Commonwealth Numbered Regulations - Explanatory Statements Commonwealth Numbered Regulations - Explanatory Statements[Index] [Search] [Download] [Related Items] [Help]
HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2007 (SLI NO 338 OF 2007)
EXPLANATORY STATEMENT
Select Legislative Instrument 2007 No. 338
Subject: Health Insurance Act 1973
Health Insurance Amendment Regulations 2007 (No. 6)
Health Insurance (Diagnostic Imaging Services Table) Regulations 2007
Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides, in part, 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 amendments to the Health Insurance Regulations 1975 (the Principal Regulations) extend the requesting rights of podiatrists to three musculoskeletal ultrasound (MSKUS) items listed in the Medicare Benefits Schedule (MBS). The extension of requesting rights for podiatrists allow podiatrists to request the MSKUS items directly, rather than sending patients to general practitioners, and provide a more comprehensive service to patients.
The amendments to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2007 (the DIST Regulations) include:
· repealing regulation 17 Musculoskeletal ultrasound services — multiple scans;
· increasing fees for certain cardiac imaging items; and
· making minor amendments to the item descriptors of two obstetric and gynaecological services to provide consistency with the Nuchal Translucency Guidelines.
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 MoUs cover radiology, cardiac imaging, nuclear medicine imaging and obstetric and gynaecological ultrasound services. The amendments to the DIST Regulations affect services covered by the Radiology MoU, Cardiac Imaging MoU, and Obstetric and Gynaecological (O&G) Ultrasound MoU.
Subsection 4AA(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4AA(1) cease to be in force and are taken to have been repealed on the day after the 15th sitting day of the House of Representatives after the end of a period of 12 months, commencing on the day on which the regulations are notified on the Federal Register of Legislative Instruments. The 2006 Regulations were registered on the Federal Register of Legislative Instruments on 24 October 2005 and commenced on 1 November 2006.
The purpose of the Regulations is to repeal the 2006 Regulations and to prescribe a new table of diagnostic imaging services for the 12 month period commencing on 1 November 2007. The new table effectively reproduces the table contained in the 2006 Regulations, with some amendments to the rules of interpretation and the schedule of services and fees. The Regulations set out the items of diagnostic imaging services which are eligible for Medicare benefits, the amount of fees applicable in respect of each item and rules for interpretation of the table.
Details of the Regulations are provided in the Attachments.
The Department of Health and Ageing consulted with the diagnostic imaging profession about the amendments affecting the Radiology, Cardiac Imaging and Obstetric and Gynaecological MOUs. Changes to the legislation will be communicated to stakeholders as part of the 1 November distribution of the MBS book, newsletter and online subscription service. The Minister for Health and Ageing consulted with general practice groups about extending requested rights for podiatrists.
The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised.
The Regulations legislative instruments for the purposes of the Legislative Instruments Act 2003.
Both of the Regulations commence on 1 November 2007.
Details of the Health Insurance Amendment Regulations 2007 (No. 6)
Regulation 1 – Name of Regulations
This regulation provides that the title of the Regulations is the Health Insurance Amendment Regulations 2007 (No. 6).
Regulation 2 - Commencement
This regulation provides for the Regulations to commence on 1 November 2007.
Regulation 3 - Amendments
This Regulation provides for Schedule 1 to amend the Health Insurance Regulations 1975 (the Principal Regulations).
Schedule 1 – Amendment
Item [1]
This item extends requesting rights for podiatrists under regulation 11 (2) to include three foot and ankle musculoskeletal ultrasound items 55836, 55840 and 55844. The amendment removes the need for podiatrists to send patients to a general practitioner in order to obtain a request for these musculoskeletal ultrasound items. This enables podiatrists to provide a more comprehensive clinical service for patients.
ATTACHMENT B
Details of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2007
Regulation 1 – Name of Regulations
This regulation provides that the title of the Regulations is the Health Insurance (Diagnostic Imaging Services Table) Regulations 2007.
Regulation 2 - Commencement
This regulation provides for the Regulations to commence on 1 November 2007.
Regulation 3 - Commencement
This regulation provides for the repeal of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006.
Regulation 4 - Definitions
Regulation 4 provides that for the purpose of the Regulations, Act means the Health Insurance Act 1973 and this table means these Regulations.
Regulation 5
Regulation 5 provides that the table of diagnostic imaging services in Schedule 1 is prescribed for the purposes of subsection 4AA(1) of the Act.
Schedule 1 - Table of diagnostic imaging services amendments
The Diagnostic Imaging Services Table 2007 amends:
§ Part 2 – Rules of interpretation; and
§ Part 3 – Services and fees.
This item repeals regulation 17 Musculoskeletal ultrasound services to allow a Medicare benefit to be payable for more than one musculoskeletal ultrasound scan performed in one day. The original intention of the regulation was to encourage appropriate servicing and assist in the management of budgetary outlays. An unintended consequence of the restriction was that when more than one scan was ordered, patients were being requested to return on different days for subsequent scans and inconvenienced in terms of time and cost. Multiple MSKUS will still be subject to the general multiple diagnostic imaging services rules where subsequent scans will be rebated at a slightly lower rate.
The Radiology Management Committee (RMC) recommended that regulation 17 be removed.
Cardiac imaging items 55113, 55114 and 55115 fee increases
This item applies a 2.03 per cent increase to the schedule fee for cardiac imaging items 55113, 55114 and 55115. In September 2006, based on the best information available at the time, outlays were projected to significantly exceed allowable limits. As a consequence, these Cardiac imaging incurred a 2 per cent reduction in benefits. In light of the subsequent trends in outlays, the Cardiac Imaging Management Committee (CIMC) recommended a reversal of this fee decrease.
Cardiac imaging items 55116 and 55117 fee increases
This item applies a 2 per cent increase to the schedule fee for cardiac imaging items 55116 and 55117. This increase is also based on the trends for outlays and a recommendation by the CIMC.
Nuchal Translucency item descriptors
This item amends measurements identifying the gestational age for obstetric and gynaecological items 55707 and 55708. The amendments were recommended by the Obstetric and Gynaecological Management Committee to provide consistency with the Nuchal Translucency Guidelines and reflect current clinical medical practice.