Health Insurance Determination HS/6/01 (Amendment) HS/06/05

Overview

The Health Insurance Determination HS/6/05 was introduced in 2005 to amend the Health Insurance Determination HS/6/01 under the Health Insurance Act 1973. The primary purpose of this amendment was to remove five specific items related to solitary pulmonary nodules, non-small cell lung cancer, and epilepsy, while simultaneously making minor technical amendments for clarity and consistency with the Health Insurance (Positron Emission Tomography) Determination HS/07/05. This determination was made by the Minister for Health and Ageing and is intended to streamline and refine the services covered under the Health Insurance Act, ensuring they align with current medical practices and technological advancements. The determination followed consultations with relevant associations and Medicare Australia, as mandated by the Legislative Instruments Act 2003, and it came into effect the day after its registration on the Federal Register of Legislative Instruments.

Scope and Application

The Health Insurance Determination HS/6/05 amends Health Insurance Determination HS/6/01, which pertains to the listing of specific health services in the general medical services, pathology services, and diagnostic imaging services tables of the Health Insurance Act 1973. This Determination applies to health services that are not explicitly listed in the aforementioned tables but may be treated as if they were listed under certain conditions. The amendment deletes specific items related to solitary pulmonary nodules, non-small cell lung cancer, and epilepsy from the list of services and makes minor technical amendments for clarity and consistency. The jurisdictional reach of this Determination is federal, as it is an instrument under the Commonwealth’s legislative authority. The Determination applies to all entities and individuals involved in the provision and administration of health services covered under the Health Insurance Act 1973. The Determination does not specify any exclusions or thresholds but extends its application through the legislative instrument process as outlined in the Legislative Instruments Act 2003. The Determination comes into effect on the day after it is registered on the Federal Register of Legislative Instruments.

Key Provisions

The Health Insurance Determination HS/6/05 (Amendment) HS/6/01 amends the previous determination by removing five items related to solitary pulmonary nodules, non-small cell lung cancer, and epilepsy from the list of services covered under the Health Insurance Act 1973 (section 2). This amendment is effective from the day it is registered on the Federal Register of Legislative Instruments (section 2). The changes also incorporate minor technical adjustments to ensure consistency and clarity, particularly aligning with the Health Insurance (Positron Emission Tomography) Determination HS/07/05 (section 3). This legislation imposes specific obligations on the entities it governs, primarily ensuring that the health services previously listed are no longer covered unless they meet new criteria set forth in the amended determination. It mandates that certain diagnostic imaging services, such as those for positron emission tomography (PET), must now be rendered pursuant to a written request by a specialist or a consultant physician (section 5). The amendment also updates the references to ensure they align with the current regulations or those that replace them, such as the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000 (subsection 6(c)). Failure to comply with the provisions of the Health Insurance Act 1973 and the amended determination may result in legal consequences. However, the specific offences, penalties, or civil/criminal consequences for breaches are not detailed within the provided text. It is essential for practitioners to consult the full Act and relevant regulations to understand the full implications of non-compliance. The legislative framework ensures that the health services listed in the Act are appropriately regulated, and any deviations from the stipulated provisions may attract penalties as prescribed by the governing statutes.