EXPLANATORY STATEMENT

Health Insurance Act 1973

Health Insurance (Endovenous Laser Therapy) Determination 2012

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 (the Determination) is to amend Medicare items 32520 and 32522 for endovenous laser therapy (ELT) to align rebates for the service with original policy intent, as recommended by the Medical Services Advisory Committee (MSAC) and approved in the 2011-2012 Budget.

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, 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. 

Monitoring of the items has disclosed that the billing of ELT with other varicose vein items on the same occasion has caused Medicare expenditure for the service to be higher than that recommended by MSAC and approved in the 2011-2012 Budget.  The Determination aligns Medicare rebates for the service by restricting items 32520 and 32522 from being billed with other varicose vein items on the same occasion.  These amendments will be interimly funded until the outcome of MSAC’s planned 18 month review.

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

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.

Since the listing of ELT items on the MBS on 1 November 2011, consultation has continued with the same professional medical groups via exchange of letters, emails and through telephone conversations.  These groups support the amendment of items 32520 and 32522 and the consequential alignment of Medicare rebates for ELT with original policy and Budget intent.

This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

The Determination commences 1 July 2012.

ATTACHMENT

Details of the Health Insurance (Endovenous Laser Therapy) Determination 2012

Section 1 – Name of Determination

Section 1 provides that the name of the Determination is the Health Insurance (Endovenous Laser Therapy) Determination 2012.

Section 2 – Commencement and term

Section 2 provides that the Determination commences on 1 July 2012.

Section 3 – Revocation

Section 3 specifies that the Determination revokes the Health Insurance (Endovenous Laser Therapy) Determination 2011.

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 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 the items applicable to the ELT service (32520 and 32522).  The item descriptors have been amended to clarify that the service includes ‘excision or injection of either tributaries or incompetent perforating veins, or both’ and may not be provided on the same occasion as a service described in any of items 32500, 32501, 32504 or 32507 of the General Medical Services Table as a Medicare-eligible service.