EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Endovenous Laser Therapy) Determination 2012 (No.2)
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 2012 (No.2) (the Determination) is to provide legal authority for annual indexation, from 1 November 2012, to the Medicare Benefits Schedule (MBS) fees for items 32520 and 32522 for endovenous laser therapy (ELT). Indexation will be applied in the same manner as for items in the Table, which are indexed annually.
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.
In December 2009, after re-evaluating cost-effectiveness, the Medical Services Advisory Committee (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 service are capped.
Following approval in the 2011-2012 Budget, the Health Insurance (Endovenous Laser Therapy) Determination 2011 permitted the payment of Medicare benefits for ELT under items 32520 and 32522 from 1 November 2011. Item 32520 enabled 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) enabled 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.
EMSN benefits are capped for each eligible service billed under these items by 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
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, were informed about the indexation of fees in September 2012.
This change is minor machinery in nature, being implementation of the annual indexing (increase) of fees for ELT items 32520 and 32522.
This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Determination commences 1 November 2012.
ATTACHMENT
Details of the Health Insurance (Endovenous Laser Therapy) Determination 2012 (No.2)
Section 1 – Name of Determination
Section 1 provides that the name of the Determination is the Health Insurance (Endovenous Laser Therapy) Determination 2012 (No.2).
Section 2 – Commencement and term
Section 2 provides that the Determination commences on 1 November 2012.
Section 3 – Revocation
Section 3 specifies that the Determination revokes the Health Insurance (Endovenous Laser Therapy) Determination 2012.
Section 4 – Interpretation
Section 4 defines terms used in this Determination.
Section 5 – Treatment of a relevant service
Paragraph 5(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 5(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 a fee is specified 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 sets out the relevant service, assigning the applicable item numbers, item descriptors and fees for the service.