Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (1998-99 DIAGNOSTIC IMAGING SERVICES TABLE) AMENDMENT REGULATIONS 1999 (NO. 2) 1999 NO. 193

STATUTORY RULES 1999 NO. 193

Issued by the Authority of the Minister for Health and Aged Care

Health Insurance Act 1973

Health Insurance (1998-99 Diagnostic Imaging Services Table) Amendment Regulations 1999 (No. 2)

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 4AA of the Act provides that the table of diagnostic imaging services may be prescribed by the Regulations. The Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1998 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 a table which included the Diagnostic Imaging Services Table (the Table)

The Regulations incorporate the following changes to the Table:

*       the introduction of professional supervision requirements for referred ultrasound services;

*       the amendment of item wording to exclude the payment of benefits where item 55036 is performed in conjunction with item 55042 or item 55044 within a 24 hour period;

*       the introduction of two new items for saline infusion sonohysterography;

*       the deletion of two items (55286 and 56019);

*       minor consequent editorial amendments following the deletion of item 55286; and

*       the implementation of fee changes.

The changes have been developed in consultation with the Royal Australian and New Zealand College of Radiologists, and the Australian and New Zealand Association of Physicians in Nuclear Medicine.

Details of the Regulations are in the attachment.

The regulations came into effect from 1 September 1999.

ATTACHMENT

Details of the Health Insurance (1998-99 Diagnostic Imaging Services Table) Amendment Regulations 1999 (No. 2)

Regulation 1 provides that the name of the regulations will be the Health Insurance (1998-99 Diagnostic Imaging Services Table) Amendment Regulations 1999 (No. 2)

Regulation 2 provides for the regulations to commence on 1 September 1999.

Regulation 3 provides that the Health Insurance (1998-99 Diagnostic Imaging Services Table) Regulations 1999 will be amended by Schedule 1 of the proposed Regulations.

Changes to the Regulations detailed in Schedule 1

Item 1 provides for a change to Rule 10 (b) to enable the fee for derived item 59013 to be reduced from $21.75 to $21.30.

Item 2 provides for the introduction of professional supervision for referred ultrasound services. The intent of this provision is to promote quality and appropriate ultrasound services by seeking to ensure that these services are provided in a situation where a medical specialist is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient. The provision has been developed through extensive consultation with ultrasound service providers. Professional supervision requirements have previously been introduced for the eligible provision of magnetic resonance imaging services, computed tomography and mammography.

Referred ultrasound services will be exempt from professional supervision requirements where rendered in an emergency or in a remote location, or where the service was rendered by or on behalf of a medical practitioner who provided more than 50 ultrasound services during the last year and who was not a specialist or consultant physician. Services rendered in a nursing home or the patient's home will also be exempt.

Items 3 to 8 provide for the payment of Medicare benefits only once in a twenty-four hour period where item 55036 (ultrasound scan of the abdomen) is performed with either items 55042 (ultrasound scan of the pelvis, female) or 55044 (ultrasound scan of the pelvis, male).

Item 9 provides for the introduction of two new ultrasound items for saline infusion sonohysterography, to be used as a second-line diagnostic procedure for abnormal uterine bleeding. The implementation of this service was proposed by the Medicare Services Advisory Committee, following assessment based on the strength of evidence as to its effectiveness, cost-effectiveness and safety.

Item 10 provides for item 55286 to be deleted from the Diagnostic Imaging Services Table. Expert advice has indicated that this item is no longer clinically relevant.

Items 11 and 12 provide for the minor amendment of items 55288 and 55290, as a consequence of the deletion of item 55286.

Item 13 provides for item 56019 to be deleted from the Diagnostic Imaging Services Table. Expert advice has indicated that this item is no longer clinically relevant.

Item 14 provides for the introduction of a range of fee reductions for nearly all diagnostic imaging services, with the exception of magnetic resonance imaging services. The fee reductions in the Nuclear Medicine Group have been targeted to particular items, on the advice of the Australian and New Zealand Association of Physicians in Nuclear Medicine (ANZAPNM). Expenditure for diagnostic imaging services in 1998-99 exceeded expected growth. These fee reductions are being proposed as part of a wider package of measures to assist in meeting the targets for expenditure that are set out in the Diagnostic Imaging Agreement.