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Health Insurance Amendment (Diagnostic Imaging Services) Bill 2000

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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)



 

HEALTH INSURANCE AMENDMENT

 (DIAGNOSTIC IMAGING SERVICES) BILL 1999

 

 

OUTLINE

 

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.

 

 

 

FINANCIAL IMPACT STATEMENT

 

The Health Insurance Amendment (Diagnostic Imaging Services) Bill 1999 will have no significant impact upon the finances of the Commonwealth.



 

HEALTH INSURANCE AMENDMENT

 (DIAGNOSTIC IMAGING SERVICES) BILL 1999

 

REGULATION IMPACT STATEMENT

 

Background

 

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.

 

Problem

 

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.

 

Objective

 

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.

 

Alternatives

 

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.

 

Impact Analysis

 

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.

 

Consultation

 

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.

 

Implementation, Monitoring and Review

 

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.

 



 

NOTES ON CLAUSES

 

Section 1: Short Title

 

This section cites the short title of the proposed legislation as the Health Insurance Amendment (Diagnostic Imaging Services) Act 1999.

 

Section 2: Commencement

 

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.

 

SCHEDULE 1 - AMENDMENTS TO THE HEALTH INSURANCE ACT 1973 (“the Act”)

 

Item 1

 

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.