Contents

1. Name of Determination

2. Commencement

3. Cessation

4. Interpretation

5. Circumstances where this Determination applies - Gippsland and South Eastern New South Wales mobile MRI services

5AA Circumstances where this Determination applies- Rockhampton, Bundaburg and Gladstone mobile MRI services 6

5A. Bulk billing incentive

6. Treatment of a relevant service

7. MRI and MRA services – meaning of scan

8. MRI and MRA services – related services that can be claimed in a 12 month period

9. MRI services – limit for items 63472 and 63475

10. MRI services – limit for item 63478

11. MRI and MRA services – modifying items

12. Diagnostic imaging services which dental practitioners may request

Schedule - Specified health services

1. Name of Determination

This Determination is the Health Insurance (Gippsland and South Eastern New South Wales Mobile MRI Service and Rockhampton, Bundaburg and Gladstone Mobile MRI Service) Determination 2009.

2. Commencement

This Determination commences on 1 November 2009.

3. Cessation

This Determination ceases to have effect at 23:59, 30 June 2013.

4. Interpretation

(1) In this Determination, unless the contrary intention appears:

Act means the Health Insurance Act 1973.

after hours means from 5pm on Mondays, Tuesdays, Wednesdays and Thursdays to 9am on the following day, and from 5pm on Fridays to 9am on Mondays.

Bega means Bega, New South Wales, 2250.

diagnostic imaging services table means the table prescribed under section 4AA of the Act.

eligible provider means a specialist in diagnostic radiology who has satisfied the Chief Executive Medicare that he or she is a participant in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.

LSPN means a location specific practice number allocated under section 23DZQ of the Act.

item means an item in the Schedule.

MRA means magnetic resonance angiography.

MRI means magnetic resonance imaging.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.

RIL funding agreement means the funding agreement between Regional Imaging Pty Ltd [ABN 81 095 630 792] and the Commonwealth of Australia as represented by the Department of Health and Ageing as in force on 31 December 2011.

Schedule means the Schedule to this Determination.

teleradiology means the electronic transmission of radiological images in digital form from one location to another using a data communication link provided by a third party carrier.

Traralgon means Traralgon, Victoria, 3844.

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.

(2) For the avoidance of doubt, in this Determination:

(a) a reference to the Act includes a reference to regulations made under the Act; and

(b) a reference to the National Health Act 1953 includes a reference to regulations made under that Act; and

(c) a reference to any legislation shall be construed as a reference to that legislation as in force from time to time.

5. Circumstances where this Determination applies – Gippsland and South Eastern New South Wales Mobile MRI services

(1) This Determination applies to a relevant service provided using mobile diagnostic imaging equipment that has as its base for mobile diagnostic imaging the Latrobe Regional Hospital, Princes Highway Traralgon West, Victoria 3844 where the following circumstances apply:

(a) in respect of items 63002 to 63483, where the service is performed pursuant to a request that is in accordance with subsection (2);

(b) where the service is performed pursuant to the RIL funding agreement; and

(c) where the service is performed in a permissible circumstance in accordance with subsection (3), (4), (5), (6), (7) or (8); and

(d) where the service is a service of a kind referred to in paragraph 10(2)(a) of the Act – the patient in respect of whom the service is provided is charged a fee that is no more than 75% of the amount specified in the Schedule as the fee applicable to the item that relates to the service; and

(e) where the service is not a service to which paragraph (d) applies – the patient in respect of whom the service is provided is charged a fee that is no more than 85% of the amount specified in the Schedule as the fee applicable to the item that relates to the service.

(2) The request referred to in paragraph (1)(a) must:

(a) be made by a practitioner who is a specialist, consultant physician or dental practitioner; and

(b) be made in writing; and

(c) identify the clinical indications for the service.

Note: Subsection 16B(2) of the Act limits the R-type diagnostic imaging services in respect of which a medicare benefit is payable where the service is requested by a dental practitioner. See section 12 below.

(3) For paragraph (1)(c), subject to subsection (4), a relevant service is performed in a permissible circumstance if the service is performed in Bega and it is:

(a) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination via telephone and real-time teleradiology; and

(b) reported by an eligible provider; and

(c) monitored by a medical practitioner by personal attendance on the patient if the circumstances are such as to require on-site monitoring by a medical practitioner.

(4) If subsection (3) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Bega and it is performed in an emergency.

(5) For paragraph (1)(c), subject to subsection (6), a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is:

(a) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination via telephone and real-time teleradiology; and

(b) reported by an eligible provider; and

(c) monitored by a medical practitioner by personal attendance on the patient if the circumstances are such as to require on-site monitoring by a medical practitioner; and

(d) not a service to which items 63492 to 63495 are attributable.

(6) If subsection (5) is not complied with, a relevant service is performed in a permissible circumstance if the service is performed in Traralgon during after hours and it is performed in an emergency.

(7) For paragraph (1)(c), subject to subsection (8), a relevant service is performed in a permissible circumstance if it is:

(a) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and

(b) reported by an eligible provider.

(8) If subsection (7) is not complied with, a relevant service is performed in a permissible circumstance if it is performed:

(c) in an emergency; or

(d) because of medical necessity, in a remote location.

5AA Circumstances where this Determination applies – Rockhampton, Bundaburg and Gladstone Mobile MRI services

(1) This Determination applies to a relevant service provided using mobile diagnostic imaging equipment that has as its base for mobile diagnostic imaging the Mater Misericordiae Hospital Rockhampton, Ward St Rockhampton, Queensland 4700, where the following circumstances apply:

(a) in respect of items 63002 to 63483, where the service is performed pursuant to a request that is in accordance with subsection (2); and

(b) the service is:

(i) both:

(A) performed under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination including, if necessary, by personal attendance on the patient; and

(B) reported by an eligible provider; or

(ii) performed in emergency; and

(c) the equipment is operated at a location mentioned in the Table; and

(d) the equipment used to perform the service is a General Electric Signa Echo Speed with Excite with a magnet strength of 1.5 Tesla and is mounted on a specifically built semi-trailer.

(2) The request referred to in paragraph (1)(a) must:

(a) be made by a practitioner who is a specialist, consultant physician or dental practitioner; and

(b) be made in writing; and

(c) identify the clinical indications for the service.

(3) For paragraph (1)(c), the operation of equipment at a location includes the operation of the equipment within the grounds of the location.

Table

5A. Bulk billing incentive

Paragraph 1.2.5A(1)(a) of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if the reference to “a service that is mentioned in an item in Division 2.5 of the table” in that clause included a reference to a service mentioned in an item in the Schedule to this Determination.

6. Treatment of a relevant service

A relevant service shall be treated as if:

(a) it were both a professional service and a medical service for the purposes of the provisions of the Act and the National Health Act 1953 that relate to professional and medical services; and

(b) there was an item in the diagnostic imaging services table that related to the relevant service and specified in respect of the service a fee in relation to a State, being the fee specified in the Schedule in relation to the State specified; and

(c) the item specified in paragraph (b) was part of Group I5 of the diagnostic imaging services table and of the relevant subgroup of Group I5 as is specified in the Schedule.

7. MRI and MRA services – meaning of scan

Clause 2.5.7 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if the reference to “items 63001 to 63482” in that clause was a reference to “items 63002 to 63483” of the Schedule.

8. MRI and MRA services – related services that can be claimed in a 12 month period

Subclause 2.5.9(2) of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if the references to the items mentioned in column 1 of the table below (Existing references) include references to the items mentioned in column 2 of the following table (Additional references).

9. MRI services – limit for items 63472 and 63475

Clause 2.5.10 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if:

(a) the reference to item 63473 in subclause (1) was a reference to “item 63472, 63473 or 63475”;

(b) the reference to item 63470 in subclause (2) was a reference to “item 63470, 63472 or 63475”;

(c) there is an additional subclause (3) as follows “Item 63472 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in items 63470, 63473 or 63475”; and

(d) there is an additional subclause (4) as follows “Item 63475 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63470, 63472 or 63473”.

10. MRI services – limit for item 63478

Item 63478 does not apply to the service described in that item if the person to whom the service is provided has previously been provided with that service or a service described in item 63476 of Part 2 of Schedule 1 of the diagnostic imaging services table.

11. MRI and MRA services – modifying items

Clause 2.5.11 of Part 2 of Schedule 1 of the diagnostic imaging services table shall have effect as if:

(a) the reference to item 63491 in that clause was a reference to item 63492; and

(b) the references to item 63494 in that clause were references to item 63493; and

(c) the references to item 63497 in that clause were references to item 63495.

12. Diagnostic imaging services which dental practitioners may request

Regulation 10 of the Health Insurance Regulations 1975 shall have effect as if the paragraphs of that regulation mentioned in column 1 of the table below (Existing references) include references to the items mentioned in column 2 of the table below (Additional references).

Schedule - Specified health services

Note Section 3C (7) of the Act deems an internal Territory to form part of the State of New South Wales.