EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Intracytoplasmic Sperm Injection) Determination HS/02/2007
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, in writing, determine 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 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 (Intracytoplasmic Sperm Injection) Determination HS/02/2007 (the Determination) permits the payment of Medicare benefits in relation to intracytoplasmic sperm injection and sperm retrieval services for the purposes of intracytoplasmic sperm injection. These services are specified in the Schedule to the Determination and concern the provision of intracytoplasmic sperm injection and sperm retrieval services to patients.
Paragraph 4(a) of the Determination provides that an intracytoplasmic sperm injection service or a transcutaneous or open surgical sperm retrieval service performed for the purposes of intracytoplasmic sperm injection specified in the Schedule to the Determination is to be treated as if the relevant service were both a professional service and a medical service for the purposes of the provisions of the Act, the National Health Act 1953, the Private Health Insurance Act 2007 and regulations and rules (as applicable) made under each Act that make provision for medical services or professional services.
Paragraph 4(b) of the Determination provides that a relevant service specified in the Schedule to the Determination is to be treated for the purposes of the provisions of the Act, the National Health Act 1953, the Private Health Insurance Act 2007 and regulations and rules (as applicable) made under each Act 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 mentioned in the Schedule to the Determination for that service.
Item 13251 will enable the payment of a Medicare benefit for an intracytoplasmic sperm injection service performed for the purposes of assisted reproductive technologies for male factor infertility.
Item 37605 will enable the payment of a Medicare benefit for sperm retrieval service performed using a transcutaneous approach. The service must be performed on a patient with male factor infertility for the purposes of intracytoplasmic sperm injection.
Item 37606 will enable the payment of a Medicare benefit for a sperm retrieval service performed using an open surgical approach. The service must be performed on a patient with male infertility for the purposes of intracytoplasmic sperm injection.
Details of the Determination are set out in the Attachment.
Consultation
Consultation took place with the National Association of Specialist Obstetricians and Gynaecologists, the IVF Directors Group, the Australian and New Zealand Association of Urological Surgeons, the Australian Medical Association and Medicare Australia.
ATTACHMENT
Notes on sections
Section 1
Section 1 provides for the name of the Determination.
Section 2
Section 2 provides that the Determination commences on 1 May 2007.
Section 3
Subsection 3(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 are three such relevant services in the Schedule.
Subsection 3(2) provides that a reference to a provision of an Act, regulations or rules (as applicable), including the Act, the National Health Act 1953, the Private Health Insurance Act 2007 and the regulations and rules (as applicable) 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 4
Paragraph 4(a) provides that a 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, the Private Health Insurance Act 2007 and regulations and rules (as applicable) made under each Act that make provision for medical services or professional services.
Paragraph 4(b) provides that a relevant service specified in the Schedule to the Determination is to be treated for the purposes of the provisions of the Act the National Health Act 1953, the Private Health Insurance Act 2007 and regulations and rules (as applicable) made under each Act 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 services and assigns to each service the applicable item number, item descriptor and fee.