EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Bone Densitometry) Determination 2007
Issued by the authority of the Minister for Health and Ageing
Background
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by writing, determine that a health service not listed in the general medical services table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed. The Table is set out in the Health Insurance (General Medical Services Table) Regulations which are remade each year.
A determination made under subsection 3C(1) is a legislative instrument (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
- Health Insurance (Bone Densitometry) Determination HS/01/2007
On 23 March 2007, the Minister for Health and Ageing made Health Insurance (Bone Densitometry) Determination HS/01/2007 (the Previous Determination) under subsection 3C(1) of the Act, which permitted the payment of Medicare benefit in relation to specified bone densitometry services.
The bone densitometry services specified in the Schedule to the Previous Determination concerned the provision of bone mineral density tests to patients who already had proven low bone mineral density or who were considered to be at high risk because they had had a fracture after minimal trauma, suffered from a condition that is associated with low bone mineral density such as chronic liver disease, or were on a course of treatment that may cause low bone mineral density.
Paragraph 5(a) of the Previous Determination provided that a bone densitometry service specified in the Schedule to the Previous Determination was to be treated as if it were both a professional service and a medical service for the purposes of the provisions of the Act, the National Health Act 1953 and regulations made under each Act that make provision for medical services or professional services.
Paragraph 5(b) of the Previous Determination provided that a bone densitometry service specified in the Schedule to the Previous Determination was to be treated as if there were an item in the general medical services table that related to the service and specified a fee in respect of that service, being the fee mentioned in the Schedule to the Previous Determination for that service.
- Health Insurance (Bone Densitometry) Determination 2007
Health Insurance (Bone Densitometry) Determination 2007 (the Determination) remakes the Previous Determination and provides for an increase of 2.2 percent in the fees in respect of the services covered by the Determination. This fee increase is in line with the general fee increase that is being applied to most services in the Table from 1 November 2007.
Details of the Determination are set out in the Attachment.
Consultation
No consultation was undertaken in the making of the Determination as the instrument is machinery in nature and does not substantially alter existing arrangements.
ATTACHMENT
Notes on sections
Section 1
Section 1 provides for the name of the Determination.
Section 2
Section 2 provides that the Determination commences on 1 November 2007.
Section 3
Section 3 provides that the Determination revokes Health Insurance (Bone Densitometry) Determination HS/01/2007.
Section 4
Subsection 4(1) defines terms used in the Determination.
A key term is 'relevant service' which means a service defined in paragraph 3C(8) of the Act that is specified in the Schedule to the Determination. There are six such relevant services in the Schedule.
Subsection 4(2) provides that a reference to a provision of an Act or regulations, including the Act, the National Health Act 1953 and the regulations made under these Acts, is a reference to the provision as in force from time to time (as authorised by subsection 3C(3) of the Act).
Section 5
Paragraph 5(a) provides that a relevant service specified in the Schedule to the Determination shall be treated as if it were both a professional service and a medical service for the purposes of the provisions of the Act, the National Health Act 1953 and regulations made under each Act that make provision for medical services or professional services.
Paragraph 5(b) provides that a relevant service specified in the Schedule to the Determination is to be treated as if there were an item in the general medical services table that related to the service and specified a fee in respect of that service, being the fee specified in the Schedule to the Determination in relation to the service.
Schedule
The Schedule sets out the relevant services and assigns to each service the applicable item number, item descriptor and fee.
Overview
The Health Insurance (Bone Densitometry) Determination 2007, enacted by the Minister for Health and Ageing, addresses the need for the inclusion of specific bone densitometry services in the Medicare benefits schedule. This Determination was introduced to amend the existing Health Insurance Act 1973 by including bone densitometry services that were not previously listed in the general medical services table. The policy objective of the Determination is to ensure that patients who require bone mineral density tests, particularly those at high risk of osteoporosis or who have already experienced related fractures or conditions, receive appropriate Medicare benefits. This legislative instrument provides an increase in fees for these services, aligning with the general fee adjustments applied to most services in the table from 1 November 2007. The Determination revokes the previous Health Insurance (Bone Densitometry) Determination HS/01/2007 and introduces new fee structures for specified bone densitometry services.
Scope and Application
The Health Insurance (Bone Densitometry) Determination 2007, issued under the authority of the Minister for Health and Ageing, pertains to the Health Insurance Act 1973. It applies to specified bone densitometry services, treating them as if they were listed in the general medical services table for the purpose of Medicare benefits. These services are aimed at patients with proven low bone mineral density, those at high risk of such conditions due to specific health issues or treatments, and individuals who have experienced fractures from minimal trauma. The Determination ensures these services are recognised as both professional and medical services under the Act and the National Health Act 1953, with applicable fees detailed in the Schedule. This Determination affects health practitioners and patients involved in bone densitometry services, ensuring that eligible services receive appropriate Medicare coverage. The Determination applies nationally, aligning with the federal structure of Australia's health insurance system. There are no exclusions or exemptions specified in the Determination, which revokes the previous Health Insurance (Bone Densitometry) Determination HS/01/2007, effective from 1 November 2007.
Key Provisions
The Health Insurance (Bone Densitometry) Determination 2007, under subsection 3C(1) of the Health Insurance Act 1973, specifies certain bone densitometry services that are eligible for Medicare benefits. These services are detailed in the Schedule to the Determination and are intended for patients who have proven low bone mineral density, are at high risk due to fractures from minimal trauma, have conditions associated with low bone mineral density such as chronic liver disease, or are undergoing treatments that may lead to low bone mineral density. The Determination (section 5(a)) stipulates that these specified services are treated as both professional and medical services under the Act and the National Health Act 1953, as well as any relevant regulations. Additionally, section 5(b) states that these services are considered to have a corresponding entry in the general medical services table, complete with a specified fee listed in the Schedule.
The Determination (section 2) came into effect on 1 November 2007, replacing the Health Insurance (Bone Densitometry) Determination HS/01/2007. It also includes a 2.2 percent increase in the fees for the specified services, aligning with the general fee increase applied to most services in the general medical services table from the same date. The relevant services, their descriptors, and associated fees are outlined in the attached Schedule. The term "relevant service" is defined in the Determination (section 4(1)) and refers to the services listed in the Schedule, which include six specific bone densitometry services.
The Determination imposes obligations on providers and patients to ensure that the services rendered are correctly classified as professional and medical services and that they fall within the specified fee structure. Service providers must ensure that the services meet the criteria outlined in the Schedule and comply with the terms of the Determination. Patients must also be aware of the eligibility criteria to ensure that the services they receive are covered under the Determination.
Breaches of the provisions set out in the Determination could potentially lead to civil or administrative penalties, depending on the nature and severity of the non-compliance. While the Determination itself does not explicitly outline penalties, non-compliance with the Health Insurance Act 1973 or related regulations could result in financial penalties, enforcement actions, or other legal consequences. The exact penalties would be in accordance with the overarching legislative framework governing health insurance services in Australia.