Commonwealth of Australia Explanatory Memoranda Commonwealth of Australia Explanatory Memoranda[Index] [Search] [Download] [Bill] [Help]
1999
THE PARLIAMENT OF THE COMMONWEALTH OF
AUSTRALIA
HOUSE OF
REPRESENTATIVES
HEALTH INSURANCE
AMENDMENT
(DIAGNOSTIC IMAGING SERVICES) BILL 1999
EXPLANATORY
MEMORANDUM
(Circulated
by authority of the Minister for Health and Aged Care
the Hon. Dr Michael
Wooldridge MP)
ISBN: 0642 406138
This Bill makes a number of amendments to the Health Insurance Act
1973 (“the Act”). These changes aim to ensure the
quality of diagnostic imaging services provided by medical practitioners under
either the remote area or pre-existing diagnostic imaging practices’
exemptions of the Act.
These exemptions enable medical practitioners
(usually general practitioners) to provide specialist-type (R-Type) diagnostic
imaging services under the Medicare Benefits Scheme (MBS):
- the remote
area exemption was introduced in 1990 to provide an exemption from the
requirements of subsection 16B(1) of the Act, to ensure access to diagnostic
imaging services provided to patients by practitioners located outside a 30
kilometre radius of another imaging practice; and
- the pre-existing
diagnostic imaging practices’ exemption was introduced in 1990 for a three
year period, and has been extended over a number of years to
31 December
1999, contingent on The Royal Australian College of General Practitioners
developing a continuing medical education and quality assurance program for
medical practitioners providing diagnostic imaging services. The exemption was
introduced so that medical practitioners providing such services were not
disadvantaged by the introduction of “arm’s length” referral
provisions.
The Bill provides that those practitioners who wish to be
exempt from the requirement that an R-type diagnostic imaging service must be
rendered by a consultant physician or specialist pursuant to a written request
from another medical practitioner, must be enrolled and participating in an
approved continuing medical education and quality assurance program in the field
of diagnostic imaging, in order for a Medicare benefit to paid for their
services. The Bill makes provision for the Minister for Health and Aged Care to
issue a disallowable instrument prescribing the relevant approved continuing
medical education and quality assurance program. The Bill also provides for the
establishment of a register by the Health Insurance Commission, with information
provided by The Australian College of Rural and Remote Medicine or The Royal
Australian College of General Practitioners, to record registration of medical
practitioners participating in a program for the purposes of this
amendment.
Agreement has been reached with The Australian College of
Rural and Remote Medicine as well as The Royal Australian College of General
Practitioners and The Royal Australian and New Zealand College of Radiologists
on a detailed program for continuing medical education and quality assurance for
medical practitioners whose services are eligible for Medicare benefits under
sub-sections 16B(7) and (11) of the Act (the remote area or pre-existing
diagnostic imaging practices’ exemptions).
Schedule 1
– Amendment of the Health Insurance Act 1973
The main
items contained in this Schedule of the Bill will:
(a) make amendments to
section 16B of the Act to provide that Medicare benefits will not be payable
unless medical practitioners who provide diagnostic imaging services under
either the remote area or pre-existing diagnostic imaging practices’
exemptions of the Act are enrolled and participating in an approved
continuing medical education and quality assurance program in the field of
diagnostic imaging;
(b) make amendments to the Act whereby the Minister
for Health and Aged Care is able to approve, by disallowable instrument, the
continuing medical education and quality assurance program in the field of
diagnostic imaging referred to in (a) above; and
(c) make amendments to
the Act to provide for the registration of medical practitioners who are
participating in the approved continuing medical education and quality assurance
program as an instrument of their eligibility for Medicare rebates for
diagnostic imaging services.
The Health Insurance Amendment (Diagnostic Imaging Services) Bill 1999
will have no significant impact upon the finances of the Commonwealth.
(DIAGNOSTIC IMAGING SERVICES) BILL 1999
The amendments in this Bill introduce a requirement that Medicare
benefits will not be payable unless medical practitioners who provide diagnostic
imaging services under either the remote area or pre-existing diagnostic imaging
practices’ exemptions of the Health Insurance Act 1973 (“the
Act”) are enrolled and participating in an approved continuing
medical education and quality assurance program in the field of
diagnostic.
The Act establishes a number of exemptions to the requirement
that, for Medicare benefits to be paid, most diagnostic imaging services must be
provided in response to a written request. Two of these exemptions enable
medical practitioners to provide specialist-type (R-Type) diagnostic imaging
services under the Medicare Benefits Scheme (MBS):
- the remote area
exemption which was introduced in 1990 to provide an exemption from the
requirements of subsection 16B(1) of the Act, to ensure access to diagnostic
imaging services provided to patients by practitioners located outside a 30
kilometre radius of another imaging practice; and
- the pre-existing
diagnostic imaging practices’ exemption was introduced in 1990 for a three
year period, contingent on The Royal Australian College of General Practitioners
developing a continuing medical education and quality assurance program for
medical practitioners providing diagnostic imaging services. The exemption was
introduced so that medical practitioners providing such services were not
disadvantaged by the introduction of “arms length” referral
provisions. This exemption currently has a sunset clause expiring on 31 December
1999.
To date there have been no formal quality assurance processes required by
the Commonwealth when non-specialists provide diagnostic imaging services.
Nevertheless, there are good reasons why non-specialists should be able to
provide these services in certain circumstances.
To provide access to high quality diagnostic imaging services to
Australians in rural and remote locations and to ensure the continued standard
of diagnostic imaging services currently provided by non-specialist medical
practitioners.
To give effect to a requirement for medical practitioners,
providing diagnostic imaging services under either the remote area or
pre-existing diagnostic imaging practices’ exemptions, to participate in a
program of continuing medical education and quality assurance developed and
agreed by The Australian College of Rural and Remote Medicine, The Royal
Australian College of General Practitioners and The Royal Australian and New
Zealand College of Radiologists.
Several options were considered:
Option 1 – maintain the
current arrangements;
Option 2 - vary conditions for provision of the
remote area and pre-existing diagnostic imaging practices’ exemptions in
the Act;
Option 3 - allow the pre-existing diagnostic imaging
practices’ exemption to lapse;
Option 4 - extend the life of the
pre-existing diagnostic imaging practices’ exemption and vary the Medicare
Benefits Schedule items for which the remote area and pre-existing diagnostic
imaging practices’ exemptions may be used.
Option 1 would maintain the current arrangements and would not adequately
address the question of quality.
Option 3 would mean that medical
practitioners would only be able to provide diagnostic imaging services via the
remote area exemption. This option would disadvantage practitioners who have
been providing such services for many years under the pre-existing diagnostic
imaging practices’ exemption and may have a potential adverse effect on
patient access.
Option 4 would vary, and probably limit, the services
able to be provided by medical practitioners and would not adequately address
the objectives trying to be attained.
Option 2 is the preferred option.
This option will support, by a process of continuing medical education and
quality assurance, the quality of diagnostic imaging services provided by
medical practitioners under the remote area and pre-existing diagnostic imaging
practices’ exemptions of the Act.
Option 2 contains the following
measures:
• In line with discussions with The Australian College of
Rural and Remote Medicine and recommendations of The Royal Australian College of
General Practitioners and The Royal Australian and New Zealand College of
Radiologists:
- the introduction of a requirement for medical
practitioners providing diagnostic imaging services under the remote area and
pre-existing diagnostic imaging practices’ exemptions that they
participate, to an appropriate standard, in a continuing medical education and
quality assurance program in the field of diagnostic imaging;
- the
introduction of a provision whereby the continuing medical education and quality
assurance program and the standards or requirements that must be met by the
practitioner in the approved program can, by disallowable instrument, be
approved by the Minister for Health and Aged Care.
The preferred option
meets the Government’s objectives of ensuring the quality delivery of
diagnostic imaging services provided by medical practitioners under these
exemptions.
Affected groups are patients, medical practitioners and
Government
Impact on Patients
Benefits for patients
from the proposed measures include improved quality assurance of diagnostic
imaging services provided by medical practitioners under the exemptions,
continued access to medical practitioners providing diagnostic imaging services
under the pre-existing diagnostic imaging practices’ exemption, and
continued access for patients in rural or remote areas to diagnostic imaging
services.
Impact on Medical Practitioners
The
proposed requirements will require the participation (to a specified standard)
of medical practitioners providing diagnostic imaging services under the remote
area and pre-existing diagnostic imaging practices’ exemptions in a
prescribed continuing medical education and quality assurance
program.
All practitioners currently with these exemptions will be placed
on the register and given time to enrol and commence participation in the
program.
The Minister will, by regulation, prescribe the program and the
standards to be met, as well as the date by which a doctor must be on the
register in order to be eligible to claim a Medicare rebate for services
provided under the exemptions.
Care will be taken to ensure sufficient
notice is given to medical practitioners to allow enrolment and registration.
Continuity of care will be an important criteria in setting the cut off
date.
While the continuing medical education and quality assurance
program has similarities and overlap with The Royal Australian College of
General Practitioner’s broader vocational registration program, the two
are distinct:
• a medical practitioner who is not vocationally
registered may be registered for the purposes of the diagnostic imaging
exemptions;
• a medical practitioner who is not vocationally
registered or pursuing vocational registration may undertake the approved
program for diagnostic imaging; and
• failure to meet the
diagnostic imaging requirement would not debar the practitioner from general
vocational registration, however, continued failure to meet the requirement
would result in ineligibility for the pre-existing diagnostic imaging
practices’ exemptions, or ineligibility for remote area exemption from the
operation of section 16B(1) of the Act.
Currently around 200 medical
practitioners hold the remote area exemption, around 100 medical practitioners
are eligible for the pre-existing diagnostic imaging practices exemption with
around 40 practitioners holding both exemptions.
The Royal Australian
College of General Practitioner’s administrative fee for maintaining a
continuing medical education and quality assurance record is $180.00 per annum.
Where doctors are not currently enrolled in a College program, this will be an
additional cost to their practice. The Australian College of Rural and Remote
Medicine is currently developing their arrangements for the delivery and
administration of the continuing medical education and quality assurance
program.
Practitioners with exemptions will already meet State
requirements with respect to diagnostic imaging services.
A number of
measures are already in place to assist medical practitioners in rural and
remote areas undertake continuing medical education and quality assurance
programs including education via Internet, CD ROM, as well as a network of rural
satellite broadcasts. The Australian College of Rural and Remote Medicine and
The Royal Australian College of General Practitioners and the Divisions of
General Practice will also provide support via rural workforce agencies and by
providing locum relief.
Medical practitioners will be advised of the
implementation of the proposed requirements by a mail out to practitioners,
information on the Department of Health and Aged Care’s and the Health
Insurance Commission’s Internet sites and notification via the Health
Insurance Commission’s “Forum” newsletter.
Impact
on Radiologists
This measure is not expected to impact on
specialist radiologists. Remote area exemptions operate where no specialist
radiology service is available. The pre-existing practices’ exemption has
been in place since 1990 and numbers of practitioners with this exemption are
declining over time.
Impact on Government
There will
be no significant impact on Government. The Health Insurance Commission
currently administers and monitors the remote area and pre-existing diagnostic
imaging practices’ exemptions and will continue in this role.
The proposal is in response to discussions with The Australian College of
Rural and Remote Medicine and on advice from both The Royal Australian College
of General Practitioners and The Royal Australian and New Zealand College of
Radiologists for the implementation of continuing medical and quality assurance
programs for medical practitioners providing diagnostic imaging services under
either the remote area or pre-existing diagnostic imaging practices’
exemptions. Consultation with these groups has been on-going since
1990.
The Act will commence on Royal Assent with provision being made for the
continuing medical education and quality assurance requirements to take effect
from a date prescribed by regulation.
Practitioners currently with the
exemptions will be advised of the implementation arrangements and lead times to
comply.
The Health Insurance Commission will continue with its
implementation and monitoring role.
The Australian College of Rural and
Remote Medicine and The Royal Australian College of General Practitioners will
advise the Health Insurance Commission concerning participation in the approved
program. The Department of Health and Aged Care will monitor and review these
arrangements.
This section cites the short title of the proposed legislation as the
Health Insurance Amendment (Diagnostic Imaging Services) Act
1999.
This section provides that the Act commences on Royal
Assent.
Section 3: Schedule(s)
This section notes that each
Act specified in the Schedules is to be amended as set out in the applicable
items in the Schedule concerned.
This item inserts a new paragraph (e) at the end of subsection 16B(7) of
the Act. Paragraph 16B(7)(e)(i) provides an additional requirement that must be
satisfied in order for a Medicare benefit to be payable for a diagnostic imaging
service rendered by medical practitioners in rural and remote areas during a
period when a remote area exemption is already in force. The new requirement is
that the service was either rendered before the date prescribed by the
regulations or if it is rendered after that date, that the practitioner was
registered in the Register of Participating Practitioners.
Item
2
This section provides that paragraph 16B(11)(d) be repealed and a
new paragraph be substituted. The new paragraph provides an additional
requirement that must be satisfied in order for a Medicare benefit to be payable
for a diagnostic imaging service rendered by a practitioner under the
pre-existing diagnostic imaging practices’ exemption. The new requirement
is that the service was either rendered before the date prescribed by the
regulations or if it is rendered after that date, that the practitioner was
registered in the Register of Participating Practitioners.
Item
3
This item introduces a new Division 1A of Part IIB of the Act
– “Continuing medical education and quality assurance in respect of
diagnostic imaging practices”.
Section 23DSA of the new Division 1A
enables the Minister, by disallowable instrument, to approve programs of
continuing medical education and quality assurance in respect of diagnostic
imaging practices.
Section 23DSB of the new Division 1A prescribes the
manner in which participants in a program approved by the Minister under section
23DSA will be registered so as to enable the Health Insurance Commission to
administer and monitor the participation of practitioners providing services
under the exemptions set out in subsections 16B(7) and 16B(11) of the
Act.
- Paragraph 23DSB(1) will provide that the purpose of section 23DSB
is to provide for the registration of medical practitioners who are
participating in a program that has been approved by the Minister in accordance
with section 23 DSA.
- Paragraph 23DSB(2) will provide that the Health
Insurance Commission will be required to establish and maintain the Register of
Participating Practitioners.
- Paragraph 23DSB(3) will provide that the
Health Insurance Commission may maintain the register in any form, which
includes the form of a computer record.
- Paragraph 23DSB(4) will provide
that if The Australian College of Rural or Remote Medicine or The Royal
Australian College of General Practitioners provides written information to the
Commission stating the names of the medical practitioners participating in a
program approved under section 23DSA, the Managing Director of the Health
Insurance Commission must ensure that the practitioners names are entered onto
the register as a participating practitioner. The date on which the
practitioner is registered must also be recorded.
- Paragraph 23DSB(5)
will provide that the date to be recorded on the register is the date on which
notice was received by the Health Insurance Commission regarding a practitioners
participation in the program.
- Paragraph 23DSB(6) will provide that once
the practitioner is registered as a participant in a program approved by the
Minister, the Managing Director of the Health Insurance Commission must write to
the practitioner informing them that they are registered, and specifying the
date on which their registration commenced.
- Paragraph 23DSB(7) will
provide that the Managing Director of the Health Insurance Commission may give
The Australian College of Rural or Remote Medicine or The Royal Australian
College of General Practitioners information regarding the practitioners who are
registered as participating practitioners, and the dates of the commencement of
registration.
Section 23DSC outlines the way in which a medical
practitioner is de-registered as a participating practitioner in a program
approved under 23DSA.
- Sub-section 23DSC(1) will provide that section
23DSC has effect if The Australian College of Rural and Remote Medicine or The
Royal Australian College of General Practitioners writes to the Health Insurance
Commission advising that a specified medical practitioner registered as a
participating practitioner is no longer enrolled or participating in the program
approved under section 23DSA, or a medical practitioner requests the Health
Insurance Commission to de-register the practitioner.
- Paragraph
23DSC(2) will provide that the Managing Director of the Health Insurance
Commission must provide written notice to a practitioner advising that the
practitioner will cease to be registered as a participating practitioner on a
date that is specified in the written notice.
- Paragraph 23DSC(3) will
provide that the date of deregistration that is advised must be at least 14 days
after the date on which the notice is provided to the
practitioner.
- Paragraph 23DSC(4) will provide that the Managing
Director of the Health Insurance Commission must ensure that a statement is
entered into the Register noting the date on which a practitioner is deemed to
no longer be registered in the Register of Participating Practitioners.