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.
Overview
The Health Insurance (Poly Implant Prosthese MRI) Amendment Determination 2012 (No. 2) amends the Health Insurance (Poly Implant Prosthese MRI) Determination 2012 to increase the bulk-billing incentive for MRI services used to check the integrity of silicone breast implants manufactured by Poly Implant Prosthese. This amendment is in line with a general increase in the bulk-billing incentive for all MRI services from 95% to 100% of the Schedule fee, effective from 1 July 2012. The determination was introduced following a review of diagnostic imaging services, which was announced in the 2009-2010 Budget and included extensive consultation with stakeholders across the diagnostic testing industry and profession. The determination, which commenced on 1 May 2012, is a legislative instrument under the Health Insurance Act 1973 and aims to address the identified need for enhanced incentives for MRI services related to breast implant integrity checks.
Scope and Application
The Health Insurance (Poly Implant Prosthese MRI) Amendment Determination 2012 (No. 2) applies to health services, specifically MRI services used to check the integrity of silicone breast implants manufactured by Poly Implant Prosthese. This determination is a legislative instrument under the Health Insurance Act 1973, and it amends the Health Insurance (Poly Implant Prosthese MRI) Determination 2012 to enhance the bulk-billing incentive for such MRI services, aligning with the general increase to the bulk-billing incentive for all MRI services in the diagnostic imaging services table. The Act allows the Minister for Health to specify that a health service not listed in the table may be treated as listed under certain circumstances, and this determination exercises that authority. The changes reflect a broader review and consultation process with stakeholders in the diagnostic imaging industry, resulting in the increased incentive aimed at ensuring broader accessibility to these critical health services.
The determination applies nationally across Australia, as it is a Commonwealth Act. It does not specify any exclusions or exemptions beyond the criteria set out in the Health Insurance Act 1973 and the Health Insurance (Diagnostic Imaging Services Table) Regulations. The application of the Act is extended and refined through subordinate instruments such as the Determination, which specifies the particular services and circumstances where the bulk-billing incentive applies. This legislative approach ensures that the Act remains responsive to industry needs and policy objectives, while maintaining a consistent and transparent framework for health insurance services.
Key Provisions
The Health Insurance (Poly Implant Prosthese MRI) Amendment Determination 2012 (No. 2) amends the Health Insurance (Poly Implant Prosthese MRI) Determination 2012 to increase the bulk-billing incentive for MRI services used to check the integrity of silicone breast implants manufactured by Poly Implant Prosthese. This is aligned with the general increase to the bulk-billing incentive for all MRI services listed in the diagnostic imaging services table from 1 July 2012. Under subsection 3C(1) of the Health Insurance Act 1973 (the Act), the Minister has the authority to determine that a health service not listed in the diagnostic imaging services table will be treated as if it were listed, under specified circumstances and for specified provisions. This determination aligns with the general increase to the bulk-billing incentive for all MRI services.
The obligations imposed by this Amendment Determination include the requirement to adjust the bulk-billing incentive for MRI services related to the integrity checks of Poly Implant Prosthese silicone breast implants. The Determination modifies the Principal Determination to reflect the new incentive rates outlined in the diagnostic imaging services table. It also mandates that providers of these services should now be compensated at the rate of 100% of the Schedule fee, as per the new clause 1.2.5A of the table. This adjustment applies specifically to MRI services performed out of hospital.
Failure to comply with the requirements set forth in the Health Insurance (Poly Implant Prosthese MRI) Amendment Determination 2012 (No. 2) may result in civil or criminal consequences. The specific penalties are not detailed within the explanatory statement, but generally, non-compliance with health insurance regulations can lead to fines or other legal actions. The precise penalties would be determined according to the Health Insurance Act 1973 and other relevant legislation. The Determination itself is considered a legislative instrument under the Legislative Instruments Act 2003, underscoring its binding nature.