Health Insurance (Permitted benefits) Determination 2007

1 Name of Determination

This Determination is the Health Insurance (Permitted benefits — diagnostic imaging services) Determination 2008.

2 Commencement

This Determination commences on 1 March 2008.

3 Definition

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 and requester are defined in subsection 23DZZID (1) of the Act.

4 Permitted benefits for diagnostic imaging services

(1) For section 23DZZIG of the Act, a benefit mentioned in Schedule 1 is a 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 Permitted benefits

(section 4)

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 at least 30 km by road from a radiology facility that is under the direction of a specialist in 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

(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