Attachment E
EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Endoscopic and Endobronchial Ultrasound for Sampling and Diagnosis of Lung Cancer) 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 2008 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 (Endoscopic and Endobronchial Ultrasound for Sampling and Diagnosis of Lung Cancer) Determination 2009 (the Determination) will permit the payment of Medicare benefits for endoscopic ultrasound plus fine needle aspiration for the sampling and diagnosis of patients with presumed or known non-small cell lung cancer or mediastinal masses; and endobronchial ultrasound guided procedures for the sampling and diagnosis of patients with non-small cell lung cancer, mediastinal/hilar masses or peripheral lung lesions.
The Determination provides for two new items (item 30696 and 30710). Item 30696 will provide a service for the sampling and diagnosis of presumed or known non-small cell lung cancer or mediastinal masses. Item 30710 will provide a service for the sampling and diagnosis of non-small cell lung cancer, mediastinal/hilar masses or peripheral lung lesions.
This Determination has been made following evaluations of endoscopic and endobronchial ultrasound guided procedures for sampling and diagnosis of lung cancer by the Medical Services Advisory Committee (MSAC). The MSAC recommended that public funding be supported for these services. The MSAC provides advice to the Australian Government on evidence relating to the safety, effectiveness and cost-effectiveness of new medical technology and procedures.
The Determination will cease on 31 October 2009.
Details of the Determination are set out in the Attachment.
Consultation
Consultations took place between November 2008 and April 2009 with Medicare Australia, the Australian Medical Association (AMA), the Gastroenterological Society of Australia, the Thoracic Society of Australia & New Zealand, the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians. All parties support the introduction of the new items. However, the AMA brought to the Department’s attention that the new items may lead to some confusion and that some practitioners may attempt to claim associated imaging items in association with Endoscopic Ultrasound (EUS)-Fine Needle Aspiration (FNA). The Department has agreed to consult further with the AMA should this become an issue.
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 July 2009 and will cease to have effect at the end of 31 October 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 (as authorised by subsection 3C(3) of the Act).
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 the General Medical Services Table 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.