EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Bone Densitometry) Determination HS/01/2007
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 an item in the diagnostic imaging 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 2006 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/02/2006
On 30 October 2006, the Minister for Health and Ageing made Health Insurance (Bone Densitometry) Determination HS/02/2006 (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 HS/01/2007
Health Insurance (Bone Densitometry) Determination HS/01/2007 (the Determination) remakes the Previous Determination and adds an additional bone densitometry service (item 12323).
As outlined above, Medicare subsidised bone densitometry services are currently available to patients who 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.
To coincide with the expanded eligibility for the osteoporosis medication ‘alendronate’ under the Pharmaceutical Benefits Scheme, the Government has decided to expand access to Medicare subsidised bone mineral density testing.
The addition of item 12323 will enable the payment of a Medicare benefit for a bone densitometry service performed on a patient aged 70 years or over.
Details of the Determination are set out in the Attachment.
Consultation
Consultation took place with the Pharmaceutical Benefits Advisory Committee, the Medical Services Advisory Committee, the Department of Veterans Affairs, Medicare Australia and the Australian Medical Association.
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 April 2007.
Section 3
Section 3 provides that the Determination revokes Health Insurance Determination HS/02/2006.
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 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
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.