This Determination is the Health
Insurance (Home-Based Sleep Studies) Determination 2010 (No. 2).
This Determination will be taken to have
commenced on 1 November 2010 and shall remain in force until midnight 31 October
2011.
This Determination revokes the Health
Insurance (Home-Based Sleep Studies) Determination 2010 (No. 1).
4.
Interpretation
(1) In
this Determination:
Act means the Health Insurance Act 1973.
Advisory Committee means the Specialist Advisory Committee in Thoracic
and Sleep Medicine of the Royal
Australasian College of Physicians.
Appeal Committee means the Appeal Committee of the Royal Australasian College of Physicians.
Credentialling Subcommittee means the Credentialling Subcommittee of the Advisory Committee.
qualified sleep medicine
practitioner means a qualified adult sleep
medicine practitioner or a qualified paediatric sleep medicine practitioner.
relevant Advanced
Training Program means:
(a) for an assessment
for qualification as a qualified adult sleep medicine practitioner — the
Advanced Training Program in Adult Sleep Medicine; and
(b) for an assessment
for qualification as a qualified paediatric sleep medicine practitioner —
the Advanced Training Program in Paediatric Sleep Medicine.
relevant field of
sleep medicine means:
(a) for an assessment
for qualification as a qualified adult sleep medicine practitioner — adult
sleep medicine; and
(b) for an assessment
for qualification as a qualified paediatric sleep medicine practitioner —
paediatric sleep medicine.
relevant provisions means all provisions, relating to professional services or to
medical services, of the Act and regulations made under the Act, and the National
Health Act 1953 and regulations made under that Act.
relevant service means a health service, as defined in subsection 3C(8)
of the Act, that is
specified in the Schedule.
Schedule means the Schedule to this
Determination.
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.
(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.
5.
Circumstances
where this Determination applies
(1)
This Determination applies only in the following
circumstances:
(a)
where the relevant service is rendered by a
qualified paediatric sleep medicine practitioner to a person who is aged less
than 18 years; or
(b)
where the relevant service is rendered by a
qualified adult sleep medicine practitioner to a person who is aged 18 years or
over.
(2)
For subsection (1), a person is a qualified
adult sleep medicine practitioner or a qualified paediatric sleep medicine
practitioner if:
(a) the person has been assessed by the
Credentialling Subcommittee or the Appeal Committee as having had, before 1
March 1999, sufficient training and experience in the relevant field of sleep
medicine to be competent in independent clinical assessment and management of
patients with respiratory sleep disorders and in reporting sleep studies; or
(b) the person has been assessed by the
Credentialling Subcommittee or the Appeal Committee as having had, before 1
March 1999, substantial training or experience in adult sleep medicine, but
requiring further specified training or experience in the relevant field of
sleep medicine to be competent in independent clinical assessment and
management of patients with respiratory sleep disorders and in reporting sleep
studies, and either:
(i) the period of 2 years immediately
following that assessment has not expired; or
(ii) the person has been assessed by
the Credentialling Subcommittee as having satisfactorily finished the further
training or gained the further experience specified for that person; or
(c) the person has attained Level I or
Level II of the relevant Advanced Training Program of the Thoracic Society
of Australia and New Zealand and the Australasian Sleep Association, after
having completed at least 12 months core training, including clinical practice
in the relevant field of sleep medicine and in reporting sleep studies; or
(d) the
Advisory Committee has recognised the person, in writing, as having training
equivalent to the training mentioned in paragraph (c).
6.
Treatment
of a relevant service
A relevant service provided in accordance
with this Determination is to be treated, for the relevant provisions, as if
(a)
it were both a professional service and a
medical service; and
(b)
there were an item in
the general medical services table that
i.
related to the service;
and
ii.
specified for the
service a fee in relation to each State, being the fee specified in the
Schedule in relation to the service.
SCHEDULE – SPECIFIED
HEALTH SERVICES
|
Item
|
Health Service
|
Fee for all States
|
|
12250
|
OVERNIGHT INVESTIGATION FOR SLEEP
APNOEA FOR A PERIOD OF AT LEAST 8 HOURS’ DURATION, WHERE:
(a) the patient is referred for the investigation by a medical
practitioner;
(b) the necessity for the investigation is determined by a qualified
sleep medicine practitioner prior to the investigation;
(c) a qualified sleep medicine practitioner has:
i.
established quality assurance procedures for
the data acquisition; and
ii.
personally analysed the data and written the
report;
(d) the investigation must include, during a period of sleep, a
continuous recording of an electrocardiograph (ECG); a continuous recording
of an electroencephalograph (EEG); and respiratory function testing (with
monitoring of oro-nasal airflow, rib cage/abdominal movement, body position
and oximetry);
(e) interpretation and report of the investigation (with analysis of
sleep stage, arousals, respiratory events and assessment of clinically
significant alterations in heart rate) are provided by a qualified sleep
medicine practitioner based on reviewing the parameters recorded under (d)
above;
(f)
the service is paid only once in a 12 month
period.
|
$322.60
|
Note Subsection 3C(7) of the Act
deems an internal territory to form part of the State of New South Wales.
Note
1. All legislative
instruments and compilations are registered on the Federal Register of
Legislative Instruments kept under the Legislative Instruments Act 2003. See
www.frli.gov.au