Health Insurance (Sacral Nerve Stimulation) Determination 2007

Administered by Department of Health, Disability and Ageing

Legislation au F2007L03880 Not in force Legislative Instrument

Legislation content

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.

Overview

The Health Insurance (Sacral Nerve Stimulation) Determination 2007 was enacted to address the issue of ongoing access to sacral nerve stimulation services for patients who had the device implanted prior to March 2002 and required ongoing care. This Determination was issued under the authority of the Minister for Health and Ageing, in accordance with the Health Insurance Act 1973, and serves to ensure that specified sacral nerve services for the management of refractory urinary incontinence or urge retention are covered by Medicare. The policy objective is to facilitate the payment of Medicare benefits for a small group of patients with pre-existing implants who need continued treatment. The Determination remakes the previous Health Insurance (Sacral Nerve Stimulation) Determination HS/07/2006, incorporating a 2.2 percent increase in fees that aligns with the general fee increase applied to most services in the general medical services table from 1 November 2007. This legislative instrument is considered machinery in nature and did not require consultation as it does not substantially alter existing arrangements.

Scope and Application

The Health Insurance (Sacral Nerve Stimulation) Determination 2007 applies to individuals who had received a sacral nerve stimulation implant for the management of refractory urinary incontinence or urge retention prior to 30 April 1998 and require ongoing access to procedures for the replacement or removal of the pulse generator and/or leads for the neurostimulator device. The Determination specifies the services that will be covered under Medicare and how they will be treated under the statutory provisions of the Health Insurance Act 1973, the National Health Act 1953, and related regulations. The Determination also includes a 2.2 percent fee increase for the specified services, aligning with the general fee increase applied to most services in the general medical services table from 1 November 2007. This Determination revokes the previous Health Insurance (Sacral Nerve Stimulation) Determination HS/07/2006 and applies nationally, covering relevant services as if they were listed in the general medical services table for the purpose of the specified statutory provisions.

Key Provisions

The Health Insurance (Sacral Nerve Stimulation) Determination 2007 (the Determination) primarily amends the previous sacral nerve stimulation determination to facilitate the continued provision of Medicare benefits for specific services related to sacral nerve stimulation implants. According to section 1, the Determination is named and section 2 specifies that it commences on 1 November 2007. Section 3 revokes the previous Health Insurance (Sacral Nerve Stimulation) Determination HS/07/2006, thereby making the new provisions the current law. Section 4 defines key terms, including 'relevant service,' which refers to services specified in the Schedule of the Determination. Subsection 4(2) clarifies that references to statutory provisions are to be interpreted as they are in force from time to time. Section 5 outlines the circumstances under which the Determination applies, specifically for patients who received a sacral nerve stimulation implant before 30 April 1998 and require ongoing management of their implants. Section 6(a) states that relevant services will be treated as professional and medical services under the Health Insurance Act 1973 and the National Health Act 1953, while 6(b) specifies that these services will be treated as if they were listed in the general medical services table with a fee specified in the Schedule. The Determination imposes certain obligations on parties involved. Health service providers must ensure that the services they provide under this Determination meet the criteria specified in section 5. Patients who qualify under the Determination must adhere to the requirements for accessing these services, including the provision of necessary documentation to substantiate their eligibility. The Department of Health is responsible for administering the Determination, ensuring that the correct fees are paid and that the services provided comply with the legislative requirements. The Determination does not explicitly state any specific offences, penalties, or civil/criminal consequences for non-compliance. However, general provisions within the Health Insurance Act 1973 and related regulations may apply. Any breaches of the Act or non-compliance with the Determination could potentially lead to civil or administrative penalties, including fines or the recovery of improperly claimed benefits. Additionally, serious breaches may attract criminal penalties under the general criminal law provisions of the Commonwealth. The specific penalties would depend on the nature and severity of the breach, as well as any applicable legislative provisions.

Legal classification tags

Area of Law
Health Law
Instrument
Regulation
Concepts
Commencement Provisions
Reporting & Disclosure Obligations
Regulatory Standards

Interactions

Authorises

All Versions

Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.