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CONTENTS
Passage History
Purpose
Background
Main Provisions
Concluding Comments
Endnotes
Contact Officer & Copyright Details
Health Insurance Amendment (Diagnostic
Imaging Services) Bill 1999
Date Introduced: 30 June 1999
House: House of Representatives
Portfolio: Health and Aged Care
Commencement: On Royal Assent.
The Health Insurance Amendment (Diagnostic
Imaging Services) Bill 1999 will amend the Health Insurance Act
1973 to change the mandatory requirements regulating the
provision of diagnostic imaging services by medical
practitioners.
What are diagnostic imaging
services?
Diagnostic imaging services range from the
familiar X-rays and ultrasound to the more high-tech magnetic
resonance imaging (MRI), computerised tomography (CT) and nuclear
medicine services.
The Health Insurance Act 1973 (the
Principal Act) requires that in order for a Medicare benefit to be
paid, diagnostic imaging services must only be provided on written
request by another medical practitioner. Several exemptions are
provided by the Principal Act. Medical practitioners providing
diagnostic imaging services under two of these exemptions (remote
areas exemption and pre-existing diagnostic imaging practices) are
affected by amendments in this Bill. While less than 350 medical
practitioners in total are expected to be affected by these
changes, a considerable proportion of these are general
practitioners operating under the 'remote areas exemption'.
Diagnostic imaging services and
Medicare
All services, procedures and interventions for
which rebates are paid under the Medicare arrangements are
contained in the Medicare Benefits Schedule (MBS). Each
professional service included in the MBS is assigned a unique item
number. Each item in the MBS also includes the fee which the
Commonwealth Department of Health and Aged Care has assessed as
appropriate for each service or procedure. This fee is known as the
'schedule fee' and is important because it is this fee (rather than
the fee charged by the practitioner) which is used when the
Medicare rebate is calculated.
The MBS comprises several distinct categories or
tables:
-
- General Medical Services: this category includes professional
attendances by general practitioners and medical specialists,
diagnostic services such as tests for glaucoma and
electrocardiography (ECG), and therapeutic procedures such as
anaesthetics and surgery.
-
- Approved Dental Practitioner Services: this category includes
the small number of dental services for which a Medicare rebate is
payable, including oral surgery.
-
- Diagnostic Imaging Services: this category includes x-ray,
ultrasound, mammography, MRI, CT and nuclear medicine
services.
-
- Pathology Services: this category includes all pathology
services covered under Medicare.
A new edition of the MBS takes effect on 1
November each year and updates are issued through the year as
required.
'R-type' services, 'NR-type' services and the
MBS
Changes to the Principal Act which took effect
from 1 May 1991 restricted, except in certain circumstances, the
payment of Medicare benefits for diagnostic imaging services.
Services affected included diagnostic radiology, CT scanning,
ultrasound and nuclear scanning. These changes required that a
Medicare benefit only be payable for a diagnostic service if it is
provided following a written request for that service by another
medical practitioner. For certain services such as X-rays of
particular parts of the body, a medical practitioner may also be a
dental practitioner, physiotherapist or podiatrist. The changes
also established a separate Diagnostic Imaging Services Table
within the MBS. Items of service which are subject to the
requirement for a written request are classified as 'R-type'
(requested) and the items not subject to the requirement are
classified as 'NR-type' (not requested) services.(1)
Certain important exemptions to these
requirements were provided for by the legislative changes which
took effect in 1991. These included a remote areas exemption and an
exemption for pre-existing diagnostic imaging practices.
Practitioners operating under either or both of these exemptions
are subject to measures proposed by the Health Insurance Amendment
(Diagnostic Imaging Services) Bill 1999.
The remote areas exemption aims, predictably, to
encourage the establishment of radiology services in areas where
they are scarce. A 'remote area' is defined at paragraph DIC.1.1 of
the MBS to be one that is more than 30 km by road from a hospital
or free-standing radiology service, or one where services are such
that patients in the area would suffer physical or financial
hardship in accessing them.
The pre-existing diagnostic imaging practices
exemption is designed to enable practices which provided 'R-type'
services on a regular basis before the 1991 legislative changes to
continue to do so. In order to qualify for this exemption, a
practitioner must have rendered at least 50 'R-type' diagnostic
services, attracting a medicare benefit, in the period 17 October
1988 - 16 October 1990, and in the same location as he or she now
practices. The exemption only applies if the practitioner is
treating their own patient.(2)
Quality Assurance
The measures proposed in the Health Insurance
Legislation (Diagnostic Imaging Services) Bill 1999 continue moves
by successive Commonwealth Governments during the 1990s to enhance
the quality of medical services. For example, recognition of the
importance of continuing medical education by both government and
the profession has resulted in the introduction of the vocational
register for general practitioners. Enhancement of quality has also
underpinned a variety of initiatives directed towards the
prescribing, dispensing and consumption of pharmaceutical drugs as
well as measures to improve patient care within public
hospitals.
Medical practitioners who have been providing
diagnostic imaging services under exemptions conferred by
legislative changes which took effect in May 1991 have not been
required to participate in quality assurance and continuing medical
education activities. Changes proposed in this Bill will now
require these practitioners to enrol and participate in an approved
continuing medical education and quality assurance program in the
field of diagnostic imaging in order for a Medicare benefit to be
provided for their services. Ultimately, the aim of such programs
is the achievement and maintenance of high quality services for
patients. Much is asserted about the high quality of Australia's
health system, however it can be argued that in order to assure the
provision of quality services in all aspects of medical practice
and in all parts of the country, continuing medical education and
quality assurance programs need to be in place and need to be
compulsory.
Schedule 1
Items 1 and 2 amend section 16B
of the Principal Act, which deals with the payment of Medicare
benefits for 'R-type' diagnostic services. Section 16B provides
that, subject to specified exemptions, a benefit will only be
payable when the service is requested in writing by a medical
practitioner, or in respect of certain 'R-type' services, by a
dental practitioner, a chiropractor, a physiotherapist or a
podiatrist. Subsection 16(7) contains the remote areas exemption
and subsection 16(11), the pre-existing diagnostic imaging
practices exemption.
Each item inserts in the respective
subsection(3) a new paragraph which makes the exemption conditional
on the practitioner being registered as a participating
practitioner in the Register of Participating Practitioners. The
subparagraph allows a period of grace for a practitioner to
register initially: the exemption will continue to apply for a
month after the commencement of the new provision, or such further
period as the Health Insurance Commission (HIC) may allow.
Item 3 then inserts new
Division 1A in Part IIB of the Principal Act, establishing
a framework for the approval of continuing medical education and
quality assurance programs in the area of diagnostic imaging, and a
register of practitioners who participate in such programs (known
as the Register of Participating Practitioners).
New section 23DSB provides that
the Minister for Health may approve a continuing medical education
program or a quality assurance program in respect of providers of
diagnostic imaging services. In giving approval, the Minister may
specify a standard that a practitioner has to reach, or requirement
that a practitioner has to satisfy, within the program. New
subsection 23DSB(3) provides that approvals given under the section
are disallowable instruments within the meaning of the section 46A
of the Acts Interpretation Act 1901. This means that the
programs must be tabled in Parliament and are subject to
disallowance by either House.
New section 23DSC concerns the
Register of Participating Practitioners. The register is to be
maintained by the HIC. New paragraphs 4(a), (b) and 5(a) require
the HIC to register upon commencement of the new Division, all
practitioners who held either a remote areas or pre-existing
diagnostic imaging practices exemption under the Principal Act
prior to the commencement of the new Division. The HIC is also
required under new paragraphs 4(c) and 5(b) to register upon
receipt of notice, any practitioner in respect of whom either the
Royal Australian College of General Practitioners (RACGP) or the
Australian College of Rural and Remote Medicine (ACRRM), gives
notice of participation in a program approved under new section
23DSB. The HIC is obliged to give a practitioner written notice of
their registration and the date upon which it commenced (new
subsection 6) and the HIC may also make this information available
to either the RACGP or ACRRM (new subsection 7).
New section 23DSD deals with
the removal of practitioners from the Register of Participating
Practitioners. Deregistration can occur in three different
ways:
a) the RACGP and ACCRM inform the HIC
that a practitioner ceases to be enrolled in, or participate in, an
approved program, or has not reached a specified standard or
satisfied a specified requirement within the program: new paragraph
(1)(a); or
b) a practitioner fails to enrol or
participate in an approved program after the expiry of the period
of grace: new paragraph (1)(b); or
c) a practitioner requests to be
deregistered: new paragraph (1)(c).
New subsections (2) - (4) set out the procedure
which the HIC must follow in deregistering a practitioner. The HIC
must give the practitioner written notice of their deregistration,
specifying in the notice that they will no longer be included on
the Register of Participating Practitioners, from a date at least
14 days after the date of the notice. The HIC must then enter in
the Register a statement stating the practitioner has ceased to be
registered, and the date when that occurred.
An important issue in relation to the Bill is
unresolved at the time of writing. The quality assurance program
and standards which the Bill proposes to be established by
regulation are still under development by the ACRRM, the RACGP and
the Royal Australian and New Zealand College of Radiologists.
Tension (or at least poor communication) between the ACRRM and the
RACGP was apparent as recently as June 1999 over the issue of
mandatory continuing medical education for non-specialist providers
of diagnostic imaging services. For example, the ACRRM reportedly
claimed in a recent newsletter that the RACGP had 'attempted to
close a deal' with the Royal Australian and New Zealand College of
Radiologists on the issue and that 'once again, there was no
consultation with ACRRM'.(4)
-
- Department of Health and Family Services, Medicare Benefits
Schedule book: operating from 1 November 1998, Canberra,
Department of Health and Family Services, 1998, p. 338.
- Section 16B(7) of the Health Insurance Act 1973.
- Item 1 inserts new paragraph (e) into section 16B(7) and item 2
replaces paragraph (d) in subsection 16B(11).
- K Murphy, 'RACGP denies secret rural radiology deal',
Australian Doctor, 18 June 1999.
Andrew Grimm and Paul Mackey
12 August 1999
Bills Digest Service
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ISSN 1328-8091
© Commonwealth of Australia 1999
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