Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination 2015 (Cth)

Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination 2015

I, MARIA JOLLY, FIRST ASSISTANT SECRETARY, MEDICAL BENEFITS DIVISION, delegate of the Minister for Health, make this determination under subsection 3C(1) of the Health Insurance Act 1973.

Dated   19 November 2015

____________________________________

MARIA JOLLY
FIRST ASSISTANT SECRETARY
MEDICAL BENEFITS DIVISION

Contents

1.         Name of Determination     3
2.         Commencement               3

3.         Revocation of Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination HS/01/2006             3

4.         Interpretation        3
5.         Circumstances where this Determination applies    3
6.         Treatment of a relevant service      4

Schedule -        Specified health services              5

1.         Name of Determination

This Determination is the Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination 2015.

2.         Commencement

This Determination commences on 1 December 2015. 

3. Revocation of Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination HS/01/2006

This Determination revokes the Health Insurance (Diabetes Testing in Aboriginal and Torres Strait Islander Primary Health Care Sites) Determination HS/01/2006.

4.         Interpretation

(1)   In this Determination:

Act means the Health Insurance Act1973.

QAAMS Program means the program, known as the Quality Assurance in Aboriginal Medical Services Program, funded by the Department of Health as a program to provide education, training, quality assurance, quality control and on-going support services for point of care diabetes testing in Aboriginal Community Controlled Health Services and Aboriginal Medical Services.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.

Note Unless the contrary intention appears, expressions used in this Determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.

(2)   Unless the contrary intention appears, in this Determination a reference to a provision of the Act or regulations made under the Act as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.

5.         Circumstances where this Determination applies

This Determination applies to a relevant service only where all of the following circumstances apply:

(a)        the service is rendered by or on behalf of a medical practitioner; 

(b)        the practitioner referred to in paragraph (a), or the organisation for which the practitioner works, is participating in the QAAMS Program; and

(c)        the service is provided in accordance with that Program; and

(d)       the practitioner referred to in paragraph (a) has determined the service to be necessary for his or her patient.

6.    Treatment of a relevant service

A relevant service shall be treated as if:

(a)        it were both a professional service and a medical service for the purposes of the provisions of the Act, the National Health Act 1953, the Health Insurance Regulations 1975 and the National Health Regulations 1954 that make provision in respect of professional services or medical services, other than provisions that make provision for pathology services specifically; and

(b)        there were an item in the pathology services table that related to the relevant service and specified in respect of the service a fee in relation to a State, being the fee specified in the Schedule in relation to the State specified.

Schedule -   Specified health services

Item	Health Service	Fee for all States
73839	Quantitation of HbA1c (glycated haemoglobin) performed for the diagnosis of diabetes in asymptomatic patients at high risk - not more than once in a 12 month period.	$16.80
73840	Quantitation of glycosylated haemoglobin performed in the management of established diabetes – each test to a maximum of 4 tests in a 12 month period.	$17.00
73844	Quantitation of urinary microalbumin as determined by urine albumin excretion on a timed overnight urine sample or urine albumin/creatinine ratio as determined on a first morning urine sample in the management of established diabetes.	$20.35

Note       Section 3C (7) of the Act deems an internal Territory to form part of the State of New South Wales.