Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Ageing, Disabilities and Carers) Share this | Hansard source

Today we are dealing with the Health Insurance Amendment (Diagnostic Imaging Accreditation) Bill 2007. This bill proposes to amend the Health Insurance Act 1973 to create a framework for the operation of diagnostic imaging services in Australia. Diagnostic imaging, a growing area of medical technology, includes a range of diagnostic medical services, including ultrasound; computer tomography, or CT; nuclear medicine; radiography, or X-ray; magnetic resonance imaging, or MRI; positron emission tomography, or PET; and bone densitometry.

The Australian government provides Medicare rebates for a number of diagnostic imaging services which are listed in the Diagnostic Imaging Services Table. The relevant legislation which provides the framework includes the Health Insurance Act 1973, the Health Insurance Regulations of 1975 and the Health Insurance (Diagnostic Imaging Services Table) Regulations.

Management of diagnostic imaging under Medicare is through the radiology memorandum of understanding. The signatories to this radiology MOU are the government, represented by the Department of Health and Ageing, and sector representatives of the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association. The radiology MOU is one of four collaborative agreements between the government and diagnostic imaging representative organisations made as part of the 2003-04 budget process for managing Medicare funded diagnostic imaging services. There are additional MOUs for cardiac imaging, nuclear medicine imaging and obstetric and gynaecological ultrasound.

The radiology MOU is the largest of the diagnostic imaging MOUs. It accounts for around 80 per cent of all diagnostic imaging services under Medicare. In the 2005-06 financial year there were approximately 12.6 million services claimed under the radiology MOU, accounting for more than $1.2 billion per annum in Medicare benefits for services. These costs—$1.3 billion per annum—account for around 10 per cent of the total Medicare budget. Clearly, then, it is important that we ensure not only the quality of the diagnostic imaging services provided to millions of patients but also that the investment of Australian taxpayers in Medicare is well protected.

This bill seeks to create an overarching framework within the Health Insurance Act 1973 for the establishment and operation of accreditation schemes for diagnostic imaging services, as agreed to by the government and representatives of the sector as part of the negotiations for the radiology MOU in 2003. Under the scheme, all diagnostic imaging practices providing services under the radiology MOU will need to be accredited by an approved accreditation provider in order for Medicare benefits to be payable for the services they provide.

By allowing the minister to establish the rules and operational details of the accreditation scheme through a legislative instrument, the bill has been designed to enable the introduction of accreditation schemes for other diagnostic imaging services in the future without further amendments to the act. As I said earlier, diagnostic imaging is a growing area of medical technology and the legislation needs to recognise its dynamic nature.

Labor supports this legislation. However, we are disappointed that there is scant detail available as to how this accreditation process will work in practice. We support the intention and the need to establish such a process, but how many times have we had to say, ‘In principle, what the government is proposing is okay, but where is the detail’?

Labor knows that accreditation schemes are widely utilised in the health sector as a method for reviewing and improving systems of care and for ensuring that consumers receive quality services irrespective of who provides the services and the facilities in which they are provided. Labor also knows how important it is to get the most out of the scarce health dollar. We support measures which will result in efficiencies under Medicare and in the health system more broadly.

Given that diagnostic imaging services account for more than $1.3 billion per annum in Medicare benefits, Labor recognises that it is in the interests of the efficient working of Medicare and the broader health system that services are provided within a framework of continuous improvement in the delivery of safe and high-quality health care. Just as past Labor governments built Medicare, Labor believes that Medicare should be retained, defended and strengthened. An accreditation system for providers of diagnostic imaging services will help protect Medicare, the cornerstone of our health system.

I now turn to the provisions of the bill. The most significant changes are affected by items 5 and 11 of schedule 1. Item 5 inserts a new section, 16EA, to the Health Insurance Act 1973. It precludes the payment of Medicare benefits for diagnostic imaging services unless the procedures are carried out at premises which are accredited under a diagnostic imaging accreditation scheme to undertake a particular type of diagnostic imaging procedure. Where the images are captured off site—for example, by mobile services—they must be captured on equipment that is ordinarily located at a base for mobile diagnostic imaging equipment or at diagnostic imaging premises accredited to undertake that procedure. Item 11 inserts a new division 5, diagnostic imaging accreditation, into part 2B of the act, which sets out the framework for the establishment and operation of diagnostic imaging accreditation schemes.

A new section, 23DZZ1AA, allows the minister to establish, via legislative instruments, a diagnostic imaging accreditation scheme, or schemes, with approved persons who will be able to accredit practices for the purposes of the scheme. Under this section, the legislative instrument establishing a scheme can specify the conditions for accreditation and provide for any matters needed to create and administer the scheme. If the legislative instrument establishing a scheme confers a power or function on the minister in administering the scheme, subsection 23DZZ1AA(5) allows the minister to delegate these powers or functions to an officer, as defined in existing section 131 of the act:

(a)  an officer of the Department; or

(aa)  a person performing the duties of an office in the Department; or

(b)  the Medicare Australia CEO; or

(c)  an employee of Medicare Australia.

A new section, 23DZZ1AB, provides that the accreditation status of accredited practices for Medicare benefits will be recorded on the diagnostic imaging register. The type of information will be recorded and will be prescribed by regulations when the legislative instrument for the scheme is made. Another new section, 23DZZ1AC, outlines the process and features that a diagnostic accreditation scheme as outlined in the legislative instrument must include, including full and proper review mechanisms for reconsideration of an accreditation decision.

Another new section, 23DZZ1AD, deals with the reconsideration by the minister of accreditation decisions. It applies where an accreditation provider does not grant accreditation, renew accreditation or revokes accreditation or varies an existing accreditation status, such that there would be a reduction of Medicare benefit entitlements. According to the explanatory memorandum, the minister’s decision will not be reviewable by the Administrative Appeals Tribunal because the minister’s decision is a review of a decision of an approved accreditation provider, which itself will be required to have a full and proper review mechanism in place.

New section 23DZZ1AE makes clear that the proprietor of an unaccredited premises or base must notify their patient before the patient undertakes the diagnostic imaging procedure that Medicare benefits are not payable. The proprietor must also advise the patient of the reason why no Medicare benefit is payable—that is, that the premises are not accredited for the procedure the patient is requesting. The offence for unaccredited sites is a strict liability offence, carrying a fine of 10 penalty units for an individual, currently $1,100, and 30 penalty units for a corporation, currently $3,300.

New section 23DZZ1AF provides that, where the proprietor has failed to notify the patient of the accreditation status or where no Medicare benefit is payable, the amount of Medicare benefit paid to the patient in respect of a diagnostic imaging service is recoverable from the proprietor of a diagnostic imaging premises. This debt will be in addition to any fine imposed on the proprietor.

Another new section, 23DZZ1AG, imposes the same rights and responsibilities on partnerships for the purposes of accreditation arrangements. These are substantial changes proposed by the bill. The introduction of an accreditation scheme via a legislative instrument for radiologists is clearly aimed at improving standards within the sector and making proprietors liable if correct procedures are not followed. These are worthy objectives. Obviously, these accountability measures will also enhance the service experienced by consumers.

Items 1 to 4 are minor amendments, inserting new definitions and cross-references. Items 6 to 8 clarify sections in the act and align them with the new accreditation processes. Items 9 and 10 amend subsection 23DZT(2) and section 23DZU, respectively, to exclude details about the accreditation status of a practice site to be released in extracts published on the internet. Item 12 contains the transitional arrangements for practices in operation at the time the diagnostic imaging scheme comes into effect. According to the explanatory memorandum, as long as a practice has registered for accreditation before 1 July 2008 it will have provisional accreditation, and the services rendered by the practice will continue to be eligible for Medicare benefits until such time as the practice goes through the accreditation process. Item 13 provides that new sections 23DZZ1AE and 23DZZ1AF apply only to diagnostic imaging procedures carried out on or after 1 July 2008.

Subject to the passage of this legislation, the government has indicated that the commencement date for the proposed scheme will be 1 July 2008. Presumably, this will coincide with the commencement of the new MOU between the Commonwealth and the diagnostic imaging sector, as the current MOU runs from 1 July 2003 to the end of June 2008. Among the current MOU’s principles and objectives are objectives to promote access to quality, affordable radiology services and to improve the quality and delivery of radiology services. These are all worthy objectives. Labor considers that these objectives would be even better served by greater investment in, and a broader emphasis on, e-health, particularly teleradiology.

Debate interrupted.