EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Oral and Maxillofacial Surgery) Determination 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, by 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 2007 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 (Oral and maxillofacial Surgery) Determination HS/2007
Health Insurance (Oral and Maxillofacial Surgery) Determination HS/2007 (the Determination) provides for an additional twenty-five oral and maxillofacial services (items 45882, 45885, 45888, 45891,45894, 45897, 45900, 45903, 45906, 45909, 45912, 45915, 45918, 45921, 45924, 45939, 45945, 45975, 45978, 45981, 45984, 45987, 45990, 45993 and 45996).
These items will enable the payment of Medicare benefits for the following services:
Item 45882 covers the treatment of a premalignant lesion of the oral mucosa by a treatment using cryotherapy, diathermy or carbon dioxide laser.
Item 45885 covers the ligation of a facial, mandibular or lingual artery or vein, or artery and vein.
Item 45888 covers the removal of a deep foreign body using interventional imaging techniques.
Item 45891 covers the repair to 1 defect using temporalis muscle by a single stage local flap.
Item 45894 covers the free grafting of a granulating area (mucosa or split skin).
Item 45897 covers the grafting of, including plastic closure of associated oro-nasal fistulae and ridge augmentation of a unilateral alveolar cleft (congenital).
Item 45900 covers the fixation of the mandible by intermaxillay wiring, excluding wiring for obesity.
Item 45903 covers the excision of the mandibular or palatal exotisis.
Item 45906 covers reduction of the mylohyoid ridge.
Item 45909 covers the reduction of a maxillary tuberosity.
Item 45912 covers the removal of less than 5 lesions within the papillary hyperplasia of the palate.
Item 45915 covers the removal of 5 to 20 lesions within the papillary hyperplasia of the palate.
Item 45918 covers the removal of more than 20 lesions within the papillary hyperplasia of the palate.
Item 45921 covers vestibuloplasty (submucosal or open) including the excision of muscle and skin or mucosal graft when performed either unilaterally or bilaterally.
Item 45924 covers the lowering of the floor of the mouth (Obwegeser or similar procedure). Including the excision of muscle and skin or mucosal graft when performed unilaterally.
Item 45939 covers cryosurgery of the peripheral branches of the trigeminal nerve for pain relief.
Item 45945 covers the treatment of a dislocation of the mandible requiring open reduction.
Item 45975 covers the treatment of a fracture of the unilateral or bilateral maxilla, not requiring splinting.
Item 45978 covers the treatment of a fracture of the mandible, not requiring splinting.
Item 45981 covers the treatment of the zygomatic bone, not requiring surgical reduction.
Item 45984 covers the treatment of a complicated fracture of the maxilla involving viscera, blood vessels or nerves, requiring open reduction not involving the use of plate(s).
Item 45987 covers the treatment of a complicated fracture of the mandible involving viscera, blood vessels or nerves, requiring open reduction not involving the use of plate(s).
Item 45990 covers the treatment of a complicated fracture of the maxilla including viscera, blood vessels or nerves requiring open reduction involving the use of plate(s).
Item 45993 covers the treatment of a complicated fracture of the mandible involving viscera, blood vessels or nerves requiring open reduction involving the use of plate(s).
Item 45996 covers the treatment of a closed fracture of the mandible involving a joint surface.
Details of the Determination are set out in the Attachment.
Consultation
Consultation took place with the Australian and New Zealand Association of Oral and Maxillofacial Surgeons and the Australian Medical Association.
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 November 2007.
Section 3
Section 3 provides that the Determination ceases to have effect at the end of 31 October 2008.
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 that is specified in the Schedule to the Determination. There are thirty-nine such relevant services 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 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 and regulations made under each Act that make provision for medical services or professional services.
Paragraph 5(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 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.