Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) AMENDMENT REGULATIONS 2003 (NO. 1) 2003 NO. 68

STATUTORY RULES 2003 No. 68

Issued by the Authority of the Minister for Health and Ageing

Health Insurance Act 1973

Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2003 (No. 1)

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

Section 10 of the Act provides for payments of Medicare benefits in respect of professional services rendered to eligible persons.

Section 4AA of the Act provides that the table of diagnostic imaging services sets out: items of diagnostic imaging services; the amount of fees applicable in respect of each item; and the rules of interpretation of the table. The Health Insurance (Diagnostic Imaging Services Table) Regulations 2002 (the Principal 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 the General Medical Services table, the Pathology Services Table and the Diagnostic Imaging Services Table (the Table).

The purpose of the Regulations is to clarify that an item in the Table includes the diagnostic imaging procedure used for the rendering of the item and substitute new descriptions for certain musculoskeletal ultrasound items, to include clinical indicators for referral.

Details of the Regulations are provided in the Attachment.

The Regulations commence on 1 May 2003.

ATTACHMENT

Regulation 1 provides that the name of the regulations will be the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2003 (No. 1).

Regulation 2 provides that the regulations commenced on 1 May 2003.

Regulation 3 provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2002, is amended by Schedule 1 of the Amendment Regulations.

The Health Insurance (Diagnostic Imaging Services Table) Regulations 2002, is amended in the following way:

Part 2 - Rules of interpretation

•       Item 1 inserts a paragraph after subrule 2 (2) to clarify that a reference to a diagnostic imaging service in an item in Part 3 includes a reference to the undertaking of the diagnostic imaging procedure used for rendering the service. Clarification that an item in the Table includes the associated diagnostic imaging procedure is required following recent representations to the Department highlighting that there was no regulatory link between the service and the procedure.

Part 3 - Services and fees

•       Item 2 substitutes anew description for musculoskeletal (MSK) ultrasound items 55808 and 55810 (shoulder) to include clinical indicators.

•       Item 3 substitutes a new description for MSK ultrasound items 55828 and 55830 (knee) to include clinical indicators.

The revised descriptions for the MSK ultrasound items were developed by the MSK Ultrasound Project Team and endorsed by the Ultrasound Reference Group and the Diagnostic Imaging Management Committee. The substituted item descriptions have been developed in response to unsustainable growth in MSK ultrasound particularly for high volume referrals of the shoulder and knee. The MSK Ultrasound Project Team, the Ultrasound Reference Group and the Diagnostic Imaging Management Committee's members comprise representatives of the following organisations:

•       Royal Australian and New Zealand College of Radiologists,

•       Australian and New Zealand Association of Physicians in Nuclear Medicine,

•       Australian Diagnostic Imaging Association,

•       Cardiac Society of Australia and New Zealand,

•       Australian Sonographers Association,

•       Australasian Society of Ultrasound in Medicine,

•       Royal Australian College of General Practitioners,

•       Royal Australian and New Zealand College of Obstetricians and Gynaecologists,

•       Royal Australasian College of Surgeons,

•       Urological Society of Australasia,

•       Australian College of Sports Physicians,

•       Australasian Musculoskeletal Imaging Group,

•       Australian Rheumatology Association,

•       Australian Orthopaedic Association,

•       Health Insurance Commission, and

•       Department of Health and Ageing.