EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health and Ageing

Health Insurance Act 1973

Health Insurance (Amendment) Determination HS/04/2005

Subsection 3C(1) of the Health Insurance Act 1973 (“the Act”) allows the Minister to determine in writing that a specified health service (which is not listed in the Medicare Benefits Schedule) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed.

The effect of subsection 3C(4) of the Act is that a determination made under subsection 3C(1) of the Act is a legislative instrument for the purposes of the Legislative Instruments Act 2003. 

Section 3C determinations have previously been made for the following health services:

HS/4/1999 – bone densitometry testing;

HS/6/1999 – grafting of infrarenal abdominal aortic aneurysm;

HS/03/2001 – treatment by hyperbaric oxygen therapy of soft tissue radionecrosis or chronic or recurring wounds where hypoxia can be demonstrated;

HS/01/2002 – treatment of sacral nerve stimulation services;

HS/09/2002  – photodynamic therapy (Patients who commenced therapy after 1 June 2002);

HS/10/2002  – photodynamic therapy (Patients who commenced therapy before 1 June 2002);

HS/01/2005 – deep brain stimulation for Parkinson’s disease;

Allied health and dental services, dated 27 June 2005.

Health Insurance (Amendment) Determination HS/04/2005 (“the Determination”) amends each of the above determinations to provide for an increase in the fees for the services covered in these determinations.  This fee increase is in line with the general fee increase of 2.0 percent that is being applied to the Medicare Benefits Schedule (MBS) from 1 November 2005.

The Determination also amends:

• HS/04/2003 (botulinum toxin) to change the date of cessation from 30 April 2006 to the beginning of 1 November 2005, as the items it covers will be listed in the MBS from 1 November 2005.

The above determination was made to allow benefits to be paid until 30 April 2006, for botulinum toxin injection for certain indications which were in long-standing clinical usage but had not been approved by the Therapeutic Goods Administration (TGA). This was done to allow time for the drug sponsors to obtain these TGA approvals.  All the indications covered under the determination now have TGA approval.  Therefore the items will be transferred to the MBS for coverage from 1 November 2005, and accordingly the determination will cease from the beginning of 1 November 2005.  

• HS/01/2005 (deep brain stimulation for Parkinson’s Disease) to:

-          change the date of cessation from 30 April 2006 to the beginning of 1 November 2006 to allow sufficient time for a review by the Medical Services Advisory Committee (MSAC) to be completed;

-          add St Vincents Private Hospital, Victoria, to the list of ‘relevant centres’ in which deep brain stimulation (DBS) services may be performed, and

-          remove the restriction on item 40862 that the service must be performed in one of the ‘relevant centres’ listed in the above determination.

The above determination was introduced (originally under HS/07/2001) following a review by the MSAC, which recommended interim funding for DBS services conducted in ‘relevant centres’, until further data was available and had been reviewed. MSAC commenced this further review this year, but because of delays in the supply of data from Australian centres will not be able to complete the review until early-to-mid 2006.  Therefore the determination is being extended from 30 April 2006 to the beginning of 1 November 2006, by which time it is expected the outcome of the MSAC review will be available.

The effect of the second amendment is to add St Vincents Private Hospital, Victoria, to the list of ‘relevant centres’ in which DBS can be conducted.  It was not one of the original centres listed, but now has the equipment and appropriate arrangements in place to perform the services.

The effect of the third amendment (removal of the restriction on item 40862 to ‘relevant centres’) is to allow this service (programming) to be claimed if done elsewhere eg doctor’s rooms. The profession and manufacturer have provided evidence that this restriction is unnecessary, as 40862 is a routine outpatient service, unlike the other DBS services, which are surgical procedures. 

• HS/09/2002 (photodynamic therapy) to

-          increase the limit on the number of photodynamic therapy treatments allowed under this  determination from 10 to 15; and

-          include two new items (42991 and 43000) to cover the 11th to 15th treatments. 

The above determination (originally made under HS/05/2002) was introduced following a review by MSAC which recommended interim funding for photodynamic therapy services under specified circumstances. This included a limit on the number of treatments allowed to 10 services per patient. The effect of the above amendments is to increase the limit to 15 for patients who require more than 10 treatments, and introduce two new items to reflect this.  This follows representations from the profession in support of this amendment, to cover the small number of patients needing additional treatments.

Details of the Determination (HS/04/2005) are set out in the Attachment.

The Determination commences on 1 November 2005.

ATTACHMENT

NOTES ON CLAUSES

Clause 1 provides that the name of the Determination is the Health Insurance (Amendment) Determination HS/04/2005.

Clause 2 provides that the Determination commences on 1 November 2005.

Clause 3 provides for the amendment of various section 3C Determinations, as set out in the Schedules to the Determination. 

Schedule 1

Item 1 of Schedule 1 amends Health Insurance Determination HS/4/1999 to increase the fee for the service in that determination by 2 per cent.

Schedule 2

Items 1 and 2 of Schedule 2 amend Health Insurance Determination HS/6/1999 to increase the fees for the services in that determination by 2 per cent.

Schedule 3

Schedule 3 amends Health Insurance Determination HS/03/2001 to increase the fees for the services in that determination by 2 per cent.

Schedule 4

Items 1, 2 and 3 of Schedule 4 amend Health Insurance Determination HS/01/2002 to increase the fees for the services in that determination by 2 per cent.

Schedule 5

Items 1 to 8 of Schedule 5 amend Health Insurance (Photodynamic Therapy) Determination HS/09/2002 to

-          increase the fees for the services in that determination by 2 per cent;

-          increase the limit on the number of photodynamic therapy treatments allowed under this  determination from 10 to 15; and

-          include two new items (42991 and 43000) to cover the 11th to 15th treatments. 

Schedule 6

Items 1, 2, and 3 of Schedule 6 amend Health Insurance (Photodynamic Therapy) Determination HS/10/2002 to increase the fees for the services in that determination by 2 per cent.

Schedule 7

Schedule 7 amends Health Insurance (Botulinum Toxin) Determination HS/04/2003 to change the date of cessation from 30 April 2006 to the beginning of 1 November 2005.

Schedule 8

Items 1 to 10 of Schedule 8 amend Health Insurance (Deep Brain Stimulation for Parkinson’s Disease) Determination HS/01/2005 to:

-          increase the fees for the services in that determination by 2 per cent;

-          change the date of cessation from 30 April 2006 to the beginning of 1 November 2006;

-          add St Vincents Private Hospital, Victoria, to the list of relevant centres where the services may be performed; and

-          remove the restriction on item 40862 that the service must be performed in one of the ‘relevant centres’ listed in the above determination.

Schedule 9

Items 1 and 2 of Schedule 9 amend Health Insurance (Allied Health and Dental Services) Determination 2005, to increase the fees for the services in that determination by 2 per cent.