Health Insurance (Section 3C General Medical Services – Extracorporeal Photopheresis for Chronic Graft Versus Host Disease) Determination 2022 (Cth)
Health Insurance (Section 3C General Medical Services – Extracorporeal Photopheresis for Chronic Graft Versus Host Disease) Determination 2022
I, Nigel Murray, delegate of the Minister for Health and Aged Care, make the following determination.
Dated 22 February 2022
Nigel Murray
Assistant Secretary
MBS Policy and Specialist Services Branch
Medical Benefits Division
Health Resourcing Group
Department of Health
Contents
1. Name....................................................................................................................................... 1
2. Commencement....................................................................................................................... 1
3. Authority................................................................................................................................. 1
4. Definitions............................................................................................................................... 1
5. Treatment of relevant services................................................................................................. 2
6. Requirements on the rendering practitioner.............................................................................. 2
7. Application of treatment cycle.................................................................................................. 2
8. Restriction on items.................................................................................................................. 2
Schedule – relevant services 4
1. Name
This instrument is the Health Insurance (Section 3C General Medical Services – Extracorporeal Photopheresis for Chronic Graft Versus Host Disease) Determination 2022.
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 | 1 March 2022 | |
Note: This table relates only to the provisions of this instrument as originally made.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. Definitions
In this instrument:
Act means the Health Insurance Act 1973.
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.
Pharmaceutical Benefits Scheme means the scheme for the supply of pharmaceutical benefits established under Part VII of the National Health Act 1953.
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 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.
5. 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.
6. Requirements on the rendering practitioner
(1) Clause 1.2.7 of the general medical services table shall have effect as if the items contained in the Schedule of the Determination were also specified in the clause.
(2) Clause 1.2.11 of the general medical services table shall have effect as if the items contained in the Schedule of the Determination were also specified in the clause.
7. Application of treatment cycle
(1) For an item in the Schedule, treatment cycle means treatment that is required to deliver extracorporeal photopheresis that:
(a)begins on the day in which the treatment begins; and
(b)ends 12 weeks after the day specified in paragraph (a).
8. Restriction on items
Services rendered in certain circumstances or for certain purposes
(1) Clause 1.2.9 of the general medical services table shall have effect as if the items in the Schedule of the Determination were specified in the clause.
Services provided with harvesting, storage, in vitro processing, or injection of non‑haematopoietic stem cells
(2) Clause 1.2.10 of the general medical services table shall have effect as if the items in the Schedule of the Determination were specified in the clause.
Services connected with provision of pain pump for post‑surgical pain management
(3) Clause 5.1.1 of the general medical services table shall have effect as if the items in the Schedule of the Determination were specified in the clause.
Services provided on the same occasion as certain attendances
(4) An item in the Schedule does not apply to a service if it is associated with a service to which an item in Group A3 or Group A4 of the general medical service tables applies.
Schedule – relevant services
| Group T1—Miscellaneous Therapeutic Procedures | ||
| Column 1 Item | Column 2 Description | Column 3 Fee ($) |
| Subgroup 8—Haematology | ||
| 13761 | Extracorporeal photopheresis for the treatment of chronic graft-versus-host disease, if: (a) the person is: (i) has received allogeneic haematopoietic stem cell transplantation; and (ii) has been diagnosed with chronic graft versus host disease following the transplantation; and (iii) steroid treatment is clinically unsuitable as the disease is steroid refractory or the person is steroid-dependent or steroid-intolerant; and (b) the person has not previously received an extracorporeal photopheresis treatment cycle; and (c) the service is delivered using an integrated, closed extracorporeal photopheresis system; and (d) the service is provided in combination with the use of methoxalen that is listed on the Pharmaceutical Benefits Scheme; and (e) the service is provided by, or on behalf of, a specialist or consultant physician who: (i) is practising in the speciality of haematology or oncology; and (ii) has experience with allogeneic bone marrow transplantation. Applicable once per treatment cycle | 1,908.35 |
| 13762 | Extracorporeal photopheresis for the treatment of chronic graft-versus-host disease, if: (a) the person is: (i) has received allogeneic haematopoietic stem cell transplantation; and (ii) has been diagnosed with chronic graft versus host disease following the transplantation; and (iii) steroid treatment is clinically unsuitable as the disease is steroid refractory or the person is steroid-dependent or steroid-intolerant; and (b) the person has previously received an extracorporeal photopheresis treatment cycle and had a partial or complete response in at least one organ in response to treatment; and (c) the person requires further extracorporeal photopheresis; and (d) the service is delivered using an integrated, closed extracorporeal photopheresis system; and (e) the service is provided in combination with the use of methoxalen that is listed on the Pharmaceutical Benefits Scheme; and (f) the service is provided by, or on behalf of, a specialist or consultant physician who: (i) is practising in the speciality of haematology or oncology; and (ii) has experience with allogeneic bone marrow transplantation. Applicable once per treatment cycle | 1,908.35 |
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