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

Administered by Department of Health, Disability and Ageing

Legislation au F2006L03529 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

Health Insurance Act 1973

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

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 2006 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/01/2002

On 12 March 2002, the then Minister for Health and Aged Care made Health Insurance Determination HS/01/2002 (the Current Determination) under subsection 3C(1) of the Act.  The Current Determination permits the payment of Medicare benefit in relation to specified sacral nerve services for the management of refractory urinary continence or urge retention.

Sacral nerve stimulation uses electrical nerve stimulation via a surgically implanted pulse generator and electrodes to improve bladder function. In March 2002, the then Minister for Health and Aged Care endorsed a recommendation by the Medical Services Advisory Committee that funding not be supported for sacral nerve stimulation therapy for patients with refractory urinary incontinence or urge retention. However, limited coverage was agreed by the former Minister in February 2002 for the small number of patients who had had the device implanted under Medicare prior to March 2002 and required ongoing access to procedures to remove or replace the implants. This was effected through the Current Determination.   

The Current Determination provides that the services for sacral nerve stimulation therapy specified in the Schedule to the Current Determination shall be treated as if they were listed in the Table for the purpose of the statutory provisions specified in clause 5 of the Current Determination.  The statutory provisions specified in clause 5 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.

Subsequent amendments have been made to the Current Determination to increase the fee in respect of the sacral nerve stimulation items specified in the Schedule to the Current Determination to be in line with general fee increases that were being applied to services in the Table (see Health Insurance (Amendment) Determination HS/08/2002, Health Insurance (Amendment) Determination HS/06/2003, Health Insurance (Amendment) Determination HS/10/2004 and Health Insurance (Amendment) Determination HS/04/2005).

 

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

Health Insurance (Sacral Nerve Stimulation) Determination HS/07/2006 (the Determination) remakes the Current Determination, as amended.

The Determination revises the wording of various provisions of the Current Determination to reflect updated drafting practice and to clarify the operation of certain provisions. 

In addition, the Determination provides for an increase of 2.1 percent in the fees in respect of the services covered by the Determination compared to the fees for the same services in the Current Determination, as amended.  This fee increase is in line with the general fee increase that is being applied to most services in the Table from 1 November 2006.

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 2006. 

Section 3

Section 3 provides that the Determination revokes Health Insurance Determination HS/01/2002.

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.

Paragraph 5(c) of the Determination corrects a minor drafting error that appeared in paragraph 5(c) of Health Insurance Determination HS/01/2002.  In setting out one of the circumstances that needed to arise in order for Health Insurance Determination HS/01/2002 to apply to a relevant service, paragraph 5(c) of Health Insurance Determination HS/01/2002 incorrectly provided that “the relevant service” had to have been funded under Medicare prior to 30 April 1998 under items 30000, 39134, 39139 and 39140.

As evidenced by the explanatory statement to Health Insurance Determination HS/01/2002, the policy intent behind Health Insurance Determination HS/01/2002 was that it was to apply where, among other things, a patient had received a sacral nerve stimulation implant for the management of refractory urinary incontinence or urge retention prior to 30 April 1998 under Medicare item 30000, 39134, 39139 or 39140.

Accordingly, the Determination corrects the wording of the requirement in paragraph 5(c) to indicate that the sacral nerve stimulation implant service referred to in paragraph 5(a) has to have been rendered to a patient prior to 30 April 1998 and a Medicare benefit paid for that service under item 30000, 39134, 39139 or 39140.

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.

Overview

The Health Insurance (Sacral Nerve Stimulation) Determination HS/07/2006, issued by the authority of the Minister for Health and Ageing, was enacted to address a specific gap in the coverage of sacral nerve stimulation services under the Health Insurance Act 1973. This Act, established to provide a framework for the national health insurance scheme, allows the Minister to determine that certain health services not listed in the general medical services table (Table) can be treated as if they were listed under specified circumstances. The Health Insurance (Sacral Nerve Stimulation) Determination HS/07/2006 was formulated to ensure continued access to necessary medical procedures for patients who had received sacral nerve stimulation implants for the management of refractory urinary incontinence or urge retention before a specific cutoff date and now require ongoing care. This determination ensures that the relevant services are treated as if they were listed in the Table for the purposes of Medicare benefits, thereby facilitating the provision of necessary healthcare services to affected patients.

Scope and Application

The Health Insurance (Sacral Nerve Stimulation) Determination HS/07/2006 applies to specific health services related to sacral nerve stimulation for patients who received implants for the management of refractory urinary incontinence or urge retention prior to 30 April 1998, and who require ongoing treatment such as replacement or removal of the pulse generator and/or leads for the neurostimulator device. The determination ensures that these specified services are treated as if they were listed in the general medical services table under the Health Insurance Act 1973, thereby allowing Medicare benefits to be paid for these services. The application of this determination is limited to those patients who had their initial implant funded under Medicare prior to the specified date and who continue to require treatment for the same condition. The Determination also includes a fee schedule that outlines the applicable item numbers, descriptors, and fees for these services, which are aligned with general fee increases applied to most services in the table from 1 November 2006. This determination does not require consultation as it is machinery in nature and does not substantially alter existing arrangements.

Key Provisions

The Health Insurance (Sacral Nerve Stimulation) Determination HS/07/2006 (the Determination) revises and replaces the previous Health Insurance Determination HS/01/2002, and it is effective from 1 November 2006. The Determination is concerned with the provision of Medicare benefits for sacral nerve stimulation services for the management of refractory urinary incontinence or urge retention. The Determination applies specifically to patients who had received a sacral nerve stimulation implant before 30 April 1998 and now require replacement or removal of the pulse generator and/or leads for the neurostimulator device (Section 5). This includes correcting a minor error in the previous determination regarding the Medicare items under which the service was originally funded. The Determination requires that specified sacral nerve stimulation services be treated as if they were listed in the general medical services table, effectively allowing them to be eligible for Medicare benefits under the Health Insurance Act 1973 and the National Health Act 1953 (Section 6). The Schedule to the Determination lists the specific services and assigns each service an applicable item number, descriptor, and fee. This ensures that the services are recognised and reimbursed appropriately under the statutory provisions related to professional and medical services. Parties governed by the Determination, primarily healthcare providers and patients, must ensure that the services provided fall within the specified circumstances outlined in Section 5. Healthcare providers must also accurately bill the services using the item numbers and fees specified in the Schedule. Patients who meet the eligibility criteria can claim Medicare benefits for these services as if they were listed in the general medical services table. There are no specific offences, penalties, or civil/criminal consequences mentioned in the Determination for breach of its provisions. However, general legal obligations under the Health Insurance Act 1973 and the National Health Act 1953 would apply to any non-compliance, which could include civil penalties or other legal actions for fraudulent claims or misrepresentation of services. The Determination itself focuses on clarifying and updating the eligibility and billing process for specified sacral nerve stimulation services.

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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.