Health Insurance (Photodynamic Therapy) Determination HS/04/2006 (Cth)

Health Insurance (Photodynamic Therapy) Determination HS/04/2006

__________________________________________________________________

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

Dated                30/10/2006

______Tony Abbott__________

Minister for Health and Ageing

Contents

1.Name of Determination   3

2.Commencement   3

3.Interpretation   3

4.Treatment of a relevant service   3

5.Circumstances where this Determination applies   3

6.Indexation of Fees   4

Schedule      Specified health services   5

1. Name of Determination

This Determination is the Health Insurance (Photodynamic Therapy) Determination HS/04/2006.

1. Commencement

This Determination is taken to have commenced on 1 November 2005.

1. Interpretation

1. In this Determination:

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

the Act means the Health Insurance Act 1973.

the 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, in this Determination a reference 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 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; and

(b)there were an item in the general medical 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 column 3 or column 4 of the Schedule in relation to the State specified.

1. Circumstances where this Determination applies

1. This Determination applies if the patient:

(a)    was diagnosed with choroidal neovascularisation resulting from an ocular disease or condition; and  

(b)   does not meet the clinical indications mentioned in items 42875 to 42999 of the general medical services table; and

(c)    commenced, before 1 November 2002, treatment for the condition mentioned in paragraph (a), being treatment that has not yet been completed.

1. Item 43008 of the Schedule applies up to a maximum of 16 times for the service described in that item, regardless of the number of patient attendances required to complete the treatment.

1. Item 43014 of the Schedule applies up to a maximum of 8 times for the service described in that item, regardless of the number of patient attendances required to complete the treatment.

1. Nothing in this section applies section 4 to more than 9 treatments by way of a relevant service for each eye.

6.        Indexation of Fees

(1)   The fee specified in Column 3 of the Schedule for a relevant service applies where the service is rendered to a patient after 31 October 2005 and before 1 November 2006.

1. The fee specified in Column 4 of the Schedule for a relevant service applies where the service is rendered to a patient after 31 October 2006.

Schedule         Specified health services

Column 1 - Item No.	Column 2 - Health Service	Column 3 - Schedule Fee for all States	Column 4 - Schedule Fee for all States
43005	Photodynamic therapy, one eye, initial treatment, including the infusion of verteporfin continuously through a peripheral vein, using a non-thermal laser at a wavelength of 689nm, for the treatment of choroidal neovascularisation resulting from an ocular disease or condition, not being a service covered by items 42875 to 42999.	$393.85	$402.10
43008	Photodynamic therapy, one eye, ongoing treatment following item 43005 or 43011, including the infusion of verteporfin continuously through a peripheral vein, using a non-thermal laser at a wavelength of 689nm, for the treatment of choroidal neovascularisation resulting from an ocular disease or condition, not being a service covered by items 42875 to 42999.	$393.85	$402.10
43011	Photodynamic therapy, both eyes, initial treatment, including the infusion of verteporfin continuously through a peripheral vein, using a non-thermal laser at a wavelength of 689nm, for the treatment of choroidal neovascularisation resulting from an ocular disease or condition, not being a service covered by items 42875 to 42999.	$472.65	$482.60
43014	Photodynamic therapy, both eyes, ongoing treatment following item 43005 or 43011, including the infusion of verteporfin continuously through a peripheral vein, using a non-thermal laser at a wavelength of 689nm, for the treatment of choroidal neovascularisation resulting from an ocular disease or condition, not being a service covered by items 42875 to 42999.	$472.65	$482.60
43017	Infusion of verteporfin for discontinued photodynamic therapy, where a session of therapy which would have been provided under item 43005, 43008, 43011 or 43014 has been discontinued on medical grounds.	$76.60	$78.20

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