Health Insurance (Faecal Incontinence and Peutz-Jeghers Syndrome) Determination 2009 (Cth)

Attachment C

Health Insurance (Faecal Incontinence and Peutz-Jeghers Syndrome) Determination 2009

__________________________________________________________________

I, NICOLA ROXON, Minister for Health and Ageing, make this Determination under subsection 3C (1) of the Health Insurance Act 1973.

Dated 10th February 2009      

NICOLA ROXON

________________________________

Minister for Health and Ageing

Contents

1.Name of Determination   3

2.Commencement and Cessation   3

3.Interpretation   3

4.Treatment of a relevant service   3

Schedule             Specified Health Service   4

1. Name of Determination

This Determination is the Health Insurance (Faecal Incontinence and Peutz-Jeghers Syndrome) Determination 2009.

1. Commencement and Cessation

1. This Determination commences on 1 March 2009.

1. This Determination will cease to have effect at the end of 30 June 2009.

1. Interpretation

1. In this Determination

Act means the Health Insurance Act 1973.

relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act

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

Schedule means the Schedule to this Determination

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.

1. Unless the contrary intention appears, a reference in this Determination to a provision of the Act or the National Health Act 1953 or regulations made under the Act or under the National Health Act 1953 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.

1. Treatment of a relevant service

A relevant service provided in accordance with this Determination is to be treated, for the relevant provisions, as if

(a)it were both a professional service and a medical service; and

(b)there were an item in the general medical services table that

i.        related to the service; and

ii.specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

Schedule           Specified Health Service

Item	Health Service	Fee for all States
11823	CAPSULE ENDOSCOPY to conduct small bowel surveillance of a patient diagnosed with Peutz-Jeghers syndrome, using a capsule endoscopy device approved by the Therapeutic Goods Administration.  The procedure includes the administration of the capsule, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered (not being a service associated with double balloon enteroscopy). Medicare benefits are only payable for this item if: a)         the service has been performed by a specialist or consultant              physician with endoscopic training that is recognised by the              Conjoint Committee for the Recognition of Training in              Gastrointestinal Endoscopy; and b)         the patient to whom the service is provided has been              conclusively diagnosed with Peutz-Jeghers syndrome (PJS) This item is available once in any two year period.	$1,883.90
32220	Insertion of an artificial bowel sphincter for severe faecal incontinence in the treatment of a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed (Anaes.) (Assist)	$835.05
32221	Removal or revision of an artificial bowel sphincter (with or without replacement) for severe faecal incontinence in the treatment of a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed (Anaes.) (Assist)	$835.05

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