EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 1)
Background
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister (or her delegate) may determine in writing that a specified 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 (the Regulations), which are re-made each year.
Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 1)
The purpose of the Determination is to provide retrospective legal authority for annual indexation that was applied from 1 November 2009 to the Medicare Benefits Schedule (MBS) fee for item 12250. The fee for item 12250 was indexed (increased) without a determination to reflect such an increase.
A home-based sleep study service is an overnight investigation for sleep apnoea for a period of at least 8 hours’ duration in an unsupervised setting (that is, a patient’s home, but may also be a hospital where a sleep technician is not in attendance), where the patient is wired up to a portable device (or devices) to record their brain wave activity, their heart rate and their respiratory function while they sleep (known as Level 2 sleep studies). Recordings from the device/s are provided to a qualified sleep medicine practitioner who analyses and reports the findings (that is, whether or not the patient has sleep apnoea and what treatment is required).
Item 12250 was introduced on an interim basis on 1 October 2008, pending Medical Services Advisory Committee (MSAC) assessment. MSAC provides advice to the Australian Government on evidence relating to the safety, clinical effectiveness and cost-effectiveness of new medical technologies and procedures.
Commencement
This determination is taken to have commenced on 1 November 2009, the date on which the fee for item 12250 was indexed on the MBS. The effect of the retrospective commencement is to authorise, from 1 November 2009, payment of Medicare benefits for the indexed (increased) fee amount provided in connection with the specified service.
Subsection 3C(2) of the Act provides that determinations made under subsection 3C(1) of the Act may be expressed to have taken effect from a day earlier than the day on which the determination is made. In accordance with subsection 12(3) of the Legislative Instruments Act 2003 (the LIA), the operation of subsection 12(2) of the LIA is subject to any contrary provision for commencement of the Determination in the Act. Therefore, the retrospective commencement of the Determination does not offend subsection 12(2) of the LIA.
Consultation
No consultation was necessary for the making of the Determination as the instrument is mechanical in nature and does not alter existing arrangements. In listing interim item 12250 in October 2008, the Department consulted the Australasian Sleep Association, the Thoracic Society of Australia and New Zealand, the Royal Australian College of General Practitioners, the Rural Doctors’ Association of Australia, the Australian Medical Association and Medicare Australia.
This Determination is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
ATTACHMENT
Details of the Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 1)
Section 1 – Name of Determination
Section 1 provides the name of the Determination is the Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 1)
Section 2 – Commencement and term
Section 2 provides that the Determination commences on 1 November 2009 and shall remain in force until midnight 31 October 2010.
Section 3 - Revocation
Section 3 specifies that the Determination revokes the Health Insurance (Home-Based Sleep Studies) Determination 2008.
Section 4 - Interpretation
Section 4 defines terms used in this Determination.
Section 5 – Circumstances where this Determination applies
Subsection 5(1) specifies the circumstances in which the Determination applies. The circumstances in relation to the relevant service are:
- for patients less than 18 years of age – the service is rendered by a qualified paediatric sleep medicine practitioner;
- for patients 18 years of age or older – the services is rendered by a qualified adult sleep medicine practitioner.
Subsection 5(2) provides that a person is a ‘qualified adult sleep medicine practitioner’ or a ‘qualified paediatric sleep medicine practitioner’ if they meet certain credentialling or training requirements.
Section 6 – Treatment of a relevant service
Subsection 6(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 6(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 – Specified Health Services
The Schedule to the Determination sets out the relevant service, assigning the applicable item number, item descriptor and fee for the service.