Health Insurance (Point of Care Testing in General Practice) Determination HS/03/2005 (Cth)
Health Insurance (Point of Care Testing
in General Practice) Determination HS/03/2005
__________________________________________________________________
I, TONY ABBOTT, Minister for Health and Ageing, make this Determination under subsection 3C (1) of the Health Insurance Act 1973.
Dated 31/8/ 2005
TONY ABBOTT
Minister for Health and Ageing
Contents
1.Name of Determination 3
2.Commencement 3
3.Interpretation 3
4.Circumstances where this Determination applies 4
5.Treatment of certain pathology services 5
Schedule - Specified health services 6
Name of Determination
This Determination is the Health Insurance (Point of Care Testing
in General Practice) Determination HS/03/2005.
Commencement
This Determination commences on 1 September 2005.
Interpretation
In this Determination:
Act means the Health Insurance Act 1973.
consent form means a form that has been approved by an Ethics Committee and notified to the Trial manager as the necessary consent form for a relevant service.
designated general practice for a medical practitioner means a medical practice, described by a location, accredited for the purposes of the PoCT trial and to which the practitioner's PoCT accreditation relates.
Ethics Committee means an ethics committee, established in accordance with the National Statement on Ethical Conduct in Research Involving Humans (2004) made for the purposes of the National Health and Medical Research Council Act 1992, that is responsible for the PoCT trial or any part of the trial.
patient participating in the PoCT trial means a patient referred to in paragraph 4 (2) (c).
PoCT or PoCT trial means the program, known as the Point of Care Testing in General Practice Trial, funded by the Department of Health and Ageing as a trial for selected medical practitioners to render relevant services.
Note The trial is discussed in the report Design for a Trial and an Evaluation Framework for the Introduction of Point of Care Testing in General Practice in Australia, available on the Department's homepage or on request to the Department.
relevant service means a health service, as defined in subsection 3C (8) (a) of the Act, that is specified in the Schedule.
Trial manager means Adelaide Research and Innovation Pty Ltd [ACN 008 027 085] or another organisation which is party to a contract with the Commonwealth for the purposes of the PoCT trial and is designated in that contract as the Trial manager.
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.
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.
Circumstances where this Determination applies
This Determination applies to a relevant service in the following circumstances:
(a)where the service is rendered after 31 August 2005 but before 1 March 2007 by or on behalf of a medical practitioner participating in the PoCT trial; and
(b)the practitioner referred to in paragraph (a) has determined the service to be necessary for his or her patient participating in the PoCT trial; and
(c)the service is bulk-billed.
Note The circumstance in paragraph (b) mirrors the requirement in section 16A(1)(a) of the Act that the treating practitioner requesting a pathology service must determine that the service is necessary.
A medical practitioner is participating in the PoCT trial if, and only if:
(a)the practitioner has completed the training provided as part of the PoCT trial and is accredited for the purposes of the PoCT trial; and
(b)the relevant service is rendered by or on behalf of the practitioner:
(i)at the designated general practice to which the practitioner's accreditation relates; and
(ii)for the purpose of monitoring an existing condition of a patient referred to in paragraph (c); and
(iii)as part of a consultation in respect of the patient's existing condition; and
Note For the avoidance of doubt, it is intended that a medicare benefit be payable in respect of both the consultation and the relevant service.
(c)the relevant service is rendered for a patient who:
(i)is 18 years or over; and
(ii)is participating in the PoCT trial in respect of an existing condition relevant to the trial and the relevant service is rendered for the proper monitoring of that condition; and
(iii)before the service is rendered, has given the practitioner a completed and signed consent form (or forms, as the case may be); and
(iv)the patient has not informed the practitioner, before the service is rendered, that he or she withdraws the consent referred to in this paragraph.
In this section, a relevant service is rendered on behalf of a medical practitioner participating in the PoCT trial if, and only if, the service is rendered:
(a)after the practitioner has determined that the service is necessary; and
(b)by a person who has completed the training provided as part of the PoCT trial and is accredited for the purposes of the PoCT trial.
A person or medical practice is accredited for the purposes of the PoCT trial if the person or principal of the medical practice, as the case may be, has:
(a)received notice in writing from the Trial manager that the person or practice has been accredited for the purposes of the PoCT trial; and
(b)the accreditation referred to in paragraph (a) remains in effect.
The accreditation referred to in subsection (4) is taken not to be in effect for the purpose of this Determination if the Trial manager has given notice in writing to the person or principal that the accreditation will cease on a specified date.
The date mentioned in subsection (5) is deemed to be the date that the accreditation ceases to have effect for the purposes of this Determination.
In this section, bulk-billed in relation to a relevant service means:
(a)a medicare benefit is payable to a person in respect of the service; and
(b)under an agreement entered into under section 20A(1) of the Act;
(i)the person assigns to the practitioner by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and
(ii)the practitioner accepts the assignment in full payment of his or her fee for the service provided.
Treatment of certain health services
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 and of the Health Insurance Regulations 1975 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 |
| 73815 |
|
|
| 73818 | For a patient participating in the PoCT trial, quantitation of fasting High Density Lipoprotein (HDL) cholesterol, total cholesterol and triglyceride levels in patients undergoing lipid lowering therapy. |
|
| 73824 | For a patient participating in the PoCT trial, 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. |
|
| 73827 | For a patient participating in the PoCT trial, determination of International Normalised Ratio (INR) in patients undergoing anticoagulant therapy. |
|
Note Section 3C (7) of the Act deems an internal Territory to form part of the State of New South Wales.
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