EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Photodynamic Therapy) Determination HS/04/2007
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 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 (Photodynamic Therapy) Determination HS/03/2006 and Health Insurance (Photodynamic Therapy) Determination HS/04/2006
On 30 October 2006, the Minister for Health and Ageing made Health Insurance (Photodynamic Therapy) Determination HS/03/2006 and Health Insurance (Photodynamic Therapy) Determination HS/04/2006 (the Previous Determinations) under subsection 3C(1) of the Act, which permitted the payment of Medicare benefit in relation to specified photodynamic therapy services.
The photodynamic therapy services specified in the Schedule to the Previous Determinations concerned the provision of photodynamic to patients who are diagnosed with predominantly classic (>50%) subfoveal choroidal neovascularisation secondary to macular degeneration; and a baseline best-corrected visual acuity equal to or better than 6/60 (20/200). This applies to the first 15 occasions on which a relevant service is rendered to a patient, regardless of when the service has been rendered to the patient.
Paragraph 4(a) of the Previous Determinations provided that a photodynamic therapy service specified in the Schedule to the Previous Determinations was to 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 4(b) of the Previous Determination provided that a photodynamic therapy service specified in the Schedule to the Previous Determinations was 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 mentioned in the Schedule to the Previous Determination for that service.
- Health Insurance (Photodynamic Therapy) Determination HS/04/2007
Health Insurance (Photodynamic Therapy) Determination HS/04/2007 (the Determination) revokes the Previous Determinations and provides for an additional three photodynamic therapy services (items 43021, 43022, and 43023).
As outlined above, Medicare subsidised photodynamic therapy services are currently available to patients who are diagnosed with predominantly classic (>50%) subfoveal choroidal neovascularisation secondary to macular degeneration; and a baseline best-corrected visual acuity equal to or better than 6/60 (20/200).
To coincide with the listing of ‘visudyne’ under the Pharmaceutical Benefits Scheme, the Government has decided to simplify the Medicare subsidised photodynamic therapy services.
Item 43021 will enable the payment of a Medicare benefit for photodynamic therapy service for one eye. Item 43022 will enable the payment of a Medicare benefit for photodynamic therapy service for both eyes. Item 43023 will enable the payment of a Medicare benefit where photodynamic therapy has been discontinued for medical reasons.
Details of the Determination are set out in the Attachment.
Consultation
Consultation took place with the Pharmaceutical Benefits Advisory Committee, the Medical Services Advisory Committee, the Department of Veterans Affairs, Medicare Australia, the Royal Australian and New Zealand College of Ophthalmologists 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 August 2007.
Section 3
Section 3 provides that the Determination ceases to have effect at the end of 31 October 2007.
Section 4
Section 4 provides that the Determination revokes Health Insurance Determination HS/03/2006 and Health Insurance Determination HS/04/2006.
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 are three such relevant services 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 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 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 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.