Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1999-2000 DIAGNOSTIC IMAGING SERVICES TABLE) AMENDMENT REGULATIONS 1999 (NO. 1) 1999 NO. 345

STATUTORY RULES 1999 No. 345

Issued by the Authority of the Minister for Health and Aged Care

Health Insurance Act 1973

Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 1999 (No. 1)

Section 133 of the Health Insurance Act 1973 ('the Act') provides that the Governor-General may make regulations prescribing matters for purposes of the Act.

The Act provides for payments to eligible persons for professional service by way of Medicare benefits.

Section 4AA of the Act provides that the table of diagnostic imaging services may be prescribed by the Regulations. The Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999 prescribe such a table.

Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services (including diagnostic imaging services) set out in a table which included the Diagnostic Imaging Services Table (the Table).

The Regulations incorporate the following changes to the Table:

*       removal of a clause in relation to Magnetic Resonance Imaging (MRI) provider eligibility;

*       restructuring of the items in relation to obstetric and gynaecological ultrasound services;

*       the amendment of a range of item fees, in line with proposals from the profession as part of the management of the Diagnostic Imaging Agreement; and

*       restructuring of a number of ultrasound and computed tomography (CT) items, including introduction of new items, according to clinical appropriateness.

The changes for the obstetric and gynaecological items have been developed in consultation with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the National Association of Specialist Obstetricians and Gynaecologists (NASOG), the Royal Australian and New Zealand College of Radiologists (RANZCR), the Australian College of Rural and Remote Medicine (ACCRM), the Royal Australasian College of General Practitioners (RACGP), the Australian and New Zealand Association of Physicians in Nuclear Medicine (ANZAPNM) ) and Australian Association of Obstetric and Gynaecological Ultrasonologists (AAOGU).

The changes for item fees and restructuring of ultrasound and CT items have been developed in consultation with the RANZCR and the Australian Diagnostic Imaging Association (ADIA).

Details of the Regulations are in the attachment.

The Regulations are taken to have commenced on 1 November 1999, except Schedule 2 which commenced on 1 February 2000.

The retrospective commencement of the Regulations does not disadvantage any person. The retrospective commencement corrects a drafting error in the 1 November Health Insurance (19992000 diagnostic Imaging Services Table) Regulations which extended the cut-off date for lodgement of statutory declarations for MRI equipment to MRI providers. It was never intended to limit the number of providers, or lockout new providers. The proposed retrospective commencement ensures that the regulatory provisions of pre-1 November 1999 are maintained and that providers are not disadvantaged.

ATTACHMENT

Details of the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 1999 (No. 1)

Regulation 1 provides that the name of the regulations will be the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 1999 (No. 1).

Regulation 2 provides that the Regulations are taken to have commenced on 1 November 1999, except schedule 2 which commences on 1 February 2000.

Regulation 3 provides that the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999 will be amended by Schedule 1 of the proposed Regulations.

Changes to the Table

MRI amendment

Section 19 of the regulations prescribes the conditions for the eligibility of MRI providers. Section 20 prescribes the eligibility requirements for AM equipment. In September 1999, an amendment was made to the regulations, effective 23 September 1999, to enable a cut-off date to be implemented in relation to the lodgement of statutory declarations in respect of MRI equipment. This cut-off date was required in order to finalise the numbers of MRI machines, in order to examine how the market had adjusted to the expansion of the MRI funding and to inform subsequent decision making about funding for MRI services.

The September 1999 regulation applied only to statutory declarations in respect of MRI equipment and did not apply to MRI providers. This was to ensure that newly qualified radiologists would continue to be able to apply for eligibility as MRI providers, and to undertake services on equipment previously deemed eligible. However, the November reprint of the Schedule contained a drafting error which has extended the application of the cut-off date from MRI equipment to include MRI providers.

The amendment in Schedule 1 removes the cut-off date from statutory declarations for MRI providers. The date of 11 October 1999 is removed from section 19(2) and the reference to 'eligible provider' is removed from section 20(6)(a). A further minor amendment has also been made to section 19(2)(d) to update the reference to the relevant section.

This Schedule is effective as from 1 November 1999.

Proposed restructure of the obstetric ultrasound items

Items 55040 and 54041 have been deleted from the DI Table, and replaced with disaggregated obstetric ultrasound items. These items have been the subject of Working Party discussions, comprising representatives of RANZCOG, NASOG, RANZCR and ANZAPNM. The Working Party recommended that the obstetric ultrasound items be disaggregated from the previous two items to thirteen new items. The new structure contains items which are clinically based and which will assist the more appropriate utilisation of these items. The new structure will also enable the collection of more specific data on current obstetric practice.

The items are intended to ensure that obstetric and gynaecological ultrasound structure does not provide the opportunity for inappropriate use of ultrasound in pregnancy. The fees for the new items are structured to reflect the varying levels of complexity in obstetric ultrasound.

The descriptors are intended to reflect the consensus statement on the use of ultrasound in pregnancy, prepared by RANZCOG, RACGP, and RANZCR under the auspices of the Australian Medical Association.

This new item structure also necessitates the change of four item numbers - item 55042 becomes 5573 1, item 55043 becomes 55733, 55046 become items 55736, item 55047 becomes item 55139. These items are the gynaecological items which have undergone a fee adjustment and have changed item numbers to maintain them in sequence with the obstetric items.

The regulations also make minor amendments to Rule 10AA(1) and item 55036, to update references to the new item numbers.

Fee adjustments

The amendments to the fees for diagnostic radiology items have been agreed with RANZCR and the ADIA. Expenditure on diagnostic imaging exceeds the targets set out in the Diagnostic Imaging Agreement with the profession. The fee reductions, together with the restructuring of other items set out below, will assist in meeting the targets.

The fee amendments apply to all diagnostic radiology, with the exception of mammography and angiography; and to twenty computed tomography (CT) items which together form the bulk of Medicare benefits paid for CT.

Restructure of ultrasound and CT items

Discussions with RANZCR and ADIA identified a number of cases where items or schedule fees have not kept up with advances to appropriate clinical practice. The amendments rectify this.

The changes include:

*       amendment of current breast ultrasound items to include scanning of one breast only, with the introduction of new items covering scans of both breasts;

*       minor changes to more effectively limit the payment of Medicare benefits for ultrasound scans of the urinary tract to once per 24 hours when performed in conjunction with a bladder scan;

*       limiting benefits for certain CT scans using intravenous contrast medium to where scans without contrast medium have been previously undertaken and show abnormal results;

*       revising the item for CT scans of the middle ear and temporal bone, as well as spiral angiography, to be more specific on the service for which benefits will be payable; and

*       introduction of one item for CT scans of certain areas of the face and brain, for which benefits are currently payable through separate items.