EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Positron Emission Tomography) Facilities Determination 2011
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 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 2010, which are remade each year.
A determination made under subsection 3C(1) is a legislative instrument (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
Background
PET was originally assessed by the Medical Services Advisory Committee (MSAC) in 2000 and 2001, which found there was insufficient evidence to recommend unrestricted funding through Medicare. Seven facilities were given access to a wide range of Medicare items for PET, to allow them to collect data to support further assessment. These PET services are currently made available under the Health Insurance (Positron Emission Tomography) Facilities Determination 2010 (No 2) (the 2010 Determination).
The data collection process undertaken by the seven facilities has now been completed and associated MSAC assessments have been finalised. It was announced in the 2011-12 Budget that MSAC recommended PET services will be added to the Health Insurance (Diagnostic Imaging Service Table) Regulations 2010, making Medicare rebates available at all Medicare-eligible PET facilities from 1 July 2011. The 2010 Determination is therefore redundant and can now be revoked.
The Health Insurance (Positron Emission Tomography) Facilities Determination 2011 revokes the 2010 Determination.
Consultation
No consultation was undertaken in the making of this Determination as the instrument is machinery in nature and does not substantially alter existing arrangements.
Overview
The Health Insurance (Positron Emission Tomography) Facilities Determination 2011 was enacted to address the issue of the availability and funding of Positron Emission Tomography (PET) services under Medicare. This legislation was introduced to align with the policy objectives set out in the Health Insurance Act 1973, which allows the Minister to determine that certain health services not explicitly listed in the diagnostic imaging services table will be treated as if they were listed, under specified conditions. This determination is a legislative instrument that revokes the previous Health Insurance (Positron Emission Tomography) Facilities Determination 2010, which had allowed only seven facilities to access a wide range of Medicare items for PET to collect data for further assessment. The 2011 Determination was made in response to the Medical Services Advisory Committee's recommendation that PET services be added to the Health Insurance (Diagnostic Imaging Service Table) Regulations 2010, thereby making Medicare rebates available at all eligible PET facilities from 1 July 2011.
Scope and Application
The Health Insurance (Positron Emission Tomography) Facilities Determination 2011 applies to the specific context of health services involving positron emission tomography (PET) scans within the Australian healthcare system. This legislation operates under the framework of the Health Insurance Act 1973, where it outlines the conditions under which PET services can be treated as listed in the diagnostic imaging services table. The primary aim is to formalise the availability of Medicare rebates for PET services across all eligible facilities from 1 July 2011, following recommendations from the Medical Services Advisory Committee (MSAC). The jurisdictional scope of this Act is national, as it pertains to the Commonwealth's regulation of health insurance services across Australia. The determination revokes the previous 2010 Determination, which had allowed only seven facilities to provide PET services under specific conditions, and it extends the provision to all Medicare-eligible PET facilities. No consultation was conducted for this determination as it is considered machinery in nature and does not significantly alter the existing legislative arrangements.
Key Provisions
The main operative sections of the Health Insurance (Positron Emission Tomography) Facilities Determination 2011 (the Determination) include the revocation of the 2010 Determination and the establishment of provisions for PET services under the Health Insurance Act 1973 (the Act). Subsection 3C(1) of the Act allows the Minister to determine that a health service not listed in the diagnostic imaging services table (the Table) can be treated as if it were listed, in specified circumstances and for specified statutory provisions. This Determination revokes the previous 2010 Determination and aligns with the recommendations of the Medical Services Advisory Committee (MSAC) that positron emission tomography (PET) services be added to the Table.
The Determination imposes certain obligations and requirements on parties and entities governed by it. It requires that the seven facilities that previously collected data on PET services now adhere to the updated regulations, which allow for Medicare rebates to be provided at all eligible PET facilities from 1 July 2011. The revocation of the 2010 Determination means that the previous arrangements are no longer applicable, and all parties must now comply with the updated provisions outlined in the Determination and the Health Insurance (Diagnostic Imaging Service Table) Regulations 2010.
There are no specific offences or penalties outlined in the Determination itself; however, failure to comply with the Act and its associated regulations could result in civil or criminal consequences. For example, providing a service that is not covered by the regulations or making false claims could lead to penalties under the Health Insurance Act 1973. The maximum penalties for such offences can include fines and imprisonment, depending on the severity of the breach. It is essential for parties and entities governed by the Determination to ensure compliance with the Act and its associated regulations to avoid any potential consequences.