Commonwealth Consolidated Acts

HEALTH INSURANCE AMENDMENT (DIAGNOSTIC IMAGING, RADIATION ONCOLOGY AND OTHER MEASURES) ACT 2003 - SCHEDULE 3

Health Insurance Act 1973

1 Paragraph 16B(7)(c)

Omit "under that Division", substitute "under section 23DX".

2 Subsection 16B(10)

Repeal the subsection, substitute:

Exemption—additional services

(10)

Subsection (1) does not apply if:

(a)

the diagnostic imaging service (the additional service ) was rendered in relation to the person because the providing practitioner formed the opinion that the results obtained from the rendering of another diagnostic imaging service in relation to the person, pursuant to a subsection 16B(1) request, indicate that the additional service is necessary; and

(b)

the additional service is a service in relation to which a medicare benefit is payable regardless of whether the service is rendered on the request of a specialist or a consultant physician.

Note: Medicare benefit is only payable on some diagnostic imaging services if they are rendered on the request of a specialist or consultant physician. The additional service must not be one of those services.

Exemption—substituted services

(10A)

Subsection (1) does not apply if:

(a)

the diagnostic imaging service (the substituted service ) was rendered in relation to the person in substitution for another service for which a subsection 16B(1) request has been made; and

(b)

the substituted service was rendered because the providing practitioner formed the opinion that it would be more appropriate in the diagnosis of the person's condition to render the substituted service than the service requested; and

(c)

the substituted service would be accepted by the general body of specialists or consultant physicians in the specialty practised by the providing practitioner as more appropriate in the diagnosis of the person's condition than the service requested; and

(d)

before providing the substituted service, the providing practitioner has either consulted the practitioner who made the subsection 16B(1) request, or taken all reasonable steps to consult that practitioner; and

(e)

the substituted service is a service in relation to which a medicare benefit is payable regardless of whether the service is rendered on the request of a specialist or a consultant physician.

Note: Medicare benefit is only payable on some diagnostic imaging services if they are rendered on the request of a specialist or consultant physician. The substituted service must not be one of those services.

3 Section 23DV

Repeal the section, substitute:

23DV Application for remote area exemption

(1)

A medical practitioner may apply in writing to the Minister, in the form approved by the Minister, for a remote area exemption under section 23DX (an exemption from the requirements in subsection 16B(1)).

(2)

A practitioner may apply in writing to the Minister, in the form approved by the Minister, for a remote area exemption under section 23DXA to station diagnostic imaging equipment or an employee at specified premises of another practitioner.

4 Section 23DX

After "remote area exemption", insert "under this section".

Note: The heading to section 23DX is altered by adding at the end "—provision of services where requirements of subsection 16B(1) are not met"

5 After section 23DX

Insert:

23DXA Grant of remote area exemption—stationing diagnostic imaging equipment and employees at the premises of another practitioner

The Minister must, by written notice given to the applicant, grant a remote area exemption under this section to the applicant to station diagnostic imaging equipment or an employee at premises specified in the application if the Minister is satisfied that:

(a)

the application is in the form approved by the Minister; and

(b)

those premises are in an area that is a remote area for the purposes of this Division; and

(c)

the facilities for rendering diagnostic imaging services in that area (including facilities provided by practitioners visiting the area regularly and facilities provided by practitioners to whom a remote area exemption has been granted under section 23DX) are such that patients in the area would suffer physical or financial hardship if the exemption were not granted.

6 Subsection 23DY(1)

After "remote area exemption", insert "under section 23DX".

Note: The heading to section 23DY is altered by adding at the end "under section 23DX"

7 After section 23DY

Insert:

23DYA Restrictions on remote area exemptions under section 23DXA

(1)

If the Minister is satisfied that the physical or financial hardship referred to in paragraph 23DXA(c) would only be suffered if an exemption were not granted to station equipment of a particular kind or an employee qualified to render services of a particular kind at the premises of another practitioner, the Minister may, in the notice granting the remote area exemption under section 23DXA, restrict the remote area exemption to the stationing of equipment of that kind or an employee with qualifications to render services of that kind.

(2)

The notice must contain the reasons for any such restriction.

(3)

The person to whom the remote area exemption is granted may, at any time, apply in writing to the Minister, in the form approved by the Minister, for:

(a)

the restriction to be removed; or

(b)

its scope to be reduced.

(4)

The Minister may, within 60 days after such an application is made, give the applicant written notice requesting the applicant to give to the Minister such further information relating to the application as is specified in the notice.

(5)

If the Minister is satisfied that physical or financial hardship of a kind referred to in paragraph 23DXA(c) will be suffered if the restriction is not removed, or its scope is not reduced, the Minister must, by written notice given to the applicant, remove the restriction, or reduce its scope, accordingly.

8 Subsection 23DZ(1)

Omit "section 23DV or subsection 23DY(3)", substitute "section 23DV, subsection 23DY(3) or subsection 23DYA(3)".

9 Subparagraph 23DZ(2)(a)(i)

After "remote area exemption", insert "under the relevant section".

10 Subparagraph 23DZ(2)(a)(ii)

After "remote area exemption", insert "under the relevant section".

11 After paragraph 23DZ(2)(b)

Insert:

; or (c) in the case of an application under subsection 23DYA(3):

(i) at the end of 60 days after the application is made, a request has not been made to the applicant under subsection 23DYA(4) and the Minister has not given the applicant a written notice under subsection 23DYA(5); or
(ii) a request has been made under subsection 23DYA(4) and, at the end of 60 days after the request was made, the Minister has not given the applicant a written notice under subsection 23DYA(5);
12 Subsection 23DZC(1)

After "medical practitioner", insert "under section 23DX".

13 After subsection 23DZC(1)

Insert:

(1A)

The Minister may revoke a remote area exemption that has been granted to a practitioner under section 23DXA if the Minister is satisfied that:

(a)

the premises in relation to which the exemption has been granted are situated in an area that is no longer a remote area for the purposes of this Division; or

(b)

the facilities for rendering diagnostic imaging services in that area (including facilities provided by practitioners visiting the area regularly and facilities provided by practitioners to whom a remote area exemption has been granted under section 23DX) are no longer such that patients in the area would suffer physical or financial hardship if the exemption were revoked; or

(c)

where a Medicare Participation Review Committee has advised the Minister under subsection 124FF(6) that the remote area exemption should be revoked—the remote area exemption should be revoked for the reasons given by the Committee in its advice.

14 Subsection 23DZC(2)

Omit "The Minister must not revoke the remote area exemption unless:", substitute "The Minister must not revoke a remote area exemption unless:".

15 Section 23DZD

Repeal the section, substitute:

23DZD Review of decisions

Applications may be made to the Administrative Appeals Tribunal for review of:

(a)

a decision under subsection 23DY(1) to restrict a remote area exemption under section 23DX to certain R-type diagnostic imaging services; or

(b)

a decision under subsection 23DYA(1) to restrict a remote area exemption under section 23DXA to the station of equipment of a particular kind, or an employee with qualifications to perform services of a particular kind, at the premises of another practitioner; or

(c)

a decision under subsection 23DY(5) reducing the scope of a remote area exemption under section 23DX; or

(d)

a decision under subsection 23DYA(5) reducing the scope of a remote area exemption under section 23DXA; or

(e)

a decision refusing to grant a remote area exemption under section 23DX or 23DXA; or

(f)

a decision refusing an application under subsection 23DY(3) for:

(i) a restriction on a remote area exemption under section 23DX to be removed; or
(ii) the scope of such a restriction to be reduced; or

(g)

a decision refusing an application under subsection 23DYA(3) for:

(i) a restriction on a remote area exemption under section 23DXA to be removed; or
(ii) the scope of such a restriction to be reduced; or

(h)

a decision under section 23DZC revoking a remote area exemption under section 23DX or section 23DXA.

16 Paragraph 23DZG(g)

Repeal the paragraph, substitute:

(g)

the person is a practitioner who, while not covered by a remote area exemption under section 23DXA to station diagnostic imaging equipment or an employee at the premises of another practitioner, stations diagnostic imaging equipment or an employee at those premises (whether it is a full-time arrangement or not), so that diagnostic imaging services may be rendered to the practitioner's patients by or on behalf of the practitioner.

17 At the end of section 23DZG

Add:

(2)

A practitioner is covered by a remote area exemption under section 23DXA to station diagnostic imaging equipment or an employee at the premises of another practitioner if:

(a)

the practitioner has been granted an exemption under that section to station diagnostic imaging equipment or an employee at those premises; and

(b)

the exemption is in force; and

(c)

if the exemption is restricted under subsection 23DYA(1) to the stationing of equipment of a particular kind or an employee with qualifications to render services of a particular kind at the premises—the equipment is of that kind or the employee has qualifications to render services of that kind (as the case may be).

18 Subsection 124FF(6)

After "remote area exemption" (first occurring), insert "either under section 23DX or section 23DXA".

19 Application

The amendments made by items 16 and 17 of this Schedule apply where diagnostic imaging equipment or an employee is stationed, or remains stationed, at premises after 30 June 2003.