Bills Digest no. 137 2006–07
Health Insurance Amendment (Diagnostic Imaging
Accreditation) Bill 2007
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
Endnotes
Contact Officer & Copyright Details
Passage
History
Health Insurance Amendment
(Diagnostic Imaging Accreditation) Bill 2007
Date
introduced: 29 March
2007
House: House of Representatives
Portfolio: Health and Ageing
Commencement:
Except for item 5 of Schedule 1, the
Bill commences on Royal Assent. Item 5, which is the key provision
dealing with accreditation of diagnostic imaging premises and bases
as a condition of Medicare payments, commences on 1 July
2008.
This Bill establishes the framework for the
introduction of an accreditation scheme for diagnostic imaging
practices covered by the Radiology Quality and Outlays Memorandum
of Understanding (Radiology MOU). This is to be done through
amendments to the Health Insurance Act 1973 (the HIA).
The term diagnostic
imaging refers to a range of diagnostic medical services including
ultrasound, computed tomography (CT), nuclear medicine, radiography
(x-ray), magnetic resonance imaging (MRI), positron emission
tomography (PET) and bone densitometry.(1)
The Australian Government provides Medicare rebates (payments)
for a number of diagnostic imaging services listed in the
Diagnostic Imaging Services Table. The legislative framework for
this is comprised of the:
- Health Insurance Act 1973
- Health Insurance Regulations 1975, and
- Health Insurance (Diagnostic Imaging Services Table)
Regulations.
The Table of Diagnostic Imaging Services is set
out in Category 5 of the Medicare Benefits Schedule
(MBS).
Management of diagnostic imaging services under Medicare is
undertaken cooperatively between the Government (Department of
Health and Ageing, or DOHA), and sector representatives (the Royal
Australian and New Zealand College of Radiologists and the
Australian Diagnostic Imaging Association) through the Radiology
MOU. There are additional MOUs for cardiac imaging, nuclear
medicine imaging and obstetrical and gynaecological ultrasound. The
four diagnostic imaging MOUs were negotiated as part of the 2003-04
Budget process for managing Medicare funded diagnostic imaging
services.(2)
The Radiology MOU is the largest of the diagnostic imaging MOUs
and accounts for around 80 per cent of all diagnostic imaging
services under Medicare.(3)
As part of negotiations for the Radiology MOU, the Government
and the diagnostic imaging sector representatives agreed to
introduce an accreditation scheme for radiology practices.
As described in the Explanatory Memorandum, accreditation is a
process of externally reviewing an organisation s performance
against a defined set of standards .(4) Accreditation
schemes are widely used throughout the health sector both in
Australia and overseas to provide a framework for continuous
improvement in the delivery of safe and high quality health
care.
Under the scheme being implemented through this Bill, all
diagnostic imaging practices providing services under the Radiology
MOU will need to be accredited by an approved accreditation
provider in order for Medicare benefits to be payable for the
services they provide .(5)
The Bill will allow the Minister to establish through a
legislative instrument the rules and operational details of the
accreditation scheme, including the Standards, the names of the
approved accreditors, the obligations of approved accreditors, the
accreditation process and the period of
accreditation.(6) The Bill has also been designed to
enable the introduction of accreditation schemes for other
diagnostic imaging services in the future without further
amendments to the HIA.(7)
The legislative instrument establishing the accreditation scheme
for the Radiology MOU will be introduced when the details of the
scheme are finalised .(8) The scheme will commence on 1
July 2008.(9)
For further background to the Radiology MOU accreditation scheme
see the DOHA webpage,
Introduction of a New Accreditation Scheme for Practices
providing Radiology Services, and the
Explanatory Memorandum.
There does not appear to have been any public commentary on the
Bill from interest groups, media commentators or the opposition and
minor parties. This may be because the details of the scheme are
not yet known.
Diagnostic imaging sector stakeholders raised a number of issues
and concerns at accreditation scheme consultation meetings
organised by DOHA in August 2006. According to DOHA, these included
the:
- cost of accreditation to practice sites and the resulting
impact on businesses and healthcare consumers
- ambitious implementation timetable and the need for
accreditation providers and practice sites to be well informed
about assessment requirements, including the radiology
accreditation standards, well in advance of 1 September 2007
- need for the new accreditation scheme to accommodate the
diversity of business structures particularly where components of
the service are undertaken by different practices
- need for the complaints handling mechanism to distinguish
between frivolous and legitimate complaints and for the
investigation of complaints by accreditation providers to be
limited to matters related to compliance with accreditation
standards, and
- importance of involving all provider groups in the development
of the radiology accreditation standards to ensure their relevance
and currency both in the immediate and longer term.
Further information on the position of stakeholders can be
obtained from the DOHA webpage,
Introduction of a New Accreditation Scheme for Practices
providing Radiology Services, and the
Explanatory Memorandum.
According to the Explanatory Memorandum, the introduction of the
accreditation scheme will require enhancements to Medicare
Australia s Medicare processing systems.(10) The
estimated cost of this is $1.2 million.
Item 5 inserts proposed section
16EA. This provides that, unless either the Minister
directs otherwise or the service is covered by relevant
regulations, Medicare benefits are only payable for diagnostic
imaging services done either:
- at premises that are accredited to perform the particular
relevant sort of diagnostic imaging procedure, or
- using portable equipment that is otherwise located or stored at
an accredited base or premises.
A Ministerial direction in the above context is not a
legislative instrument.
Item 11 inserts proposed sections
23DZZIAA-DZZIAG which set out the framework for diagnostic
imaging accreditation schemes. The Explanatory Memorandum comments
that the allowance for more than one accreditation scheme is to
cater:(11)
for situations where there may be a need for
accreditation schemes with different rules to cater for the diverse
range of clinical settings in which diagnostic imaging services are
rendered.
The accreditation scheme(s) are established by legislative
instrument, and thus disallowable by Parliament in the usual
manner.(12) The actual accreditation of diagnostic
imaging premises will be done by approved accreditors . These
persons will be appointed via legislative instrument. The
legislative instrument establishing a scheme may specify the
conditions with which persons or organisations must comply to get
approval and stay approved. It may also provide that Ministerial
powers under the scheme be delegated to persons such as
departmental officers and employees of Medicare Australia.
Under proposed section 23DZZIAC, an
accreditation scheme must include a process for reconsideration of
an accreditation decision. In cases where a person has their
accreditation revoked, the scheme must provide for a stay on
implementation of the decision until the reconsideration process
has been exhausted (assuming the person applies for reconsideration
of the revocation). However, this requirement does not apply where
the relevant accreditation has been revoked on the grounds that
there is potential risk to public health and safety .
In addition to the proposed section 23DZZIAC
reconsideration process, there is a further appeal process to the
Minister: proposed section 23DZZIAD. The Minister
may either confirm the decision or set it aside and substitute a
new accreditation decision. Whilst a little unclear, the ability of
the Minister to delegate his or her powers under proposed
subsection 23DZZIAA(5) via a signed instrument would
probably not extend to the proposed section
23DZZIAD process.
Under proposed section
23DZZIAE, the proprietor of a diagnostic imaging premises
or base that does not have accreditation must inform a prospective
patient that no Medicare benefit is payable for any diagnostic
imaging procedure done at the premises or using equipment from that
base. They may do this by either giving the patient a written
notice to this effect or prominently displaying a similar notice
where the procedure is proposed to be carried out. The notice must
also tell the patient the reason no Medicare benefits are payable
is because of the lack of accreditation. A failure to inform
patients as required is strict liability offence carrying a penalty
of 10 penalty units ($1 100). In cases where a patient has not been
informed before the procedure, the Minister may nonetheless direct
that the relevant Medicare benefit be paid, but in such cases the
benefit is recoverable from the proprietor as a debt to the
Commonwealth: proposed section 23DZZIAF.
Existing section 23DZZI provides that that each partner in a
partnership shares equal responsibility for the legal obligations
applying under Division 4 of Part IIB to a proprietor of a
registered diagnostic imaging premises or a mobile base. This is
irrespective of what is contained in the relevant partnership
agreement. Proposed section 23DZIAG applies this
joint responsibility principle to the Division 5 accreditation
obligations (and penalties) that are imposed by item
11.
Item 12 provides for transitional arrangements.
If a proprietor lodges an application for accreditation by 1 July
2008, they will be deemed to be accredited until certain times set
out in sub-items 12(3)-(4).
Concluding comments
This Bill does not appear, in
itself, to be controversial. The Government and diagnostic imaging
sector representatives agreed to the introduction of an
accreditation scheme as part of negotiations for the Radiology MOU
in 2003. Further, accreditation schemes are widely accepted
throughout the health sector as a method for reviewing and
improving systems of care.
Nevertheless, the Bill does not provide operational details of
the proposed scheme, such as the Standards to be used, the names of
the approved accreditors, the accreditation process and the period
of accreditation. Rather, it simply allows the Minister to
establish, through a legislative instrument the rules and
operational details of the scheme. Given that diagnostic imaging
sector representatives have previously raised concerns in relation
to operational details for the scheme, it is possible that similar
concerns may be raised again when the details of the scheme are
announced.
- Diagnostic Imaging, Department of Health and Ageing
(DOHA), at:
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/Diagnostic+Imaging-1,
accessed 3 May 2007.
- Explanatory Memorandum, p. 2.
- ibid. p. 1.
- ibid. p. 1.
- ibid. p. 1.
- Plain English Guide Proposed amendments to the Health
Insurance Act 1973 through the Health Insurance Amendment
(Diagnostic Imaging Accreditation) Bill 2007, DOHA,
at:
http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/diagnosticimaging-accred-plainengguide.htm,
accessed 3 May 2007.
- Explanatory Memorandum, p. 1.
- Plain English Guide Proposed amendments to the Health
Insurance Act 1973 through the Health Insurance Amendment
(Diagnostic Imaging Accreditation) Bill 2007, op. cit.
- Introduction of a New Accreditation Scheme for Practices
providing Radiology Services, DOHA at
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/diagnosticimaging-accred,
accessed 3 May 2007.
- Explanatory Memorandum, p. 1.
- ibid. p. 11.
- Assuming the accreditation scheme is not an intergovernmental
scheme within the meaning of subsection 44(1) of the
Legislative Instruments Act 2003.
Luke Buckmaster
Social Policy Section
Angus Martyn
Law and Bills Digest Section
8 May 2007
Bills Digest Service
Parliamentary Library
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ISSN 1328-8091
© Commonwealth of Australia 2007
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