EXPLANATORY STATEMENT

 

Select Legislative Instrument 2010 No. 263

 

Health Insurance Act 1973

 

Health Insurance (Diagnostic Imaging Services Table) Regulations 2010

 

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 2009 (the 2009 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Subsection 4AA(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4AA(1) cease to be in force and are taken to have been repealed on the day after the fifteenth sitting day of the House of Representatives after the end of the period of 12 months, commencing on the day on which the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 2009 Regulations were registered on the Federal Register of Legislative Instruments on 12 October 2009 and commenced on

1 November 2009.

 

The purpose of the Regulations is to repeal the 2009 Regulations and prescribe a new diagnostic imaging services table for the 12 month period commencing on 1 November 2010. 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 2009 Regulations with some minor changes to the rules of interpretation and to the schedule of services and fees and in order to align it with stylistic changes in the Health Insurance (General Medical Services Table) Regulations 2010 effective 1 November 2010.

 

The Health Insurance Amendment (Midwives and Nurse Practitioners) Act 2010 amended the Act to provide for new arrangements to enhance and expand the role of midwives and nurse practitioners, allowing them to take a greater role in providing quality health care through the Medicare scheme.

 

These new arrangements enable participating midwives and participating nurse practitioners to request certain diagnostic imaging services as Medicare eligible services from 1 November 2010. The Regulations incorporate amendments to relevant items found in Schedule 1 of the 2009 Regulations to specify that the relevant diagnostic imaging services may be provided following a request from a participating midwife or nurse practitioner, as appropriate.

 

As part of the ongoing management of the table items 64990 and 64991 is indexed to take effect from 1 November 2010.

 

Details of the Regulations are set out in the Attachment.

 

Advice on all aspects of the measure has been sought from nursing, midwifery, consumer and medical groups, including the Australian Medical Association (AMA), through the Maternity Services Advisory Group, Nurse Practitioner Advisory Group and the associated technical advisory groups.

 

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 2010.

 

 

 

ATTACHMENT

 

 

DETAILS OF THE HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2010

 

Regulation 1 – Name of Regulations

 

This regulation provides for the Regulations to be referred to as the Health Insurance (Diagnostic Imaging Services Table) Regulations 2010.

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on 1 November 2010.

 

Regulation 3 – Repeal

 

This regulation repeals the Health Insurance (Diagnostic Imaging Services Table) Regulations 2009 (the 2009 Regulations) (as amended).

 

Regulation 4 – Dictionary

 

This regulation provides that for the purpose of the Regulations, the dictionary at the end of the Regulations defines certain words and expressions.

 

Regulation 5 – Diagnostic Imaging Services Table

 

This regulation provides that the table of diagnostic imaging services (the Table) 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 2009 Regulations except with changes to the following provisions:

·        Part 1 – Preliminary; and

·        Part 2 – Services and fees.

 

Part 1 - Preliminary

 

Schedule 1, Part 1, Division 1.2, Clause 1.2.3

 

This item expands the requirement in subrule 5(1) of the Table that a practitioner who renders a diagnostic imaging service must provide a report of the service to the requesting practitioner to include a requirement that a report be provided to a requesting participating midwife or participating nurse practitioner.

 

Part 2 – Services and fees

 

Schedule 1, Part 2, Division 2.6 Group I6 – Management of Bulk-Billed Services

 

The fees and benefits for Group P12 (Management of Bulk-Billed Services), following indexation, are amended as follows: item 64990 – new fee of $6.75; and item 64991 – new fee of $10.25.

 

Schedule 1, Part 2

 

Consequential amendments to items 55036, 55070, 55076, 55600, 55768, 55800, 55804, 55808, 55812, 55816, 55820, 55824, 55828, 55832, 55836, 55840 and 55844 (‘nurse practitioner referred items’) are made by the Regulations to specify that the items may also be provided following a request from a participating nurse practitioner, where that nurse practitioner does not have a business or financial arrangement with the diagnostic imaging provider.

 

Items 55037, 55073, 55079, 55770, 55802, 55806, 55810, 55814, 55818, 55822, 55826, 55830, 55834, 55838, 55842 and 55846 of the Table are non-referred items corresponding to the nurse practitioner referred items. Changes to these non-referred items provide that the services may also not be provided if the patient has been referred by a participating nurse practitioner.

 

Consequential amendments to items 55700, 55704, 55706, 55707 and 55718 of the Table are made to specify that the items may also be provided following a request from a participating midwife, where that midwife does not have a business or financial arrangement with the diagnostic imaging provider.

 

Items 55703, 55705 and 55708 of the Table are non-referred items corresponding to items 55700, 55704 and 55707, respectively. Changes to these non-referred items provide that the services may also not be provided if the patient has been referred by a participating midwife.

 

Dictionary

 

This item replaces the note currently appearing in subrule 2(1) of the Table with a new note that includes reference to ‘participating midwife’ and ‘participating nurse practitioner’ as words that have the meaning given by subsection 3(1) of the Act.

 

Restyling

The stylistic changes to the Regulations include a change of terminology such that rules in the 2009 Regulations are referred to as clauses. The correspondence between the rules and clause numbers is detailed in the table below.

 

2009 Regulations Rule	2010 Regulations Clause
1	-
2	Dictionary
3	1.2.1
4	1.2.2
5	1.2.3, 2.1.1, 2.2.7, 2.3.1, 2.3.3, 2.3.4, 2.3.7
6	2.1.4
8	2.1.2
9	2.1.3
10	1.2.4
11	2.1.5
12	2.1.6
13	2.1.7
14	2.1.8
15	2.1.9
16	2.1.10
18	2.2.1
19	2.2.2
20	2.2.3
21	2.2.4
22	2.2.5
23	2.2.6
24	2.3.2
25	2.3.5
26	2.3.5
27	2.4.1
27A	2.4.2
27B	2.4.3
27C	2.4.4
27D	2.4.5
28	1.2.5
29	1.2.6
30	1.2.7
31	2.5.1
32	2.5.2
33	2.5.3
34	2.5.4
35	2.5.5
36	2.5.6
37	2.5.7
38	2.5.8
39	2.5.9
40	2.5.10
41	2.5.11
42	2.6.1