Health Insurance (Section 3C General Medical Services — Artificial Bowel Sphincter Services) Determination 2023 (Cth)

Health Insurance (Section 3C General Medical Services — Artificial Bowel Sphincter Services) Determination 2023

I, Daniel McCabe, delegate of the Minister for Health and Aged Care, make the following Determination.

Dated               25 May 2023              

Daniel McCabe

First Assistant Secretary

Medicare Benefits and Digital Health Division

Health Resourcing Group

Department of Health and Aged Care

Contents

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

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

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

4  Cessation.................................................................................................................................. 1

5  Definitions................................................................................................................................ 1

6  Treatment of relevant services.................................................................................................. 2

7  Application of provisions of the general medical services table................................................ 2

8  When artificial bowel sphincter is contraindicated for item 32221............................................ 3

9  Schedules................................................................................................................................. 3

Schedule 1—Relevant Services  4

1  Name

This instrument is the Health Insurance (Section 3C General Medical Services — Artificial Bowel Sphincter Services) Determination 2023.

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	Immediately after the commencement of the Health Insurance Legislation Amendment (2023 Measures No. 1) Regulations 2023.

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  Cessation

Unless revoked earlier, this instrument will cease on 30 June 2028.

5  Definitions

(1)In this instrument:

Act means the Health Insurance Act 1973.

(Anaes.) has the meaning given by subclause 5.9.4(1) of the general medical services table.

(H) has the meaning given by clause 1.1.7 of the general medical services table.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under the National Health act 1953, relating to medical services, professional services or items.

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

Schedule means a Schedule to this instrument.

Note: The following terms are defined in subsection 3(1) of the Act

·     clinically relevant service;

·     general medical services table;

·     item;

·     professional service.

(2)      Unless the contrary intention appears, a reference in this instrument to

a provision of the Act of 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.

6  Treatment of relevant services

For subsection 3C(1) of the Act, a relevant service, provided in accordance with this instrument and as a clinically relevant service, 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 the general medical services table that:

i.related to the service; and

ii.specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

7  Application of provisions of the general medical services table

1. Clause 1.2.6 of the general medical services table shall have effect as if the item in the Schedule of this instrument were specified in subsection (1) of that clause.

1. Clause 1.2.7 of the general medical services table shall have effect as if the item in the Schedule of this instrument were specified in subsection (1) of that clause.

1. Clause 5.1.1 of the general medical services table shall have effect as if the item in the Schedule of this instrument were specified for the purposes of that clause.

8  When artificial bowel sphincter is contraindicated for item 32221

(1)      An artificial bowel sphincter under item 32221 is contraindicated in:

(a)    patients with inflammatory bowel disease, pelvic sepsis, pregnancy, progressive degenerative diseases or a scarred or fragile perineum; and

(b)   patients who have had an adverse reaction to radiopaque solution; and

(c)    patients who engage in receptive anal intercourse.

9  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—Relevant Services

Group T8—Surgical operations
Column 1 Item	Column 2 Description	Column 3 Fee ($)
Subgroup 2—Colorectal
32221	Removal or revision of an artificial bowel sphincter (with or without replacement) for severe faecal incontinence in the treatment of a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed (Anaes.) (Assist.)	990.00