EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health and Ageing

Health Insurance Act 1973

Health Insurance (Positron Emission Tomography) Facilities Determination 2009

Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides, in part, that the Minister may, by writing, determine that a health service not listed in the diagnostic imaging 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 (Diagnostic Imaging Services Table) Regulations 2008 which are remade each year.

A determination made under subsection 3C(1) is a legislative instrument for the purposes of the Legislative Instruments Act 2003 (see subsection 3C(4) of the Act and paragraph 6(d) of the Legislative Instruments Act 2003).

The Health Insurance (Positron Emission Tomography) Facilities Determination 2009 (the Determination) revokes and replaces the Health Insurance (Positron Emission Tomography) Facilities Determination 2008. 

Positron Emission Tomography (PET) is a form of nuclear medicine used mainly to determine the presence and severity of cancers, neurological conditions and cardiovascular disease.  PET images reveal the chemistry of organs and other tissues such as tumours.  A radiopharmaceutical that gives off signals is injected into the patient and its emissions are measured by a PET scanner.

The Determination allows for the payment of Medicare benefits in relation to PET services provided by a limited number of providers with eligibility agreements with the Commonwealth.  The Determination maintains the current availability of Medicare benefits for nineteen items relating to PET services and deletes eleven items relating to oesophageal, gastric, and head and neck cancer.  The content of nine of these items will be found in six new items in the Health Insurance (Positron Emission Tomography) Determination 2009.   This means that from 1 July 2009, these items will be available to all eligible PET facilities, rather than only to those providers with eligibility agreements with the Commonwealth.

The two items removed from the Determination relating to gastric cancer were not recommended for continued funding by the Medical Services Advisory Committee (MSAC).

Details of the Determination are set out in the Attachment.

The Determination commences on 1 September 2009.

Consultation

The Department wrote to the facilities on 13 November 2008, advising them that oesophageal items have been approved for public funding by the Minister, but that gastric cancer had not been recommended for public funding and would, therefore, be removed from the Facilities Determination.  This means that no facility in Australia will be able to access gastric items on the MBS from 1 July 2009.

DIAGNOSTIC SERVICES BRANCH

DEPARTMENT OF HEALTH AND AGEING

JUNE 2009

ATTACHMENT

NOTES ON SECTIONS TO THE DETERMINATION

Section 1

Section 1 provides that the Determination may be cited as the Health Insurance (Positron Emission Tomography) Facilities Determination 2009.

Section 2

Section 2 provides that the Determination commences on 1 September 2009.

Section 3

Section 3 provides that the Determination revokes the Health Insurance (Positron Emission Tomography) Facilities Determination 2008.

Section 4

Subsection 4(1) defines terms used in the Determination.  

Section 5

Section 5 specifies the circumstances in which the Determination applies.  These circumstances are:

·               that a written agreement between the owner or operator of the PET facility and the Commonwealth relating to the rendering of the service by the facility is in place; and

·               the service is rendered pursuant to a written request made by a specialist or consultant physician (other than the practitioner who renders the service) that the service was necessary and whose patient the person was.

Section 6

Subsection 6 (a) provides that a relevant service specified in the Schedule to the Determination shall be treated for the purposes of all provisions of the Act, regulations made under the Act, the National Health Act 1953 and regulations made under the National Health Act 1953 that make provision in respect of professional services or medical services, as if it were both a professional service and a medical service.

Subsection 6(b) provides that a relevant service specified in the Schedule to the Determination shall be treated for the purposes of all provisions of the Act, regulations made under the Act, the National Health Act 1953 and regulations made under the National Health Act 1953 that make provision in respect of professional services or medical services, as if there were an R-type diagnostic imaging service in the diagnostic imaging services table that related to the service and specified a fee in respect of that service being the fee specified in the Schedule.

Section 7

Section 7 provides that the provisions specified in section 7 shall have effect as if a relevant service and the items that relate to a relevant service by virtue of section 6(b) were also specified in those provisions specified in section 7.

The Schedule

The Schedule sets out the relevant services and assigns to the services the applicable item number, item descriptor and fee.