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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
This Determination reduces Medicare rebates for diagnostic imaging (X‑ray, ultrasound, MRI, mammography, nuclear medicine, diagnostic radiology) when equipment is older than its specified effective life and not meaningfully upgraded, creating lower‑fee (NK) items. Radiology providers may face reduced payments and patients higher out‑of‑pocket costs, but facilities in Outer/Remote areas are exempt and Inner Regional clinics can seek exemptions from the Secretary; upgrades and mammography accreditation preserve full rebates.
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Direct links to the current provisions in Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011
as amended
made under subsection 3C(1) of the
Health Insurance Act 1973
Compilation start date: 1 November 2013
Includes amendments up to: Health Insurance (Diagnostic Imaging Capital Sensitivity) Amendment and Repeal Determination 2013
About this compilation
This compilation
This is a compilation of the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011 as in force on 1 November 2013. It includes any commenced amendment affecting the legislation to that date.
This compilation was prepared on 3 December 2013.
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of each amended provision.
Uncommenced amendments
The effect of uncommenced amendments is not reflected in the text of the compiled law but the text of the amendments is included in the endnotes.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Modifications
If a provision of the compiled law is affected by a modification that is in force, details are included in the endnotes.
Provisions ceasing to have effect
If a provision of the compiled law has expired or otherwise ceased to have effect in accordance with a provision of the law, details are included in the endnotes.
Contents
Contents
1. Name of Determination
2. Commencement
3. Interpretation
4. Treatment of certain diagnostic imaging services
5. Items in the diagnostic imaging services table
6. NK items
7. References in Regulations
8. Reconsideration of decisions
9. Delegation
SCHEDULE 1 – Specified health services
This Determination is the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011.
This Determination commences on 1 July 2011.
Definitions
(1) In this Determination, unless the contrary intention appears:
Act means the Health Insurance Act 1973.
ASGC means the Australian Standard Geographical Classification, July 2010, published by the Australian Bureau of Statistics.
DIST service means a service to which an item in the diagnostic imaging services table relates.
maximum extended life age has the meaning given in subsection (5).
new effective life age has the meaning given in subsection (4).
relevant proprietor, for diagnostic imaging equipment, means:
(a) if the diagnostic imaging equipment is ordinarily located at diagnostic imaging premises, the proprietor of the diagnostic imaging premises; or
(b) if the diagnostic imaging equipment is ordinarily located at a base for mobile diagnostic imaging equipment when not in use and is not ordinarily located at diagnostic imaging premises, the proprietor of the base for mobile diagnostic imaging equipment.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in Schedule 1.
Rural, Remote and Metropolitan Areas Classification has the meaning given by the general medical services table.
Schedule means a Schedule to this Determination.
Note Unless the contrary intention appears, expressions used in this Determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.
References to legislation
(2) Unless the contrary intention appears, in this Determination a reference to a provision of the Act or regulations made under the Act or the National Health Act 1953 or regulations made under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
Age of equipment
(3) The date from which the age of equipment is worked out for this Determination is:
(a) the date that the equipment was first installed in Australia; or
(b) if the equipment was imported as used equipment — the date of manufacture of the oldest component of the equipment.
(4) The new effective life age for diagnostic imaging equipment is the period set out in the following table for that type of diagnostic imaging equipment:
| Modality | New effective life age |
|---|---|
| Ultrasounddiagnostic imaging equipment used to perform a service to which an item in Group I1 in Division 2.1 in Schedule 1 applies | 10 years |
| Mammographydiagnostic imaging equipment used to perform a service to which an item in Subgroup 10 of Group I3 in Division 2.3 in Schedule 1 applies | 10 years |
| Rest of diagnostic radiologydiagnostic imaging equipment used to perform a service to which an item in Subgroups 1 to 9, 11, 12, 14, 15 or 17 of Group I3 in Division 2.3 in Schedule 1 applies | 15 years |
| Nuclear medicine (excluding PET)diagnostic imaging equipment used to perform a service to which an item in Group I4 in Division 2.4 in Schedule 1 applies | 10 years |
| MRIdiagnostic imaging equipment used to perform a service to which an item in Group I5 in Division 2.5 in Schedule 1 applies | 10 years |
(5) The maximum extended life age for diagnostic imaging equipment is the period set out in the following table for that type of diagnostic imaging equipment:
| Modality | Maximum extended life age |
|---|---|
| Ultrasounddiagnostic imaging equipment used to perform a service to which an item in Group I1 in Division 2.1 in Schedule 1 applies | 15 years |
| Mammographydiagnostic imaging equipment used to perform a service to which an item in Subgroup 10 of Group I3 in Division 2.3 in Schedule 1 applies | 15 years |
| Rest of diagnostic radiologydiagnostic imaging equipment used to perform a service to which an item in Subgroups 1 to 9, 11, 12, 14, 15 or 17 of Group I3 in Division 2.3 in Schedule 1 applies | 20 years |
| Nuclear medicine (excluding PET)diagnostic imaging equipment used to perform a service to which an item in Group I4 in Division 2.4 in Schedule 1 applies | 15 years |
| MRIdiagnostic imaging equipment used to perform a service to which an item in Group I5 in Division 2.5 in Schedule 1 applies | 15 years |
Upgrades
(6) For this Determination, diagnostic imaging equipment has been upgraded if:
(a) an additional reasonable investment has been made within the new effective life age for the diagnostic imaging equipment that improves the overall performance of the imaging system so that it is equivalent to new diagnostic imaging equipment supplied in Australia at the time of the improvement; or
(b) the diagnostic imaging equipment is currently accredited under The Royal Australian and New Zealand College of Radiologists' Mammography Quality Assurance Program.
Note Proprietors can obtain further information on what constitutes an upgrade from the Department's website: www.health.gov.au/capitalsensitivity
A relevant service shall in the circumstances specified in this Determination be treated for the purposes of the provisions of the Act and of regulations made under the Act and the provisions of the National Health Act 1953 and of regulations made under the National Health Act 1953 that make provision in respect of professional services or medical services as if:
(a) it was both a professional service and a medical service; and
(b) there was an item in the diagnostic imaging services table that:
(i) related to the relevant service; and
(ii) specified in respect of the relevant service a fee in relation to a State, being the fee specified in Schedule 1 in relation to the State specified.
This Determination does not apply to a relevant service if a medicare benefit was paid in respect of a DIST service (other than item 63491, 63494, 63497, 64990 or 64991) rendered using the same diagnostic imaging procedure.
Application of NK items
(1) Despite clause 1.2.4 of Schedule 1 to the diagnostic imaging services table, subject to subsections (2) to (8), an item in Schedule 1 that includes the symbol (NK) at the end of the item applies where:
(a) the age of the diagnostic imaging equipment used to perform the service exceeds the new effective life age for the diagnostic imaging equipment and the diagnostic imaging equipment has not been upgraded; or
(b) the age of upgraded diagnostic imaging equipment used to perform the service exceeds the maximum extended life age for the diagnostic imaging equipment.
Exemption – outer regional, remote and very remote areas
(2) An item in Schedule 1 that includes the symbol (NK) at the end of the item does not apply where:
(a) the diagnostic imaging equipment used to perform the service is ordinarily located at diagnostic imaging premises; and
(b) the diagnostic imaging premises are located in any of the following Remoteness Areas as defined in the ASGC:
(i) Outer Regional Australia (Remoteness Area 2);
(ii) Remote Australia (Remoteness Area 3);
(iii) Very Remote Australia (Remoteness Area 4).
Note Proprietors can identify what Remoteness Area they fall under at the Department's DoctorConnect website: www.doctorconnect.gov.au Proprietors should refer to the category names, rather than category numbers as the website uses different category numbers from those specified in this Determination.
(3) An item in Schedule 1 that includes the symbol (NK) at the end of the item does not apply where:
(a) the diagnostic imaging equipment used to perform the service is ordinarily located at a base for mobile diagnostic imaging equipment when not in use;
(b) the diagnostic imaging equipment used to perform the service is not ordinarily located at diagnostic imaging premises; and
(c) the base for mobile diagnostic imaging equipment is located in any of the following Remoteness Areas as defined in the ASGC:
(i) Outer Regional Australia (Remoteness Area 2);
(ii) Remote Australia (Remoteness Area 3);
(iii) Very Remote Australia (Remoteness Area 4).
Note Proprietors can identify what Remoteness Area they fall under at the Department's DoctorConnect website: www.doctorconnect.gov.au Proprietors should refer to the category names, rather than category numbers as the website uses different category numbers from those specified in this Determination.
Exemption – inner regional areas
(4) An item in Schedule 1 that includes the symbol (NK) at the end of the item does not apply where:
(a) the Department has notified the relevant proprietor of the receipt of a valid application under subsection (6) in respect of the diagnostic imaging equipment used to perform the service and a decision has not been made by the Secretary under subsection (5); or
(b) the Secretary has granted an exemption in respect of the diagnostic imaging equipment used to perform the service under subsection (5); or
(c) the Secretary has notified the relevant proprietor that he or she has refused to grant an exemption under subsection (5) and either:
(i) if the proprietor has not yet applied for reconsideration under section 8, the period to apply for reconsideration has not yet expired; or
(ii) if the proprietor has applied for reconsideration under section 8, the Secretary has not yet notified the proprietor of his or her reconsideration decision.
(5) The Secretary may grant an exemption in writing in respect of diagnostic imaging equipment where the Secretary is satisfied that the diagnostic imaging equipment is operated on a rare and sporadic basis and provides crucial patient access to diagnostic imaging services.
(6) The Secretary must make a decision under subsection (5) within 28 days of the day on which the relevant proprietor was notified of the receipt of a valid application by the Department referred to in paragraph 4(a).
(7) A relevant proprietor may only apply for an exemption under
subsection (5) if:
(a) the age of the diagnostic imaging equipment exceeds the maximum extended life age for the diagnostic imaging equipment by less than three years; and
(b) either:
(i) all of the following apply:
(A) the diagnostic imaging equipment is ordinarily located at diagnostic imaging premises;
(B) the diagnostic imaging premises are located in Inner Regional Australia (Remoteness 1) as defined in the ASGC; and
(C) the diagnostic imaging premises are located in an area classified as RRMA 4 or 5 (small rural centres and other rural areas) under the Rural, Remote and Metropolitan Areas Classification; or
(ii) all of the following apply:
(A) the diagnostic imaging equipment is ordinarily located at a base for mobile diagnostic imaging equipment when not in use;
(B) the diagnostic imaging equipment is not ordinarily located at diagnostic imaging premises;
(C) the base for mobile diagnostic imaging equipment is located in Inner Regional Australia (Remoteness 1) as defined in the ASGC; and
(D) the base for mobile diagnostic imaging equipment is located in an area classified as RRMA 4 or 5 (small rural centres and other rural areas) under the Rural, Remote and Metropolitan Areas Classification.
Note Proprietors can identify what Remoteness Area they fall under at the Department's DoctorConnect website: www.doctorconnect.gov.au Proprietors should refer to the category names, rather than category numbers as the website uses different category numbers from those specified in this Determination.
(8) An application under subsection (6) must be made in writing to the Department.
(1) Each provision of the regulations or any instrument made under or given pursuant to the Act which refers to a Division, Subdivision, Group or Subgroup in the diagnostic imaging services table shall have effect as if the reference to the Division, Subdivision, Group or Subgroup also specified the items in the corresponding Division, Subdivision, Group or Subgroup in Sc
This is an opening excerpt, not the complete document.