Explanatory Statement
Issued by the Authority of the Minister for Health
Health Insurance Act 1973
Health Insurance (Poly Implant Prosthese MRI) Amendment Determination 2012 (No. 2)
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. The Table is set out in the Health Insurance (Diagnostic Imaging Services Table) Regulations, which is remade each year.
Purpose
The Health Insurance (Poly Implant Prosthese MRI) Amendment Determination 2012 (No. 2) (the Determination) amends the Health Insurance (Poly Implant Prosthese MRI) Determination 2012 to increase the bulk-billing incentive applying to MRI services performed to check the integrity of silicone breast implants manufactured by Poly Implant Prosthese. This is in line with a general increase to the bulk-billing incentive applying to all MRI services in the Table from 1 July 2012.
Background and details of Determination
The Act provides, in part, for payments of Medicare benefits in respect of professional services.
Subsection 10(2) of the Act provides for the amount of medicare benefit 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% 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.
Amendments to the Table taking effect from 1 July 2012 increase the bulk-billing incentive for MRI services from 95% to 100% of the Schedule fee mentioned in the Table when the MRI service is provided out of hospital (new clause 1.2.5A of the Table).
The Determination makes consequential amendments to subsection 5(1) of the Principal Determination, removing reference to paragraph 1.2.5(1)(a) of the Table and replacing it with reference to new paragraph 1.2.5A(1)(a) of the Table. This applies the 100% MRI bulk-billing incentive in new clause 1.2.5A of the Table to the items in the Principal Determination.
Consultation
The decision to increase bulk-billing incentive for MRI 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.
This Determination commences on 1 May 2012.
A determination made under subsection 3C(1) of the Act is a legislative instrument for the purposes of the Legislative Instruments Act 2003.