Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE AMENDMENT REGULATIONS 2000 (NO. 2) 2000 NO. 290

STATUTORY RULES 2000 No. 290

Issued by authority of the Minister for Health and Aged Care

Health Insurance Act 19 73

Health Insurance Amendment Regulations 2000 (No. 2)

The Health Insurance Act 1973 (the Act) provides in part for the payment of Medicare benefits for professional services rendered by medical practitioners and for certain professional services rendered by dental practitioners and optometrists.

Section 133 of the Act provides that the Governor-General may make regulations for the purposes of the Act.

Section 4AA of the Act provides that the Regulations may prescribe a table of diagnostic imaging services which includes among other things, R-type diagnostic imaging services.

Subsection 16B(1) of the Act provides in part that Medicare benefits are not payable for an R-type diagnostic imaging service rendered by the providing practitioner unless the service was requested in writing by a medical practitioner, a dental practitioner, a chiropractor, a physiotherapist or a podiatrist. An R-type service is a service identified with the symbol (R) and comprises the majority of services in the Table.

Subsection 16B(2) of the Act prescribes that a request made by a dental practitioner for an R-type diagnostic imaging service has no effect for the purposes of subsection 16B(1) of the Act unless it is a request for a service specified in the regulations.

A number of changes have been made to Regulation 10 of the Health Insurance Regulations 1975 as part of the ongoing management of the Table. The Regulations incorporate the following changes:

*       The amendment of the list of services that prosthodontists can request;

*       The establishment of a list of imaging items which can be requested by dental specialists;

*       The establishment of a list of imaging items which can be requested by oral medicine specialists and oral pathology specialists; and

*       The introduction of definitions of dental specialists, oral medicine specialists and oral pathology specialists.

These changes have been developed in consultation with State and Territory Dental Boards, the Australian Council of Dental Specialists and the Oral Medicine Society of Australia and New Zealand. The Diagnostic Imaging Management Committee and the Ultrasound Group have approved these changes.

Details of the Regulations are in the attachment.

The regulations commenced on 1 November 2000.

Attachment 1

Details of the Health Insurance Amendment Regulations 2000 (No. 2)

Regulation 1 provides that the name of the regulations will be the Health Insurance Amendment Regulations 2000 (No. 2).

Regulation 2 provides for the regulations to commence on 1 November 2000.

Regulation 3 provides that the Health Insurance Regulations 1975 will be amended by Schedule 1 of the Regulations.

Changes to the Regulation detailed in Schedule 1

Regulation 10, entitled "Diagnostic imaging services which dental practitioners may request", establishes the services that different categories of dental practitioners may request.

Sub-regulation 10(1) provides lists of services that may be requested by different categories of dentists and has been amended by the inclusion of additional clinically relevant services to the list of imaging services that can be requested by prosthodontists (56062, 58306, 63621, 63671 and 63712), the addition of a list of services that can be requested by dental specialists, and the addition of a list of services that can be requested by oral medicine specialists or oral pathology specialists.

In identifying the appropriate item numbers that these dental specialists should be granted referral rights to, the department took into account the clinical conditions that these dental specialists manage on a regular basis that separated them from other areas of dental specialty. Consequently, oral medicine and oral pathology specialists have been separated from the other dental specialists as the focus of their speciality differs.

A new sub-regulation 10(3) has been introduced that provides definitions of dental specialist, oral medicine specialist and oral pathology specialist for the purposes of subrule 10(1). Dental specialists are dental practitioners who are recognised by their respective State and Territory Dental Boards as specialists in one of the following areas: periodontistry, endodontistry, pedeodontistry, orthodontistry, oral medicine and oral pathology.

These changes have been developed in consultation with State and Territory Dental Boards, the Australian Council of Dental Specialists and the Oral Medicine Society of Australia and New Zealand.

The Diagnostic Imaging Management Committee and the Ultrasound Group have approved these changes. The Diagnostic Imaging Management Committee membership represents the following organisations: Australian Diagnostic Imaging Association, Health Insurance Commission (HIC), Royal Australian and New Zealand College of Radiologists (RANZCR), and the Department of Health and Aged Care. The Ultrasound Group membership represents the following organisations: The Urological Society of Australia, HIC, RANZCR, Royal Australian College of Obstetricians and Gynaecologists, Cardiac Society of Australia and New Zealand, Royal Australasian College of Surgeons, Australian and New Zealand Association of Physicians in Nuclear Medicine, Australian Society of Ultrasound Medicine, Royal Australian College of General Practitioners, Australian Sonographers Association and the Department of Health and Aged Care.