EXPLANATORY STATEMENT

Health Insurance Act 1973

Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 2)

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 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. 2)

The purpose of the Determination is to permit ongoing payment of Medicare benefits for home-based sleep studies (under Medicare Benefits Schedule (MBS) item 12250) ordered and analysed by practitioners qualified in the field of sleep medicine from 1 November 2010.  This Determination also indexes (increases) the MBS fee for item 12250 in the same manner that items in the General Medical Services Table are annually indexed.

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 from 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. 

In March 2010, MSAC recommended ongoing public funding for comprehensive (Level 2) home-based sleep studies on a referred basis.

Consultation

For interim item 12250 (introduced on 1 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, Medicare Australia and the Australian Medical Association.

Following the Minister’s approval to publicly release MSAC’s findings on home-based sleep studies (on 2 June 2010), the Department contacted the Australasian Sleep Association, the Thoracic Society of Australia and New Zealand, the Royal Australian College of General Practitioners, Medicare Australia and the Australian Medical Association regarding MSAC’s recommendations.

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

The Determination commences 1 November 2010 and shall remain in force until midnight

31 October 2011.

ATTACHMENT

Details of the Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 2)

Section 1 – Name of Determination

Section 1 provides the name of the Determination is the Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 2)

Section 2 – Commencement and term

Section 2 provides that the Determination commences on 1 November 2010 and shall remain in force until midnight 31 October 2011.

Section 3 – Revocation

Section 3 specifies that the Determination revokes the Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 1).

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.