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

Administered by Department of Health, Disability and Ageing

Legislation au F2010L02724 Not in force Legislative Instrument

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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.

 

Overview

The Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 2) was enacted by the Australian government to provide ongoing payment of Medicare benefits for home-based sleep studies ordered and analysed by qualified practitioners in the field of sleep medicine from 1 November 2010. This Determination was made under subsection 3C(1) of the Health Insurance Act 1973, allowing the Minister or her delegate to determine that a health service not listed in the General Medical Services Table will be treated as if it were listed, in specified circumstances. The policy objective of this Determination is to ensure that home-based sleep studies, which are overnight investigations for sleep apnoea conducted in an unsupervised setting, are eligible for Medicare benefits. The Determination was introduced following recommendations by the Medical Services Advisory Committee (MSAC) in March 2010, which advised on the safety, clinical effectiveness, and cost-effectiveness of home-based sleep studies. This legislative instrument was subject to consultation with various medical associations and bodies, including 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. The Determination revokes the earlier Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 1) and remains in force until 31 October 2011.

Scope and Application

The Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 2) applies to home-based sleep studies ordered and analysed by practitioners qualified in the field of sleep medicine, specifically paediatric and adult sleep medicine practitioners. This Determination ensures that these services are treated as if they were listed in the General Medical Services Table under the Health Insurance Act 1973. The Determination applies nationally, affecting all qualified sleep medicine practitioners and their patients across Australia. It commences on 1 November 2010 and remains in force until 31 October 2011. The Determination revokes its predecessor, the Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 1), and sets out specific circumstances where it applies, including the requirement that paediatric services are rendered by a qualified paediatric sleep medicine practitioner, while adult services are rendered by a qualified adult sleep medicine practitioner. The Determination also indexes the Medicare Benefits Schedule fee for these services, aligning it with the annual indexing of items in the General Medical Services Table.

Key Provisions

The Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 2) (the Determination) introduces specific provisions under the Health Insurance Act 1973 (the Act) to allow the continued provision of Medicare benefits for home-based sleep studies, ordered and analysed by qualified sleep medicine practitioners, from 1 November 2010 (Section 2). This Determination is applicable until 31 October 2011 (Section 2) and it revokes the previous Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 1) (Section 3). The Determination applies to home-based sleep studies conducted on patients under 18 years of age by qualified paediatric sleep medicine practitioners, and on patients 18 years of age or older by qualified adult sleep medicine practitioners (Section 5). A practitioner qualifies if they meet the credentialling or training requirements outlined in the Determination (Section 5(2)). The Determination imposes specific obligations on the practitioners involved in home-based sleep studies. Practitioners must meet the defined credentialling and training requirements to qualify as either a paediatric or adult sleep medicine practitioner (Section 5(2)). They are also responsible for ensuring that the sleep studies they order and analyse comply with the standards and guidelines set out in the Determination, including the use of appropriate equipment and the provision of accurate and timely analysis and reporting to patients (Schedule). There are no specific offences, penalties, or civil/criminal consequences outlined in the Determination for breaches of its provisions. However, failure to comply with the requirements of the Determination could potentially result in the non-payment of Medicare benefits for services provided, as the Determination stipulates that only qualified practitioners can order and analyse home-based sleep studies to be eligible for Medicare benefits. Additionally, practitioners who do not meet the required credentialling or training standards may face professional consequences, such as disciplinary action from their respective professional bodies or loss of registration to practise.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.