EXPLANATORY STATEMENT
Health Insurance Act 1973
Health Insurance (Radioactive Seed Implantation of Prostate)
Determination 2010
Background
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister or her delegate may, by writing, determine that a health service not listed 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 (the Regulations), 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 (Radioactive Seed Implantation of Prostate) Determination 2010
The Health Insurance (Radioactive Seed Implantation of Prostate) Determination 2010 (the Determination) is made to correct an error in the drafting of the item descriptor of item 37220 of the Table. This error has resulted in medicare benefits not being payable for anaesthesia services provided in connection with item 37220.
Anaesthesia services are located in Group T10 of the Table. In accordance with the Regulations, medicare benefits are only payable for most services in Group T10 of the Table where those services are provided in connection with a service that, among other things, is specified in an item that includes ‘(Anaes.)’ in its item descriptor.
Item 37220 was first included in the Table in November 2001. The item relates to the implantation of small radioactive ‘seed’ capsules in a tumour, or seed brachytherapy, for the treatment of localised prostate cancer. This procedure would normally be performed in an operating theatre under general or spinal anaesthesia taking approximately two hours. Due to a drafting oversight, ‘(Anaes.)’ was omitted from the item descriptor of item 37220, meaning that medicare benefits have not been payable for most anaesthesia services provided in connection with the item since its inclusion in the Table.
The Determination creates two new items relating to seed brachytherapy for the treatment of prostate cancer, which include ‘(Anaes.)’ in their item descriptors, to be taken to have had effect from 1 November 2001. Item 37222 will enable the payment of medicare benefits for anaesthesia services provided in connection with the service from 1 November 2001 to 31 October 2005. Item 37225 will enable the payment of medicare benefits for anaesthesia services provided in connection with the service from 1 November 2005 to 28 February 2010.
Details of the Determination are set out in the Attachment.
Commencement
This determination is taken to have commenced on 1 November 2001, the date on which item 37220 was first included in the Table. The effect of the retrospective commencement is to authorise, from 1 November 2001 and 1 November 2005 respectively, the payment of medicare benefits for the specified services and for anaesthesia services provided in connection with the specified services.
Subsection 3C(2) of the Act provides that determinations made under subsection 3C(1) of the Act may be expressed to have taken effect from a day earlier than the day on which the determination is made. In accordance with subsection 12(3) of the Legislative Instruments Act 2003 (the LIA), the operation of subsection 12(2) of the LIA is subject to any contrary provision for commencement of the Determination in the Act. Therefore, the retrospective commencement of the Determination does not offend subsection 12(2) of the LIA.
Consultation
No consultation was undertaken in the making of the Determination as the instrument is mechanical in nature and does not substantially alter existing arrangements.
ATTACHMENT
Details of the Health Insurance (Radioactive Seed Implantation of Prostate) Determination 2010
Section 1
Section 1 provides that the name of the Determination is the Health Insurance (Radioactive Seed Implantation of Prostate) Determination 2010.
Section 2
Section 2 provides that the Determination is to be taken to have commenced on 1 November 2001 and will cease at midnight 31 July 2010.
Section 3
Section 3 defines terms used in the Determination.
Subsection 3(1)
The term ‘relevant service’ for the purpose of this Determination means a health service as defined in subsection 3C(8) of the Act that is specified in the Schedule to the Determination. That subsection defines the types of services that are health services for the purposes of determinations under subsection 3C(1) of the Act.
Subsection 3(2)
This subsection provides that a reference to a provision of an Act or regulations in this Determination is a reference to that provision as it is in force from time to time, as authorised by subsection 3C(3) of the Act.
Section 4
Section 4 deals with the treatment of relevant services.
Paragraph 4(a) provides that a relevant services 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 the regulations made under those Acts that make provision for medical or professional services.
Paragraph 4(b) provides that a relevant service specified in the Schedule to the Determination is to be treated as if there were an item in Group T8 of the Table that related to the service and which specified a fee in respect of that service, being the fee specified in the Schedule to the Determination in relation to the service.
Section 5
Section 5 applies certain rules of Table to the relevant services, when those services are provided at particular times. This ensures that the conditions applying to the payment of medicare benefits for items 37222 and 37225, as appropriate, correspond to those which applied to item 37220 at the time the service was rendered.
Paragraph 5(1)(a) applies subrules 9(2) and 10(3) and rule 57 of the Health Insurance (General Medical Services Table) Regulations 2001 to item 37222, when provided from 1 November 2001 until 31 October 2002.
Paragraph 5(1)(b) applies subrules 10(2) and 11(3) and rule 58 of the Health Insurance (General Medical Services Table) Regulations 2002 to item 37222, when provided from 1 November 2002 until 31 October 2003.
Paragraph 5(1)(c) applies subrules 10(2) and 11(3) and rule 58 of the Health Insurance (General Medical Services Table) Regulations 2003 to item 37222, when provided from 1 November 2003 until 31 October 2004.
Paragraph 5(1)(d) applies subrules 11(2) and 12(3) and rule 64 of the Health Insurance (General Medical Services Table) Regulations 2004 to item 37222, when provided from 1 November 2004 until 31 October 2005.
Paragraph 5(2)(a) applies subrules 11(2) and 12(3) and rule 64 of the Health Insurance (General Medical Services Table) Regulations 2005 to item 37225, when provided from 1 November 2005 until 31 October 2006.
Paragraph 5(2)(b) applies subrules 11(2) and 12(3) and rule 64 of the Health Insurance (General Medical Services Table) Regulations 2006 to item 37225, when provided from 1 November 2006 until 31 October 2007.
Paragraph 5(2)(c) applies subrules 12(2) and 13(3) and rule 86 of the Health Insurance (General Medical Services Table) Regulations 2007 to item 37225, when provided from 1 November 2007 until 31 October 2008.
Paragraph 5(2)(d) applies subrules 12(2) and 13(3) and rules 86 and 78A of the Health Insurance (General Medical Services Table) Regulations 2008 to item 37225, when provided from 1 November 2008 until 31 October 2009.
Paragraph 5(2)(e) applies subrules 12(2) and 13(3) and rules 86 and 78A of the Health Insurance (General Medical Services Table) Regulations 2009 to item 37225, when provided from 1 November 2009 until 28 February 2010.
Section 6
Section 6 provides a method of calculating the schedule fee for relevant services specified in the Schedule. As the Determination is taken to have commenced on 1 November 2001, different schedule fees apply to the items in respect of different years.
Schedule
The Schedule sets out the relevant services and assigns to the services the applicable item number, item descriptor and fee.