Health Insurance (Patient Episode Initiation) Determination 2011 (No. 1) (Cth)
Health Insurance (Patient Episode Initiation) Determination 2011 (No. 1)
I, RICHARD BARTLETT, delegate of the Minister for Health and Ageing, make this Determination under subsection 3C(1) of the Health Insurance Act 1973.
Dated 25 November 2011
__________________________
RICHARD BARTLETT
DELEGATE OF THE MINISTER FOR HEALTH AND AGEING
Contents
1.Name of Determination 3
2.Commencement and term 3
3.Interpretation 3
SCHEDULE 1 – SPECIFIED HEALTH SERVICES FROM 1 NOVEMBER
2007 4
1.Treatment of a relevant service in the table under clause 4 of this Schedule from 1 November 2007 4
2. Note in relation to Patient Episode Initiation items from 1 November 2007 4
3. Specification of items in the pathology services table from 1 November 2007 4
4. Table of items 4
SCHEDULE 2 - SPECIFIED HEALTH SERVICES FROM 1 NOVEMBER
2008 6
1.Treatment of a relevant service in the table under clause 4 of this Schedule from 1 November 2008 6
2. Note in relation to Patient Episode Initiation items from 1 November 2008 6
3. Specification of items in the pathology services table from 1 November 2008 6
4. Table of items 6
SCHEDULE 3 - SPECIFICATION OF ITEMS FROM 1 NOVEMBER
2009 7
1. Specification of items in the pathology services table from 1 November 2009 7
Part 1 Preliminary
Name of Determination
This Determination is the Health Insurance (Patient Episode Initiation) Determination 2011 (No.1).
Commencement and term
This Determination is taken to have commenced as follows:
(1) Part 1 will be taken to have commenced at 12.01 am on 1 November 2007.
(2) Schedule 1 will be taken to have commenced at 12.01 am on 1 November 2007 and remain in force until midnight 31 October 2008.
(3) Schedule 2 of this Determination will be taken to have commenced at 12.01am on 1 November 2008.
(4) Schedule 3 of this Determination will be taken to have commenced at 12.01am on 1 November 2009.
Interpretation
(1) In this Determination:
Act means the Health Insurance Act 1973.
relevant service means a health service, as defined in subsection 3C(8)
of the Act, that is specified in either clause 4 of Schedule 1 or clause 4 of Schedule 2 of this Determination.
NoteUnless 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 or the National Health Act 1953 or regulations made 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.
SCHEDULE 1 – SPECIFIED HEALTH SERVICES FROM 1 NOVEMBER 2007
1. Treatment of a relevant service in the table under clause 4 of this Schedule from 1 November 2007
When provided during the period specified in subsection 2(2) of this Determination, a relevant service specified in the table under clause 4 of this Schedule, shall be treated for the purposes of all provisions of the Act and of regulations made under the Act and all provisions of the National Health Act 1953 and of regulations made under the National Health Act 1953 that relate to professional services or medical services, as if:
(a)it were both a professional service and a medical service; and
(b)there was an item in Group 10 of the Health Insurance (Pathology Services Table) Regulations 2007, that:
i. related to the service; and
ii.specified in respect of the service a fee in relation to each State being the fee specified in the table under clause 4 of this Schedule, in relation to the service.
2. Note in relation to Patient Episode Initiation items from 1 November 2007
The note at Group P10 of Part 3 of Schedule 1 of the Health Insurance (Pathology Services Table) Regulations 2007 shall have effect as if the reference to “items 73922 to 73927” in that note includes a reference to “items 73902, 73904, 73906 and 73908”.
3. Specification of items in the pathology services table from 1 November 2007
Items 73928 to 73929 shall have effect as if items 73902, 73904, 73906 and 73908 in the table under clause 4 of this Schedule, were also specified in the description of the items in the pathology services table.
4. Table of Items
| Item | Health Service | Fee for all States ($) |
| 73902 | Initiation of a patient episode that consists of 1 or more services described in item 72838 (in circumstances other than those described in item 73904) from a person who is an in-patient of a hospital | 14.75 |
| 73904 | Initiation of a patient episode that consists of 1 or more services described in item 72838 if the person is: | 2.40 |
| Item | Health Service | Fee for all States ($) |
| 73906 | Initiation of a patient episode that consists only of 1 or more services described in item 72838 (in circumstances other than those described in item 73908) from a person who is not a patient of a hospital | 8.25 |
| 73908 | Initiation of a patient episode by a prescribed laboratory that consists of 1 or more services described in item 72838 from a person who is not a patient of a hospital | 2.40 |
SCHEDULE 2 – SPECIFIED HEALTH SERVICES FROM 1 NOVEMBER 2008
1. Treatment of a relevant service in the table under clause 4 of this Schedule from 1 November 2008
When provided during the period specified in subsection 2(3) of this Determination, a relevant service specified in the table under clause 4 of this Schedule, shall be treated for the purposes of all provisions of the Act and of regulations made under the Act and all provisions of the National Health Act 1953 and of regulations made under the National Health Act 1953 that relate to professional services or medical services, as if:
(a) it were both a professional service and a medical service; and
(b) there was an item in Group 10 of the pathology services table, that:
i. related to the service; and
ii. specified in respect of the service a fee in relation to each State being the fee specified in the table under clause 4 of this Schedule, in relation to the service.
Note in relation to Patient Episode Initiation items from 1 November
2008
The note at Group P10 of Part 3 of Schedule 1 of the pathology services table shall have effect as if the reference to “items 73922 to 73927” in that note includes a reference to “items 73914, 73916, 73918 and 73919”.
3. Specification of items in the pathology services table from 1 November 2008
Items 73928 to 73929 shall have effect as if items 73914, 73916, 73918 and 73919 in the table under clause 4 of this Schedule, were also specified in the description of the items in the pathology services table.
4. Table of Items
| Item | Health Service | Fee for all States ($) |
| 73914 | Initiation of a patient episode that consists of 1 or more services described in items 72827, 72828 and 72838 (in circumstances other than those described in item 73916) from a person who is an in-patient of a hospital | 14.75 |
| 73916 | Initiation of a patient episode that consists of 1 or more services described in items 72827, 72828 and 72838 if the person is: (a) a private patient of a recognised hospital; or (b) a private patient of a hospital who receives the service or services from a prescribed laboratory | 2.40 |
| 73918 | Initiation of a patient episode that consists only of 1 or more services described in items 72827, 72828 and 72838 (in circumstances other than those described in item 73919) from a person who is not a patient of a hospital | 8.25 |
| 73919 | Initiation of a patient episode by a prescribed laboratory that consists of 1 or more services described in items 72827, 72828 and 72838 from a person who is not a patient of a hospital | 2.40 |
SCHEDULE 3 - SPECIFICATION OF ITEMS FROM 1 NOVEMBER 2009
1. Specification of items in the pathology services table from 1 November 2009
(1) Item 74994 shall have effect as if item 73914 in the table under clause 4 of Schedule 2, were also specified in the description of item 74994 in the pathology services table.
(2) Item 74993 shall have effect as if item 73918 in the table under clause 4 of Schedule 2, were also specified in the description of item 74993 in the pathology services table.
(3) Item 74999 shall have effect as if items 73916 and 73919 in the table under clause 4 of Schedule 2, were also specified in the description of item 74999 in the pathology services table.
Note Subsection 3C(7) of the Act deems an internal territory to form part of the State of New South Wales.
Note
1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See
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