EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Positron Emission Tomography) Determination 2009 (No. 2)
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides, in part, that the Minister may, by writing, determine 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) Regulations 2009 (the DIST Regulations) which are remade each year.
The Health Insurance (Positron Emission Tomography) Determination 2009 (No.2) (the Determination) revokes and replaces the Health Insurance (Positron Emission Tomography) Determination 2009.
The purpose of the Determination is to incorporate changes to the current Determination in order to give effect to the new rule 28 of the DIST Regulations. This amendment will ensure that rule 28 will apply to positron emission tomography services specified in the Determination. New rule 28 of the DIST Regulations allows a Medicare rebate increase for relevant diagnostic imaging services that are provided out of hospital and are bulk-billed. This change is reflected in the Determination.
Details of the Determination are set out in the Attachment.
The Determination a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Consultation
The changes regarding the new bulk billing fees were developed through internal-to-government Budget processes and have reached the form of the current proposal as a result of a Cabinet decision. These processes were Budget-in-Confidence and thus stakeholders could not be engaged in them. However, submissions to the 2009-10 Budget emerged from a Strategic Review of Pathology and Diagnostic Imaging Services conducted by the Department of Health and Ageing in the 12 months prior. This Review included broad and extensive consultation with key stakeholders, including the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association. Approximately 30 submissions were received and considered.
The Determination commences on 1 November 2009.
DIAGNOSTIC SERVICES BRANCH
DEPARTMENT OF HEALTH AND AGEING
SEPTEMBER 2009
ATTACHMENT
Notes on sections
Section 1
Section 1 provides for the name of the Determination.
Section 2
Section 2 provides that the Determination is to commence on 1 November 2009 and shall remain in force until midnight on 30 June 2010.
Section 3
Section 3 provides that this Determination revokes Health Insurance (Positron Emission Tomography) Determination 2009.
Section 4
Subsection 4(1) defines terms used in the Determination.
A key term is ‘accredited site’ which means one that is accredited by the Australian and New Zealand Association of Physicians in Nuclear Medicine (ANZAPNM) as a site for advanced training in Positron Emission Tomography (PET).
Another key term is ‘comprehensive facility’ which means either one building or a part of a building, or buildings that are joined by a covered pedestrian walkway, where each of the following services is provided: PET, computed tomography, x-ray, diagnostic ultrasound, medical oncology, surgical oncology, radiation oncology and neurology services.
Another key term is ‘relevant service’ which means a health service as defined in subsection 3C(8) of the Act that is specified in the Schedule to the Determination. There are fifteen such relevant services in the Schedule.
Subsection 3(2) provides that a reference to a provision of an Act or regulations, is a reference to the provision as in force from time to time (as authorised by subsection 3C(3) of the Act).
Section 5
Subsection 5(1) specifies the circumstances in which the Determination applies. These circumstances include that:
- the service is a service referred in writing by a specialist or consultant physician;
- the service is performed by or under the personal supervision of a credentialled specialist or a practitioner possessing prescribed qualifications and experience;
- the service is performed at an accredited site in a comprehensive facility;
- the equipment used to render the service meets identified technical standards; and
- the facility providing the service has met the minimum quarterly throughput targets specified in the Determination.
The intention is that an “accredited site in a comprehensive facility" is one that can provide a
full range of cancer treatment services (including chemotherapy, radiation oncology and surgical oncology) at the one site. That is, a facility that is providing services equivalent to those provided by facilities under the following sections of Part 3 of Schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2009:
Group T2 - Radiation Oncology;
Group T1 - Miscellaneous Therapeutic Procedures, Subgroup 11; and
Group T8 - Surgical Operations.
Subsection 5(2) defines a “credentialled specialist” as a specialist or consultant physician credentialled under the “Joint Nuclear Medicine Specialist Credentialling Program for the Recognition of the Credentials of Nuclear Medicine Specialists for Positron Emission Tomography”.
Subsection 5(2A) prescribes the appropriate “qualifications and experience” for an additional pathway for recognition as a practitioner who may render, or personally supervise the rendering of, the relevant services as being: a Fellow of the Royal Australasian College of Physicians or the Royal Australian and New Zealand College of Radiologists, having reported 400 or more studies forming part of PET services in respect of which a Medicare benefit was payable and holding a current licence to prescribe and administer PET radiopharmaceuticals to humans from the relevant State radiation licensing body.
Subsection 5(3) specifies the technical standards, as specified by ANZPANM, which the equipment must meet. These requirements are as set out in the Requirements for PET Accreditation (Instrumentation and Radiation Safety) dated May 2007 issued by the Australian and New Zealand Society of Nuclear Medicine and the NEMA NU 2-2001 Standard referred to in the document.
Subsection 5(4) specifies the minimum throughput requirements as at least 20 relevant services per PET scanner per quarter. A quarter is the three months beginning on 1 January, 1 April, 1 July or 1 October of each year.
Subsection 5(5) describes the circumstances where an authorised officer from Medicare Australia or an Australian Public Service employee authorised by the Secretary may revoke a notice issued under paragraph 5(1)(b) which identifies that a PET scanner has failed to meet the throughput requirements.
Section 6
Subsection 6 (a) provides that the relevant service specified in the Schedule to the Determination shall be treated for the purposes of all provisions of the Act, regulations made under the Act, the National Health Act 1953 and the National Health Regulations 1954 that make provision in respect of professional services or medical services, as if it were both a professional service and a medical service.
Subsection 6(b) provides that the relevant service specified in the Schedule to the Determination shall be treated for the purposes of all provisions of the Act, regulations made under the Act, the National Health Act 1953 and National Health Regulations 1954 that make provision in respect of professional services or medical services, as if there were an R-type diagnostic imaging service in the Table that related to the service and specified a fee in respect of that service being the fee specified in the Schedule.
Section 7
Section 7 provides that the provisions specified in section 7 shall have effect as if a relevant service and the items that relate to a relevant service by virtue of section 6(b) were also specified in those provisions specified in section 7.
New paragraph 7(1)(d) specifies subrule 28(1)(a) of Part 2 of Schedule 1 of the DIST Regulations or regulations that replace them.
Schedule
The Schedule sets out the relevant services and assigns to the services the applicable item number, item descriptor and fee.