EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Health Insurance Act 1973
Health Insurance (Section 3C General Medical Services – Heart Health Assessment) Determination 2019
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by legislative instrument, determine that a health service not specified in an item in the general medical services table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were specified in the Table.
The general medical services table is set out in the Health Insurance (General Medical Services Table) Regulations 2018 made under subsection 4(1) of the Act.
Purpose
On 24 February 2019, the Government announced it would list new Medicare heart health assessment services for the diagnosis, treatment and management of patients with, or at risk of, heart disease.
The purpose of the Health Insurance (Section 3C General Medical Services – Heart Health Assessment) Determination 2019 (the Determination) is to list two new items (117 and 702) to subsidise access to the heart health assessment services. The new services will support patients with cardiovascular disease, or patients at risk of developing cardiovascular disease, to access the heart health assessment through a doctor in general practice.
The new items will fund a heart health assessment, lasting at least 20 minutes, by a general practitioner (item 702) or a medical practitioner working in general practice (item 117). The new items will provide patients a comprehensive assessment of their cardiovascular health, identification of any physical or lifestyle-related risks to their cardiovascular health, and a comprehensive preventive health care plan to improve their cardiovascular health.
The new items enhance the range of subsidised heart health services available to patients under Medicare. This includes medical consultations and procedures, pathology and other diagnostic services, performed by GPs, cardiologists, surgeons and other specialists.
Consultation
The new services align with accepted medical practice assessment of patients with cardiovascular disease. Targeted consultation was undertaken with the Heart Foundation, the Royal Australian College of General Practitioners and the Australian National University regarding some of the requirements of the new heart health assessment items. A broader consultation on the specifics of the Determination was not undertaken as this process would have delayed the listing of the items. This was considered appropriate to ensure patients had access to the services as soon as possible.
Details of the Determination are set out in the Attachment.
The Determination commences on 1 April 2019.
The Determination is a legislative instrument for the purposes of the Legislation Act 2003.
Authority: Subsection 3C(1) of the
Health Insurance Act 1973
ATTACHMENT
Details of the Health Insurance (Section 3C General Medical Services – Heart Health Assessment) Determination 2019
Section 1 – Name
Section 1 provides for the instrument to be referred to as the Health Insurance (Section 3C General Medical Services – Heart Health Assessment) Determination 2019.
Section 2 – Commencement
Section 2 provides that the Determination commences on 1 April 2019.
Section 3 – Authority
Section 3 provides that the Determination is made under subsection 3C(1) of the Health Insurance Act 1973.
Section 4 – Definitions
Section 4 defines terms used in the instrument.
Section 5 – Treatment of relevant services
Section 5 provides that a clinically relevant service provided in accordance with the Determination shall be treated, for relevant provisions of the Health Insurance Act 1973 and National Health Act 1953, and regulations made under those Acts, as if it were both a professional service and a medical service and as if there were an item specified in the general medical services table for the service.
Section 6 – Application of item 702
Subsection 6(1) of the Determination provides that item 702 will be treated as if it was specified in clause 2.17.1 of the general medical services table. Clause 2.17.1 provides that a service is to be provided by a single general practitioner on a single patient.
Subsection 6(2) of the Determination provides that item 702 will be treated as if it was specified in clause 2.17.14 of the general medical services table. Clause 2.17.14 specifies the restrictions that are applicable for health assessment services provided under items in Group A14. The restrictions include that a health assessment:
must not include a screening service;
must not be performed in conjunction with a separate consultation, unless it is clinically necessary;
must be performed by the patient’s usual general practitioner, if reasonably practical; and
the rendering general practitioner may be assisted by a practice nurse, Aboriginal health worker or Aboriginal and Torres Strait Islander health practitioner, in accordance with medical practice and under the supervision of the rendering practitioner.
Subsection 6(3) of the Determination provides that item 702 is not applicable more than once in a 12 month period. Item 702 is also not applicable if the patient has been provided a health assessment service mentioned in Group A14 of the general medical services table within the previous 12 months.
Section 7 – Application of item 117
Subsection 7(1) provides that a service provided under item 117 is to be provided by a single medical practitioner on a single patient.
Subsection 7(2) provides that a service provided under item 117 must not include a ‘health screening service’. A health screening service is defined in section 4 of the Determination.
Subsection 7(3) provides that a separate consultation must not be performed in conjunction with a service provided under item 117, unless clinically necessary.
Subsection 7(4) provides that a practice nurse, Aboriginal health worker or Aboriginal and Torres Strait Islander health practitioner may assist the rendering medical practitioner in performing a service under item 117, in accordance with accepted medical practice, and under the supervision of the rendering practitioner.
Subsection 7(5) provides assistance provided to a medical practitioner may include activities associated with information collection, and at the direction of the rendering practitioner, advising the patient on recommended interventions.
Subsection 7(6) of the Determination provides that item 117 is not applicable more than once in a 12 month period. Item 117 is also not applicable if the patient has been provided a health assessment service mentioned in Group A7, Subgroup 5 of the Health Insurance (Section 3C General Medical Services – Other Medical Practitioner) Determination 2018 within the previous 12 months.
Schedule 1 – Relevant service
The Schedule specifies the service and the associated fees for items 117 and 702.
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Health Insurance (Section 3C General Medical Services – Heart Health Assessment) Determination 2019
This instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Determination
The purpose of the Health Insurance (Section 3C General Medical Services – Heart Health Assessment) Determination 2019 (the Determination) is to list two new items (117 and 702) to subsidise access to the heart health assessment services. The new services will support patients with cardiovascular disease, or patients at risk of developing cardiovascular disease, to access the heart health assessment through a doctor in general practice.
The new items will fund a heart health assessment, lasting at least 20 minutes, by a general practitioner (item 702) or a medical practitioner working in general practice (item 117). The new items will provide patients a comprehensive assessment of their cardiovascular health, identification of any physical or lifestyle-related risks to their cardiovascular health, and a comprehensive preventive health care plan to improve their cardiovascular health.
Human rights implications
This instrument engages Articles 9 and 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the rights to health and social security.
The Right to Health
The right to the enjoyment of the highest attainable standard of physical and mental health is contained in Article 12(1) of the ICESCR. The UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not a right for each individual to be healthy, but is a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.
The Committee reports that the ‘highest attainable standard of health’ takes into account the country’s available resources. This right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs, and conditions necessary for the realisation of the highest attainable standard of health.
The Right to Social Security
The right to social security is contained in Article 9 of the ICESCR. It requires that a country must, within its maximum available resources, ensure access to a social security scheme that provides a minimum essential level of benefits to all individuals and families that will enable them to acquire at least essential health care. Countries are obliged to demonstrate that every effort has been made to use all resources that are at their disposal in an effort to satisfy, as a matter of priority, this minimum obligation.
The Committee reports that there is a strong presumption that retrogressive measures taken in relation to the right to social security are prohibited under ICESCR. In this context, a retrogressive measure would be one taken without adequate justification that had the effect of reducing existing levels of social security benefits, or of denying benefits to persons or groups previously entitled to them. However, it is legitimate for a Government to re-direct its limited resources in ways that it considers to be more effective at meeting the general health needs of all society, particularly the needs of the more disadvantaged members of society.
Analysis
This instrument will advance rights to health and social security by ensuring patients with, or at risk of cardiovascular disease, have access to publicly subsidised health services which are clinically effective, safe and cost-effective. These services will assist patients in discussing their risk of heart disease with their general practitioner, and in implementing a management plan to target prevention and treatment.
Conclusion
This instrument is compatible with human rights as it maintains the right to health and the right to social security.
Andrew Simpson
Assistant Secretary
MBS Reviews Unit
Medical Benefits Division
Health Financing Group
Department of Health