Amendments to the Health Insurance Act 1973 (the Act) relating to pathology and diagnostic imaging services funded under Medicare came into effect on 1 March 2008. The changes were introduced in the Health Insurance Amendment (Inappropriate and Prohibited Practices and Other Measures) Act 2007.
Inappropriate and Prohibited Practices amendmentsThe majority of the changes clarify and strengthen previous provisions in the Act that aim to prevent inducements or threats that may lead to referrals for pathology or diagnostic imaging services. A new range of criminal and civil penalties were also included in the amendments.
The changes are explained in the Frequently Asked Questions and Explanatory Guide to the Health Insurance Amendment (Inappropriate and Prohibited Practices and Other Measures) Act 2007 (PDF 179 KB)
Brochure - Changes to legislation relating to Pathology and Diagnostic Imaging (PDF 158 KB)
Supporting legislationThe amendments allow for legislative instruments to be made to support the prohibited practices provisions in the Act.
In December 2007, the Department released two Discussion Papers for comment relating to the proposed content of the supporting legislation.
Prohibited Pathology Practices - Discussion Paper (PDF 110 KB)
Prohibited Diagnostic Imaging Practices - Discussion Paper (PDF 102 KB)
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After comments on the discussion papers were taken into account, the Minister for Health and Ageing, the Hon Nicola Roxon MP, approved two Determinations – one for diagnostic imaging and one for pathology. The Determinations set out benefits that providers of pathology or diagnostic imaging services are permitted to provide to requesters, and the conditions under which they are permitted. The Determinations supplement the list of permitted benefits that are set out in the Act.
Health Insurance (Permitted benefits – diagnostic imaging services) Determination 2008
Health Insurance (Permitted benefits – pathology services) Determination 2008
Under the Act, payments for property, goods or services are permitted, provided that the payments are not substantially different from the market value of the property, goods or services exchanged.
Market Value RegulationsRegulations to support the Health Insurance Amendment (Inappropriate and Prohibited Practices and Other Measures) Act 2007 have been made. These Regulations [Health Insurance Amendment Regulations 2009 (No.2)] are referred to as the ‘Market Value Regulations’.
The purpose of the Regulations is to amend the Health Insurance Regulations 1975 to set out a method for determining the amount that is to be the market value of property, goods or services and a method of working out whether the amount of a payment or of consideration for property, goods or services is substantially different from the market value of the property, goods or services.
The changes are explained in a communication brochure titled “Changes to Laws Relating to Pathology and Diagnostic Imaging (PDF 454 KB)”. This brochure is a summary of the key issues and responsibilities for health practitioners who can request or provide pathology or diagnostic imaging services.
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It is important to familiarise yourself with the legislation and review any arrangements that may be affected. You may wish to seek independent legal advice to clarify the change in legislation and how it might impact your practice.