EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Positron Emission Tomography) Facilities Determination 2008
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).
Health Insurance (Positron Emission Tomography) Facilities Determination 2008 (the Determination) revokes the Health Insurance Determination HS/6/01, as amended by the Health Insurance Determination HS/6/01 (Amendment) HS/6/05.
The purpose of the Determination is to maintain the current availability of Medicare items for PET and to delete eight items relating to colorectal carcinoma, ovarian carcinoma and melanoma. The content of these items will be found in six new items in the Health Insurance (Positron Emission Tomography) Determination 2008 (No. 2). The Determination also does not include five items that were removed by the Health Insurance Determination HS/6/01 (Amendment) HS/6/05.
Details of the Determination are set out in the Attachment.
The Determination commences on 1 December 2008.
Consultation
The Department has consulted with expert clinicians in PET nominated by the Australian and New Zealand Association of Physicians in Nuclear Medicine and the Royal Australian and New Zealand College of Radiologists for input into item descriptors, which are being implemented through this Determination.
DIAGNOSTIC SERVICES BRANCH
DEPARTMENT OF HEALTH AND AGEING
NOVEMBER 2008
ATTACHMENT
NOTES ON SECTIONS TO THE DETERMINATION
Section 1
Section 1 provides that the Determination may be cited as the Health Insurance (Positron Emission Tomography) Facilities Determination 2008.
Section 2
Section 2 provides that the Determination commences on 1 December 2008
Section 3
Section 3 provides that this Determination revokes the Health Insurance Determination HS/6/01, as amended by Health Insurance HS/6/01 (Amendment) HS/6/05.
Section 4
Subsection 4(1) defines terms used in the Determination.
Section 5
Section 5 specifies the circumstances in which the Determination applies.
Section 6
Section 6 (a) provides that the relevant service specified in the Schedule to the Determination shall be treated for the purposes of all provisions of the Act, regulations made under the Act and of all provisions of the National Health Act 1953 and regulations made under the National Health Act 1953 that make provision in respect of professional services or medical services, as if it were both a professional service and a medical service.
Paragraph 6(b) provides that the relevant service specified in the Schedule to the Determination shall be treated for the purposes of all provisions of the National Health Act 1953 and regulations made under the National Health Act 1953 that make provision in respect of professional services or medical services, 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 being the fee specified in the Schedule.
Section 7
Section 7 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
The Schedule sets out the relevant services and assigns to the services the applicable item number, item descriptor and fee.
Overview
The Health Insurance (Positron Emission Tomography) Facilities Determination 2008, enacted under the Health Insurance Act 1973, was introduced to address the need for updating Medicare items related to Positron Emission Tomography (PET) services. The Minister for Health and Ageing, exercising powers under subsection 3C(1) of the Act, made this determination to maintain the availability of Medicare services for PET while also revising and consolidating related services. The policy objective behind the determination was to streamline the existing services, ensuring they align with current medical practices and technological advancements. This was achieved by revoking the previous Health Insurance Determination HS/6/01, as amended, and replacing it with new items that more accurately reflect contemporary PET services. The determination was developed after consultations with expert clinicians, ensuring the changes were grounded in clinical expertise. The Determination commenced on 1 December 2008, marking the official update in the provision of Medicare services for PET.
Scope and Application
The Health Insurance (Positron Emission Tomography) Facilities Determination 2008 applies to services related to Positron Emission Tomography (PET) and is made under subsection 3C(1) of the Health Insurance Act 1973. This Determination affects individuals who receive PET services and entities that provide such services, specifically ensuring these services are recognised and reimbursed under the Medicare system. The geographic reach of the Act is national, as it pertains to the Commonwealth's health insurance scheme. The Determination revokes the previous Health Insurance Determination HS/6/01, as amended, and introduces new item descriptors for PET services, while also removing certain items relating to colorectal carcinoma, ovarian carcinoma, and melanoma. The Determination is effective from 1 December 2008 and aligns with the National Health Act 1953, ensuring the specified PET services are treated as professional and medical services for the purposes of Medicare. Additionally, the Determination includes provisions for fees and item numbers associated with these services, as outlined in the Schedule.
Key Provisions
The Health Insurance (Positron Emission Tomography) Facilities Determination 2008, which is a legislative instrument under the Health Insurance Act 1973, aims to regulate the provision of positron emission tomography (PET) services. Under section 6(a), the Determination specifies that PET services are to be treated as if they were both professional and medical services for all relevant provisions of the Health Insurance Act 1973, the regulations made under it, and the National Health Act 1953. Section 6(b) further elaborates that for the purposes of the National Health Act 1953, PET services are treated as if there is an R-type diagnostic imaging service that includes a specified fee. The Determination, which commences on 1 December 2008, revokes the previous Health Insurance Determination HS/6/01, as amended, and introduces new specifications for PET services.
The Act imposes specific obligations on parties and entities it governs. Firstly, the Determination mandates that PET services be recognised and treated as professional and medical services under the legislation. This includes adherence to the fee structures and descriptors as outlined in the Schedule of the Determination. Providers must ensure that their billing and service delivery comply with these definitions to be eligible for Medicare benefits. Additionally, the Act requires that any changes to the service specifications or fees be communicated and implemented in accordance with legislative requirements.
There are potential consequences for non-compliance with the provisions of the Determination. Although the Determination itself does not explicitly detail offences, penalties, or consequences for breach, the overarching Health Insurance Act 1973 provides a framework for enforcement. Under this Act, breaches of Medicare regulations can lead to civil or criminal penalties. For example, providing false or misleading information to obtain benefits can result in fines, imprisonment, or both. The specific penalties would depend on the nature and severity of the breach, but they are substantial enough to enforce compliance with the legislative requirements.
Furthermore, the Health Insurance (Positron Emission Tomography) Facilities Determination 2008 ensures that the services provided are aligned with the current medical standards and practices. By revoking outdated determinations and introducing new specifications, the Determination aims to maintain the effectiveness and availability of PET services under the Medicare scheme. The involvement of expert clinicians in drafting the item descriptors also indicates a commitment to evidence-based healthcare practices, ensuring that the services provided are clinically relevant and of high quality.