Health Insurance (Section 3C Pathology Services—BRAF Gene Testing) Determination 2017 (Cth)

Health Insurance (Section 3C Pathology Services—BRAF Gene Testing) Determination 2017

I, TERESA GORONDI, delegate of the Minister for Health, make this Determination under subsection 3C(1) of the Health Insurance Act 1973. 

Dated           10 April 2017

Teresa Gorondi

Acting Assistant Secretary

Medical Specialist Services Branch

Medical Benefits Division

Department of Health

Contents

1.           Name of Determination

2.           Commencement

3.           Authority

4.           Definitions

5.           Treatment of relevant services

6.           Effect of specified provisions

Schedule – relevant services

1. Name of Determination

This Determination is the Health Insurance (Section 3C Pathology Services—BRAF Gene Testing) Determination 2017.

1. Commencement

This Determination commences on 1 May 2017.

1. Authority

This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.

1. Definitions

1. In this Determination:

Act means the Health Insurance Act 1973.

Pharmaceutical Benefits Scheme means the scheme for the supply of pharmaceutical benefits established under Part VII of the National Health Act 1953.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act, 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 the Schedule.

Schedule means the Schedule to this Determination.

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

·clinically relevant

·pathology services table

·item

·professional service

(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 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 relevant services

For subsection 3C(1) of the Act:

(a)          a relevant service, provided in accordance with this Determination and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

(i)it were both a professional service and a medical service; and

(ii)there were an item in Group P7 of the pathology services table that:

(A)related to the service; and

(B)specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.

1. Effect of specified provisions

(1)     Section 5 of the Health Insurance (Pathologist-determinable Services) Determination 2015 shall have effect if:

(a)          each relevant service was also specified in paragraph 5(a); and

(b)                   item 73336 was specified in the cell at table item 1 of column 1 (Pathology             service) of the table to subparagraph 5(b)(iii).

Schedule – relevant services

Group P7—Genetics
Item	Service	Fee ($)
73336	A test of tumour tissue from a patient with unresectable stage III or stage IV metastatic cutaneous melanoma, requested by, or on behalf of, a specialist or consultant physician, to determine if the requirements relating to BRAF V600 mutation status for access to dabrafenib or vemurafenib under the Pharmaceutical Benefits Scheme are fulfilled	230.95