EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under subsections 73AAG (6) and (7)
(HIB 13/2006)
Subsection 73AAG(6) of the National Health Act 1953 (the Act) provides that the Minister may determine in writing the prostheses that are no gap prostheses and the benefit amount for each no gap prosthesis.
Subsection 73AAG(7) provides that the Minister may determine in writing the prostheses that are gap permitted prostheses, and the minimum and maximum benefit amounts for each gap permitted prosthesis.
The Schedule to this determination has two parts:
- Part A – Prostheses; and
- Part B – Human Tissues.
The Schedule to this determination is known as the “Prostheses List”.
This determination commences on 24 March 2006. It replaces, in its entirety, the determination dated 22 February 2006 (HIB 05/2006).
This determination corrects errors in the previous Prostheses List by:
- adding twenty two (22) new no gap products that were omitted in error from the previous determination;
- deleting one listing that was duplicated;
- removing the maximum benefit amount from one gap permitted prosthesis, at the request of the sponsor; and
- changing the listed details of fifteen (15) products to correctly describe them.
Details of the changes are listed below.
1. New products added:
- EK075 - Talar Component Ankle Joint Cementless Ha (ESKA Australia)
- TB326 - Scaminos Screw (Taylor Bryant Pty Ltd)
- TB327 - MiniFix (Taylor Bryant Pty Ltd)
- TB328 - MCP Finger Prosthesis “Ariadna” (Taylor Bryant Pty Ltd)
- TB329 - PIP Finger Prosthesis “DGT” (Taylor Bryant Pty Ltd)
- TB330 - MCP Finger Prosthesis “Ariadna” (Taylor Bryant Pty Ltd)
- TB331 - RadioFix (Taylor Bryant Pty Ltd)
- TB332 - Carpal Button (Taylor Bryant Pty Ltd)
- TB333 - Trapezio Metacarpal Prostheses DLC (Taylor Bryant Pty Ltd)
- TB334 - Trapezio Metacarpal Prostheses DLC (Taylor Bryant Pty Ltd)
- TB335 - Elektra Stem (Taylor Bryant Pty Ltd)
- TB336 - Elektra Neck (Taylor Bryant Pty Ltd)
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- TB337 - Memofix Staples (Taylor Bryant Pty Ltd)
- TB338 - Trapezio Metacarpal Prostheses DLC (Taylor Bryant Pty Ltd)
- TB339 - Trapezio Metacarpal Prostheses DLC (Taylor Bryant Pty Ltd)
- TB340 - Poing Fix (Taylor Bryant Pty Ltd)
- TB341 - Wrist Fixator PF11 (Taylor Bryant Pty Ltd)
- TB342 - MicroFix (Taylor Bryant Pty Ltd)
- TB343 - Minos Screw (Taylor Bryant Pty Ltd)
- TB344 - PIP Finger Prosthesis “DGT” (Taylor Bryant Pty Ltd)
- TB345 - Weil Screw (Taylor Bryant Pty Ltd)
- TB346 - Elektra Cup (Taylor Bryant Pty Ltd)
2. Product deleted:
- EM017 - MiniMizer Adjustable Gastric Band (EMT Healthcare Pty Ltd)
3. Maximum benefit removed at sponsor’s request:
- TB304 - HemiCAP Contoured Articular Knee System (Taylor Bryant Pty Ltd)
3. Corrections to product details:
- AO023 - Tecnis Multifocal Intraocular Lens (Advanced Medical Optics)
- MC707 - Danek Unit Rod System (Medtronic Australasia Pty Ltd)
- MC708 - CD Horizon (Medtronic Australasia Pty Ltd)
- MC684 - Infuse Bone Graft (Medtronic Australasia Pty Ltd)
- MC687 - Lead Accessory Plug and Closed Boot Kit Model 3550-29 (Medtronic Australasia Pty Ltd)
- MC690 - Neurostimulation System - Octad Leads (Medtronic Australasia Pty Ltd)
- AD259 - OSSStaple Osteosynthesis Staple (Advanced Surgical Technologies)
- CR028 - Zirconia Femoral Head (Corin Australia Pty Ltd)
- CR029 - CoCr Femoral Head (Corin Australia Pty Ltd)
- CR031 - LARS Interference Screw (Corin Australia Pty Ltd)
- CR084 - Modular Endo Head (Corin Australia Pty Ltd)
- CR089 - Alpha Fit Stem (Corin Australia Pty Ltd)
- KA015 - Entristar Skin Level Gastrostomy Kits (Kendall Australasia Pty Ltd)
- KA017 - NutriPort Balloon Skin Level Gastrostomy Kit (Kendall Australasia Pty Ltd)
- AL027 - ReSTOR multipiece apodised diffractive blue light filtering PC IOL Model MN60D3.
The determination is consistent with the recommendation of the Prostheses and Devices Committee.
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Benefits payable in respect of the products that have been assessed and grouped by Clinical Advisory Groups (CAGs), and new products have been negotiated with the suppliers. Benefits payable in respect of products that have not yet been assessed and grouped by CAGs have been determined by application of a formula taking into account the benefits payable in respect of each product as at 1 October 2004 and, where available, the utilisation of each product.
CONSULTATION
This Determination has been made having regard to advice provided by the Prostheses and Devices Committee (PDC), a ministerially appointed committee comprised of nominees from health funds, hospitals, clinicians, prostheses and devices suppliers, the Commonwealth, and consumer representatives. In making their recommendations, the PDC were advised by CAGs, other clinical experts, and benefits negotiators, all appointed by the PDC.
This determination and this Explanatory Statement have been registered on the Federal Register of Legislative Instruments.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
March 2006.