EXPLANATORY STATEMENT

 

Select Legislative Instrument 2009 No. 271

 

Health Insurance Act 1973

 

Health Insurance (Diagnostic Imaging Services Table) Regulations 2009

 

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.

 

Section 4AA of the Act provides that the regulations may prescribe a table of diagnostic imaging services that sets out items of pathology services, the amount of fees applicable in respect of each item, and rules for interpretation of the diagnostic imaging services table. The Health Insurance (Diagnostic Imaging Services Table) Regulations 2008 (the 2008 Regulations) currently prescribe such a table.

 

Subsection 4AA(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4AA(1) cease to be in force and are taken to have been repealed on the day after the 15^th sitting day of the House of Representatives after the end of the period of 12 months, commencing on the day on which the regulations are notified on the Federal Register of Legislative Instruments. The 2008 Regulations were registered on the Federal Register of Legislative Instruments on 17 October 2008 and commenced on

1 November 2008.

 

The purpose of the Regulations is to repeal the 2008 Regulations and prescribe a new diagnostic imaging services table for the 12 month period commencing on

1 November 2009. The Regulations set out items of diagnostic imaging services that are eligible for Medicare benefits, the amount of fees applicable for each item and rules for interpretation of the table. The new table reproduces the table contained in the 2008 Regulations with some minor changes to the rules of interpretation and to the schedule of services and fees.

 

The following changes to the table have been approved through the 2009/10 Budget process:

 

·        A new rule is introduced such that, for out of hospital services that are bulk billed, the schedule fee is reduced by 5 per cent and rebates paid at 100 per cent of this new fee;

·        Item 59103 is changed from a derived fee to a standard fee and the descriptor is amended to restrict it to being claimed in association with another item in the same group; and

·        Consequential rule changes are made to reflect the above.

 

Details of the Regulations are set out in the Attachment.

 

The changes regarding the new bulk billing fees and item 59103 were developed through internal-to-government Budget processes and have reached the form of the current proposal as a result of a Cabinet decision. These processes were Budget-in-Confidence and thus stakeholders could not be engaged in them. However, submissions to the 2009-10 Budget emerged from a Strategic Review of Pathology and Diagnostic Imaging Services conducted by the Department of Health and Ageing in the 12 months prior. This Review included broad and extensive consultation with key stakeholders, including the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association. Approximately 30 submissions were received and considered.

 

The Act specifies no conditions that need to be satisfied 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 November 2009.

 

 

 

 

ATTACHMENT

 

 

DETAILS OF THE HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2009

 

Regulation 1 – Name of Regulations

 

This regulation provides for the Regulations to be referred to as the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009.

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on 1 November 2009.

 

Regulation 3 – Repeal

 

This regulation repeals the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008 (the 2008 Regulations) (as amended).

 

Regulation 4 – Definitions

 

This regulation provides that for the purpose of the Regulations, Act means the Health Insurance Act 1973 and this table means these Regulations.

 

Regulation 5 – Diagnostic Imaging Services Table

 

This regulation 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

 

Schedule 1 sets out a diagnostic imaging services table which is similar to the table in the 2008 Regulations except with changes to the following provisions:

·        Part 2 – Rules of interpretation; and

·        Part 3 – Services and fees

 

Part 2 – Rules of interpretation

 

Rule 7 is deleted. This rule spells out how the derived fee operates for item 59103. Since this item is being changed to a standard fee, the rule no longer applies.

 

Rule 28 is added. This is a new rule that provides a rebate increase for services that are provided out of hospital and are bulk billed (excluding item 61369). (Item 61369 is prescribed by Health Insurance (Indium-labelled Octreotide Study) Determination HS/09/2006, and is treated as an item on the Diagnostic Imaging Services Table for Medicare Australia claiming purposes. This item is excluded from the rebate increase due to the size of the rebate it currently attracts).

 

These services have their fee decreased by 5 per cent, after which benefits are paid at

100 per cent of this new fee, rather than the usual benefit of 85 per cent. This rule thus provides a bulk billing incentive of around an extra 10 per cent of the schedule fee.

 

Part 3 – Services and fees

 

Item 59103 has its descriptor changed to reflect its change from a derived to a standard fee. Previously, the derived fee arrangement has meant that item 59103, which provides a fee for the localisation of a foreign body, is claimed instead of the investigative procedure used. The switch to a standard fee means that both items can be claimed.