 1).
Section 2 – Commencement
This section provides for the regulation to commence on 1 May 2012.
Section 3 – Amendment of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2011
This section provides that Schedule 1 amends the Health Insurance (Diagnostic Imaging Services Table) Regulations 2011.
Section 4 – Amendment of the Health Insurance Regulations 1975
This section amends the Health Insurance Regulations 1975.
Schedule 1 Amendments of Health Insurance (Diagnostic Imaging Services Table) Regulations 2011
Item [1] – Schedule 1, paragraph 1.2.5(1)(a)
This item amends the paragraph to remove the cross reference to Division 2.5, thereby removing MRI or MRA services from the existing bulk billing arrangements.
Item [2] – Schedule 1, subclause 1.2.5(3)
This item amends the subclause to remove the cross reference to subsection 10(2) and replaces it with a cross reference to paragraph 10(2)(aa) to make the cross reference more specific.
Item [3] – Schedule 1, clause 1.2.5, note
This item amends the note under subclause 1.2.5(3) to remove the cross reference to regulation 6EF and replaces it with a cross reference to subparagraph 6EF(b)(ii). This will make the cross reference more specific.
Item [4] – Schedule 1, after clause 1.2.5
This item inserts a new provision to allow the bulk billing incentive for MRI or MRA services to be paid at 100 per cent of the schedule fee for services that are provided out of hospital and are bulk billed.
Item [5] – Schedule 1, clauses 2.5.1 and 2.5.2
This item removes the current various conditions which apply to the provision of ‘eligible services’ by different categories of ‘eligible equipment’ thereby providing that the same conditions apply to all MRI equipment. This item also amends clause 2.5.2 to insert a cross reference to paragraph 2.5.1(a).
Item [6] – Schedule 1, clause 2.5.3
This item amends the clause to remove the cross reference to clause 2.5.1 and replaces it with a cross reference to paragraph 2.5.1(a) to make the cross reference more specific.
Item [7] – Schedule 1, clauses 2.5.4 and 2.5.5
This item removes the current various definitions of ‘eligible provider’ and ‘eligible equipment’ and introduces a single definition for each, regardless of when the equipment first became ‘eligible equipment’.
All eligible providers must be participants in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program. A person must be an eligible provider at the time the MRA or MRI service is performed.
In order to be ‘eligible equipment’ the person who owns or leases the equipment must be subject to a deed with the Commonwealth (as represented by the Department of Health and Ageing) that relates to that equipment. A ‘person’ includes a body corporate or body politic as well as an individual. The equipment must also be located in a comprehensive practice which can either be a medical practice or a radiology department in a hospital that offers a comprehensive range of diagnostic imaging procedures.
The purpose of this provision is to provide a record of the identity of the owner or lessee of the eligible equipment, and a description of that equipment, which can be easily accessed and maintained by both the Commonwealth and the other party to the deed.
Currently, the Commonwealth does not hold an up to date record of the identity of those eligible providers referred to in paragraph 2.5.4(1), nor of the eligible equipment referred to in clause 2.5.5. This has resulted in disputes over entitlement to eligibility where the equipment has been located in the premises of a third party. This item is intended to remove that doubt. The deed will be entered into by the owner or lessee of the equipment and will be executed on behalf of the Commonwealth by the Assistant Secretary of the branch which has responsibility for administering the arrangements for the payment of medicare benefits for MRI or MRA services.
Item [8] – Schedule 1, clause 2.5.6
This item removes further various descriptions of ‘eligible equipment’ which currently exist.
Schedule 2 Amendment of Health Insurance Regulations 1975
Item [1] – Subparagraph 6EF(b)(ii)
This item inserts a cross reference to the new clause 1.2.5A and removes the reference to the 2010 diagnostic imaging services table and replaces it with a reference to the 2011 diagnostic imaging services table.