Medicare-Eligibile MRI

$104M is available to ensure ongoing, affordable and convenient diagnostic imaging services for patients.

Background

As part of the 2009-10 Budget the Government announced detailed reviews of funding arrangements for diagnostic imaging and pathology services (‘the Review’), to ensure that it is paying the right amount of support for patients to access quality pathology and diagnostic imaging services, and consider whether there is any need for structural changes to the way these services are provided through Medicare.

In response to the Review, on 10 May 2011, the Government announced that it will provide $104.4 million over four years to implement the Diagnostic Imaging Review Reform Package (the Package).  The Diagnostic Imaging Review Reform Package will ensure ongoing, affordable and convenient diagnostic imaging services for patients, with a key focus on the staged expansion of patient access to Medicare-eligible MRI services.

The Diagnostic Imaging Review Reform Package will be implemented cooperatively with the sector, over a five-year timeframe commencing from 1 July 2011 until 30 June 2016, to improve the quality and value of diagnostic imaging services. The key elements of the Diagnostic Imaging Review Reform Package are:

• Addressing fee relativities and incentives;
• Ensuring appropriate requesting of diagnostic imaging;
• Enhancing the role of radiologists in appropriate imaging;
• Enhancing the Diagnostic Imaging Accreditation Scheme;
• Expanding patient access to MRI; and
• Increasing access to MRI services for primary care patients.

The Diagnostic Imaging Review Reform Package includes support to expand patient access and service provision of Medicare funded MRI services, supporting faster diagnosis and earlier detection of disease.  The Diagnostic Imaging Review Reform Package includes a number of MRI specific initiatives which seek to:

• standardise the operating arrangements of the 125 Medicare-eligible MRI units from 1 May 2012;
• provide an incentive for bulk-billing by increasing the bulk-billing incentive from 95% to 100% of the MBS fee from 1 May 2012;
• extend access to all Medicare-eligible MRI services to compliant Medicare-ineligible MRI units, operating in non-major cities from 1 November 2012;
• extend limited access to a suitable range of Medicare-eligible MRI services to compliant Medicare-ineligible MRI units, operating in major cities (as defined by the Australian Standard Geographical Classification – Remoteness Areas) from 1 November 2012;
• extend Medicare requesting rights to GPs for patients under 16 to a small set of clinically appropriate indications from 1 November 2012;
• extend access to Medicare eligibility for MRI items listed in the MBS for the staging of rectal and cervical cancer and the screening of breast cancer in women under 50 years of age for compliant Medicare-ineligible MRI units, operating in major cities from 1 November 2012;
• extend full Medicare eligibility to a further 12 MRI units over a four year period from 2012-2015 in identified areas of geographical or clinical need from 2012.
• extend Medicare requesting rights to GPs for all patients to a small set of clinically appropriate indications from 1 November 2013.

Areas of Need

The department has identified three area of need streams (see below).  When responding to the weighted criteria Applicants will be required to select two areas of need streams, the first will be a primary/major stream, and the second will be your secondary/minor stream.

Patient Group Stream

These patient groups may relate to particular medical/clinical conditions, and/or to a specific patient population. These could include:

• Aboriginal and Torres Strait Islander populations;
• populations with low socio-economic status;
• Patients with a greater demand for a specific type of MRI services such as cardiac or breast; and/or
• Populations with a higher incidence of obese patients.

Health Service Integration

The Health Service integration stream recognises that the integration of a Medicare-eligible MRI service into an area that already has a number of health services/facilities may contribute to better health outcomes for patients and improve the continuity of care.

These services could include:

• Regional Cancer Centres (RCC);
• GP super clinics;
• Medicare locals;
• Aboriginal Community Controlled Health Organisations; and/or
• State Government funded health services, including hospitals.

Geographical Distribution

The Geographical stream recognises that there may still be areas that do not have adequate access to Medicare-eligible MRI services.  Under the Diagnostic Imaging Review Reform Package the Government has committed to the expansion of Medicare-eligible MRI services into both rural and metropolitan areas.  To demonstrate a claim to be an area of need, applicants will need to provide data for the specified geographic area about:

• Serviceable patient population;
• Number of specialists likely to refer patients for MRI, as well as number of GPs; and
• Proximity to existing or expected Medicare-eligible MRI services.

Who Can Apply?

Diagnostic Imaging providers can submit an application under ITA DOHA 309/1112.  For legal and accountability reasons, only incorporated bodies are eligible to apply for funding under this program.  The types of organisations that may apply for funding include:

• Non-profit/charitable organisations.
• For profit organisations.
• Non-government health care providers.
• Government funded health care providers.
• Aged care providers.
• Aboriginal or Torres Strait Islander organisations.
• Local community groups.

The Australian Government proposed to extend Medicare eligibility to up to 12 MRI units over four years commencing 2012. ITA DOHA 309/1112 is designed to inform the Department about areas where there may be a need for Medicare-eligible MRI services.  The Department anticipates that the two successful Applicants that may gain Medicare eligibility in 2012 will be in a position to provide Medicare-eligible services as of November 2012.

Expert Assistance

We have specialist expertise in successfully assisting clients obtain health funding. Typical areas where we can assist include demonstrating knowledge and understanding of patient needs and how the establishment of a Medicare-eligible MRI service in the identified area of need will improve patient access and contribute to better health outcomes.

Other areas that we would assist with include:

Patient Group Stream: or

(a)     What is the Identified Patient Group and the estimated number of patients?

(b)     Why do you consider the identified Patient Group an area of need?

(c)    How do the health outcomes of the identified Patient Group compare to the broader population?

(d)    How would access to Medicare-eligible MRI services at the proposed location improve access to MRI services, for the identified Patient Group and other interventions contingent upon an MRI scan?

(e)    How would improved access to MRI services improve the health outcomes of the identified Patient Group?

Health Service Integration: or

(f)  What other health service facilities are available in identified area?

(g)  How does the existing health infrastructure in the area contribute to patient health outcomes?

(h)   How will a Medicare-eligible MRI service integrate within the identified health service infrastructure

(i)    How would a Medicare-eligible MRI service improve patient access to MRI services and other interventions contingent upon an MRI scan?

(j)  How will a Medicare-eligible MRI service improve patient health outcomes beyond the current health services available to patients?

Geographical

(k)   How many MRI services are available in the identified area?

(l)    What distance (in Kilometres) is the nearest Medicare-eligible MRI service to the identified location?

(m)  What is the projected patient catchment area of the identified location?

(n)   What is the population and does the population overlap with that of the closest Medicare-eligible MRI service?

(o)  How many requesting specialists and GPs deliver services to patients  in the catchment area either through a local practice or through an established telehealth network?

FAQ

Is this process (the Area of need ITA) a separate process to the expansion of Medicare eligibility to existing or planned units in Regional and Metropolitan location?

Yes, the Area of Need ITA process is a separate initiative under the Diagnostic Imaging Review Reform Package (Clause 34.4 of the ITA DOHA 309/1112).  The expansion of either full Medicare eligibility in regional locations or partial Medicare eligibility in metropolitan locations is a separate initiative the department is undertaking concurrent to ITA DOHA 309/1112.

The department is still assessing claims for Medicare eligibility under the ‘Expansion initiative’. If you have questions in relation to claims for Medicare eligibility under the expansion process please contact the MRI section on (02) 6289 9100 or via email to mri@health.gov.au

Is ITA DOHA 309/1112 for the procurement of a Medicare-eligible MRI unit?

ITA DOHA 309/1112 is for the provision of Medicare-eligible MRI services. As per Clause 46 the ITA does not make any provision for grant funding for the purchase and/or capital cost relating to an MRI unit.  ITA DOHA 309/1112 is for the provision of Medicare eligibility for MRI services.  If an organisation has an existing or planned Medicare-ineligible MRI unit they may wish to submit an application under ITA DOHA 309/1112.

Why do I need to register? Why can’t I just download the documents from somewhere?

The document is only available to applicants once they have registered their details on the Health Tenders website (www.health.gov.au/tenders).  Potential Applicants are required to register their details to ensure that the Department retains a list of interested/potential applicants. This list is used by the Department to inform potential applicants of an addendum to the ITA or responses to questions.

If you are not registered you may not receive any addendum issued by the Department and as a result may not be compliant against the requirements of the ITA.

Will the department hold a public briefing for ITA DOHA 309/1112?

No, the Department will not be holding a briefing.

Does ITA DOHA 309/112 apply for the 12 MRI units over the next 4 years? Do Applicants need to submit to be eligible for any of them or each year it will go out to tender?

ITA DOHA 309/1112 is intended to inform the Department of areas where there may be both a need for Medicare-eligible MRI services and a provider who is would be willing to provide them. This ITA may be utilized to extend Medicare eligibility to up to 12 MRI units from 2012 to 2015.

Could I arrange a time to discuss our application for ITA DOHA 309/1112?

The Department is not holding a public or individual briefing sessions.  Applicants are encouraged to email any questions or queries relating to ITA DOHA 309/1112 to MRI.ITA@health.gov.au.

What is the Department’s definition of a comprehensive practice? If we have a split location service (approximately 200m apart) doe that meet the comprehensive practice definition?

As per Clause 48.8 of ITA 309/1112, a comprehensive practice is a medical practice, or a radiology department of a hospital, that provides x-ray, ultrasound and computed tomography services.

The department will accept applications where the diagnostic imaging modalities of a practice are physically split between two locations. However the practice must operate in an integrated way and the physical distance between the identified locations/practices needs to be accessible by patients to enable access to the full range of diagnostic imaging services in spite of being physically located in a different building.

Closing Date

Applications for the current round. Please subscribe to our newsletter to be informed of future rounds. 

Recipients

On 21 June 2012, Health Minister Tanya Plibersek today announced another 30 regional licences for Medicare-rebated magnetic resonance imaging services.  Under a $104.4 million Diagnostic Imaging Review Reform Package, thousands of additional patients will benefit from having access to faster diagnosis of medical conditions and more timely choices of treatment.

This announcement will bring the total number of Medicare-eligible MRI services available in regional Australia to 64. On top of the 30 regional licences, the Government will also extend partial Medicare eligibility to 161 existing or planned MRI operators in metropolitan areas. This will mean greater access for patients to Medicare-eligible MRI services for breast cancers and the staging of rectal and cervical cancers. These changes will take effect from 1 November 2012.

 3 September 2012

Young patients in Western Sydney and regional NSW will benefit from new, state-of-the-art magnetic resonance imaging (MRI) facilities after the Children’s Hospital at Westmead unveiled its second MRI suite today.

The Minister for Health Tanya Plibersek opened the new MRI suite which is funded by $5 million from the Commonwealth Government.

“This new suite will give young patients better access to MRI scans, enabling quicker diagnosis and faster access to what can be life-saving treatments.

“It will offer advanced diagnostic capabilities for children – especially those with abnormalities of the brain, spinal cord, blood vessels, joints and internal organs.

“The suite will be used in conjunction with the existing MRI Suite which means reduced waiting times for MRI procedures.

As each MRI machine is a different strength, the new addition also allows the Hospital to better cater for the specific clinical needs of the patient,” said Ms Plibersek.

“This is great news for local families in Parramatta as well as across Western Sydney and regional NSW,” said Member for Parramatta, Ms Julie Owens.

“Every parent wants their child to receive high quality care and this MRI will allow the fantastic doctors, nurses and health professionals at the Children’s Hospital Westmead to expand the number of scans.

They currently conduct more than 4,000 MRI scans each year,” said Ms Owens.

Ms Plibersek also announced 161 MRI scanners in major cities around Australia were set to be granted Medicare eligibility for certain types of scans of some patients.

“I’m very happy to tell you that one of the new machines at Westmead is among those 161 scanners.”

Together with 30 new locations in regional areas announced in June, these new locations will increase the total number of Medicare-eligible MRI units from 125 in 2011 to 316 from 1 November this year.

“More than doubling the number of places where people can get MRIs will help thousands of people, including young patients at Westmead, to get accurate and timely diagnosis and treatment,” Ms Plibersek said.

Medicare rebates at the new locations will be available from 1 November 2012 for scans for rectal and cervical cancer, screening for breast cancer for women under 50 years of age, and six types of scans on children under 16 years of age.

“Families will be able to get referrals for their children from their GPs instead of going through the extra expense and waiting time to see a specialist,” Ms Plibersek said.

The Australian Government is also committed to making scans cheaper for patients through bulk billing. Since May 2012, the bulk-billing incentive for MRI scans has been 100 per cent of the scheduled fee.

The expansion of Medicare-eligible MRI units was part of the Australian Government’s $104.4 million diagnostic imaging reform package announced in May 2011.

For all media inquiries, please contact the Minister’s Office on 02 6277 7220

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