EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Bone Densitometry) Determination 2011
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) of the Act is a legislative instrument (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
The Health Insurance (Bone Densitometry) Determination 2011 (‘the Determination’) revokes and replaces the Health Insurance (Bone Densitometry) Determination 2010 (‘the 2010 Determination’).
Health Insurance (Bone Densitometry) Determination 2011
The services specified in the Schedule to the Determination concern the provision of bone mineral density tests to patients who already have proven low bone mineral density or who are considered to be at high risk because they have had a fracture after minimal trauma, suffer from a condition that is associated with low bone mineral density such as chronic liver disease, or are on a course of treatment that may cause low bone mineral density.
The Determination will replace the 2010 Determination. The purpose of the Determination is to replace the fees with new fees, due to annual indexation. These changes will apply from
1 November 2011.
Details of the Determination are set out in the Attachment.
Commencement
The Determination commences on 1 November 2011.
Consultation
No consultation was undertaken in the making of the Determination as the changes to the Schedule are minor and machinery in nature and do not substantially alter existing arrangements.
ATTACHMENT
Details of the Health Insurance (Bone Densitometry) Determination 2011
Section 1 Name of Determination
Section 1 provides for the name of the Determination.
Section 2 Commencement
Section 2 provides that the Determination commences on 1 November 2011.
Section 3 Revocation
Section 3 provides that the Determination revokes the Health Insurance (Bone Densitometry) Determination 2010.
Section 4 Interpretation
Subsection 4(1) defines terms used in the Determination.
A key term is 'relevant service' which means a health service as defined in subsection 3C(8) of the Act that is specified in the Schedule to the Determination. There are seven 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 Treatment of a relevant service
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 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 Specified health services
The Schedule sets out the relevant services and assigns to each relevant service the applicable item number, item descriptor and fee.
Overview
The Health Insurance (Bone Densitometry) Determination 2011 was enacted to update the fees for bone densitometry services under the Health Insurance Act 1973. This legislation, issued by the Minister for Health and Ageing, addresses the need for regular indexation of fees for bone density tests, ensuring that they are treated as general medical services for the purposes of Medicare. The Determination aims to provide clarity and updated financial provisions for specified bone densitometry services, which are essential for patients with proven low bone mineral density or those at high risk due to various conditions or treatments. By replacing the 2010 Determination, it ensures that the fees align with current standards and economic adjustments, effective from 1 November 2011. The policy objective is to maintain equitable access to necessary diagnostic services within the Medicare framework.
Scope and Application
The Health Insurance (Bone Densitometry) Determination 2011 applies to specified health services related to bone mineral density tests. These services are provided to patients who have proven low bone mineral density, are at high risk due to factors such as having experienced a fracture after minimal trauma, suffer from conditions associated with low bone mineral density such as chronic liver disease, or are undergoing treatments that may cause low bone mineral density. The Determination ensures that these services are treated as if they were listed in the general medical services table under the Health Insurance Act 1973, thereby entitling them to the specified fees. This legislative instrument is a Commonwealth initiative, affecting health service providers and patients across Australia, and it commenced on 1 November 2011. The Determination revokes the previous 2010 version and updates the fees due to annual indexation. Notably, no consultation was undertaken for this Determination as the changes were considered minor and administrative in nature.
Key Provisions
The main operative sections of the Health Insurance (Bone Densitometry) Determination 2011 (the Determination) pertain to the treatment of specified bone mineral density tests as listed services under the Health Insurance Act 1973 (the Act). Section 5(a) of the Determination specifies that these bone densitometry services will be treated as if they are both professional and medical services, aligning with the provisions of the Act and the National Health Act 1953 (subsection 3C(1) of the Act). Section 5(b) further stipulates that these services will be treated as if there were an item in the general medical services table (the Table) that specifies a fee for these services, with the fee being that specified in the Schedule to the Determination.
The Determination imposes obligations on parties and entities by requiring bone densitometry services to be treated in the manner specified, ensuring they are recognised as both professional and medical services and that they have a corresponding fee listed in the Table. This treatment is applicable for the purposes of the Act and the National Health Act 1953 (subsection 3C(1) and paragraph 5(b) of the Determination). The obligation extends to the revocation of the previous Health Insurance (Bone Densitometry) Determination 2010, which is addressed in Section 3 of the Determination, ensuring that only the 2011 Determination is in effect from the commencement date.
Any breach of the provisions in the Determination may lead to civil or administrative consequences under the Act. However, the Explanatory Statement does not explicitly detail specific penalties or consequences for non-compliance. The Determination is a legislative instrument under the authority of the Minister for Health and Ageing, and any breaches could potentially result in administrative actions or penalties as prescribed under the overarching Health Insurance Act 1973 and other relevant legislation. The maximum penalties, if applicable, would be determined by the provisions of the Act and other relevant laws.