HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS (NO. 1) 2020 (F2020L00459) EXPLANATORY STATEMENT

Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS (NO. 1) 2020 (F2020L00459)

EXPLANATORY STATEMENT

 

Health Insurance Act 1973

 

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020

 

Subsection 133(1) of the Health Insurance Act 1973 (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.

 

Part II of the Act provides for the payment of Medicare benefits for professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits be calculated by reference to the fees for medical services set out in prescribed tables.

 

Subsection 4AA(1) of the Act provides that regulations may prescribe a table of diagnostic imaging services which sets out items of diagnostic imaging services, the fees applicable for each item, and rules for interpreting the table. The table made under this subsection is referred to as the diagnostic imaging services table (DIST). 

 

Subsection 4AA(2) of the Act provides that, unless repealed earlier, the DIST will cease to be in force and will be taken to have been repealed on the day following the 15th sitting day of the House of Representatives after the end of a 12 month period which begins on the day when the regulation is registered on the Federal Register of Legislation (FRL). The Health Insurance (Diagnostic Imaging Services Table) Regulations 2019 (the 2019 Regulations) were registered on 8 April 2019. 

 

Purpose

The purpose of the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020 (the Regulations) is to repeal the 2019 Regulations and prescribe a new table of diagnostic imaging services from 1 May 2020. This will ensure that Medicare benefits continue to be payable for diagnostic imaging services.

 

The Regulations will implement the Government's response to a significant number of recommendations of the clinician-led Medicare Benefits Schedule (MBS) Review Taskforce (the MBS Review Taskforce) to diagnostic imaging services. These changes were announced in the 2019-20 Budget under the Guaranteeing Medicare - improved patient access to diagnostic imaging measure.

 

The Regulations will implement a number of minor policy changes that were recommended by the Medical Services Advisory Committee (MSAC). This includes the removal of the requirement that cone beam computed tomography services are performed on dedicated equipment, and to amend to nuclear medicine items to clarify the intent of the services. These changes were approved by the Government in the 2019-20 Mid-Year Economic Financial Outlook under the Guaranteeing Medicare -- Medicare Benefits Schedule -- new and amended listings measure. Abdominal ultrasound items will also be amended to reflect contemporary clinical practice. This change is cost neutral and administrative in nature.  

 

The Regulations will also implement a number of editorial and drafting improvements to better reflect original policy.

 

 

Consultation

Consultation was not undertaken for the remake of this instrument as it is machinery in nature. However, consultation was undertaken on the changes to diagnostic imaging services that were recommended by the MBS Review Taskforce, and announced in the 2019-20 Budget under the Guaranteeing Medicare - Medicare Benefits Schedule - new and amended listings measure.

 

The MBS Review is conducted by expert committees and working groups focusing on specific areas of the MBS. The Taskforce endorsed reports were released for public comment prior to finalisation of the recommendations to Government. This was undertaken through the public consultation process during consideration by the Taskforce. 

 

Consultation was undertaken as part of the MSAC application for the removal of cone beam computed tomography requirements for dedicated equipment, and the amendment to abdominal ultrasound items. MSAC reviews new or existing medical services or technology, and the circumstances under which public funding should be supported through listing on the MBS.

 

Details of the Regulations are set out in the Attachment.

 

The Regulations are a legislative instrument for the purposes of the Legislation Act 2003.

 

The Regulations commence on 1 May 2020. 

 

                                                       Â                Authority:     Subsection 133(1) of the

                                                                                                Health Insurance Act 1973 


 

ATTACHMENT

 

Details of the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020

 

Section 1 - Name

 

This section provides for the Regulations to be referred to as the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020.

 

Section 2 - Commencement

 

This section provides for the Regulations to commence on 1 May 2020.

 

Section 3 - Authority 

 

This section provides that the Regulations are made under the Health Insurance Act 1973.

 

Section 4 - Diagnostic imaging services table

 

This section provides that the new table of diagnostic imaging services set out in Schedule 1 be prescribed for subsection 4AA(1) of the Act.

 

Section 5 - Schedule 2

 

This section provides that each instrument that is specified in Schedule 2 to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

 

Schedule 1 - Diagnostic imaging services table

 

This part of the Regulations remakes the existing diagnostic services table, which is currently prescribed by the Health Insurance (Diagnostic Imaging Services Table) Regulations 2019.

 

Clause 2.1.1 of the Regulations provides that items for the provision of ultrasound services (except items 55600 and 55603) are only applicable if the diagnostic imaging procedure (the ultrasound scan) is performed by either:

*         a medical practitioner; or

*         a person who is named on the Register of Sonographers that is kept by the Chief Executive Medicare, and who performs the procedure on behalf of the medical practitioner.

 

Under section 32 of the Human Services (Medicare) Regulations 2017, a prescribed function of the Chief Executive Medicare is to establish and maintain a register of sonographers. The note under clause 2.1.1 is to clarify that maintaining a register of sonographers is a statutory function of the Chief Executive Medicare. The Register of Sonographers can be accessed on the Australian Sonographer Accreditation Register website at www.asar.com.au/sonographer-info/find-a-sonographer/.

 

 

The Regulations will also make the following changes to the existing table.

 

Changes to diagnostic imaging services recommended by the MBS Review Taskforce

 

Promoting the use of modern diagnostic imaging equipment

The Regulations will promote the use of modern diagnostic imaging equipment by removing all NK items. Currently, items have two different schedule fees (i.e. 'mirror items') known as schedule K and schedule NK items. Schedule K items refer to services performed on newer/upgraded equipment and schedule NK items refer to services performed on older/aged equipment. NK items have a lower Medicare rebate than K items.

 

The removal of schedule NK items will mean that all equipment will need to meet the new effective life age or maximum extended life age requirements for Medicare benefits to be payable. Providers will only be able to claim for services performed on newer/upgraded equipment unless they have an exemption.

 

Under new arrangements, the Secretary will be able to grant an exemption where a provider, through no fault of their own, is unable to upgrade their equipment prior to it reaching its effective life age or extended life age. Circumstances in which the Secretary may use his or her discretion includes unforeseen delays due to building works or deliveries of equipment.

Any exemption must be applied for prior to the equipment reaching its effective life age or maximum extended life age.

 

Providers will be given a maximum exemption of three months after the expiry of the effective life age or maximum extended life age of the equipment. Providers will be able to re-apply for a further exemption should there be further delays in replacing or upgrading equipment beyond the practice's control.

 

If the diagnostic imaging premises is located in an outer regional, remote and very remote area, then the diagnostic imaging premises will continue to automatically be able to claim an item for diagnostic imaging service rendered, regardless of the age of the equipment. Diagnostic imaging premises located in an inner regional area will also continue to be able to apply for an exemption.

 

Exemptions that were granted under previous arrangements prior to 1 May 2020 will continue to apply.

 

Introduce new computed tomography (CT) items and remove two obsolete items

The Regulations will introduce six new CT items that separate the upper and lower limb (excluding the knee) (56622, 56623, 56627, 56628, 56629 and 56630). These services will provide better clarity of confirming these services. Two current CT items 56619 and 56625 will be removed as they will no longer be required.

 

Modify co-claim restrictions on interventional CT and interventional fluoroscopy items

The Regulations will modify co-claiming restrictions on one interventional CT item (57341) and three interventional fluoroscopy items (60506, 60509 and 61109).

 

Under current restrictions, benefits are not payable for either an interventional CT or an interventional fluoroscopy item with another diagnostic imaging service of any modality (i.e. any ultrasound, other CT, diagnostic radiology, nuclear medicine or MRI scan). This change will limit the restriction on interventional fluoroscopy items to being only with diagnostic radiography items. Interventional CT items will be allowed to be claimed with other imaging types, including diagnostic CT.

 

Introduce new CT spiral angiography items and amend CT spiral angiography item

The Regulations will introduce three new CT spiral angiography items for the following anatomical areas to accommodate different clinical circumstances:

*         Arch of aorta, carotid arteries, vertebral arteries and their branches (head and neck) (57352).

*         Ascending and descending aorta common iliac and abdominal branches including upper limbs (chest, abdomen and upper limbs) (57353).

*         Descending aorta, pelvic vessels (aorto-iliac segment) and lower limbs (57354).

 

Services provided under the three new items will have no frequency restrictions, which will enable the use of these services to be provided as deemed clinically necessary by the requesting clinician. General practitioners (GPs) will be required to discuss the case with a specialist or a consultant physician in order to request the service.

 

Current CT spiral angiography item 57351 will also be amended to include the requirement that the GP discusses the case with the specialist or consultant physician in order to request the service, and that the service includes digital reporting requirements. The word "spiral" will be removed as it is outdated, and a service will need to be provided under at least one of the new items (57352, 53753 or 57354) within the previous 12 months, in order to claim a service under item 57351. Current item 57350 will be removed as it will be obsolete.

 

Consolidate x-ray items

The Regulations will consolidate x-ray items as the utilisation of these items is low and this change will simplify the MBS.

 

The x-ray item of the mastoid (57906) and the x-ray item of the petrous temporal bones (57909) will be removed. One new item that will provide an x-ray for both of these body parts will be introduced (57905).

 

The x-ray item of the sinus (57903) and the x-ray of the facial bone (57912) will be removed. One new item that will provide an x-ray for both of these body parts will be introduced (57907). 

 

Changes to mammography, mammary ductogram and breast ultrasound services

The Regulations will amend two mammography items (59300 and 59303) to encourage patients to utilise BreastScreen services appropriately.

 

The MBS is not intended to be used for population-based screening of large numbers of asymptomatic women. Current mammography services under the MBS are intended for patients who have:

*         symptoms of breast cancer or non-cancerous breast disease; and/or

*         a significant family history of breast and/or ovarian cancer; and/or

*         a previous diagnosis of breast cancer within the last five years.

 

The item descriptor of items 59300 and 59303 will be amended to include an additional requirement where the patient is to have a significant family history of breast or ovarian malignancy. Women with a less significant family history (including a first diagnosis of breast cancer in an elderly first-degree family member) should utilise BreastScreen services for screening mammography.

A further amendment will be made to specify that on examining the patient, the GP finds symptoms or indications of breast disease, as opposed to symptoms or indications of malignancy. This will provide access in the investigation of some benign breast conditions under items 59300 and 59303.

 

Two mammary ductogram items 59306 and 59309 will be removed as they are clinically obsolete.

 

Two new items (55066 and 55071) will be introduced for a diagnostic ultrasound of the breast and subsequent ultrasound used to guide a biopsy within the one service. A service under these items will allow a diagnostic breast ultrasound to be immediately followed by an ultrasound-guided breast biopsy. This will avoid the patient having to go back to their doctor for a new referral for a biopsy, after the initial ultrasound.

 

Removal of co-claiming restrictions for cardiac and vascular ultrasound with other ultrasound services

The Regulations will remove co-claiming restrictions for general ultrasound services (not including interventional services), obstetric, gynaecological and musculoskeletal ultrasound services with cardiac or vascular ultrasound services (with the exception of lower leg ultrasound).

 

This will ensure that ultrasound services will be able to be performed on more than one area, when clinically necessary.

 

The removal of the restriction will apply the following items in Group I1 - Ultrasound:

*         Subgroup 1 - General: 55028, 55029, 55030, 55031, 55032, 55033, 55036, 55037, 55038, 55039, 55048, 55049, 55065, 55068, 55070, 55073, 55076, 55079, 55084 and 55085.

*         Subgroup 5 - Obstetric and gynaecological: 55700, 55703, 55704, 55705, 55706, 55707, 55708, 55709, 55712, 55715, 55718, 55721, 55723, 55725, 55729, 55736, 55739, 55759, 55762, 55764, 55766, 55768, 55770, 55772 and 55774.

*         Subgroup 6 - Musculoskeletal: 55812, 55814, 55844, 55846, 55852 and 55854.

 

Prohibit claiming of pelvic ultrasound for solely pregnancy-related services and removal of co-claiming restrictions for ultrasound pelvis services with ultrasound abdomen services

The Regulations will amend two pelvic ultrasound items (55065 and 55068) so that they are not claimed solely for pregnancy related services, and that the co-claiming restrictions for ultrasound services with abdomen services is removed. One abdomen ultrasound item (55036) will also be amended.

 

The item descriptor of items 55065 and 55068 will be amended to make it clear that an ultrasound to investigate an incomplete or suspected miscarriage should be claimed under one of the less than 12 weeks gestation pregnancy ultrasound items, rather than the pelvis ultrasound item.

 

The item descriptor of the items 55065, 55068 and 55036 will be amended to allow both abdominal and pelvic ultrasound to be claimed during the same attendance. Female patients with abdominal or pelvic symptoms can be referred for both abdomen and pelvis ultrasound examinations. Frequently, transvaginal sonography of the pelvis is required, which requires considerable setup, preparation and the presence of a chaperone. This change will eliminate the need for patients to be seen on separate days for a pelvis and an abdomen ultrasound.

 

Amend bilateral breast ultrasound items to include post-mastectomy surveillance

The Regulations will amend two bilateral breast ultrasound items (55076 and 55079) so that the service can include an ultrasound scan for post mastectomy surveillance.

 

An ultrasound examination of a mastectomy site is appropriate for the two bilateral breast ultrasound items, as the service is approximately equivalent, in terms of time and effort, to scanning two breasts.

 

Amend musculoskeletal ultrasound items to restrict claiming with breast ultrasound items

The Regulations will amend two musculoskeletal ultrasound items (55812 and 55814) so that the service cannot be claimed with breast ultrasound items.

 

This change will ensure that, in the setting of suspected breast pathology, only the breast ultrasound items are used. This change will also ensure that a bilateral breast ultrasound item is claimed for mastectomy patients, instead of one breast ultrasound and one chest wall ultrasound item.

 

Remove musculoskeletal ultrasound items and introduce new unilateral and bilateral musculoskeletal ultrasound items

The Regulations will remove 20 musculoskeletal ultrasound items and introduce 40 new musculoskeletal ultrasound items for unilateral and bilateral services.

 

The current musculoskeletal ultrasound items incorporate unilateral and bilateral scans in the same item with the same fee, irrespective of whether a unilateral or bilateral scan is undertaken. Currently, when bilateral musculoskeletal ultrasound scans have been requested, patients are required to make separate appointments on separate days, so that two items can be claimed rather than one. This practice is associated with increased inconvenience for patients and is not clinically appropriate if both sides can be scanned during the one attendance.

 

The existing musculoskeletal ultrasound items will be removed:

 

The following 40 new items will be introduced, separating bilateral and unilateral services:

 

The current item fees allow for multiple claims where the intention is only for only one claim. The new unilateral items will retain the current fee as only one scan will be undertaken, and the new bilateral items will include a slightly higher fee to compensate for the additional scan. It is expected that the new fee structure will result in a decrease in overall costs, as patients will not be bought back on a separate day for bilateral scans.

 

Provision of a report for a musculoskeletal ultrasound service

The Regulations will provide that a complete diagnostic musculoskeletal ultrasound report must be produced for musculoskeletal ultrasound item 55850, by removing this item from subclause 1.2.9(2).

 

Clause 1.2.9 provides that the practitioner who provides a diagnostic imaging services that is requested (an R-type service), must give a report of the service to the practitioner, participating midwife or participating nurse practitioner who requested the service. Subclause 1.2.9(2) includes a list of items where this requirement does not apply (i.e. a report must not be provided).

 

The provision of a complete diagnostic imaging report will ensure that musculoskeletal ultrasound item 55848 (which does not require the provision of a report) is claimed, where it is more suitable.

 

Amend musculoskeletal cross-sectional items to ensure descriptor is contemporary and to prevent co-claiming with consultation items

The Regulations will amend two musculoskeletal cross-sectional items (55848 and 55850) to ensure the descriptors are contemporary and to prevent specialist radiologists co-claiming consultations with musculoskeletal ultrasound items.

 

On 1 November 2009, joint injection item 50124 was removed as it was considered minor and routine in nature, and could be delivered as part of a standard consultation. Practitioners administering this service could continue to perform the service under the relevant attendance item for the relevant medical speciality, or the relevant imaging item for diagnostic imaging specialists. Since this item has ceased, many radiologist have started claiming items 55848 and 55850 when they performed joint injections.

 

A restriction will be applied to restrict radiologist co-claiming attendance items, including specialist attendance items 104 and 105 and professional attendance consultation items 52, 53, 54 and 57, which are in the general medical services table, in conjunction with all musculoskeletal ultrasound items. Subject to this restriction, the fees for items 55848 and 55850 will also be increased by $27.50, as this would have been the indexed fee for item 50124 had it still been available for radiologists to use.

 

A rule will also be applied to restrict all musculoskeletal ultrasound items (Category 5, Group I1, Subgroup 6) with consultation items in the general medical services table.

 

Introduce co-claim restrictions for joint injection with ultrasound items

The Regulations will amend the item descriptor of joint injections ultrasound item 55054 to prohibit co-claiming with musculoskeletal cross-sectional items 55848 and 55850.

 

The introduction of the restriction on the co-claiming of ultrasound items 55848 and 55850 with consultation or attendance items (as outlined above) would result in joint injection services shifting to item 55054. This change will exclude joint injection services to be claimed with a service provided under item 55054.

 

As there are other musculoskeletal interventions that can be undertaken under imaging guidance (for example, aspiration of ganglion cysts), the item descriptor should be wide enough to cover those interventions.

 

Amend obstetric ultrasound scans and remove the list of clinical indications

The Regulations will amend obstetric ultrasound scan items to provide that the purpose of the service is to determine the gestation, location, viability or number of fetuses, and will remove the list of clinical indications for the items.

 

Clause 2.1.6 lists clinical indications that must be present for a patient to access a number of obstetric and gynaecological ultrasound service. One of the clinical indications is "risk of fetal abnormality" (subclause 2.1.6(1)(zd)). All patients can access these services simply by being pregnant, as all pregnancies are at a risk of fetal abnormality or miscarriage.

 

As the list of clinical indications is not required, clause 2.1.6 will be removed. Subject to this change, the item descriptor of items 55700, 55703, 55704 and 55705 will be amended to include the item is for determining the gestation, location, viability or number of fetuses.

 

Consequential amendments will be made to items 55707, 55708, 55718 and 55723 by removing the reference to subclause 2.1.6(2).

 

Amend nuclear medicine imaging services to remove references to imaging technology

The Regulations will amend 11 nuclear medicine imaging items by removing reference to imaging technology (61310, 61313, 61314, 61328, 61340, 61348, 61353, 61356, 61438, 61461 and 61480).

 

Planar imaging is largely superseded technology for cardiac imaging and has been replaced by single photon emission computed tomography (SPECT) in almost all cases. These changes will make the items easier to interpret without having any effect on the eligible patient population.

 

Remove obsolete nuclear imaging items

The Regulations will remove three nuclear imaging items (61316, 61317 and 61320) and consolidate the services into current item (61314). The Regulations will also remove seven items (61352, 61401, 61405, 61417, 61437, 61458 and 61484) as they are no longer clinical best practice and are obsolete.

 

Amend nuclear medicine imaging items to clarify co-claiming restrictions and to enable consistent approach

The Regulations will amend nuclear medicine imaging item (61505) to change co-claiming restrictions, and will amend nuclear medicine imaging item (61647) to exclude CT scans for anatomical localisation and attenuation correct, and to reduce the schedule fee for the service.

 

The descriptor of item 61505 will be amended to enable the service to be co-claimed with items in the range of 61302 to 61650, which include SPECT and positron emission tomography (PET) items. Item 61505 is for a CT scan that is performed at the same time as SPECT for anatomical localisation and attenuation correction. The service has undergone rapid growth over the years due to multiple factors including improved diagnostic accuracy and certainty compared with SPECT alone, referrer expectations, specific guideline and protocol recommendations, and the widespread availability of hybrid SPECT/CT systems throughout Australia.

 

Items that can be currently be co-claimed with item 61505 include PET items, however the item descriptor is ambiguously worded. To remove this ambiguity, the item descriptor will be amended to make it clear that PET items can be co-claimed with item 61505.

 

PET item 61647 is for staging of gastro-entero-pancreatic neuroendocrine tumours and includes a fee component for co-registered CT. Therefore, a MBS payment exists for co-registered CT when performed together with a SPECT examination or Ga-68 peptide PET. However, this is not the case for other PET items.

 

To ensure there is a consistent approach, the item descriptor of item 61647 will be amended to exclude the CT component of the service. Subject to this, the schedule fee for item 61647 will be reduced by the value of the schedule fee for item 61505 i.e. a reduction of $100.00.

 

Amend nuclear medicine imaging item to remove uptake of measurement

The Regulations will amend nuclear medicine imaging item (61473) to remove the reference that the service includes the uptake measurement when performed. This reference is no longer necessary, as the service can be provided in either instance.

 

Changes to diagnostic imaging services recommended by MSAC

 

Remove cone beam CT requirements for dedicated equipment

The Regulations will remove the requirement for cone beam computed tomography (CBCT) item 57362 to be performed on dedicated equipment, by removing clause 2.2.6. This change was recommended by MSAC.

 

Clause 2.2.6 provides that a service under certain CBCT items can only be performed with diagnostic imaging equipment that is not used to perform any other diagnostic imaging service (i.e. dedicated CBCT equipment). This restriction is no longer required as there are no longer differences in safety and quality between hybrid and dedicated CBCT equipment.

 

Amend nuclear medicine items to clarify intent of the services

The Regulations will amend two nuclear medicine items (61446 and 61449) to clarify that these items can be used for localised studies of any body part using a bone-scanning agent, not exclusively bone studies. This will also encourage use of regional instead of whole body scans.

 

Amend abdominal ultrasound items to reflect clinical contemporary practice

The Regulations will amend two abdominal ultrasound items (55036 and 55037) by adding that the service is for a morphological assessment. This change was recommended by MSAC. It is a cost neutral, administrative change to reflect clinical contemporary practice of the abdominal ultrasound items, and will not affect patient populations.

 

 

Editorial and drafting improvements

 

Amend ultrasound services to remove reference to requesting requirements

The Regulations will amend ultrasound service items to remove reference to requesting requirements to ensure provisions are consistent with the Health Insurance Act 1973 (the Act).

 

Subsection 16B(6) of the Act allows consultant physicians and specialists (other than specialist radiologists) to render R-type diagnostic imaging services without a request from another practitioner. 

 

Most R-type ultrasound services have NR-type equivalents. The item descriptors for the NR items specify that the item applies when 'not requested by '. The R-type items specify that the item applies where the service is 'requested by '. This wording circumvents the rights of consultant physicians and specialists (other than specialist radiologists) under subsection 16B(6) of the Act.

 

To ensure that the items are consistent with the Act, reference to requesting requirements of medical practitioners, participating nurse practitioners, or participating midwife practitioners for ultrasound items will be removed. These changes are cost neutral and administrative in nature.

 

Change terminology of "refer" to "request"

The Regulations will amend references in the remaining item descriptors of patients being referred or not referred for specific services, to the service being requested or not requested.

 

This terminology is more appropriate as the relevant practitioner needs to specifically provide a request for the service for it to be provided. Section 57 of the Health Insurance Regulations 2018 (HIR) provides the particulars that are to be prescribed for when a diagnostic imaging service is requested. Sections 39 to 44 of the HIR provides diagnostic imaging services that can be requested by allied health providers. These changes are cost neutral and administrative in nature.

 

Insert subgroups into Group I2 and Group I4

The Regulations will insert subgroups into Group I2 - Computed tomography - examination and Group I4 - Nuclear medicine imaging. All groups in the DIST, except CT and nuclear medicine imaging, are broken into subgroups. The subgroups are generally related to the body area being imaged. This change will enable easier reporting and will be consistent with other groups in the DIST.

 

Amend subgroup names in Group I5

The Regulations will amend a number of subgroup names that are in Group I5 - magnetic resonance imaging. This change is administrative in nature and will reduce duplication and provide more clarity about the types of services provided in each subgroup. These changes are cost neutral and administrative in nature.

 

Amendment and removal of definitions

The Regulations will amend the definition of Commonwealth concession card holder, which is in subclause 2.6.1(3), so it is consistent with the definition in the general medical services table. The Regulations will remove the definition of Group, Subgroup and group of practitioners in Part 3 - Dictionary, as the definitions are not required. The Regulations will also expand the definition of ASGC to include a definition of ASGC 2006 as well as the definition of ASGC 2010 in the Dictionary. The remoteness areas in the Dictionary will be updated with the relevant names of the areas and to specify that these are classified in the ASGC 2006. The meaning of non-metropolitan hospital will be updated in the Dictionary to specify that the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin and Canberra statistical divisions are classified in the ASGC 2010. These changes are cost neutral and administrative in nature.

 

Incorporate liver and obstetric MRI services

The Regulations will incorporate four items (63454, 63545, 63546 and 63496) from the Health Insurance (Section 3C Diagnostic Imaging Services - Liver and Obstetric MRI Services) Determination 2019. These changes are machinery in nature.

 

Schedule 2 - Repeals

 

This section repeals the Health Insurance (Diagnostic Imaging Services Table) Regulations 2019.


Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020

 

This Regulation is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

 

Overview of the Disallowable Legislative Instrument

The purpose of the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 1) 2020 (the Regulations) is to repeal the Health Insurance (Diagnostic Imaging Services Table) Regulations 2019 and prescribe a new table of diagnostic imaging services from 1 May 2020. This will ensure that Medicare benefits continue to be payable for diagnostic imaging services.

 

The Regulations will implement the Government's response to a significant number of recommendations of the clinician-led Medicare Benefits Schedule (MBS) Review Taskforce (the MBS Review Taskforce) to diagnostic imaging services. These changes were announced in the 2019-20 Budget under the Guaranteeing Medicare - improved patient access to diagnostic imaging measure.

 

The Regulations will implement a number of minor policy changes that were recommended by the Medical Services Advisory Committee (MSAC). This includes the removal of the requirement that cone beam computed tomography services are performed on dedicated equipment, and to amend to nuclear medicine items to clarify the intent of the services. These changes were approved by the Government in the 2019-20 Mid-Year Economic Financial Outlook under the Guaranteeing Medicare -- Medicare Benefits Schedule -- new and amended listings measure. Abdominal ultrasound items will also be amended to reflect contemporary clinical practice. This change is cost neutral and administrative in nature. 

 

The Regulations will also implement a number of minor administrative amendments, which are cost neutral.

Human rights implications

The Regulations engage Articles 9 and 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the rights to health and social security.

The Right to Health

The right to the enjoyment of the highest attainable standard of physical and mental health is contained in Article 12(1) of the ICESCR. The UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not a right for each individual to be healthy, but is a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.

The Committee reports that the 'highest attainable standard of health' takes into account the country's available resources. This right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs, and conditions necessary for the realisation of the highest attainable standard of health.

The Right to Social Security

The right to social security is contained in Article 9 of the ICESCR. It requires that a country must, within its maximum available resources, ensure access to a social security scheme that provides a minimum essential level of benefits to all individuals and families that will enable them to acquire at least essential health care. Countries are obliged to demonstrate that every effort has been made to use all resources that are at their disposal in an effort to satisfy, as a matter of priority, this minimum obligation.

The Committee reports that there is a strong presumption that retrogressive measures taken in relation to the right to social security are prohibited under ICESCR. In this context, a retrogressive measure would be one taken without adequate justification that had the effect of reducing existing levels of social security benefits, or of denying benefits to persons or groups previously entitled to them. However, it is legitimate for a Government to re-direct its limited resources in ways that it considers to be more effective at meeting the general health needs of all society, particularly the needs of the more disadvantaged members of society.

Analysis

The Regulations maintain rights to health and social security by ensuring access to publicly subsidised diagnostic imaging services which are clinically and cost-effective.

Conclusion

This instrument is compatible with human rights because it maintains existing arrangements and the protection of human rights.

 

Greg Hunt

Minister for Health

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