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HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2000 2000 NO. 291
EXPLANATORY STATEMENTSTATUTORY RULES 2000 No. 291
Issued by the Authority of the Minister for Health and Aged Care
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Regulations 2000
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 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.
Section 4AA of the Act provides that the table of diagnostic imaging services may be prescribed by the regulations. The purpose of the Health Insurance (Diagnostic Imaging Services Table) Regulations is to prescribe such a table. The new table has replaced the table in the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999.
A number of changes to the Regulations have been made as part of the ongoing management of the Table. The Regulations incorporate the following changes to the Table:
* Amendment of the professional supervision rule for ultrasound to include the new musculoskeletal ultrasound items and to exclude urological ultrasound items;
* the amendment of items 55036, 55037, 55038, 55039, 55044 and 55045 to exclude the use of these items for transrectal prostate examinations;
* the replacement of the existing musculoskeletal and joint ultrasound items with a new musculoskeletal ultrasound subgroup consisting of 26 new items and the introduction of four new musculoskeletal. ultrasound rules;
* the restructure of the cardiac ultrasound items, with the deletion of two items, the addition of two items, and the amendment of three existing items;
* the introduction of multiple pregnancy ultrasound items and the introduction of a new Rule for obstetric ultrasound; and
* the, introduction of a new Rule for the credentialling of specialists in nuclear medicine.
The changes have been developed in consultation with relevant medical colleges, and professional associations. Some changes of detail have also been introduced to improve clarity. These changes of detail do not introduce any changes to the intent or application of the Regulations.
Details of the Regulations are in the attachment.
The Regulations commenced on 1 November 2000.
ATTACHMENT
Details of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000
Regulation 1 specifies the regulations as the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000.
Regulation 2 provides for the regulations to commence on 1 November 2000.
Regulation 3 repeals the statutory rules Nos. 255 and 345 of 1999, and Nos. 59 and 147 of 2000.
Regulation 4 provides definitions for the purposes of the Regulations.
Regulation 5 prescribes the table of diagnostic imaging services.
Changes to the Table
The November 2000 Diagnostic Imaging Services Table differs from the previous tables in the following ways:
Changes of detail
* The renumbering and reordering of the Rules to ensure a more logical sequence. This does not impact on the application of the Rules.
Prescription of table
* The insertion of a new Rule 1, to enhance the relationship between the Regulation and the Act. A similar Rule has been introduced for all tables prescribed under the Health Insurance Act.
General
* The incorporation of Rules, from the previous Health Insurance (DIST) Regulations, entitled "References to Items in the General Medical Services Table", Weaning of report in certain items ", and Weaning of Group of Practitioners " into the Rule 2 "General".
Amendment to professional supervision requirements for ultrasound
* The amendment of Rule 9 "Ultrasound Services- Eligible Services", to exclude the urological ultrasound items 55600 and 55603. Rule 9 establishes supervision conditions for referred ultrasound services when performed on behalf of a medical practitioner. This Rule is intended to apply to all applicable referred ultrasound services.
Items 55600 and 55603 require personal performance of the service by the medical practitioner and therefore Rule 9, which establishes conditions for performance of the service on behalf of a medical practitioner, does not apply. The amendment simply makes this clear.
* The amendment of Rule 9 to include the new musculoskeletal ultrasound items (55800 to 55850). The new musculoskeletal items replace items to which this Rule applied and consequently, the Rule has been amended to apply to the new items.
Urological Ultrasound
* The amendment of items 55036, 55037, 55038, 55044 and 55045 to exclude the use of these items for transrectal prostate examinations. Transrectal prostate examinations are covered by items 55600 and 55603, which include a number of quality measures not contained in the more generic items (55036, 55037, 55038, 55044 and 55045).
Musculoskeletal Ultrasound
* The deletion of the existing musculoskeletal and joint ultrasound items (55050, 55051, 55052, and 55053) with the introduction of a new musculoskeletal ultrasound subgroup consisting of 26 location specific ultrasound items (55800. to 55850).
Musculoskeletal ultrasound is one of the fastest growing applications of ultrasound. The new item structure is intended to encourage more appropriate use, and provide better information on how the technology is being used. The fees for the new items are the same as the previous items, except for a higher rebate composite item and a lower rebate item for ultrasound of subcutaneous lumps.
Four new Rules have been developed to enhance the quality use of musculoskeletal ultrasound:
* The introduction of a new Rule 10 "Personal attendance for musculoskeletal ultrasound", that requires the providing practitioner to personally attend on the patient when providing musculoskeletal ultrasound services, for the service to be eligible for a Medicare rebate. An exemption is provided for services provided in remote areas of Australia. The introduction of personal attendance on the patient will enhance the quality of musculoskeletal ultrasound services performed, by involving the medical practitioner in the real time, dynamic examination of the patient.
* The introduction of a new Rule 14 "Comparison ultra-sonography " that makes explicit that comparison studies of opposite limbs form part of a single musculoskeletal study and do not constitute a separate service.
* The introduction of a new Rule 15 "Equipment" that establishes minimum equipment requirements for the provision of musculoskeletal ultrasound. This Rule is intended to enhance the quality of musculoskeletal. ultrasound by only providing a rebate for services performed on appropriate equipment.
* The introduction of a new Rule 16 "Items 55800 to 55850- Multiple Scans" that restricts practitioners to one musculoskeletal ultrasound service rebate per patient per day. This Rule formalises an existing Rule of interpretation, previously in the Medicare Benefits Schedule Book, that restricts practitioners to the provision of one musculoskeletal ultrasound service per patient per day.
The musculoskeletal ultrasound changes have been agreed to by the Diagnostic Imaging Management Committee (DIMC), and their sub-group, the Musculoskeletal Ultrasound Working Group, and draw on the expertise of the medical colleges and professional associations involved in the provision of these services, including the Royal Australian and New Zealand College of Radiologists, the Australian Diagnostic Imaging Association, the Royal Australasian College of General Practitioners, the Australian College of Sports Physicians, the Australian Sonographer Association, the Australian Rheumatology Association, , the Australian Orthopaedic Association, and the Australian and New Zealand Association of Physicians in Nuclear Medicine.
Cardiac Ultrasound
* The deletion of cardiac ultrasound items 55102 and 55105, as they no longer have clinical relevance.
* Minor wording changes to cardiac ultrasound items 55112, 55118 and 55130 to reflect current clinical practice.
* The introduction of two additional cardiac ultrasound items, being 55116 and 55117, in order to separate stress echocardiography services from item 55112. This will allow more accurate monitoring and control of expenditure on item 55112.
The Diagnostic Imaging Management Committee (DIMC), and the Cardiac Ultrasound Working Group, have approved the proposed cardiac ultrasound changes. These groups consist of representatives from the Cardiac Society of Australia and New Zealand, Australian and New Zealand Association of Physicians in Nuclear Medicine, Royal Australian and New Zealand College of Radiologists, Australian Society of Ultrasound in Medicine, and the Royal Australian College of Physicians.
Nuclear Medicine Credentialling
The introduction of a new Rule 24 "Nuclear Scanning Services", which, from 1 November 2000, will limit payment of Medicare rebates for nuclear medicine imaging services to those medical specialists who are credentialled by the Joint Nuclear Medicine Credentialling and Accreditation Committee of the Royal Australasian College of Physicians (RACP) and the Royal Australian and New Zealand College of Radiologists (RANZCR). Re-credentialling will occur on an annual basis.
The new credentialling arrangements have been developed jointly between the Department, the Australian and New Zealand Association of Physicians in Nuclear Medicine (ANZAPNM), the RACP and RANZCR to ensure that specialists in nuclear medicine are appropriately trained and licensed, provide appropriate personal supervision of procedures and are involved in ongoing continuing medical education. This is in line with evidence based medicine and continues the ongoing reform of the MBS to ensure that Medicare benefits are paid only for appropriate medical practices.
Obstetric Ultrasound
The introduction of 8 new items for ultrasound scanning in multiple pregnancy. The items have been developed by the Obstetric and Gynaecological Ultrasound Monitoring and Review Group. This group comprises representatives from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australian and New Zealand College of Radiologists, the Royal Australasian College of General Practitioners, and the Australian College of Rural and Remote Medicine, the Health Insurance Commission and the Department.
The items mirror the current second and third trimester item structure (55706 to 55725) for singleton pregnancies and contain the same quality provisions and restrictions as the current items to ensure a strong focus on quality patient care. The proposed fees for the new items reflect the additional complexity and time required for examining multiple pregnancy, with up to a 60% increase on the current fees for obstetric ultrasound scans. As a consequence of this proposed amendment, the clinical indicator 'multiple pregnancy' has been removed from items 55718 and 55723.
The amendment of Rule 12 "Clinical indications", to include the multiple pregnancy obstetric ultrasound services that specify clinical indications.
The introduction of a new Rule 13 "Referral forms from practitioners who have obstetric privileges at a non-metropolitan hospital" that requires practitioners referring patients for obstetric ultrasound, on the basis of having obstetric privileges at a non-metropolitan hospital, to indicate this on the referral form. The recognition of practitioners with obstetric privileges is intended to enhance rural access to obstetric ultrasound. Rule 13 is intended to enable the identification of this group of practitioners and the facilitation of their capacity to access Medicare rebates.