Health Insurance (RET Gene Testing) Revocation Determination 2015

Overview

The Health Insurance (RET Gene Testing) Revocation Determination 2015, issued under subsection 3C(1) of the Health Insurance Act 1973, revokes the previous Health Insurance (RET Gene Testing) Determination 2014. This revocation was necessary because the two item numbers (73339 and 73340) pertaining to RET gene testing, which were previously determined to be funded under the Act, have been incorporated into the Health Insurance (Pathology Services Table) Regulation 2015. This incorporation ensures that these services continue to be recognised and funded within the Regulation, effective from 1 July 2015. The revocation determination was made by the Minister for Health, aligning with the policy objective to streamline and update the health services funding provisions in line with clinical practice and cost-effectiveness recommendations.

Scope and Application

The Health Insurance (RET Gene Testing) Revocation Determination 2015 applies to the Health Insurance Act 1973, which governs the regulation of private health insurance in Australia. The Determination itself specifically revokes the previous Health Insurance (RET Gene Testing) Determination 2014, as the services it covered are now incorporated into the Health Insurance (Pathology Services Table) Regulation 2015. This means that the Determination impacts entities and individuals who may have previously been covered under the 2014 Determination, which concerned the genetic testing for RET mutations and associated genetic counselling for patients suspected of having multiple endocrine neoplasia type II (MEN2) and their close family members. This process is a standard clinical practice offered in both state and territory hospitals and private facilities. The revocation and incorporation of these services into the Pathology Services Table means that they will continue to be covered under the regulation from 1 July 2015 onwards. There are no exclusions or thresholds specified in this Determination, and it applies nationally across Australia, as it concerns the regulation of private health insurance services under Commonwealth legislation.

Key Provisions

The Health Insurance (RET Gene Testing) Revocation Determination 2015 (section 1) operates under the Health Insurance Act 1973 to revoke the previous Health Insurance (RET Gene Testing) Determination 2014. This revocation occurs because the specific item numbers (73339 and 73340) for RET gene testing have been incorporated into the Health Insurance (Pathology Services Table) Regulation 2015 (section 3), effective from 1 July 2015. Consequently, these services will continue to be recognised and funded under the new Regulation rather than the Determination. The Act imposes obligations on parties such as the Minister for Health, who has the authority to determine that certain health services, not listed in the Pathology Services Table, can be treated as if they were listed under specified circumstances (subsection 3C(1)). The Act also mandates that the Pathology Services Table is updated annually, with the latest version being the Health Insurance (Pathology Services Table) Regulation 2015. This ensures that the services covered by health insurance are kept current with medical advancements and clinical practices. In terms of compliance and consequences, the Act does not specify particular conditions that must be met before the power to make the Determination can be exercised. However, the Determination itself is a legislative instrument governed by the Legislative Instruments Act 2003. Any failure to comply with the requirements set forth in the Act or the Regulations could potentially lead to legal repercussions, although specific penalties are not detailed in the Act itself. It is crucial for all stakeholders, including healthcare providers and patients, to stay updated with the latest regulations to ensure continued coverage and compliance with health insurance provisions.