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HEALTH INSURANCE (1999-2000 DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 1999 1999 NO. 255
EXPLANATORY STATEMENTSTATUTORY RULES 1999 NO. 255
Issued by the Authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999
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 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).
A number of changes to the Regulations have been made as part of the annual renewal of the Table.
The Regulations incorporate the following changes to the Table:
* the introduction of a new item;
* new restrictions placed in two items;
* introduction of a new rule for Nuclear Medicine Imaging items;
* clarification of a rule for MRI services;
* amendment of a rule relating to eligibility provisions for MRI services;
* deletion of an item; and
* minor item amendments to reflect a change in an item number;
The changes have been developed in consultation with the Royal Australian and New Zealand College of Radiologists, and the Australian and New Zealand Association of Physicians in Nuclear Medicine.
Details of the Regulations are in the Attachment.
The Regulations commenced on 1 November 1999.
ATTACHMENT
Details of the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999
Regulation 1 provides that the name of the regulations will be the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999.
Regulation 2 provides for the regulations to commence on 1 November 1999.
Regulation 3 repeals the 1998-1999 Diagnostic Imaging Services Table
Regulation 4 prescribes the new table of diagnostic imaging services and rules of interpretation as set out in Schedule 1.
Schedule 1 - Table of diagnostic imaging services
The 1999-2000 Diagnostic Imaging Services Table differs from the previous tables in the following way:
* the introduction of a new bone marrow item for bone marrow studies using localised technetium labelled agent. This was proposed by ANZAPMN and reflects current clinical practice.
* limiting item 61441 (whole body bone marrow studies) to where 'technetium labelled bone marrow agents' are used. Again, ANZAPMN proposed this restriction in line with the most appropriate clinical practice.
* the amendment of item 61462 to ensure that it is only performed where a positive clinical indication has been provided through the result of performing either of items 61364, 61426, 61429, 61430, 61442, 61450, 61453 or 61469. The previous exclusions under this item no longer apply.
* an amendment to Rule 13 to ensure that positron emission tomography (PET) scans are not inappropriately billed against nuclear medicine items. Currently, benefits are only available for PET scans performed at two specific locations, via a Section 3C Determination under the Health Insurance Act 1973. The wider use of PET is being considered as part of the Review of Positron Emission Tomography.
* a minor amendment to Section 23 to clarify the number of MRI services that can be claimed in a 12 month period. The wording of this section had previously caused some confusion and has now been amended to make clear the number of services that can be ordered in each group of MRI services.
* a minor amendment to items in subgroup 1 of the ultrasound group, to replace references to item 55055, which has been moved to the General Medical Services Table and renumbered as 11240.
* deletion of item 56059, which is a capital sensitive version of item 56019, which had previously been deleted as it was no longer clinically relevant.
* Amendment to section 20, which provides for the date by which MRI equipment was to have been installed or contracted for purchase, in order for it to be eligible for Medicare Benefits. This date has been amended from 7.30pm on 12 May 1998 to 10 February 1998, with a limited exemption for MRI machines ordered between 10 February 1998 and 12 May 1998. This amendment has also resulted in concomitant changes to section 19.
The amendment is proposed following a recently completed review by the Health Insurance Commission into the numbers of MRI machines (both installed and contracted for purchase) that are eligible for Medicare benefits. While the Australian Health Technology Advisory Committee's 1997 report into MRI indicated that the use of this technology has increasing application, the quantity of MRI machines has exceeded the number which was predicted through modelling undertaken at the time MRI was introduced onto the MBS. In addition to this, the Health Insurance Commission is investigating possible fraudulent activity in relation to the acquisition of some MRI machines.
The regulation is designed to ensure that machines operating outside metropolitan areas can continue to claim Medicare benefits. MRI machines in these areas which were ordered before 12 May 1998 and are currently operating will continue to be eligible for benefits.
A review of the technology is also being undertaken, which aims to determine how best to provide appropriate, quality and accessible MRI services. The amendment to the Regulation will assist in the management of MRI pending the outcome of the review.