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Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007

Schedule 1 Amendments

   

Health Insurance Act 1973

1  Subsection 3(1)

Insert:

approved accreditor has the meaning given by paragraph 23DZZIAA(1)(b).

2  Subsection 3(1)

Insert:

diagnostic imaging accreditation scheme means a scheme established by the Minister under section 23DZZIAA.

3  Subsection 16D(7)

After “Division 4”, insert “or 5”.

Note:       The heading to section 16D is altered by adding at the end “ : registration ”.

4  Subsection 16D(9)

After “Division 4”, insert “or 5”.

5  After section 16E

Insert:

16EA   Medicare benefits not payable for certain diagnostic imaging services: accreditation

             (1)  Unless the Minister otherwise directs, a medicare benefit is not payable in respect of a diagnostic imaging service rendered by or on behalf of a medical practitioner unless the diagnostic imaging procedure used in rendering that service is carried out:

                     (a)  at diagnostic imaging premises that are, or at a base for mobile diagnostic imaging equipment that is, accredited for that procedure under a diagnostic imaging accreditation scheme; or

                     (b)  using diagnostic imaging equipment that:

                              (i)  when not in use, is ordinarily located at a base for mobile diagnostic imaging equipment that is accredited for that procedure under a diagnostic imaging accreditation scheme; and

                             (ii)  is not ordinarily located at diagnostic imaging premises; or

                     (c)  using diagnostic imaging equipment that is ordinarily located at diagnostic imaging premises that are accredited for that procedure under a diagnostic imaging accreditation scheme.

             (2)  Subsection (1) does not apply in relation to a diagnostic imaging service prescribed by the regulations for the purposes of this subsection.

             (3)  A direction in writing under subsection (1) is not a legislative instrument.

6  Paragraph 23DZL(b)

Repeal the paragraph, substitute:

                     (b)  the diagnostic imaging procedures carried out using the equipment:

                              (i)  are not carried out at the premises; or

                             (ii)  are frequently carried out off the premises; and

7  Section 23DZM

Before “ Diagnostic ”, insert “(1)”.

8  At the end of section 23DZM

Add:

             (2)  A base for mobile diagnostic imaging equipment is not diagnostic imaging premises .

9  At the end of subsection 23DZT(2)

Add:

                    ; (f)  any information required to be recorded for the premises or base under section 23DZZIAB (accreditation status).

10  At the end of section 23DZU

Add:

                   ; (e)  any information required to be recorded for the premises or base under section 23DZZIAB (accreditation status).

11  At the end of Part IIB

Add:

Division 5 Diagnostic imaging accreditation

23DZZIAA   Diagnostic imaging accreditation

             (1)  The Minister may, by one or more legislative instruments:

                     (a)  establish one or more schemes under which diagnostic imaging premises and bases for mobile diagnostic imaging equipment may be accredited for diagnostic imaging procedures; and

                     (b)  approve one or more persons ( approved accreditors ) to accredit premises and bases under a scheme or schemes.

             (2)  An instrument under subsection (1) may specify conditions with which an approved accreditor must comply.

             (3)  An instrument under subsection (1) may provide for any matters necessary or convenient to be provided for in relation to a diagnostic imaging accreditation scheme.

             (4)  Without limiting subsection (3), an instrument under subsection (1) may provide for any or all of the following in relation to a diagnostic imaging accreditation scheme:

                     (a)  how premises and bases become accredited;

                     (b)  the standards and conditions that are to be met for accreditation, including (without limitation) standards and conditions in relation to:

                              (i)  proprietors, staff, equipment and management of premises and bases; and

                             (ii)  persons who render diagnostic imaging services that use procedures for which premises or bases are accredited; and

                            (iii)  other matters associated with the carrying out of diagnostic imaging procedures and the rendering of diagnostic imaging services;

                     (c)  the charging of fees by approved accreditors in relation to services they provide;

                     (d)  when accreditation expires, how it may be renewed and when the renewal takes effect;

                     (e)  the circumstances in which accreditation may be varied or revoked, and when the variation or revocation takes effect;

                      (f)  directions by the Minister to approved accreditors;

                     (g)  the obligations of approved accreditors to keep the Minister informed about the operation of the scheme;

                     (h)  obligations to maintain records in relation to accredited premises and bases.

             (5)  If an instrument under subsection (1) confers a power or function on the Minister, the Minister may, by signed instrument, delegate the power or function to an officer within the meaning of section 131.

23DZZIAB   Diagnostic Imaging Register to include accreditation status

             (1)  If:

                     (a)  an approved accreditor accredits diagnostic imaging premises, or a base for mobile diagnostic imaging equipment, under a diagnostic imaging accreditation scheme; or

                     (b)  such accreditation is renewed;

the Minister must, after the day on which the accreditation or renewal takes effect, record on the Diagnostic Imaging Register, for the premises or base, the prescribed information in relation to the accreditation or renewal.

             (2)  If the accreditation of diagnostic imaging premises or a base for mobile diagnostic imaging equipment under a diagnostic imaging accreditation scheme:

                     (a)  expires and is not renewed; or

                     (b)  is varied or revoked;

the Minister must, after the day on which the expiry, variation or revocation takes effect, record on the Diagnostic Imaging Register, for the premises or base, the prescribed information in relation to the expiry, variation or revocation.

23DZZIAC   Reconsideration of accreditation decisions

             (1)  A diagnostic imaging accreditation scheme must include a process under which:

                     (a)  decisions made under the scheme in relation to accreditation of premises or a base are to be reconsidered on application by the proprietor of the premises or base concerned; and

                     (b)  the proprietor is to be notified of the result of the reconsideration and of the proprietor’s rights under section 23DZZIAD.

             (2)  A diagnostic imaging accreditation scheme must not allow:

                     (a)  a decision to refuse to renew accreditation, or to refuse to renew accreditation for a procedure; or

                     (b)  a decision to vary accreditation of diagnostic imaging premises or a base for mobile diagnostic imaging equipment so that the premises are or the base is accredited for fewer diagnostic imaging procedures; or

                     (c)  a decision to revoke accreditation (other than a decision made on the ground that there is a potential danger to public health or safety if the accreditation is not revoked);

to take effect before the proprietor’s rights to reconsideration under the scheme and under section 23DZZIAD are exhausted or have expired.

23DZZIAD   Reconsideration by Minister of accreditation decisions

             (1)  The proprietor of premises or a base may, after a first reconsideration of a decision in relation to accreditation of the premises or base in accordance with the process included in the scheme for the purposes of paragraph 23DZZIAC(1)(a), apply in writing to the Minister for further reconsideration of the decision.

             (2)  The application must:

                     (a)  be made within 28 days after the date of the notice given to the proprietor of the result of the first reconsideration (see paragraph 23DZZIAC(1)(b)); and

                     (b)  set out the reasons why the proprietor believes the decision should be reconsidered.

             (3)  The Minister may, by notice in writing to the proprietor, request the proprietor to provide, before the end of the period specified in the notice, specified further information in relation to the application.

             (4)  If:

                     (a)  the proprietor applies before the end of the 28 days; and

                     (b)  if the Minister requests further information under subsection (3)—the proprietor provides the further information before the end of the period specified in the notice;

the Minister must, by notice in writing to the proprietor:

                     (c)  affirm the decision; or

                     (d)  set aside the decision and make a new decision in substitution for it.

             (5)  The Minister’s decision takes effect on the day specified in the notice to the proprietor of the decision. Subject to subsection (6), the day may be earlier than the date of the notice.

             (6)  A decision of the kind to which paragraph 23DZZIAC(2)(a), (b) or (c) applies must not take effect earlier than the date of the notice.

23DZZIAE   Proprietor of unaccredited premises or base must notify patients that medicare benefit not payable

             (1)  The proprietor of diagnostic imaging premises commits an offence if a diagnostic imaging procedure is carried out on a person in the following circumstances:

                     (a)  the procedure is carried out:

                              (i)  at the premises; or

                             (ii)  using equipment that is ordinarily located at the premises; and

                     (b)  medicare benefit is not payable in respect of a diagnostic imaging service rendered using the procedure; and

                     (c)  medicare benefit is not payable because the premises are not accredited for the procedure under a diagnostic imaging accreditation scheme; and

                     (d)  the proprietor has neither:

                              (i)  given the person notice in writing stating that medicare benefit will not be payable in respect of a diagnostic imaging service rendered using the procedure and the reasons why medicare benefit will not be payable; nor

                             (ii)  caused written notice to that effect to be displayed prominently at the place where the procedure is carried out.

Penalty:  10 penalty units.

             (2)  The proprietor of a base for mobile diagnostic imaging equipment commits an offence if a diagnostic imaging procedure is carried out on a person in the following circumstances:

                     (a)  the procedure is carried out:

                              (i)  at the base; or

                             (ii)  using equipment that is ordinarily located at the base when not in use, and is not ordinarily located at diagnostic imaging premises; and

                     (b)  medicare benefit is not payable in respect of a diagnostic imaging service rendered using the procedure; and

                     (c)  medicare benefit is not payable because the base is not accredited for that procedure under a diagnostic imaging accreditation scheme; and

                     (d)  the proprietor has neither:

                              (i)  given the person notice in writing stating that medicare benefit will not be payable in respect of a diagnostic imaging service rendered using the procedure and the reasons why medicare benefit will not be payable; nor

                             (ii)  caused written notice to that effect to be displayed prominently at the place where the procedure is carried out.

Penalty:  10 penalty units.

             (3)  Strict liability applies to subsections (1) and (2).

Note:          For strict liability, see section 6.1 of the Criminal Code .

23DZZIAF    Debt recovery if proprietor fails to inform patient that premises or base not accredited

             (1)  If:

                     (a)  a diagnostic imaging procedure used in rendering a diagnostic imaging service is carried out on a person at diagnostic imaging premises, or using equipment that is ordinarily located at diagnostic imaging premises; and

                     (b)  at the time the procedure is carried out, medicare benefit is not payable in respect of the service because the premises are not accredited for the procedure under a diagnostic imaging accreditation scheme; and

                     (c)  the proprietor of the premises failed to inform the person that no medicare benefit would be payable in respect of the service and of the reasons why no medicare benefit would be payable; and

                     (d)  after the procedure is carried out, the Minister directs under subsection 16EA(1) that medicare benefit is to be paid in respect of the service;

an amount equal to the medicare benefit is recoverable from the proprietor as a debt due to the Commonwealth.

             (2)  If:

                     (a)  a diagnostic imaging procedure used in rendering a diagnostic imaging service is carried out on a person:

                              (i)  at a base for mobile diagnostic imaging equipment; or

                             (ii)  using equipment that is ordinarily located at a base for mobile diagnostic equipment when not in use, and that is not ordinarily located at diagnostic imaging premises; and

                     (b)  at the time the procedure is carried out, medicare benefit is not payable in respect of the service because the base is not accredited for the procedure under a diagnostic imaging accreditation scheme; and

                     (c)  the proprietor of the base failed to inform the person that no medicare benefit would be payable in respect of the service and of the reasons why no medicare benefit would be payable; and

                     (d)  after the procedure is carried out, the Minister directs under subsection 16EA(1) that medicare benefit is to be paid for the service;

an amount equal to the medicare benefit is recoverable from the proprietor as a debt due to the Commonwealth.

23DZZIAG   Application of this Division to partnerships

                   Section 23DZZI applies as if the references in that section to Division 4 included references to this Division.

12  Transitional provisions for existing premises and bases

(1)       A proprietor of:

                     (a)  diagnostic imaging premises; or

                     (b)  a base for mobile diagnostic imaging equipment;

may register the premises or base for accreditation for one or more diagnostic imaging procedures, by lodging with a person designated by the Minister under subitem (5) a notice in the form (if any) approved by that person.

(2)       If the proprietor of premises or a base lodges a notice under subitem (1) before 1 July 2008, the premises are, or the base is, for the purposes of section 16EA of the Health Insurance Act 1973 , taken to be accredited, for the procedures specified in the notice, under a diagnostic imaging accreditation scheme. This is deemed accreditation for those procedures.

(3)       The proprietor of premises that have or a base that has deemed accreditation for a procedure must apply for accreditation for that procedure under a diagnostic imaging accreditation scheme:

                     (a)  unless paragraph (b) applies—before 1 July 2009; or

                     (b)  if a diagnostic imaging accreditation scheme specifies another day for this purpose (which may be earlier or later)—before that other day.

(4)       Deemed accreditation of premises or a base for a procedure ceases on the earliest of the following days:

                     (a)  if the proprietor of the premises or base fails to apply for accreditation for that procedure under a diagnostic imaging scheme before the day that applies under subitem (3)—on that day; or

                     (b)  if an approved accreditor grants accreditation for that procedure under a diagnostic imaging accreditation scheme—on the day the accreditation takes effect; or

                     (c)  if an approved accreditor refuses accreditation for that procedure under a diagnostic imaging accreditation scheme—on the day after the proprietor’s rights to reconsideration of that decision under the scheme and under section 23DZZIAD of the Health Insurance Act 1973 are exhausted or expire.

(5)       The Minister may, by legislative instrument, designate a person with whom notices under subitem (1) are to be lodged.

(6)       The Minister may, by signed instrument, delegate the Minister’s power under subitem (5) to the Secretary of the Department or to an APS employee in the Department.

(7)       A designated person may charge fees in relation to registration under subitem (1). A designated person may charge different fees in relation to different kinds of registrations.

(8)       Notices cannot be lodged under subitem (1) on or after 1 July 2008.

(9)       Expressions used in this item that are defined in the Health Insurance Act 1973 have the same meaning as they have in that Act.

13  Delayed application of certain provisions

Sections 23DZZIAE and 23DZZIAF apply in relation to diagnostic imaging procedures carried out on or after 1 July 2008.