EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Cataract Surgery) Determination 2009
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may determine in writing that a health service not listed in an item 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 2009 which are re-made 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 (Cataract surgery) Determination 2009 (the Determination) will permit the payment of Medicare benefits for cataract surgery.
The Determination provides for four items (item 42698, 42701, 42702 and 42718). Item 42698 will enable a Medicare benefit to be payable where a service for lens extraction is rendered. Item 42701 will enable a Medicare benefit to be payable where a service for the insertion of an artificial lens is rendered. Item 42702 will enable a Medicare benefit to be payable where a service for lens extraction and insertion of an artificial lens is rendered. Item 42718 will enable a Medicare benefit to be payable for the rendering of a service involving a complex lens extraction and insertion of an artificial lens with a surgical procedure time of 40 minutes or more.
This Determination has been made following the disallowance motion passed in the Senate on 28 October 2009 which disallowed items 42698, 42701, 42702 and 42718 from the Health Insurance (General Medical Services Table) Regulations 2009.
Details of the Determination are set out in the Attachment.
Consultation
Medicare Australia was consulted on the development of the new item for complex cataract procedures and the Royal Australian and New Zealand College of Ophthalmologists were consulted on the fee relativities for the cataract item structure and the new item for complex cataract procedures.
ATTACHMENT
Notes on sections in the Determination
Section 1
Section 1 provides the name of the Determination.
Section 2
Section 2 provides that the Determination commences on 1 November 2009.
Section 3
Section 3 defines terms used in this Determination. These terms are referred to in section 4 of the Determination.
Subsection 3(2) provides that a reference to a provision of an Act or Regulations, is a reference to the provision as in force from time to time.
Section 4
Subsection 4(a) provides that a relevant service specified in the Schedule to the Determination will 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 which provide for medical services or professional services.
Subsection 4(b) provides that a relevant service specified in the Schedule to the Determination is to be treated as if there were an item in Group T8 of the General Medical Services Table that related to the service and specified a fee for that service, being the fee specified in the Schedule to the Determination in relation to the service.
Schedule
The Schedule to the Determination sets out the relevant services, assigning the applicable item number, item descriptor and fee for each service.