EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Positron Emission Tomography) Facilities 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) Facilities Determination 2009 (No. 2) (the Determination) revokes and replaces the Health Insurance (Positron Emission Tomography) Facilities 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 is 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 TO THE DETERMINATION
Section 1
Section 1 provides that the Determination may be cited as the Health Insurance (Positron Emission Tomography) Facilities Determination 2009 (No. 2).
Section 2
Section 2 provides that the Determination commences on 1 November 2009.
Section 3
Section 3 provides that the Determination revokes the Health Insurance (Positron Emission Tomography) Facilities Determination 2009.
Section 4
Subsection 4(1) defines terms used in the Determination.
Section 5
Section 5 specifies the circumstances in which the Determination applies. These circumstances are:
- that a written agreement between the owner or operator of the Positron Emission Tomography (PET) facility and the Commonwealth relating to the rendering of the service by the facility is in place; and
- the service is rendered pursuant to a written request made by a specialist or consultant physician (other than the practitioner who renders the service) that the service was necessary and whose patient the person was.
Section 6
Subsection 6(a) provides that a 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 a 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 there were an
R-type diagnostic imaging service in the diagnostic imaging services 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.
The Schedule
The Schedule sets out the relevant services and assigns to the services the applicable item number, item descriptor and fee.