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HEALTH INSURANCE (1999-2000 DIAGNOSTIC IMAGING SERVICES TABLE) AMENDMENT REGULATIONS 2000 (NO. 1) 2000 NO. 59

STATUTORY RULES 2000 NO. 59

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

Health Insurance Act 1973

Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 2000 (No. 1)

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 (1999-2000 Diagnostic Imaging Services Table) Regulations 1999 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:

* changes to the item descriptors for three ' obstetric ultrasound items;

* introduction of a definition in relation to the above obstetric ultrasound descriptors;

* changes to a rule for obstetric ultrasound;

* renumbering of two computed tomography (CT) items to be consistent with other items;

* a change to an NK spiral angiography item to match equivalent K item descriptor. and

* clarification of sub-rule 9A of the schedule to the Principal Rules covering CT services.

The changes have been developed in consultation, where required, with the Royal Australian College of Radiologists, the Royal Australian College of Obstetricians and Gynaecologists, the Royal Australian College of General Practitioners, and the Australian College of Rural and Remote Medicine.

Details of the Regulations are in the attachment.

The regulations commenced on 1 May 2000.

ATTACHMENT

Details of the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 2000

Regulation 1 provides that the name of the regulations will be the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Amendment Regulations 2000 (No. 1)

Regulation 2 provides for the regulations to commence on 1 May 2000.

Regulation 3 provides that the Health Insurance (1999-2000 Diagnostic Imaging Services Table) Regulations 1999 will be amended by Schedule 1 of the proposed Regulations.

Changes to the Table

The May 2000 Diagnostic Imaging Services Table differs from the previous tables in the following way:

* The amendment of the qualification requirements for obstetric ultrasound items, 55712, 55721 and 55728 to include medical practitioners who have obstetric privileges at a non-metropolitan hospital, and to include overseas obstetric diploma qualifications where recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. The aim of this amendment is to extend access in rural areas.

* The introduction of a new rule 10AD that defines "non-metropolitan hospital". This removes ambiguity in the administration of the proposed amended qualification requirements for items 55712, 55721 and 55728. This new rule mirrors the existing definition of metropolitan in the Diagnostic Imaging Services Table.

* A minor amendment to Rule 10AB to clarify that the restriction of payment of Medicare benefits to a maximum of three NR type services in any one pregnancy applies only to obstetric ultrasound. The 1 February 2000 regulation for this rule created difficulties of interpretation for the Health Insurance Commission, as it includes gynaecological items as well as obstetric items. Services in the Table that are subject to written request requirements are identified by the prefix "R". Services that are not subject to this rule are identified by the prefix "NR". NR services are determined by a practitioner in the course of the treatment of their own patient.

* A minor amendment changing the item numbers for computed tomography (CT) items 56033 and 56039 to 56070 and 56076 respectively to ensure numbering is consistent in the Table.

* An amendment of item descriptor for NK spiral angiography item 57355 to match the item descriptors for the equivalent K item 57350. Item 57355 was overlooked when the descriptor for item 57550 was amended in February 2000. On 1 March 2000, a range of lower rebate items were introduced for computed tomography services provided on machines that were 10 years old or older. These items are identified by the prefix "NK". The higher rebate items for newer machines are identified with the prefix "K". The aim of the "K/NIC' measure was to ensure that the schedule fees reflect the differential capital cost between old and new machines.

* Amendment of sub-rule 9A of the Schedule to remove any implication that the Health Insurance Commission has discretion to determine when CT equipment was first installed and used.