Health Insurance Legislation Amendment (Section 3C – Medical and Diagnostic Imaging Services) Determination 2020 (Cth)

Health Insurance Legislation Amendment (Section 3C – Medical and Diagnostic Imaging Services) Determination 2020

I, DAVID WEISS, delegate of the Minister for Health, make the following Determination.

Dated               24 April 2020

David Weiss

First Assistant Secretary

Medical Benefits Division

Health Financing Group

Department of Health

Contents

1  Name........................................................................................................................................ 1

2  Commencement........................................................................................................................ 1

3  Authority.................................................................................................................................. 1

4  Schedules................................................................................................................................. 1

Schedule 1— Amendments................................................................................................... 2

Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Determination 2019      2

Health Insurance (Section 3C General Medical Services – Mental Health Services for Bushfire Response) Determination 2020   2

Health Insurance (Optometric services) Determination 2016   2

Health Insurance (Section 3C General Medical Services—Transvaginal repair of pelvic organ prolapse and procedures for the excision of graft material) Determination 2018   2

Health Insurance (Health Care Homes) Determination 2017   3

Health Insurance (Section 3C Diagnostic Imaging Services – 3D Breast Tomosynthesis) Determination 2018          3

Health Insurance (Section 3C Diagnostic Imaging Services—Multiparametric MRI of the prostate) Determination 2018   4

Health Insurance (Section 3C General Medical Services - General Practitioner Telehealth Services) Determination 2018   5

1  Name

This instrument is the Health Insurance Legislation Amendment (Section 3C – Medical and Diagnostic Imaging Services) Determination 2020.

2  Commencement

(1)       Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

Commencement information
Column 1	Column 2	Column 3
Provisions	Commencement	Date/Details
1.  The whole of this instrument	1 May 2020

Note:        This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

(2)       Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3  Authority

This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.

4  Schedules

Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1— Amendments

Health Insurance (Section 3C General Medical Services – Heart Health Assessment No.2) Determination 2019

1  Subsection 7(1)

Omit “2.17.1” (wherever occurring), substitute “2.15.1”

2  Subsection 7(2)

Omit “2.17.14” (wherever occurring), substitute “2.15.14”

Health Insurance (Section 3C General Medical Services – Mental Health Services for Bushfire Response) Determination 2020 

3  Subsection 6(1)

Omit “1.2.4” (wherever occurring), substitute “1.2.5”

4  Subsection 6(2)

Omit “1.2.5” (wherever occurring), substitute “1.2.6”

5  Subsection 6(3)

Omit “1.2.6” (wherever occurring), substitute “1.2.7”

Health Insurance (Optometric services) Determination 2016

6  Subsection 4(1)

Repeal the definition of “institution”.

7 Subsection 14(1)

Omit “1.2.4” (wherever occurring), substitute “1.2.5”.

8  Subsection 14(2)

Repeal the subsection, substitute:

(2)     Clauses 1.2.8 and 1.2.9 of the general medical services table have effect as if items 10905 to 10948 were also specified in those clauses.

Health Insurance (Section 3C General Medical Services—Transvaginal repair of pelvic organ prolapse and procedures for the excision of graft material) Determination 2018

9  Subsection 7(1)

Repeal the subsection, substitute:

(1)        Clause 1.2.6 of the general medical services table shall have effect as if the items contained in the Schedule were also specified in subclause 1.2.6(1).

10  Subsection 7(2)

Repeal the subsection, substitute:

(2)        Clause 1.2.7 of the general medical services table shall have effect as if the items contained in the Schedule were also specified in subclause 1.2.7(1).

Health Insurance (Health Care Homes) Determination 2017

11  Section 8

Repeal the section (not including the heading), substitute:

“Clauses 1.2.8, 1.2.9 and 1.2.10 of the general medical service table have effect as if item 6087 were also specified in those provisions.”

Health Insurance (Section 3C Diagnostic Imaging Services – 3D Breast Tomosynthesis) Determination 2018

12  Subsection 6(1)

Omit “2.3.3”(wherever occurring),  substitute “2.3.5”.

13 Schedule 1 (below the heading)

Repeal the table, substitute:

Category 5 – Diagnostic Imaging Services
Group I3 – Diagnostic Radiology
Subgroup 10 – Radiographic Examination of Breasts
Item	Service	Fee ($)
59302	Three dimensional tomosynthesis of both breasts, if there is reason to suspect the presence of malignancy because of: a)      the past occurrence of breast malignancy in the patient; or b)    significant history of breast or ovarian malignancy in the patient’s family; or c)      symptoms or indications of breast disease found on examination of the patient by a medical practitioner Not being a service to which item 59300 applies (R)	202.00
59305	Three dimensional tomosynthesis of one breast, if there is reason to suspect the presence of malignancy because of: a)      the past occurrence of breast malignancy in the patient; or b)    significant history of breast or ovarian malignancy in the patient’s family; or c)      symptoms or indications of breast disease found on examination of the patient by a medical practitioner Not being a service to which item 59303 applies (R)	114.00

Health Insurance (Section 3C Diagnostic Imaging Services—Multiparametric MRI of the prostate) Determination 2018

14 Subsection 7(1)

Repeal the subsection, substitute:

(1)        For any particular patient, item 63541 is applicable not more than once in a 12 month period.”

15 Subsection 7(2)

Repeal the subsection, substitute:

(2)         For any particular patient, item 63543 is applicable:

(a)   at the time of diagnosis of prostate cancer; and

(b)   12 months following diagnosis; and

(c)   every third year thereafter; or

(d)   at any time if there is clinical concern from the specialist requesting the service in paragraph 6(1)(a).

16  Subsection 7(3)

Repeal the subsection, substitute:

(3)        Item 63543 is not applicable for the purposes of treatment planning or for monitoring after treatment of prostate cancer.

17 Schedule 1 (below the heading)

Repeal the table, substitute:

Category 5 – Diagnostic Imaging Services
Group I5 – Magnetic Resonance Imaging
Sub Group 19 – Scan of Body – For Specified Conditions
Item	Service	Fee ($)
63541	Multiparametric Magnetic Resonance Imaging scan of the prostate for the detection of cancer, if the request for the scan identifies: a)    that the patient is suspected of  developing prostate cancer, due to one    of the following: (i)     a digital rectal examination which is suspicious for prostate cancer; or (ii)    in a person under 70 years, at least two prostate specific antigen (PSA) tests performed within an interval of 1- 3 months are greater than 3.0 ng/ml, and the free/total PSA ratio is less than 25% or the repeat PSA exceeds 5.5 ng/ml; or (iii)   in a person under 70 years, whose risk of developing prostate cancer based on relevant family history is at least double the average risk, at least two PSA tests performed within an interval of 1- 3 months are greater than 2.0 ng/ml, and the free/total PSA  ratio is less than 25%; or (iv)   in a person 70 years or older, at least two PSA tests performed within an interval of 1- 3 months are greater than 5.5ng/ml and the free/total PSA ratio is less than 25%. b)     using a standardised image acquisition protocol involving T2 Weighted Imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated)  (R) (Anaes)	450.00
63543	Multiparametric Magnetic Resonance Imaging scan of the prostate for the assessment of cancer: a)   if the request for the scan identifies: (i)    the patient is under active surveillance following a confirmed diagnosis of prostate cancer by biopsy histopathology; and (ii)   the patient is not planning or undergoing treatment for prostate cancer. b)    using a standardised image acquisition protocol involving T2 Weighted Imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated)  (R) (Anaes)	450.00

Health Insurance (Section 3C General Medical Services - General Practitioner Telehealth Services) Determination 2018

18  Section 7

Omit “2.22.7”, substitute “2.20.7”.