Health Insurance (Hyperbaric Oxygen Therapy) Determination HS/06/2006

Administered by Department of Health, Disability and Ageing

Legislation au F2006L03528 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

Health Insurance Act 1973

Health Insurance (Hyperbaric Oxygen Therapy) Determination HS/06/2006

Issued by the authority of the Minister for Health and Ageing

Background

Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by writing, determine that a health service not listed 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 2006 which are remade each year.

A determination made under subsection 3C(1) is a legislative instrument (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).

         Health Insurance Determination HS/03/2001

On 5 September 2001, the then Minister for Health and Aged Care made Health Insurance Determination HS/03/2001 (the Current Determination) under subsection 3C(1) of the Act.  The Current Determination permits the payment of Medicare benefit for hyperbaric oxygen therapy to treat slowly healing wounds in non-diabetic patients and slowly healing soft tissue damage following radiation therapy.  The Current Determination was made to facilitate the payment of Medicare benefits while an evidence based assessment of the safety, effectiveness and cost-effectiveness of treating these conditions by hyperbaric oxygen therapy was undertaken by the Medical Services Advisory Committee.

The Current Determination provides that the hyperbaric oxygen therapy service specified in the Schedule to the Current Determination shall be treated as if it were listed in the Table for the purposes of the statutory provisions specified in clause 5 of the Current Determination.  The statutory provisions specified in clause 5 of the Current Determination are those contained in the Act, the National Health Act 1953 and regulations made under each Act which relate to professional services and medical services generally.

Subsequent amendments have been made to the Current Determination to extend the cessation date and increase the fee to be in line with general fee increases that were being applied to services in the Table (see Health Insurance (Amendment) Determination HS/08/2002, Health Insurance (Amendment) Determination HS/06/2003, Health Insurance (Amendment) Determination HS/4/2004, Health Insurance (Amendment) Determination HS/08/2004, Health Insurance (Amendment) Determination HS/10/2004 and Health Insurance (Amendment) Determination HS/04/2005).

 

         Health Insurance (Hyperbaric Oxygen Therapy) Determination HS/06/2006

Health Insurance (Hyperbaric Oxygen Therapy) Determination HS/06/2006 (the Determination) remakes the Current Determination, as amended.

In addition, the Determination provides for an increase of 2.1 percent in the fee in respect of the service covered by the Determination compared to the fee in respect of the same service in the Current Determination, as amended.  This fee increase is in line with the general fee increase that is being applied to most services in the Table from 1 November 2006.

Details of the Determination are set out in the Attachment.

Consultation

No consultation was undertaken in the making of the Determination as the instrument is machinery in nature and does not substantially alter existing arrangements.

 

 


ATTACHMENT

Notes on sections

Section 1

Section 1 provides for the name of the Determination.

Section 2

This section provides that the Determination is to commence on 1 November 2006.

Section 3

This section provides that the Determination will cease to have effect at the end of 31 October 2007.

Section 4

Section 4 provides that the Determination revokes Health Insurance Determination HS/03/2001.

Section 5

Subsection 5(1) defines terms used in the Determination.

A key term is 'relevant service' which means a service defined in paragraph 3C(8) of the Act that is specified in the Schedule to the Determination.  There is one such relevant service in the Schedule.

Subsection 5(2) provides that a reference to a provision of an Act or regulations, including the Act, the National Health Act 1953 and the regulations made under these Acts, is a reference to  the provision as in force from time to time (as authorised by subsection 3C(3) of the Act).

Section 6

Paragraph 6(a) provides that the relevant service specified in the Schedule to the Determination shall 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 that make provision for medical services or professional services.

Paragraph 6(b) provides that the 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 that related to the service and specified a fee in respect of that service, being the fee specified in the Schedule to the Determination in relation to the service.

Schedule

The Schedule sets out the relevant service and assigns the applicable item number, item descriptor and fee for the relevant service.

 

Overview

The Health Insurance (Hyperbaric Oxygen Therapy) Determination HS/06/2006 was enacted to address the issue of providing Medicare benefits for hyperbaric oxygen therapy in specified circumstances, particularly for treating slowly healing wounds in non-diabetic patients and slowly healing soft tissue damage following radiation therapy. This determination was introduced by the authority of the Minister for Health and Ageing under subsection 3C(1) of the Health Insurance Act 1973. The policy objective was to facilitate the payment of Medicare benefits while an evidence-based assessment of the safety, effectiveness, and cost-effectiveness of hyperbaric oxygen therapy was being undertaken by the Medical Services Advisory Committee. The determination also includes a fee increase in line with general fee adjustments applied to services in the general medical services table from 1 November 2006. The determination remakes the previous Health Insurance Determination HS/03/2001, as amended, and is designed to ensure continuity in the provision of these specific services while adjustments are made to the fee structure.

Scope and Application

The Health Insurance (Hyperbaric Oxygen Therapy) Determination HS/06/2006 applies to hyperbaric oxygen therapy services for the treatment of slowly healing wounds in non-diabetic patients and slowly healing soft tissue damage following radiation therapy, thereby ensuring they are treated as listed in the general medical services table for the purposes of the Health Insurance Act 1973, the National Health Act 1953, and related regulations. This determination was made to facilitate the payment of Medicare benefits during an evaluation of the therapy's effectiveness and cost-effectiveness. The determination is effective from 1 November 2006 until 31 October 2007 and supersedes the previous Health Insurance Determination HS/03/2001. It includes a 2.1 percent increase in the fee for the relevant service, aligning with the general fee increase applied to services in the general medical services table. The determination applies nationally, and there are no exclusions or exemptions specified within the text. The scope of application is extended through the Schedule, which details the relevant service, item number, descriptor, and fee.

Key Provisions

The Health Insurance (Hyperbaric Oxygen Therapy) Determination HS/06/2006, made under the authority of the Minister for Health and Ageing, specifies the conditions under which hyperbaric oxygen therapy can be considered for Medicare benefits. This determination (section 1) is effective from 1 November 2006 and will cease to have effect on 31 October 2007 (section 2 and 3). It replaces the previous Health Insurance Determination HS/03/2001 (section 4) and defines key terms such as 'relevant service' (section 5). The primary operative sections of the Determination (section 6) ensure that hyperbaric oxygen therapy for specified conditions is treated as if it were listed in the general medical services table, allowing for Medicare benefits to be paid accordingly. The Act imposes several obligations on the parties it governs. Health service providers must ensure that the hyperbaric oxygen therapy they provide meets the criteria outlined in the Determination to be eligible for Medicare benefits. This includes treating the therapy as both a professional and medical service (section 6(a)) and aligning with the specified fee (section 6(b)). Patients seeking this therapy must also be aware that it is only covered under the terms defined in the Determination. Additionally, the Minister for Health and Ageing is responsible for periodically reviewing and updating the fee structure to reflect general fee increases applied to other services listed in the Table. Failure to comply with the provisions of the Determination can result in significant consequences. While the Determination itself does not explicitly list offences or penalties, breaches of the Health Insurance Act 1973 or related statutes could lead to legal actions. The Act generally provides for civil and criminal penalties for non-compliance, including fines and potential imprisonment for serious breaches. However, specific penalties would depend on the nature and severity of the breach and the relevant statutory provisions under which the Determination operates. Given the machinery nature of the instrument, it is essential that all parties adhere strictly to the terms and conditions specified to avoid any legal repercussions.

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