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Determinations/Health as made
This determination provides for classes of benefits, in relation to diagnostic imaging services, that would otherwise be unlawful under the Health Insurance Act 1973, to be permitted benefits.
Administered by: Health
Registered 15 Mar 2018
Tabling HistoryDate
Tabled Senate19-Mar-2018
Tabled HR26-Mar-2018

I, Celia Street, delegate of the Minister for Health, make this Determination under section 23DZZIG of the Health Insurance Act 1973.

Dated 13 March 2018

CELIA STREET

Assistant Secretary

Diagnostic Imaging and Pathology Branch

Medical Benefits Division

Department of Health


  

  

1              Name

                This Determination is the Health Insurance (Permitted benefits — diagnostic imaging services) Determination 2018.

2              Commencement

                This Determination commences on the day after it is registered.

3              Authority

                This Determination is made under section 23DZZIG of the Health Insurance Act 1973.

4              Definitions

                In this Determination:

Act means the Health Insurance Act 1973.

Note:   Diagnostic imaging equipment, diagnostic imaging service, hospital and specialist are defined in subsection 3(1) of the Act. Provider, requester and connected are defined in subsection 23DZZID(1) of the Act.

5              Repeal

                The Health Insurance (Permitted benefits – diagnostic imaging services) Determination 2008 is repealed.

6              Permitted benefits for diagnostic imaging services

         (1)   For section 23DZZIG of the Act, a benefit mentioned in Schedule 1 is a class of permitted benefit if:

                (a)    a beneficiary who is, or is connected to, a requester of a kind of diagnostic imaging service, asks for, or accepts, the benefit from a provider, or a person connected to a provider, of a kind of diagnostic imaging service; or

               (b)    a provider, or a person connected to a provider, of a kind of diagnostic imaging service offers or provides the benefit to a beneficiary who is, or is connected to, a requester of a kind of diagnostic imaging service.

         (2)   However, a benefit is not a permitted benefit if:

                (a)    it is related to the number, kind or value of requests for diagnostic imaging services made by a requester to a particular provider; or

               (b)    taken with other benefits of the same kind, it exceeds the number that would usually be needed by the beneficiary’s practice.


Schedule 1        Classes of permitted benefits

(section 6)

  

        1     Items related to diagnostic imaging that help the requester to read film or images, or to make requests for the rendering of services relating to diagnostic imaging, if:

              (a)      they do not have the effect of preventing the requester from reading film or images produced by a provider other than the provider of the benefit or making requests for the rendering of services relating to diagnostic imaging to a provider other than the provider of the benefit; and

              (b)      one of the following applies:

                         (i)    they can only be used for purposes connected with diagnostic imaging;

                        (ii)    if an item has more than 1 use — it has special features that help the requester to request the rendering of diagnostic imaging services or view images.

Examples

1   Light box

2   Requesting software

3   Digital imaging reading software

4   Monitor designed specifically to enable the requester to view images

        2     The provision of staff or diagnostic imaging equipment at premises of the beneficiary if:

              (a)     the premises are located more than 30 km by road from a radiology facility that is under the direction of a specialist in the specialty of diagnostic radiology; or

              (b)     the premises are a hospital; or

              (c)     the staff or equipment are stationed at the premises for the sole purpose of enabling services relating to diagnostic imaging to be rendered during a surgical procedure performed at the premises (including a procedure performed by fine needle aspiration).

        3     Free or discounted diagnostic imaging services to a patient who is, or is connected to, the requester.

          4     Educational material about diagnostic imaging, including material that may be given to patients.

        5     Education sessions on diagnostic imaging for the beneficiary if:

              (a)     the primary objective of the session is to provide relevant information about diagnostic imaging; and

              (b)     the venue is appropriate for the educational purpose of the session; and

              (c)     any hospitality given is secondary to the educational purpose of the session; and

              (d)     the cost of any hospitality is reasonable having regard to the venue and the conduct of the session; and

              (e)     no travel or accommodation costs of the beneficiary are paid by the provider of the benefit; and

              (f)      the session does not include, and is not held with, a sporting event or other entertainment.

Examples of topics for educational material or sessions

1   Appropriate requesting of diagnostic imaging services

2   Understanding results and reports for areas of diagnostic imaging and for particular processes

        6     Gifts or hospitality if:

              (a)     they are a non‑cash benefit that is not convertible to cash; and

              (b)     they are given infrequently and only in relation to a significant occasion; and

              (c)     they are not given as inducement, consideration or reward for the beneficiary requesting diagnostic imaging services from a particular provider; and

              (d)     the cost of the gift or hospitality is reasonable in the circumstances.

Examples

1        Flowers given because of the death of a family member of the beneficiary

2        Hospitality given for Christmas parties

          7     Diagnostic imaging request forms, promotional publications and promotional items, including material promoting the quality, convenience and cost to patients of diagnostic imaging services, if:

              (a)     it has no resale value for the beneficiary; and

              (b)     it is clearly identified as coming from the provider of the diagnostic imaging service.