EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Duplex Scanning for Erectile Dysfunction) Amendment Determination 2011(No. 1)
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 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 (Diagnostic Imaging Services Table) Regulations, which are remade each year.
The Table contains items covering Duplex scanning services for erectile dysfunction. However these items are restricted to services provided by a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub-specialising in vascular surgery) or a consultant physician in nuclear medicine.
There is a medical practitioner, Dr Christopher McMahon, who has experience to render Duplex scanning services for erectile dysfunction but whose services would not normally attract a Medicare rebate because he is not a specialist or consultant physician in the specialities referred to above.
On the 24 December 1996 the Minister for Health and Family Services signed Health Insurance Determination HS/6/1996 (the HS/6/1996 Determination), which provided Medicare benefits for Duplex scanning services for erectile dysfunction performed by Dr Christopher McMahon. The Royal Australasian College of Radiologists, the Vascular Section of the Royal Australasian College of Surgeons, the Australian and New Zealand Association of Urological Surgeons and the Australian Medical Association supported the issue of the HS/6/1996 Determination.
On 3 November 1997 the Minister for Health and Family Services signed the Health Insurance Determination HS/5/1997 (the HS/5/1997 Determination), which revoked and replaced the HS/6/1996 Determination. The HS/5/1997 Determination differed from HS/6/1996 Determination in that it decreased the Schedule fee for items 55208 and 55211 in line with the fee decrease for the two equivalent items in the Table. The fee decrease was the result of the restructure of the vascular ultrasound items.
The HS/5/1997 Determination was revoked by the Health Insurance (Duplex Scanning for Erectile Dysfunction) Determination 2010 (the Determination), which commenced on 1 July 2010. The Health Insurance (Duplex Scanning for Erectile Dysfunction) Amendment Determination 2011 (No. 1) (the Amendment Determination) will amend the Determination.
The effect of the Amendment Determination is to ensure that Dr Christopher McMahon is subject to requirements that other diagnostic imaging providers must comply with under the Health Insurance (Diagnostic Imaging Capital Sensitivity) Determination 2011 (the Capital Sensitivity Determination). This is done by: a) requiring items in the Determination to be read for appropriate purposes as if they were items in the Capital Sensitivity Determination; and b) inserting two new items that provide for a Medicare rebate, where equipment used does not meet the definition of either “new effective life age” or “maximum extended life age” as set out in section 3(4) and (5) respectively of the Capital Sensitivity Determination.
Consultation
There has been ongoing consultation with stakeholders since the measure was announced. These consultations have helped shape the implementation arrangements including the new effective life period and the five-year extension period for appropriate upgrades, which differs from the original age restrictions based on the Australian Taxation Office depreciation schedule.
The Department will continue to work closely with stakeholders to develop the final form of the measure to apply from 1 July 2012.
Details of the Determination are set out in the Attachment.
This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
This Determination commences on 1 July 2011.
Authority: Section 3C of the Health Insurance Act 1973
ATTACHMENT
DETAILS OF THE HEALTH INSURANCE (DUPLEX SCANNING FOR ERECTILE DYSFUNCTION) AMENDMENT DETERMINATION 2011 (No. 1)
Section 1 Name of Determination
Section 1 provides for the name of the Amendment Determination, Health Insurance (Duplex Scanning for Erectile Dysfunction) Amendment Determination 2011 (No. 1)
Section 2 Commencement
Section 2 provides that the Amendment Determination commences on 1 July 2011.
Section 3 Revocation
Section 3 provides that Schedule 1 of the Amendment Determination amends the Determination
Schedule 1
Item [1] deletes the word “and” at the end of paragraph (a) in section 5.
Item [2] inserts the word “and” at the end of paragraph (b) in section 5 and inserts a new paragraph (c). Paragraph (c) provides that a relevant service shall have effect as if items referred to in Schedule 1 of the Determination were also specified as items in Group I1 of the Schedule to the Capital Sensitivity Determination as in force from time to time.
Item [3] inserts two new items into Schedule 1 of the Determination. These items have similar descriptors to the current items in the Determination but the Medicare rebate amount reflects where the services were provided by equipment that falls within the definition of either “new effective life age” or “maximum extended life age” as set out in section 3(4) and (5) respectively in the Captial Sensitivity Determination and will be the amount that would be paid if the two new items were located in the Capital Sensitivity Determination.