Health Insurance (Poly Implant Prosthese MRI) Determination 2012 (Cth)
Health Insurance (Poly Implant Prosthese MRI) Determination 2012
as amended
made under subsection 3C(1) of the Health Insurance Act 1973
Compilation start date: 27 November 2013
Includes amendments up to: Health Insurance (MRI for Patients 16 Years and Over and Capital Sensitivity Consequential Amendments) Determination 2013
Department of Health, Canberra
About this compilation
This compilation
This is a compilation of the Health Insurance (Poly Implant Prosthese MRI) Determination 2012 amended and in force on 27 November 2013. It includes any commenced amendment affecting the legislation to that date.
This compilation was prepared on 8 December 2013.
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of each amended provision.
Uncommenced amendments
The effect of uncommenced amendments is not reflected in the text of the compiled law but the text of the amendments is included in the endnotes.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Modifications
If a provision of the compiled law is affected by a modification that is in force, details are included in the endnotes.
Provisions ceasing to have effect
If a provision of the compiled law has expired or otherwise ceased to have effect in accordance with a provision of the law, details are included in the endnotes.
Contents
Name of Determination 2
Commencement 2
Definitions 2
Treatment of relevant services 3
Specification of relevant services 3
Supervision and reporting of relevant services 3
Requests for relevant services 4
Limitation on number of services 4
Modifying items 4
Schedule Relevant services and fees 5
Name of Determination
This Determination is the Health Insurance (Poly Implant Prosthese MRI) Determination 2012.
Commencement
This Determination will be taken to have commenced on 12 March 2012.
Definitions
(1) In this Determination:
Act means the Health Insurance Act 1973.
MRI means magnetic resonance imaging.
PIP implant means a silicone breast prosthesis manufactured by Poly Implant Prosthese.
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, other than clause 1.2.12 of the diagnostic imaging services table.
Note Clause 1.2.12 of the diagnostic imaging services table sets out the ‘multiple services rule’, which provides for reductions in the fees for diagnostic imaging services where multiple services are provided to the same patient on the same day, for example 2 or more diagnostic imaging services or one or more R-type diagnostic imaging service and one or more consultation service. The exclusion of clause 1.2.12 means that the services in the Determination will not be relevant in the application of the multiple services rule.
relevant service means a service specified in an item in Part 1 or Part 2 of the Schedule.
remote location means a place within Australia that is more than 30 kilometres by road from:
(a) a hospital that provides a radiology or computed tomography service under the direction of a specialist in the specialty of diagnostic radiology; or
(b) a free‑standing radiology or computed tomography facility under the direction of a specialist in the specialty of diagnostic radiology.
Schedule means the schedule to this Determination.
Note Unless a contrary intention appears, an expression used in this Determination has the same meaning as in the Health Insurance Act 1973 — see section 13 of the Legislative Instruments Act 2003. Expressions defined in the Health Insurance Act 1973 include:
·diagnostic imaging services table
·item
·medical practitioner
·professional service
·specialist
(2) 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 that provision 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.
Treatment of relevant services
(1) A relevant service in Part 1 of the Schedule, 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 Group I5 of the diagnostic imaging services table that:
(i) related to the service; and
(ii) specified for the service a fee for each State, being the fee mentioned in the item in the Schedule for the service.
(2) A relevant service in Part 2 of the Schedule, 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 Subgroup 22 of Group I5 of the diagnostic imaging services table that:
(i) related to the service; and
(ii) specified for the service a fee for each State, being the fee mentioned in the item in the Schedule for the service.
Note For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.
Specification of relevant services
(1) Paragraph 1.2.10(1)(a) of the diagnostic imaging services table shall be taken to have effect as if the relevant services were also specified in that paragraph.
(2) Clause 2.5.7 of the diagnostic imaging services table shall be taken to have effect as if the items in Part 1 of the Schedule were also specified in that clause.
Supervision and reporting of relevant services
An item in Part 1 of the Schedule applies only to a service:
(a) both:
(i) performed under the professional supervision of a specialist in
diagnostic radiology who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and
(ii) reported by a specialist in diagnostic radiology; or
(b) performed:
(i) in an emergency; or
(ii) because of medical necessity, in a remote location.
Requests for relevant services
(1) An item in Part 1 of the Schedule applies only to a service provided at the request of a medical practitioner.
(2) A request must be in writing and specify:
(a) that the patient is a person who has or is suspected of having a PIP implant; and
(b) whether the patient displays symptoms indicating that the implant has or may have ruptured.
Limitation on number of services
Items 63501 and 63502 do not apply to the service described in the item if a patient has been provided with the service described in either item in the previous 12 months.
Modifying items
(1) Subject to subsections (2), (3) and (4), if item 63498 or 63499 applies to a service in this Determination, the fee specified in the item applies in addition to the fee specified in the other item in this Determination that applies to the service.
(2) If 2 or more services described in item 63498 are performed for a person on the same day, the fee specified in that item applies to one of those services only.
(3) If 2 or more services described in item 63499 are performed for a person on the same day, the fee specified in that item applies to one of those services only.
(4) If:
(a) one or more services described in item 63498; and
(b) one or more services described in item 63499;
are performed for a person on the same day, the fee specified in item 63498 or item 63499, but not both those items, applies to one of those services only.
Schedule Relevant services and fees
(section 3)
Part 1
| Item | Service | Fee ($) |
| Subgroup 32 – Magnetic resonance imaging – PIP breast implant | ||
| 63501 | MRI – scan of one or both breasts for the evaluation of implant integrity where: (a) a dedicated breast coil is used; and (i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and | $500.00 |
| 63502 | MRI – scan of one or both breasts for the evaluation of implant integrity where: (a) a dedicated breast coil is used; and (i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and | $500.00 |
| 63504 | MRI – scan of one or both breasts for the evaluation of implant integrity where: (a) a dedicated breast coil is used; and (i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and | $500.00 |
| 63505 | MRI – scan of one or both breasts for the evaluation of implant integrity where: (a) a dedicated breast coil is used; and (i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and | $500.00 |
Part 2
| Item | Service | Fee ($) |
| 63498 | MRI service to which item 63501, 63502, 63504 or 63505 applies if: (a) the service is performed in accordance with sections 6 – 8 of this Determination; and (b) the service is performed on a person using intravenous or intra muscular sedation | $44.80 |
| 63499 | MRI service to which item 63501, 63502, 63504 or 63505 applies if: (a) the service is performed in accordance with sections 6 – 8 of this Determination; and (b) the service is performed on a person under anaesthetic in the presence of a medical practitioner who is qualified to perform an anaesthetic | $156.80 |
Endnotes
Endnote 1—About the endnotes
The endnotes provide details of the history of this legislation and its provisions. The following endnotes are included in each compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Endnote 5—Uncommenced amendments
Endnote 6—Modifications
Endnote 7—Misdescribed amendments
Endnote 8—Miscellaneous
If there is no information under a particular endnote, the word “none” will appear in square brackets after the endnote heading.
Abbreviation key—Endnote 2
The abbreviation key in this endnote sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended the compiled law. The information includes commencement information for amending laws and details of application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision level. It also includes information about any provisions that have expired or otherwise ceased to have effect in accordance with a provision of the compiled law.
Uncommenced amendments—Endnote 5
The effect of uncommenced amendments is not reflected in the text of the compiled law, but the text of the amendments is included in endnote 5.
Modifications—Endnote 6
If the compiled law is affected by a modification that is in force, details of the modification are included in endnote 6.
Misdescribed amendments—Endnote 7
An amendment is a misdescribed amendment if the effect of the amendment cannot be incorporated into the text of the compilation. Any misdescribed amendment is included in endnote 7.
Miscellaneous—Endnote 8
Endnote 8 includes any additional information that may be helpful for a reader of the compilation.
Endnote 2—Abbreviation key
| ad = added or inserted | pres = present |
| am = amended | prev = previous |
| c = clause(s) | (prev) = previously |
| Ch = Chapter(s) | Pt = Part(s) |
| def = definition(s) | r = regulation(s)/rule(s) |
| Dict = Dictionary | Reg = Regulation/Regulations |
| disallowed = disallowed by Parliament | reloc = relocated |
| Div = Division(s) | renum = renumbered |
| exp = expired or ceased to have effect | rep = repealed |
| hdg = heading(s) | rs = repealed and substituted |
| LI = legislative instrument | s = section(s) |
| LIA = Legislative Instruments Act 2003 | Sch = Schedule(s) |
| mod = modified/modification | Sdiv = Subdivision(s) |
| No = Number(s) | SLI = Select Legislative Instrument |
| o = order(s) | SR = Statutory Rules |
| Ord = Ordinance | Sub-Ch = Sub-Chapter(s) |
| orig = original | SubPt = Subpart(s) |
| par = paragraph(s)/subparagraph(s) | |
| /sub-subparagraph(s) |
Endnote 3—Legislation history
| Name | FRLI registration or gazettal | Commencement | Application, saving and transitional provisions |
| Health Insurance (Poly Implant Prosthese MRI) Determination 2012 | 13 March 2012 (see F2012L00566) | 12 March 2012 | |
| Health Insurance (Poly Implant Prosthese MRI) Amendment Determination 2012 (No. 1) | 30 March 2012 (see F2012L00724) | 12 March 2012 | ― |
| Health Insurance (Poly Implant Prosthese MRI) Amendment Determination 2012 (No. 2) | 30 April 2012 (see F2012L00957) | 1 May 2012 | ― |
| Health Insurance (MRI for Patients 16 Years and Over and Capital Sensitivity Consequential Amendments) Determination 2013 | 31 October 2013 (see F2013L01863) | Sch 2 (items 10 and 11): 27 November 2013 | ― |
Endnote 4—Amendment history
| Provision affected | How affected |
| s 3(1)……………………….. | am F2013L01863 |
| Note to s 3(1)………………. | am F2012L00724 |
| s 5…………………………. | am F2013L01863 |
| s 7………………………….. | am F2012L00724 |
Endnote 5—Uncommenced amendments [none]
Endnote 6—Modifications [none]
Endnote 7—Misdescribed amendments
This endnote sets out amendments of the Health Insurance (Poly Implant Prosthese MRI) Determination 2012 that have been misdescribed.
Health Insurance (Poly Implant Prosthese MRI) Amendment Determination 2012 (No. 2)
[1] Subsection 5(1), Specification of relevant services
omit
paragraph 1.2.5(1)(a)
insert
paragraph 1.2.5A(1)(a)
Endnote 8—Miscellaneous [none]
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