Health Insurance (Indium-labelled Octreotide Study) Determination HS/09/2006

Administered by Department of Health, Disability and Ageing

Legislation au F2006L03533 Not in force Legislative Instrument

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Explanatory Statement

Health Insurance Act 1973

Health Insurance (Indium-labelled Octreotide Study) Determination HS/09/2006

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 diagnostic imaging 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 (Diagnostic Imaging 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 (Indium-labelled Octreotide Study) Determination HS/03/2004

On 27 April 2004, the then Minister for Health and Aged Care made Health Insurance Determination HS/03/2004 (the Current Determination) under subsection 3C(1) of the Act.  The Current Determination permits the payment of Medicare benefit in relation to the Indium-labelled Octreotide Study service specified in the Schedule to the Current Determination.

The Current Determination provides that the Indium-labelled Octreotide Study service specified in the Schedule to the Current Determination is to be treated as if it were listed in the Table, for the purposes of the statutory provisions specified in section 5 of the Current Determination.  The statutory provisions specified in section 5 of the Current Determination are those contained in the Act, the National Health Act 1953 and the regulations made under each Act which relate to professional services and medical services generally.

Health Insurance (Amendment) Determination HS/10/2004, effective 1 November 2004, amended the Current Determination to increase the fee in respect of the Indium-labelled Octreotide Study service specified in the Schedule to the Current Determination to be in line with the general fee increase that was being applied to nuclear medicine services in the Table.

  • Health Insurance (Indium-labelled Octreotide Study) Determination HS/09/2006

Health Insurance (Indium-labelled Octreotide Study) Determination HS/09/2006 (the Determination) remakes the Current Determination.

The Determination clarifies that rule 27 of Schedule 1, Part 2 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006 applies to the service covered by the Determination.

In addition, the Determination provides for an increase of 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 1 percent fee increase that is being applied to nuclear medicine 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

Section 3 provides that the Determination revokes Health Insurance Determination HS/03/2004.

Section 4

Subsection 4(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 which is specified in the Schedule of the Determination.  There is one such relevant service in the Schedule.

Subsection 4(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 5

Paragraph 5(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 5(b) provides that the relevant service shall be treated as if there were an item in the diagnostic imaging 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.

Paragraph 5(c) provides that rule 27 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006 applies to the relevant service.

Schedule

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

Overview

The Health Insurance (Indium-labelled Octreotide Study) Determination HS/09/2006 was enacted to address the need for updating the fee structure of a specific health service, namely the Indium-labelled Octreotide Study, in alignment with the general fee increases applied to nuclear medicine services. This determination is a legislative instrument made under subsection 3C(1) of the Health Insurance Act 1973, which empowers the Minister to include health services not listed in the diagnostic imaging services table, under specified circumstances and statutory provisions. This determination serves to treat the Indium-labelled Octreotide Study as if it were listed in the diagnostic imaging services table for the purposes of relevant statutory provisions. It revokes the previous Health Insurance Determination HS/03/2004 and incorporates a 1 percent fee increase, consistent with the general fee increases applied to nuclear medicine services as of 1 November 2006. The enactment of this determination by the Minister for Health and Ageing aims to ensure that the fee for this specific service remains in line with broader adjustments within the health insurance framework.

Scope and Application

The Health Insurance (Indium-labelled Octreotide Study) Determination HS/09/2006 applies to the Indium-labelled Octreotide Study service, which is not listed in the diagnostic imaging services table under the Health Insurance Act 1973. This Determination treats the specified service as if it were listed in the table for particular statutory provisions. It applies nationally across Australia as it is an instrument made under Commonwealth legislation. The Determination is targeted at entities and individuals providing the Indium-labelled Octreotide Study service, and it aligns with the statutory provisions of the Health Insurance Act 1973, the National Health Act 1953, and related regulations. The Determination revokes the previous Health Insurance Determination HS/03/2004, which had made similar provisions but was amended in 2004. There are no exclusions or exemptions specified in the Determination, and it extends its application through the Schedule, which details the service, assigns an item number, provides an item descriptor, and specifies the fee for the service.

Key Provisions

The Health Insurance (Indium-labelled Octreotide Study) Determination HS/09/2006 is a legislative instrument made under the authority of the Minister for Health and Ageing. It is designed to treat a specified health service, the Indium-labelled Octreotide Study, as if it were listed in the diagnostic imaging services table (section 5(a) and (b)). This treatment means the service is recognised as both a professional and a medical service under the Health Insurance Act 1973 (the Act), the National Health Act 1953, and any regulations made under these Acts (section 5(a)). Additionally, the Determination treats the service as if it had an entry in the diagnostic imaging services table with a specific fee (section 5(b)). This specific treatment allows the service to qualify for Medicare benefits and other statutory provisions that apply to listed services (section 5). Under the Act, the Determination imposes obligations on health service providers and beneficiaries. Providers must ensure that the service meets the criteria set out in the Determination to be eligible for Medicare benefits. Beneficiaries must be aware that the service is recognised under the Act, which means they may be entitled to claim benefits for it. Furthermore, the Determination specifies that rule 27 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006 applies to the relevant service, thereby ensuring consistency with other nuclear medicine services (section 5(c)). The Determination does not explicitly outline specific offences or penalties for non-compliance. However, any breach of the provisions of the Act, the National Health Act 1953, or the regulations made under these Acts, could potentially lead to civil or criminal consequences, depending on the nature and severity of the breach. Penalties for breaches of health-related legislation can include fines, imprisonment, or both, depending on the specific offence and jurisdiction. The maximum penalties for such offences can vary widely, with more severe breaches typically resulting in higher penalties.

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