EXPLANATORY STATEMENT

Health Insurance Act 1973

Health Insurance (Sacral Nerve Stimulation) Determination 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 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 2007 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 Determination HS/07/2006

On 30 October 2006, the then Minister for Health and Aged Care made Health Insurance (Sacral Nerve Stimulation) Determination HS/07/2006 (the Previous Determination) under subsection 3C(1) of the Act.  The Previous Determination permits the payment of Medicare benefit in relation to specified sacral nerve services for the management of refractory urinary incontinence or urge retention.

Sacral nerve stimulation uses electrical nerve stimulation via a surgically implanted pulse generator and electrodes to improve bladder function. The Previous Determination was made to facilitate the payment of Medicare benefits for the small number of patients who had the device implanted under Medicare prior to March 2002 and required ongoing access to procedures to remove or replace the implants.

The Previous Determination provides that the services for sacral nerve stimulation therapy specified in the Schedule to the Previous Determination shall be treated as if they were listed in the Table for the purpose of the statutory provisions specified in clause 4 of the Current Determination.  The statutory provisions specified in clause 4 of the Current Determination are those contained in the Act, the National Health Act 1953 and regulations made under each Act which relate to professional and medical services generally.

• Health Insurance (Sacral Nerve Stimulation) Determination 2007

Health Insurance (Sacral Nerve Stimulation) Determination 2007 (the Determination) remakes the Previous Determination and provides for an increase of 2.2 percent in the fee in respect of the service covered by the Determination compared to the fee in respect of the same service in the Previous Determination.  This fee increase is in line with the general fee increase that is being applied to most services in the Table from 1 November 2007.

Details of the Determination are set out in the Attachment.

Consultation

No consultation was undertaken in the making of the Determination as the instrument is machinery in nature and does not substantially alter existing arrangements.

ATTACHMENT

Notes on sections

Section 1

Section 1 provides for the name of the Determination.

Section 2

Section 2 provides that the Determination is to commence on 1 November 2007. 

Section 3

Section 3 provides that the Determination revokes Health Insurance (Sacral Nerve Stimulation) Determination HS/07/2006.

Section 4

Section 4 defines certain terms used in the Determination.

A key term is 'relevant service' which means a service defined in paragraph 3C(8) of the Act which is specified in the Schedule of the Determination.  There are three such relevant services in the Schedule.

Subsection 4(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 5

Section 5 specifies the circumstances in which the Determination applies.

The Determination applies in circumstances where patients had received a sacral nerve stimulation implant for the management of refractory urinary incontinence or urge retention prior to 30 April 1998 (which was originally funded under Medicare items 30000, 39134, 39139 or 39140) and require replacement or removal of the pulse generator and /or leads for the neurostimulator device.

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 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 for the relevant service.