EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Endovenous Laser Therapy) Determination 2011
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may determine in writing that a health service not specified 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 specified. The Table is set out in the Health Insurance (General Medical Services Table) Regulations (the Regulations), which are re-made each year.
Purpose
The purpose of the Health Insurance (Endovenous Laser Therapy) Determination 2011 (the Determination) is to permit payment of Medicare benefits for endovenous laser therapy (ELT) from 1 November 2011 under two new Medicare items 32520 and 32522.
Background
ELT is a minimally invasive procedure to treat severe varicose veins, primarily performed in outpatient settings. It is an alternative treatment to in-hospital vein stripping, currently funded under Medicare items 32508 and 32511. ELT involves insertion of a laser probe into the long or short saphenous vein of the leg, with laser energy applied to heat and occlude diseased veins.
Item 32520 will enable the payment of Medicare benefits for abolition of venous reflux by occlusion of a primary or recurrent great (long) or small (short) saphenous vein of one leg. Item 32522 (applicable in approximately 10% of cases) will enable the payment of Medicare benefits for abolition of venous reflux by occlusion of a primary or recurrent great (long) and small (short) saphenous vein of one leg.
The Medical Services Advisory Committee (MSAC) provides advice to the Australian Government on evidence relating to the safety, clinical effectiveness and cost-effectiveness of new medical technologies, procedures and consultations. In March 2008, MSAC assessed that ELT was as safe and clinically effective as conventional vein stripping, however a cost effectiveness issue was identified. In December 2009, after re-evaluating cost-effectiveness, MSAC endorsed its March 2008 recommendation that public funding be supported for ELT, as long as the Medicare benefits are equivalent to its in-hospital comparator (surgical vein stripping) and Extended Medicare Safety Net (EMSN) benefits for the services are capped.
From 1 November 2011, EMSN benefits will be capped for each eligible service billed under items 32520 and 32522, by the Health Insurance (Extended Medicare Safety Net) Amendment Determination 2011 (No.3), which amends the Health Insurance (Extended Medicare Safety Net) Determination 2009. This approach is consistent with MSAC’s recommendation to limit the amount of benefits paid through the EMSN for ELT services.
Details of the Determination are in the Attachment.
Consultation
Since MSAC’s earlier decision in March 2008, the Department has been involved in ongoing consultation with the Australasian College of Phlebology, Australian and New Zealand Society of Phlebology, Australian and New Zealand Society for Vascular Surgery (within the Royal Australasian College of Surgeons) and the Royal Australian and New Zealand College of Radiologists. Earlier consultation occurred with the Royal Australian College of General Practitioners, who deferred opinion to medical organisations representing vein specialists.
Consultations have included face-to-face meetings, a vascular conference ‘question and answer’ session, teleconferences and exchanges of letters and emails. The relevant professional groups have endorsed the introduction of the new ELT items with EMSN benefit caps.
This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Determination commences 1 November 2011 and shall remain in force until midnight
31 October 2012.
ATTACHMENT
Details of the Health Insurance (Endovenous Laser Therapy) Determination 2011
Section 1 – Name of Determination
Section 1 provides that the name of the Determination is the Health Insurance (Endovenous Laser Therapy) Determination 2011.
Section 2 – Commencement and term
Section 2 provides that the Determination commences on 1 November 2011 and shall remain in force until midnight 31 October 2012.
Section 3 – Interpretation
Section 3 defines terms used in this Determination.
Section 4 – Treatment of a relevant service
Paragraph 4(a) provides that a relevant service (being a 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 relate to medical services or professional services.
Paragraph 4(b) provides that a relevant service 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 – Specified Health Services
The Schedule to the Determination specifies two new ELT services, assigning the applicable item numbers (32520 and 32522), item descriptors and fees for the services. The item descriptors for both services specify that the service includes all preparation and immediate clinical aftercare but does not include the performance of radiofrequency diathermy or radiofrequency ablation.