Bills Digest no. 86 2009–10
Health Insurance Amendment (Diagnostic Imaging
Accreditation) Bill 2009
WARNING:
This Digest was prepared for debate. It reflects the legislation as
introduced and does not canvass subsequent amendments. This Digest
does not have any official legal status. Other sources should be
consulted to determine the subsequent official status of the
Bill.
CONTENTS
Passage history
Purpose
Background
Financial implications
Main provisions
Concluding comments
Contact officer & copyright details
Passage history
Date
introduced: 25 November
2009
House: House of Representatives
Portfolio: Health and Ageing
Commencement:
Schedule 1 commences on
the day this Act receives Royal Assent, or 1 April 2010, whichever
is the later.
Links: The
relevant links to the Bill, Explanatory Memorandum and second
reading speech can be accessed via BillsNet, which is at http://www.aph.gov.au/bills/.
When Bills have been passed they can be found at ComLaw, which is
at http://www.comlaw.gov.au/.
The Health Insurance Amendment
(Diagnostic Imaging Accreditation) Bill 2009 (the Bill) proposes
amendments to the Health Insurance Amendment
(Diagnostic Imaging Accreditation) Act 2007 (the DIA Act)
which established the Diagnostic Imaging Accreditation Scheme (the
Scheme).[1] The
proposed amendments would broaden the Scheme to medical practices
offering non-radiology diagnostic imaging procedures which are
currently not covered by the Scheme.
Diagnostic imaging refers to a wide range of technologies used
by medical professionals to allow them to look inside the human
body in order to diagnose medical conditions. Diagnostic imaging
technologies include radiography (x-rays), computed tomography (CT
scans), magnetic resource imaging (MRI), ultrasound, mammography,
and positron emission tomography (PET), a category of nuclear
medicine.[2]
The services targeted under this Bill, which the Government
describes as non-radiology diagnostic imaging services, are a
subgroup that specifically includes cardiac ultrasound and
angiography, obstetric and gynaecological ultrasound and nuclear
medicine imaging.[3]
In addition, services involving preparation for radiological
procedures are also covered under the proposed provisions.
The Australian Government provides Medicare rebates for
diagnostic imaging services listed in the Diagnostic Imaging
Services Table as set out in the Medicare Benefits Schedule (MBS).
Management of diagnostic imaging services is undertaken
cooperatively between the Department of Health and Ageing and the
diagnostic imaging sector. Historically, this was done through a
number of agreements known as Quality and Outlays Memoranda of
Understanding (MOUs) until these expired in July 2008.[4] In July 2008 new
accreditation arrangements for diagnostic imaging commenced.
The Diagnostic Imaging Accreditation Scheme, which commenced in
July 2008, established an accreditation framework for most
diagnostic imaging premises and bases for mobile imaging equipment.
Accreditation is a process to ensure that organisations meet
defined safety and quality standards in the delivery of
services.[5]
The Scheme is being implemented in two stages. Stage 1
established the framework and operational arrangements for the
Scheme and is due to expire on 30 June 2010, at which time Stage 2
is due to commence.[6] The Government has been undertaking consultations with
the diagnostic imaging sector on moving to the next stage and on
broadening the scheme to include non-radiology diagnostic imaging
practices. Although arrangements for Stage 2 are yet to be
finalised, it is expected to include an accreditation maintenance
program.[7]
Since mid-2008, practices rendering diagnostic imaging services
have been required to participate in the Scheme and obtain
accreditation or deemed accreditation in order to be able to
provide Medicare rebatable services. Around 2700 practices mostly
in the radiology sector participate in the Scheme.[8] Accreditation is undertaken by
approved accreditors. Currently, practices that render
non-radiology diagnostic imaging services specifically cardiac
ultrasound and angiography, nuclear medicine and obstetric and
gynaecological ultrasound are not included in the Scheme.[9] This Bill would allow the
Scheme to be broadened to cover these previously excluded practices
which the Government estimates number around 1400.[10] Of this total, a significant
number are private specialist practices.[11]
It is worth noting that this Bill does not set out the
arrangements that will apply when Stage 2 of the Scheme commences.
As noted, these are yet to be finalised. Rather, this Bill is
proposing transitional accreditation arrangements for practices
offering non-radiology diagnostic imaging services which were
excluded from the Scheme. These practices were specifically
excluded because unlike the MOU governing radiology services, the
agreements applying to these other services did not mandate an
accreditation scheme linked to the payment of Medicare
benefits.[12] The
proposed transitional arrangements for these non-accredited
practices would align their proposed accreditation schedule with
the commencement date for Stage 2.[13]
The transitional accreditation process proposed in this Bill is
broadly similar to that introduced under Stage 1 of the Scheme, in
that it involves two main steps. The proposed transitional
arrangements would apply to providers of non-radiology diagnostic
imaging services in the following way:
- firstly, establishing a 3 month registration period from 1
April to 30 June 2010, during which time a practice can lodge a
notice with an approved accreditor for a premises (or base) to be
registered for deemed accreditation [14]
- deemed accreditation would cease on 1 July 2011. A practice
with deemed accreditation would have 12 months to obtain
accreditation by demonstrating compliance with either entry level
standards or the full suite of standards, or accreditation under
the Medical Imaging Accreditation program.[15]
A practice that fails to obtain accreditation by 1 July 2011
would no longer be eligible to render Medicare rebatable diagnostic
imaging services. Penalty provisions apply to a practice which
renders a service to a patient without first notifying them that a
Medicare benefit is not payable because the practice is not
accredited.[16]
The Government s intention to broaden the Scheme to include
non-radiology practices was stated in a consultation paper released
in April 2009, where this approach was outlined.[17] As the Minister notes in her
second reading speech, it is the Government s intention to ensure
consistency and uniformity across the whole diagnostic imaging
sector .[18] The
Rudd Government s approach to ensuring accreditation across the
sector is slightly different to that favoured by the former Health
Minister, Tony Abbott, in 2007, when he first introduced the Scheme
on behalf of the Howard Government. At that time Mr Abbott
described how the framework for the Scheme had been designed to
allow for the introduction of accreditation schemes for other
diagnostic imaging services without further amendments to the Act
.[19] Rather than
introduce additional accreditation schemes without legislation, the
approach favoured by the Rudd Government is to broaden the existing
Scheme to include these other imaging services, through amendments
to the legislation.
Although press commentary on the Bill has been largely absent, a
number of stakeholders have responded to the Government s
consultation paper on broadening the scope of the Scheme to include
non-radiology services. Thirteen of the 15 submissions received
were posted on the Department s website.[20] The Department noted some concerns
across a number of areas. In summary these were:
- the suitability of applying one accreditation model to a
diverse range of practitioners
- the potential for duplication and the importance of integrating
with other accreditation systems
- the importance of consultation in the development of
standards
- the need for a comprehensive lead time to facilitate budgeting
and planning, and
- the lack of evidence for universal practice standards as a way
of improving safety and quality across diverse diagnostic imaging
services.[21]
Many of these issues are not specifically addressed in this
Bill, although these may be resolved when the Stage 2 details are
finalised. Some stakeholder concerns may re-emerge, in particular
from those practices that would face difficulties in meeting the
3 month deadline in which to register for deemed accreditation
, and from those with concerns over a single accreditation model
being applied to all practitioners.
The Explanatory Memorandum estimates the cost of implementing
this measure at around $649 000, which would be met from
existing Departmental resources. Some of the costs that practices
would incur by participating in the Scheme are calculated in the
Business Cost Calculator contained in the Explanatory Memorandum.
This Calculator estimates the likely administrative costs to
practices in lodging the registration forms. These are expected to
vary depending on the type of labour resources involved in lodging
the registration form.
Practices using administrative staff to lodge the forms would
face the lowest cost burden estimated at around $47; those using
technical staff would face a slightly higher cost of around $84.
Practices using a diagnostic imaging specialist to submit the form
would face the highest cost estimated at around $600.[22] The cost of any
lodgement fees levied by accreditors is not included in the Cost
Calculator estimates.[23] At least some of the four accreditors currently
registered under Stage 1 of the Scheme appear to include the cost
of any lodgement fee in the overall fee they charge for
accreditation.[24]
However, it is not certain that these fee structures would remain
unchanged.
The Bill seeks to amend the DIA Act by inserting
proposed item 12A into Schedule 1 of the Act.
Proposed item 12A sets out the new provisions
to be included in the DIA Act. It extends the scope of the
Diagnostic Imaging Accreditation Scheme (the Scheme) to proprietors
of a diagnostic imaging premises or of a base for mobile diagnostic
imaging equipment who render non-radiology diagnostic imaging
procedures at the premises or base before 30 June 2010. Where the
relevant premises or base is not accredited under a diagnostic
imaging accreditation scheme, such proprietors may register for the
Scheme. Failure to register would result in the relevant
non-radiology diagnostic imaging procedures not attracting Medicare
rebates under the HIA.
Non-radiology diagnostic imaging procedure is defined in
proposed subitem 12A(2) as a diagnostic imaging
procedure for the following services:
- cardiac ultrasounds
- gynaecology and obstetrics ultrasounds
- cardiac angiography
- nuclear medicine imaging, and
- preparations for radiological procedures.
Under proposed subitems 12A(3) and
(4), the proprietor may register the premises or
base only for non-radiology diagnostic imaging procedures; or for a
combination of diagnostic imaging procedures, by lodging a notice
with the person whom the Minister designates by 30 June 2010. It
would be necessary to comply with any requirements as to the form
of such notice and/or any fees charged for lodging the notice under
proposed subitems 12A(5) and (6)
respectively.
Proposed subitem 12A(7) provides that the
premises or base would have a deemed accreditation status
if it is so registered in other words, it would be considered as
being accredited in relation to the diagnostic imaging procedures
specified in the notice for the purposes of section 16EA of the
Health Insurance Act 1973.
It is noted that the proprietor of the premises or base may
include additional diagnostic imaging procedures in the deemed
accreditation by lodging a notice with the person deemed by the
Minister by 30 June 2011 under proposed subitem
12A(8).
While under proposed subitem 12A(9), the deemed
accreditation would not be transferable in that it would only apply
to the premises or base specified in the notice proposed
subitem 12A(10) provides that the deemed accreditation
would not be affected by any change in the proprietor of the
premises or base.
Proposed subitem 12A(11) provides that the
deemed accreditation status would end:
- if the application for deemed accreditation is approved on the
day accreditation takes effect, or
- if such application is refused on the later of the following:
- 30 June 2011, or
- the day on which the right to reconsideration of such refusal
expires, or
- in any other case on 30 June 2011.
It is noted that the DIA Bill seeks to amend what is essentially
an amendment Act, which has already been incorporated into the
Health Insurance Act 1973 (the primary legislation),
instead of amending the primary legislation itself.
As this is not usual practice, the Parliamentary Library is
seeking clarification from the Department of Health and Ageing and
the Office of Parliamentary Counsel.
Concluding comments
The provisions in this Bill will expand the scope of the
diagnostic imaging accreditation Scheme to cover non-radiology
based practices to ensure consistency across the sector. To achieve
this, the Bill proposes transitional provisions to move these
practices to deemed accreditation status under the Scheme by July
2010, which also aligns with the scheduled introduction of the next
stage of the Scheme. There will be some administrative costs to
those practices affected by these provisions, which will vary with
the size of the practice. However, the full cost burden is
difficult to estimate. Although most of the proposed provisions are
largely uncontroversial, stakeholder concerns may yet emerge.
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Amanda Biggs
Sharon Scully
22 January 2010
Bills Digest Service
Parliamentary Library
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