Contents
1. Name of Determination 3
2. Commencement and term 3
3. Revocation of Health Insurance (Positron Emission Tomography) Facilities Determination 2008 3
4. Interpretation 3
5. Circumstances where this Determination applies 4
6. Treatment of certain positron emission tomography services 4
7. Certain positron emission tomography services—items and specifications etc 5
Schedule – Specified health services 6
1.Name of Determination
This Determination is the Health Insurance (Positron Emission Tomography) Facilities Determination 2009.
2. Commencement
This Determination commences on 1 September 2009.
3. Revocation of Health Insurance (Positron Emission Tomography) Facilities Determination 2008
The Health Insurance (Positron Emission Tomography) Facilities Determination 2008 is revoked.
4. Interpretation
(1) In this Determination
Act means the Health Insurance Act 1973.
FDG means 18F-fluorodeoxyglucose.
PET means positron emission tomography.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.
(2) Unless the contrary intention appears, in this Determination a reference to a provision of the Act or regulations made under the Act or the National Health Act 1953 or regulations made under the National Health Act 1953 as applied, adopted or incorporated in relation to specifying a matter is a reference to those provisions as in force from time to time and any other reference to provisions of an Act or regulations is a reference to those provisions as in force from time to time.
Note Unless the contrary intention appears, expressions used in this determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.
5. Circumstances where this Determination applies
This Determination applies to a relevant service in the following circumstances:
(a) where there is in force a written agreement between the owner or operator of a PET facility and the Commonwealth that relates to the rendering of the service by means of the facility; and
(b) where the service is rendered pursuant to a written request made by a specialist or a consultant physician (not being the practitioner who renders the service) who determined that the service was necessary and whose patient the person was.
Note The circumstance in paragraph (b) mirrors the requirement in paragraph 16B(1)(b) of the Act that for a medicare benefit to be payable in respect of an R-type diagnostic imaging service, the service must be rendered pursuant to a written request, but limits which practitioners may request a relevant service.
6. Treatment of certain positron emission tomography services
A relevant service shall be treated for the purposes of the provisions of the Act and of regulations made under the Act and the provisions of the National Health Act 1953 and of regulations made under the National Health Act 1953
that make provision in respect of professional services or medical services as if:
(a) it was both a professional service and a medical service; and
(b) there was an item of an R-type diagnostic imaging service in the diagnostic imaging services table that:
(i) related to the relevant service; and
(ii) specified in respect of the relevant service a fee in relation to a State, being the fee specified in the Schedule in relation to the State specified.
7. Certain positron emission tomography services—items and specifications etc
(1) Each of the following provisions:
(a) subrule 3(1) of Part 2 of Schedule 1 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008;
(b) any regulation made under the Act that identifies an item in the diagnostic imaging services table as an R-type diagnostic imaging service; and
(c) regulation 13 of the Health Insurance Regulations 1975, so far it relates to professional services generally or diagnostic imaging services specifically;
shall have effect as if a relevant service, and the items that by virtue of paragraph 6 (b) relate to a relevant service, were also specified in the provision.