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Determinations/Health as made
This Determination permits ongoing payment of Medicare benefits for home-based studies ordered and analysed by practitioners qualified in the field of adult sleep medicine.
Administered by: Health
Made 22 Oct 2010
Registered 26 Oct 2010
Tabled HR 28 Oct 2010
Tabled Senate 28 Oct 2010
Date of repeal 19 Mar 2014
Repealed by Health (Spent and Redundant Instruments) Repeal Regulation 2014

Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 2)

 

I, RICHARD BARTLETT, delegate of the Minister for Health and Ageing, make this Determination under subsection 3C(1) of the Health Insurance Act 1973.

Dated  22 October 2010



 

________________________________

 

RICHARD BARTLETT

DELEGATE OF THE MINISTER FOR HEALTH AND AGEING

 

 


Contents

 

1.            Name of Determination                                                                               3

2.            Commencement and term                                                                            3

3.            Revocation                                                                                              3

4.                Interpretation                                                                                                                          3

5.                Circumstances where this Determination applies                                              4

6.                Treatment of a relevant service                                                                                           5

 

                SCHEDULE – SPECIFIED HEALTH SERVICES                                                                                  6

 

 


1.                       Name of Determination

This Determination is the Health Insurance (Home-Based Sleep Studies) Determination 2010 (No. 2).

2.                       Commencement and term

This Determination will be taken to have commenced on 1 November 2010 and shall remain in force until midnight 31 October 2011.

3.                       Revocation

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