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HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) AMENDMENT REGULATIONS 2007 (NO. 3) (SLI NO 99 OF 2007)
EXPLANATORY STATEMENT
Select Legislative Instrument 2007 No. 99
Subject: Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2007 (No. 3)
Subsection 133(1) 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.
The Act provides, in part, for payments of Medicare benefits in respect of professional services rendered to eligible persons. 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 prescribed tables.
Subsection 4AA of the Act provides that the regulations may prescribe a table of diagnostic imaging services, the amount of fees applicable in respect of each item and the rules for interpretation of the table. Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006 (the Principal Regulations) prescribes such a table.
The purpose of the Regulations is to amend the Principal Regulations to:
· introduce a new Medicare item for Computed Tomography (CT) for the purposes of attenuation correction (AC) and anatomical localisation (AL) when performed in conjunction with a Single Photon Emission Tomography (item 61505); and
· amend item 61462 (a repeat scan) from a derived fee to its own stand-alone schedule fee.
The Regulations affect services covered by the Nuclear Medicine Imaging Memoranda of Understanding (MoU). The Australian Government (as represented by the Department of Health and Ageing) manages Medicare funding for diagnostic imaging services through four agreements known as the 2003-2008 Quality and Outlays Memoranda of Understanding (MoUs).
The Regulations were developed and approved in consultation with the Nuclear Imaging Consultative Economics Committee (NICEC). The NICEC is comprised of representatives from the Department, the Australian and New Zealand Association of Physicians in Nuclear Medicine (ANZAPNM), the Royal Australian and New Zealand College of Radiologists (RANZCR) and the Australian Diagnostic Imaging Association (ADIA). Medicare Australia was also consulted about operational aspects of the amendments.
Details of the Regulations are provided in the Attachment.
The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised.
The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Regulations commence on 1 May 2007.
Details of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2007(No. 3)
Regulation 1 – Name of Regulations
This regulation provides that the title of the Regulations is the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2007 (No. 3).
Regulation 2 - Commencement
This regulation provides for the Regulations to commence on 1 May 2007.
Regulation 3 – Amendment of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006
This regulation provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006 (the Principal Regulations) are amended as set out in Schedule 1.
Schedule 1 – Amendments
Item 2
This item inserts a note at the end of rule 27 to recognise that Item 61650 is taken to be an item in the table by virtue of a Determination made under section 3C of the Act.
Item 3
This item repeals rule 28 of the rules of Interpretation of the Diagnostic Imaging Services Table. The rule provided for a derived fee to be allocated to Item 61462 (which applies to certain repeat scans). Item 4 (see below) amends Item 61462 to prescribe a fee of $129.00 in respect of that item, and therefore rule 28 is no longer required.
Item 4
This item amends the fee in respect of item 61462 (repeat scan) from a derived fee to a fixed schedule fee. Item 61462 is a repeat scan subsequent to items 61364, 61426, 61429, 61430, 61442, 61450, 61453 or 61469. This amendment prescribes a separate, stand-alone schedule fee for this item of $129.00 rather than being the fee calculated on the basis of a previous scan (a derived fee). The amendment is because processing of the derived fee was difficult for Medicare Australia and required manual intervention which led to inconsistencies and a lack of accurate utilisation statistics.
The item is subject to the general multiple diagnostic imaging services rule when rendered on the same day by the same provider as its pre-requisite items. The general multiple services rule is provided for in subrule 1 of rule 30 of the Diagnostic Imaging Services Table. There is no change in other requirements for the item.
Item 5
This item introduces a new Medicare eligible item 61505 for Computed Tomography (CT) for the purposes of attenuation correction (AC) and anatomical localisation (AL) when performed in conjunction with a Single Photon Emission Tomography (this is often referred to as Single Photon Emission Computed Tomography, SPECT).
It was agreed in consultation with the Nuclear Imaging Consultative Economic Committee, that the introduction of this item will improve SPECT reporting. SPECT is a nuclear medicine imaging technique that provides functional information that indicates the presence of biochemical activity and changes. The combination of SPECT and CT enhances the SPECT image by showing where biochemical activity occurs in relation to organs and skeleton. The combined technique allows for significant improvements in sensitivity and specificity, compared to SPECT alone thereby improving the accuracy and quality of the report.