EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Vertebroplasty) Determination HS/05/2005
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 statuary provisions, be treated as if it were so listed. The Table is set out in the Health Insurance (General Medical Services Table) Regulations.
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 (Vertebroplasty) Determination HS/05/2005 (the Determination) provides that the vertebroplasty services specified in the Schedule to the Determination are to be treated as if they were listed in the Table for the purposes of the statutory provisions specified in clause 5 of the Determination.
The statutory provisions specified in clause 5 of the Determination are those contained in the Act, the National Health Act 1953 and regulations made under each Act which relate to professional services and medical services generally.
Vertebroplasty is a procedure used to stabilise fractured vertebrae in order to relieve pain in patients with osteoporotic vertebral compression fractures or expanding spinal cancer secondaries or multiple myeloma. It involves the percutaneous injection of artificial bone cement and an opacifier into the marrow space of the fractured vertebra, under imaging guidance, which hardens to fill spaces and provide stability.
The Medical Services Advisory Committee (MSAC) reviewed vertebroplasty and recommended on 24 August 2005 that interim funding be provided for patients with specified indications, signs and symptoms.
Vertebroplasty is being introduced under a 3C Determination to ensure that Medicare benefits are payable for vertebroplasty services under appropriate items and fees from 1 November 2005. This is necessary as, from 1 November 2005, restrictions will be applied to existing items of the Table that are currently being claimed inappropriately for vertebroplasty services. The Determination will avoid disadvantage to patients by ensuring that there is a seamless and timely transfer from inappropriate use of existing items to new items specific to vertebroplasty.
The Determination ceases at the end of 30 April 2006, as the new vertebroplasty items are expected to be introduced in the Table in the 1 May 2006 update to the Health Insurance (General Medical Services Table) Regulations.
Details of the Determination are set out in the Attachment.
The Determination commences on 1 November 2005.
ATTACHMENT
NOTES ON CLAUSES
Clause 1 provides that the Determination may be cited as the Health Insurance (Vertebroplasty) Determination HS/05/2005.
Clause 2 defines certain terms used in the Determination.
Clause 3 provides that the Determination commences on 1 November 2005.
Clause 4 provides that the Determination ceases at the end of 30 April 2006.
Clause 5 provides that the vertebroplasty services specified in the Schedule to the Determination shall be treated as if they 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 relate to professional services and medical services. Clause 5 also provides that each vertebroplasty service specified in the Schedule to the Determination shall be treated as if there were an item in the general medical services table that related to the service that specified a fee in respect of that service, being the fee specified in the Schedule to the Determination for that service.
The Schedule sets out the vertebroplasty services to which the Determination relates and specifies the fees in respect of each service.