EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (MRI Crohn’s disease) Determination 2014
Issued by the Authority of the Minister for Health
Authority
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may determine in writing that a health service not listed in the Diagnostic Imaging Services Table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. The Table is set out in the Health Insurance (Diagnostic Imaging Services Table) Regulation 2014 (the DIST Regulation) which is remade each year.
Purpose
There are no existing items on the Table relating to Magnetic Resonance Imaging (MRI) scans for Crohn’s disease. The purpose of the Health Insurance (MRI Crohn’s disease) Determination 2014 (the Determination) is to introduce a set of three specific items relating to MRI scans for Crohn’s disease. Three corresponding capital sensitivity items are included to provide a reduced rebate for services provided on equipment that is more than 10 years old. These are interim arrangements that will apply until the Table is amended to include these six items in July 2015.
Background
In April 2014, the Medical Services Advisory Committee (MSAC) recommended the addition of three new Medicare Benefits Schedule (MBS) items (along with three corresponding half-rebate alternatives for services performed on older equipment) for MRI scans for Crohn’s disease. This Determination provides the authority to introduce these items to the MBS.
Details of the Determination are set out in the Attachment.
This Determination commences on 1 November 2014 and ceases to have effect at 23:59 on 30 June 2015.
This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Consultation
The Department consulted with key stakeholders via MSAC’s standard Protocol Advisory Sub-Committee (PASC) process. PASC noted that the responses were positive and supportive and that the potential disadvantages are few (only that some patients experience claustrophobia with MRI).
ATTACHMENT
Details of the Health Insurance (MRI Crohn’s disease) Determination 2014
1 Name of Determination
Section 1 states that the name of the Determination is the Health Insurance (MRI Crohn’s disease) Determination 2014.
2 Commencement
Section 2 states that the Determination commences on 1 November 2014.
3 Cessation
Section 3 provides that the Determination is repealed at 23:59, 30 June 2015.
4 Authority
Section 4 provides that the Determination is made under the Act.
5 Interpretation
Section 4 defines terms used in the Determination.
A key term is 'relevant service' which means a health service, as defined in subsection 3C(8) of the Act, which is specified in the Schedule 2 of the Determination.
Subsection 5(2) provides that for the avoidance of doubt, a reference to the Act includes a reference to regulation made under the Act. Similarly, a reference to the National Health Act 1953 includes a reference to regulation made under that Act. Subsection 5(2) also provides that a reference to any legislation shall be construed as a reference to that legislation as in force from time to time.
6 Treatment of a relevant service
Section 6 provides that a relevant service provided in accordance with the Determination is to be treated for the relevant provisions as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in Group I5 of the Table that related to the service and specified a fee in respect of that service; being the fee specified in the Schedule to the Determination in relation to the service.
Group I5 of the Table lists all of the MRI services included in the DIST Regulation. This means that the various rules in the DIST Regulation which are stated to apply to items in Group I5 will also apply to items for relevant services specified in this Determination.
7 Specification of relevant services
Section 7 provides that paragraph 1.2.10(1)(a), subclause 2.5.1(1) and clause 2.5.7 of the Table should be taken to have effect as if the relevant services described in Schedule 1 to the Determination were also specified in those provisions.
Clause 1.2.10 outlines the circumstances in which the fee for certain MRI services is 100 percent of the fee mentioned in the Table for the service.
Clause 2.5.1 provides the criteria for when certain items will apply to an MRI or MRA service.
Clause 2.5.7 provides a definition of ‘scan’ for the purposes of certain items related to MRI services that it must include a minimum of 3 sequences.
Schedule
The Schedule sets out the relevant services and assigns to each service the applicable item number, item descriptor and fee.
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Health Insurance (MRI Crohn’s disease) Determination 2014
This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Legislative Instrument
The purpose of the Health Insurance (MRI Crohn’s disease) Determination 2014 (the Determination) is to introduce a set of six specific items relating to MRI scans for Crohn’s disease.
Human rights implications
The right to health
The right to health – the right to the enjoyment of the highest attainable standard of physical and mental health – is contained in article 12(1) of the International Covenant on Economic, Social and Cultural Rights (ICESCR). The UN Committee on Economic, Social and Cultural Rights (the Committee) has stated that health is a ‘fundamental human right indispensable for the exercise of other human rights’, and that the right to health is not to be understood as a right to be healthy, but rather entails a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.
Right to Social Security
The right to social security is contained in article 9 of the ICESCR. The right requires that a country must, within its maximum available resources, ensure access to a social security scheme that provides a minimum essential level of benefits to all individuals and families that will enable them to acquire at least essential health care. Countries are obliged to demonstrate that every effort has been made to use all resources that are at their disposal in an effort to satisfy, as a matter of priority, this minimum obligation.
The Committee has stated that the notion of ‘the highest attainable standard of health’ takes into account both the conditions of the individual and the country’s available resources. The right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs and conditions necessary for the realisation of the highest attainable standard of health.
The Committee has also stated that with respect to the right to social security that the qualifying conditions for benefits must be reasonable, proportionate and transparent.
This Determination gives access to affordable MRI services for Crohn’s disease through subsidisation.
There is no incompatibility with the right to health or social security because the legislation is for a legitimate objective and reasonable, necessary and proportionate in the circumstances.
Conclusion
This Legislative Instrument is compatible with human rights as it has a positive effect on human rights issues.