Commonwealth: Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007 (Cth)

Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007 Act No. 83 of 2007 as amended This compilation was prepared on 1 April 2010 taking into account amendments up to Act No. 22 of 2010 The text of any of those amendments not in force on that date is appended in the Notes section The operation of amendments that have been incorporated may be affected by application provisions that are set out in the Notes section Prepared by the Office of Legislative Drafting and Publishing, Attorney‑General's Department, Canberra Contents 1 Short title [see Note 1] 2 Commencement 3 Schedule(s) Schedule 1—Amendments Health Insurance Act 1973 Notes An Act to amend the Health Insurance Act 1973, and for related purposes 1 Short title [see Note 1] This Act may be cited as the Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007. 2 Commencement (1) Each provision of this Act specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms. Commencement information Column 1 Column 2 Column 3 Provision(s) Commencement Date/Details 1. Sections 1 to 3 and anything in this Act not elsewhere covered by this table The day on which this Act receives the Royal Assent. 21 June 2007 2. Schedule 1, items 1 to 4 The day on which this Act receives the Royal Assent. 21 June 2007 3. Schedule 1, item 5 1 July 2008. 1 July 2008 4. Schedule 1, items 6 to 13 The day on which this Act receives the Royal Assent. 21 June 2007 Note: This table relates only to the provisions of this Act as originally passed by both Houses of the Parliament and assented to. It will not be expanded to deal with provisions inserted in this Act after assent. (2) Column 3 of the table contains additional information that is not part of this Act. Information in this column may be added to or edited in any published version of this Act. 3 Schedule(s) Each Act that is specified in a Schedule to this Act is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Act has effect according to its terms. Schedule 1—Amendments Health Insurance Act 1973 1 Subsection 3(1) Insert: approved accreditor has the meaning given by paragraph 23DZZIAA(1)(b). 2 Subsection 3(1) Insert: diagnostic imaging accreditation scheme means a scheme established by the Minister under section 23DZZIAA. 3 Subsection 16D(7) After "Division 4", insert "or 5". Note: The heading to section 16D is altered by adding at the end ": registration". 4 Subsection 16D(9) After "Division 4", insert "or 5". 5 After section 16E Insert: 16EA Medicare benefits not payable for certain diagnostic imaging services: accreditation (1) Unless the Minister otherwise directs, a medicare benefit is not payable in respect of a diagnostic imaging service rendered by or on behalf of a medical practitioner unless the diagnostic imaging procedure used in rendering that service is carried out: (a) at diagnostic imaging premises that are, or at a base for mobile diagnostic imaging equipment that is, accredited for that procedure under a diagnostic imaging accreditation scheme; or (b) using diagnostic imaging equipment that: (i) when not in use, is ordinarily located at a base for mobile diagnostic imaging equipment that is accredited for that procedure under a diagnostic imaging accreditation scheme; and (ii) is not ordinarily located at diagnostic imaging premises; or (c) using diagnostic imaging equipment that is ordinarily located at diagnostic imaging premises that are accredited for that procedure under a diagnostic imaging accreditation scheme. (2) Subsection (1) does not apply in relation to a diagnostic imaging service prescribed by the regulations for the purposes of this subsection. (3) A direction in writing under subsection (1) is not a legislative instrument. 6 Paragraph 23DZL(b) Repeal the paragraph, substitute: (b) the diagnostic imaging procedures carried out using the equipment: (i) are not carried out at the premises; or (ii) are frequently carried out off the premises; and 7 Section 23DZM Before "Diagnostic", insert "(1)". 8 At the end of section 23DZM Add: (2) A base for mobile diagnostic imaging equipment is not diagnostic imaging premises. 9 At the end of subsection 23DZT(2) Add: ; (f) any information required to be recorded for the premises or base under section 23DZZIAB (accreditation status). 10 At the end of section 23DZU Add: ; (e) any information required to be recorded for the premises or base under section 23DZZIAB (accreditation status). 11 At the end of Part IIB Add: Division 5—Diagnostic imaging accreditation 23DZZIAA Diagnostic imaging accreditation (1) The Minister may, by one or more legislative instruments: (a) establish one or more schemes under which diagnostic imaging premises and bases for mobile diagnostic imaging equipment may be accredited for diagnostic imaging procedures; and (b) approve one or more persons (approved accreditors) to accredit premises and bases under a scheme or schemes. (2) An instrument under subsection (1) may specify conditions with which an approved accreditor must comply. (3) An instrument under subsection (1) may provide for any matters necessary or convenient to be provided for in relation to a diagnostic imaging accreditation scheme. (4) Without limiting subsection (3), an instrument under subsection (1) may provide for any or all of the following in relation to a diagnostic imaging accreditation scheme: (a) how premises and bases become accredited; (b) the standards and conditions that are to be met for accreditation, including (without limitation) standards and conditions in relation to: (i) proprietors, staff, equipment and management of premises and bases; and (ii) persons who render diagnostic imaging services that use procedures for which premises or bases are accredited; and (iii) other matters associated with the carrying out of diagnostic imaging procedures and the rendering of diagnostic imaging services; (c) the charging of fees by approved accreditors in relation to services they provide; (d) when accreditation expires, how it may be renewed and when the renewal takes effect; (e) the circumstances in which accreditation may be varied or revoked, and when the variation or revocation takes effect; (f) directions by the Minister to approved accreditors; (g) the obligations of approved accreditors to keep the Minister informed about the operation of the scheme; (h) obligations to maintain records in relation to accredited premises and bases. (5) If an instrument under subsection (1) confers a power or function on the Minister, the Minister may, by signed instrument, delegate the power or function to an officer within the meaning of section 131. 23DZZIAB Diagnostic Imaging Register to include accreditation status (1) If: (a) an approved accreditor accredits diagnostic imaging premises, or a base for mobile diagnostic imaging equipment, under a diagnostic imaging accreditation scheme; or (b) such accreditation is renewed; the Minister must, after the day on which the accreditation or renewal takes effect, record on the Diagnostic Imaging Register, for the premises or base, the prescribed information in relation to the accreditation or renewal. (2) If the accreditation of diagnostic imaging premises or a base for mobile diagnostic imaging equipment under a diagnostic imaging accreditation scheme: (a) expires and is not renewed; or (b) is varied or revoked; the Minister must, after the day on which the expiry, variation or revocation takes effect, record on the Diagnostic Imaging Register, for the premises or base, the prescribed information in relation to the expiry, variation or revocation. 23DZZIAC Reconsideration of accreditation decisions (1) A diagnostic imaging accreditation scheme must include a process under which: (a) decisions made under the scheme in relation to accreditation of premises or a base are to be reconsidered on application by the proprietor of the premises or base concerned; and (b) the proprietor is to be notified of the result of the reconsideration and of the proprietor's rights under section 23DZZIAD. (2) A diagnostic imaging accreditation scheme must not allow: (a) a decision to refuse to renew accreditation, or to refuse to renew accreditation for a procedure; or (b) a decision to vary accreditation of diagnostic imaging premises or a base for mobile diagnostic imaging equipment so that the premises are or the base is accredited for fewer diagnostic imaging procedures; or (c) a decision to revoke accreditation (other than a decision made on the ground that there is a potential danger to public health or safety if the accreditation is not revoked); to take effect before the proprietor's rights to reconsideration under the scheme and under section 23DZZIAD are exhausted or have expired. 23DZZIAD Reconsideration by Minister of accreditation decisions (1) The proprietor of premises or a base may, after a first reconsideration of a decision in relation to accreditation of the premises or base in accordance with the process included in the scheme for the purposes of paragraph 23DZZIAC(1)(a), apply in writing to the Minister for further reconsideration of the decision. (2) The application must: (a) be made within 28 days after the date of the notice given to the proprietor of the result of the first reconsideration (see paragraph 23DZZIAC(1)(b)); and (b) set out the reasons why the proprietor believes the decision should be reconsidered. (3) The Minister may, by notice in writing to the proprietor, request the proprietor to provide, before the end of the period specified in the notice, specified further information in relation to the application. (4) If: (a) the proprietor applies before the end of the 28 days; and (b) if the Minister requests further information under subsection (3)—the proprietor provides the further information before the end of the period specified in the notice; the Minister must, by notice in writing to the proprietor: (c) affirm the decision; or (d) set aside the decision and make a new decision in substitution for it. (5) The Minister's decision takes effect on the day specified in the notice to the proprietor of the decision. Subject to subsection (6), the day may be earlier than the date of the notice. (6) A decision of the kind to which paragraph 23DZZIAC(2)(a), (b) or (c) applies must not take effect earlier than the date of the notice. 23DZZIAE Proprietor of unaccredited premises or base must notify patients that medicare benefit not payable (1) The proprietor of diagnostic imaging premises commits an offence if a diagnostic imaging procedure is carried out on a person in the following circumstances: (a) the procedure is carried out: (i) at the premises; or (ii) using equipment that is ordinarily located at the premises; and (b) medicare benefit is not payable in respect of a diagnostic imaging service rendered using the procedure; and (c) medicare benefit is not payable because the premises are not accredited for the procedure under a diagnostic imaging accreditation scheme; and (d) the proprietor has neither: (i) given the person notice in writing stating that medicare benefit will not be payable in respect of a diagnostic imaging service rendered using the procedure and the reasons why medicare benefit will not be payable; nor (ii) caused written notice to that effect to be displayed prominently at the place where the procedure is carried out. Penalty: 10 penalty units. (2) The proprietor of a base for mobile diagnostic imaging equipment commits an offence if a diagnostic imaging procedure is carried out on a person in the following circumstances: (a) the procedure is carried out: (i) at the base; or (ii) using equipment that is ordinarily located at the base when not in use, and is not ordinarily located at diagnostic imaging premises; and (b) medicare benefit is not payable in respect of a diagnostic imaging service rendered using the procedure; and (c) medicare benefit is not payable because the base is not accredited for that procedure under a diagnostic imaging accreditation scheme; and (d) the proprietor has neither: (i) given the person notice in writing stating that medicare benefit will not be payable in respect of a diagnostic imaging service rendered using the procedure and the reasons why medicare benefit will not be payable; nor (ii) caused written notice to that effect to be displayed prominently at the place where the procedure is carried out. Penalty: 10 penalty units. (3) Strict liability applies to subsections (1) and (2). Note: For strict liability, see section 6.1 of the Criminal Code. 23DZZIAF Debt recovery if proprietor fails to inform patient that premises or base not accredited (1) If: (a) a diagnostic imaging procedure used in rendering a diagnostic imaging service is carried out on a person at diagnostic imaging premises, or using equipment that is ordinarily located at diagnostic imaging premises; and (b) at the time the procedure is carried out, medicare benefit is not payable in respect of the service because the premises are not accredited for the procedure under a diagnostic imaging accreditation scheme; and (c) the proprietor of the premises failed to inform the person that no medicare benefit would be payable in respect of the service and of the reasons why no medicare benefit would be payable; and (d) after the procedure is carried out, the Minister directs under subsection 16EA(1) that medicare benefit is to be paid in respect of the service; an amount equal to the medicare benefit is recoverable from the proprietor as a debt due to the Commonwealth. (2) If: (a) a diagnostic imaging procedure used in rendering a diagnostic imaging service is carried out on a person: (i) at a base for mobile diagnostic imaging equipment; or (ii) using equipment that is ordinarily located at a base for mobile diagnostic equipment when not in use, and that is not ordinarily located at diagnostic imaging premises; and (b) at the time the procedure is carried out, medicare benefit is not payable in respect of the service because the base is not accredited for the procedure under a diagnostic imaging accreditation scheme; and (c) the proprietor of the base failed to inform the person that no medicare benefit would be payable in respect of the service and of the reasons why no medicare benefit would be payable; and (d) after the procedure is carried out, the Minister directs under subsection 16EA(1) that medicare benefit is to be paid for the service; an amount equal to the medicare benefit is recoverable from the proprietor as a debt due to the Commonwealth. 23DZZIAG Application of this Division to partnerships Section 23DZZI applies as if the references in that section to Division 4 included references to this Division. 12 Transitional provisions for existing premises and bases (1) A proprietor of: (a) diagnostic imaging premises; or (b) a base for mobile diagnostic imaging equipment; may register the premises or base for accreditation for one or more diagnostic imaging procedures, by lodging with a person designated by the Minister under subitem (5) a notice in the form (if any) approved by that person. (2) If the proprietor of premises or a base lodges a notice under subitem (1) before 1 July 2008, the premises are, or the base is, for the purposes of section 16EA of the Health Insurance Act 1973, taken to be accredited, for the procedures specified in the notice, under a diagnostic imaging accreditation scheme. This is deemed accreditation for those procedures. (3) The proprietor of premises that have or a base that has deemed accreditation for a procedure must apply for accreditation for that procedure under a diagnostic imaging accreditation scheme: (a) unless paragraph (b) applies—before 1 July 2009; or (b) if a diagnostic imaging accreditation scheme specifies another day for this purpose (which may be earlier or later)—before that other day. (4) Deemed accreditation of premises or a base for a procedure ceases on the earliest of the following days: (a) if the proprietor of the premises or base fails to apply for accreditation for that procedure under a diagnostic imaging scheme before the day that applies under subitem (3)—on that day; or (b) if an approved accreditor grants accreditation for that procedure under a diagnostic imaging accreditation scheme—on the day the accreditation takes effect; or (c) if an approved accreditor refuses accreditation for that procedure under a diagnostic imaging accreditation scheme—on the day after the proprietor's rights to reconsideration of that decision under the scheme and under section 23DZZIAD of the Health Insurance Act 1973 are exhausted or expire. (5) The Minister may, by legislative instrument, designate a person with whom notices under subitem (1) are to be lodged. (6) The Minister may, by signed instrument, delegate the Minister's power under subitem (5) to the Secretary of the Department or to an APS employee in the Department. (7) A designated person may charge fees in relation to registration under subitem (1). A designated person may charge different fees in relation to different kinds of registrations. (8) Notices cannot be lodged under subitem (1) on or after 1 July 2008. (9) Expressions used in this item that are defined in the Health Insurance Act 1973 have the same meaning as they have in that Act. 12A Transitional provisions for providers of non‑radiology services (1) This item applies to a proprietor of diagnostic imaging premises, or of a base for mobile diagnostic imaging equipment, if: (a) the proprietor is rendering a non‑radiology diagnostic imaging procedure at the premises or base before 30 June 2010; and (b) the premises or base is not accredited under a diagnostic imaging accreditation scheme. (2) A non‑radiology diagnostic imaging procedure is a diagnostic imaging procedure for services described in the following items in the diagnostic imaging services table: (a) each item in subgroup 2 of Group I1; (b) each item in subgroup 5 of Group I1; (c) items 59903 to 59925 (inclusive); (d) items 59971 to 59973 (inclusive); (e) each item in subgroup 16 of Group I3; (f) each item in Group I4. (3) The proprietor may register the premises or base for: (a) one or more non‑radiology diagnostic imaging procedures; or (b) one or more non‑radiology diagnostic imaging procedures and one or more other diagnostic imaging procedures. (4) The proprietor may do so by lodging a notice, no later than 30 June 2010, with the person who is designated by the Minister. (5) If the person designated by the Minister approves a form for the notice, the notice must be in that form. (6) The person designated by the Minister may charge a fee for lodgment of the notice. (7) If the proprietor registers the premises or base in accordance with subitems (3) to (6), the premises or base is taken to be accredited for the diagnostic imaging procedures specified in the notice, for the purposes of section 16EA of the Health Insurance Act 1973. This is deemed accreditation for those procedures. (8) The proprietor may add one or more diagnostic imaging procedures to the deemed accreditation by lodging a notice, no later than 30 June 2011, with the person who is designated by the Minister. (9) The deemed accreditation applies only to the premises or base specified in the notice, and cannot be transferred to other premises or another base. (10) The deemed accreditation is not affected by any change in the proprietor of the premises or base. (11) The deemed accreditation ends: (a) if a proprietor's application for accreditation for the diagnostic imaging procedures that are covered by the deemed accreditation is approved—on the day when the accreditation takes effect; or (b) if a proprietor's application for accreditation for the diagnostic imaging procedures that are covered by the deemed accreditation is refused—on the later of the following days: (i) 30 June 2011; (ii) the day when the proprietor's right to have the decision to refuse the application reconsidered is exhausted or expires under the scheme or under section 23DZZIAD of the Health Insurance Act 1973; or (c) in any other case—on 30 June 2011. (12) The Minister may, by legislative instrument, designate a person with whom notices under subitem (4) are to be lodged. (13) The Minister may, by signed instrument, delegate that power to: (a) the Secretary of the Department; or (b) an SES employee in the Department. (14) Expressions used in this item that are defined in the Health Insurance Act 1973 have the same meaning as they have in that Act. 13 Delayed application of certain provisions Sections 23DZZIAE and 23DZZIAF apply in relation to diagnostic imaging procedures carried out on or after 1 July 2008. Notes to the Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007 Note 1 The Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007 as shown in this compilation comprises Act No. 83, 2007 amended as indicated in the Tables below. Table of Acts Act Number Date Date of commencement Application, saving or transitional provisions and year of Assent Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2007 83, 2007 21 June 2007 See s. 2(1) Health Insurance Amendment (Diagnostic Imaging Accreditation) Act 2010 22, 2010 24 Mar 2010 Schedule 1: 1 Apr 2010 — Remainder: Royal Assent Table of Amendments ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted Provision affected How affected Schedule 1 Item 12A................ ad. No. 22, 2010