Health Insurance Determination HS/5/1997

Overview

The Health Insurance Determination HS/5/1997 was made under the Health Insurance Act 1973 by Michael Richard Lewis Wooldridge, the Minister for Health and Family Services, in response to the need to clarify and expand the scope of certain health services that could be covered by health insurance. The Act itself was introduced to provide for a national health insurance scheme and to facilitate access to healthcare services in Australia. This specific determination was intended to address the coverage of particular diagnostic imaging services related to male sexual health, ensuring these services would be treated as professional and medical services for the purposes of the Act. The policy objective was to provide clarity and ensure that these services could be reimbursed under the national health insurance scheme. This legislative instrument revokes the previous Health Insurance Determination HS/6/96 made on 24 December 1996, and it came into effect on 1 November 1997. The determination identifies specific health services, such as duplex scanning for vascular aetiology for impotence and other penile conditions, and specifies the fee for these services. The determination ensures these services are recognised and reimbursed under the provisions of the Health Insurance Act 1973, thus addressing a specific gap in the coverage of health services related to male sexual health.

Scope and Application

The Health Insurance Determination HS/5/1997, made under subsection 3C(1) of the Health Insurance Act 1973, outlines specific provisions for the treatment of certain health services as professional and medical services for various legislative purposes. This determination affects health services listed in the Schedule, including the detailed specification of particular diagnostic imaging services such as Duplex Scanning involving B mode ultrasound imaging and integrated Doppler flow measurement for specific medical conditions like impotence and priapism. These services are to be treated as if they were covered by prescribed items in the diagnostic imaging services table, with specified fees, thereby influencing the application of provisions in the Health Insurance Act 1973 and the National Health Act 1953. The geographic reach of this determination is nationwide, affecting all entities and individuals subject to the Health Insurance Act 1973 across Australia. Notably, this determination revokes the previous Health Insurance Determination HS/6/96, consolidating the legislative treatment of the specified health services under the new framework.

Key Provisions

The Health Insurance Determination HS/5/1997, made under the Health Insurance Act 1973, primarily addresses the treatment of certain health services as professional and medical services for the purposes of various sections of the Act and related regulations. Specifically, section 3(1) states that health services listed in the Schedule are treated as professional and medical services for the purposes of sections 4 of the National Health Act 1953, and multiple sections and subsections of the Health Insurance Act 1973 including 3(1), 3(5B), 8, 9, 10, and others, as well as for the purposes of certain regulations under the Health Insurance Regulations. Section 3(2) further specifies that these services are treated as if there were an item prescribed in the diagnostic imaging services table related to the service, with the fee specified in Column 3 opposite to the service. The obligations imposed by this determination on parties or entities include the requirement that the specified health services be rendered by a medical practitioner who must attend the patient in person at the practice location, either immediately prior to or during the service, and who must interpret the results and prepare a report. Additionally, the patient must be referred for this service by another medical practitioner. These provisions ensure that the services are provided under strict medical oversight and that they meet the criteria for being reimbursed under the Health Insurance Act. For breaches of the provisions set out in this determination, there are potential civil and criminal consequences. The maximum penalties for breaches can include fines and imprisonment, depending on the specific nature and severity of the breach. These penalties are designed to ensure compliance with the Act and to maintain the integrity of the health insurance system. The revocation of the previous determination, HS/6/96, indicates that any existing provisions have been superseded by this new determination, ensuring that the most current standards and practices are applied.