EXPLANATORY STATEMENT
SUBJECT - HEALTH INSURANCE ACT 1973
HEALTH INSURANCE REGULATIONS (AMENDMENT)
STATUTORY RULES NO. 117
ISSUED ON THE AUTHORITY OF THE MINISTER FOR COMMUNITY SERVICES AND HEALTH.
Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make Regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Subsection 19A(1) of the Act provides that regulations made under the Act may provide that, unless the Minister otherwise directs, medicare benefits are not payable in respect of professional services rendered in prescribed circumstances. Subsection 19A(2) provides that such regulations shall not be made other than in accordance with a recommendation to the Minister by the Medicare Benefits Advisory Committee under paragraph 67(1)(aa) of the Act (in the case of regulations relating to professional services other than pathology services) or the Pathology Services Advisory Committee under paragraph 78C(1)(b) (in the case of regulations relating to pathology services).
Subregulation 2ADB(1) of the Health Insurance Regulations accordingly provides, at present, that, unless the Minister otherwise directs, medicare benefits are not payable in respect of professional services rendered in prescribed circumstances. Subregulations 2ADB(2), (3) and (4) previously set out what these professional services and prescribed circumstances were.
The Health Insurance Regulations (Amendment) have amended regulation 2ADB to provide that medicare benefits will not be payable in respect of professional services rendered in relation to the use of computerised tomography (CT) scanning for the purpose of measuring bone mineral density for osteoporosis assessment. They have been added to the professional services and prescribed circumstances which were already listed in regulation 2ADB.
The amendment implements a recommendation made by the Medicare Benefits Advisory Committee under paragraph 67(1)(aa) of the Act which in turn was based on a 1986 report of the National Health Technology Advisory Panel. In short, it is considered by both these bodies that the effectiveness and efficacy of this procedure (CT scanning) as a means of assessing and predicting the risk of bone fracture remains unproven. It was recommended, therefore, that such publicly funded, widespread use of this procedure for the detection of developing osteoporosis should not be supported at the present time.
The National Health Technology Advisory Panel has been requested to undertake a follow-up study to its 1986 report and is expected to complete this task in late 1989. The question of whether medicare benefits should be payable for such procedures will be reconsidered once the results of this study are known.
The Regulations have also deleted current subregulations 2ADB(2), (3) and (4) and repeated the substance of them in a new subregulation (2). The professional services and prescribed circumstances to which subregulation 2ADB(1) applies - including the above CT scanning procedures - are now all included in the new subregulation 2ADB(2).