EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance Determination HS/7/05
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 pathology services table or the diagnostic imaging services table shall, in specified circumstances and for specified statutory provisions, be treated as if it were so listed.
A determination made under subsection 3C(1) is a legislative instrument for the purposes of the Legislative Instruments Act 2003 (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).
The purpose of Health Insurance (Positron Emission Tomography) Determination HS/7/05 (the Determination) is to allow positron emission tomography (PET) services specified in the Schedule to the Determination, in the circumstances outlined in section 4, to be treated as if they were listed in the diagnostic imaging services table.
PET is a form of nuclear medicine used mainly to determine the presence and severity of cancers, neurological conditions, and cardiovascular disease. PET images reveal the chemistry of organs and other tissues such as tumours. A radiopharmaceutical that gives off signals is injected into the patient and its emissions are measured by a PET scanner.
An original determination (HS/6/01) was made under subsection 3C(1) in 2001 for PET services to be provided by a limited number of providers with eligibility agreements with the Commonwealth. This Determination will allow additional facilities without eligibility agreements to access the items specified in the determination provided that they meet the criteria in section 4 of the Determination.
Section 4 of the Determination details the circumstances to which this Determination applies. These circumstances include that the service is a referred service; performed by or under the personal supervision of a credentialled specialist; at an accredited and comprehensive facility; and that the equipment meets identified technical standards. The facility providing the service must also meet the minimum quarterly throughput targets which are specified in the Determination.
In accordance with section 17 of the Legislative Instruments Act 2003, consultations have been undertaken with the Australian and New Zealand Association of Physicians in Nuclear Medicine and Medicare Australia in relation to the making of the Determination.
Details of the Determination are set out in the Attachment.
The Determination commences on the day after it is registered on the Federal Register of Legislative Instruments and remains in force until midnight on 31 October 2007.
ATTACHMENT
NOTES ON SECTIONS TO THE DETERMINATION
Section 1 provides that the Determination may be cited as the Health Insurance (Positron Emission Tomography) Determination HS/7/05.
Section 2 provides that the Determination commences on the day after it is registered on the Federal Register of Legislative Instruments and shall remain in force until midnight on 31 October 2007.
Section 3 defines certain terms used in the Determination.
Section 4(1) specifies the circumstances in which the Determination applies. These circumstances include that:
- the service is a service referred by a specialist or consultant physician;
- the service is performed by or under the personal supervision of a credentialled specialist;
- the service is performed at an accredited and comprehensive facility;
- the equipment used to render the service meets identified technical standards; and
- the facility providing the service has met the minimum quarterly throughput targets specified in the Determination
Subsection 4(2) defines a “credentialled specialist” as a specialist or consultant physician credentialled under the “Joint Nuclear Medicine Specialist Credentialling Program for the Recognition of the Credentials of Nuclear Medicine Specialists for Positron Emission Tomography”. Information on this program and the standards can be viewed on the website of the Australian and New Zealand Association of Physicians in Nuclear Medicine (ANZAPNM) at: www.anzapnm.org.au/qaprograms/credentialling.htm
Subsection 4(3) defines an “accredited and comprehensive facility” as one that is accredited by the ANZAPNM as a site for advanced training in PET and that also provides PET, computed tomography, x-ray, diagnostic ultrasound, medical oncology, surgical oncology, radiation oncology and neurology, including neurosurgery.
Subsection 4(4) defines “one location” as either one building or a part of a building, or buildings that are joined by a covered pedestrian walkway.
Subsection 4(5) specifies the technical standards which the equipment must meet as the “Interim Recommendations for PET accreditation (Technical Aspects)” dated 16 May 2001 and issued by the Australian and New Zealand Society of Nuclear Medicine. These standards can be viewed on the website of the Department of Health and Ageing at: www.health.gov.au. The equipment must also meet the NEMA NU 2-2001 referred to in the “Interim Recommendations for PET accreditation (Technical Aspects)” which is a standard published on 20 June 2001 and issued by the National Electrical Manufacturers Association, a non-stock corporation organized under the General Corporation Law of the State of Delaware in the United States of America. These standards can be purchased through the website of the National Electrical Manufacturers Association at: www.nema.org
Subsection 4(6) specifies the minimum throughput requirements as at least 20 relevant services per PET scanner per quarter. A quarter is the three months beginning on 1 January, 1 April, 1 July or 1 October of each year.
Subsection 4(7) provides that an authorised officer from Medicare Australia or an APS employee authorised by the Secretary may revoke a notice issued under paragraph 4(1)(b) which identifies that a PET scanner has failed to meet the throughput requirements.
Section 5 provides that a PET service 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 relate to professional services and medical services.
Section 5 also provides that each PET service specified in the Schedule to the Determination shall be treated as if there were an R-type diagnostic imaging service in the diagnostic imaging services table that related to the service and specified a fee in respect of that service.
Section 6 provides that the specified provisions shall have effect as if a relevant service and the items that relate to a relevant service were also specified in those specified provisions.
The Schedule sets out the PET services to which the Determination relates and specifies the fees in respect those services.