Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2002 2002 NO. 247

STATUTORY RULES 2002 No. 247

Issued by the Authority of the Minister for Health and Ageing

Health Insurance Act 1973

Health Insurance (Diagnostic Imaging Services Table) Regulations 2002

Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make regulations prescribing matters for the purposes of the Act.

The Act provides 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.

Subsection 4AA (1) of the Act provides that the regulations may prescribe a table of diagnostic imaging services setting out items of diagnostic imaging services; the amount of fees applicable in respect of each item; and rules for interpretation of the table. Subsection 4AA(2) provides that, unless sooner repealed, regulations made under section 4AA cease to be in force and are taken to be repealed on the day next following the 15^th sitting day of the House of Representatives after the expiration of a period of 12 months commencing on the day on which the regulations are notified in the Gazette.

The purpose of the Regulations is to prescribe a table of diagnostic imaging services for the 12 month period commencing on 1 November 2002, which 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. The new table will replace the table contained in the Health Insurance (Diagnostic Imaging Services Table) Regulations 2001.

The Regulations contain the following changes made as part of the ongoing management of the Diagnostic Imaging Services Table:

•       amendment to Rule 18 - Musculoskeletal Ultrasound Services - multiple scans to reflect the intention of the rule to restrict practitioners to the provision of one musculoskeletal ultrasound service per patient per day;

•       amendments to the multiple vascular ultrasound services site rule and the multiple services rules, Rules 30 and 31 respectively;

•       deletion of four orthopantomography (OPG) items 57948, 57951, 57954 and 57957 and substituted with four new OPG items 57960, 57963, 57966 and 57969;

•       deletion of item 58118 and addition of item 58108;

•       deletion of items 60081 and 60084; and

•       indexation of fees for nuclear medicine items, 61302 to 61499, by 2.5%.

These changes have been developed in consultation with the relevant professional bodies, including the Royal Australian and New Zealand College of Radiologists, the Australian Diagnostic Imaging Association, the Australian Dental Association, the Australian Society of Orthodontists and the Australian and New Zealand Association of Physicians in Nuclear Medicine.

Details of the Regulations are set out in the Attachment.

The Regulations commence on 1 November 2002.

ATTACHMENT

DETAILS OF THE HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2002

Regulation 1 provides that the name of the regulations will be the Health Insurance (Diagnostic Imaging Services Table) Regulations 2002.

Regulation 2 provides that the regulations commence on 1 November 2002.

Regulation 3 repeals the Health Insurance (Diagnostic Imaging Services Table) Regulations 2001 (as amended).

Regulation 4 defines certain terms used in the Regulations.

Regulation 5 provides that the table of diagnostic imaging services set out in Schedule 1 is prescribed for the purposes of subsection 4AA (1) of the Act.

The 1 November 2002 Health Insurance (Diagnostic Imaging Services Table) Regulations differ from the previous Regulations in the following ways:

Schedule 1, Part 2 - Rules of interpretation

•       It amends Rule 18 to reflect the policy intention of this rule to restrict practitioners to the provision of one musculoskeletal ultrasound service per patient per day.

•       It clarifies that, where multiple vascular ultrasound services are performed in addition to another diagnostic imaging service, the multiple vascular ultrasound services site rule (Rule 30) applies before the diagnostic imaging multiple services rules (Rule 31). The multiple services rules have also been amended to specify that where two or more vascular ultrasound services are performed in addition to another diagnostic imaging service, the amount of fees payable for the vascular ultrasound services is taken, for the purposes of the calculation of the multiple services rules, to be an amount payable for one diagnostic imaging service.

Schedule 1, Part 3 - Services and Fees

•       Orthopantomography (OPG) items 57948, 57951, 57954, 57957 have been deleted and substituted with four new OPG items 57960, 57963, 57966, 57969. The Diagnostic Imaging Management Committee established an OPG working group to develop clinical criteria and guidelines for ordering OPG items with the aim of best practice in ordering. The DIMC endorsed the amended descriptions for the new OPG items and that these should replace the existing OPG items.

•       Item 58118 has been deleted and replaced with item 58108. This corrects a typographical error in the Regulations.

ATTACHMENT

•       Items 60081 and 60084 have been deleted. These items were originally to have been withdrawn from the Regulations 1 November 2001.

•       Nuclear Medicine items in the Diagnostic Imaging Services Table are indexed by 2.5% as part of managing Medicare expenditure under the Nuclear Medicine Agreement.