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Determinations/Health as amended, taking into account amendments up to Health Insurance Legislation Amendment (Section 3C – Medical and Diagnostic Imaging Services) Determination 2020
Administered by: Health
Registered 03 Jun 2020
Start Date 01 May 2020
Table of contents.

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Health Insurance (Section 3C Diagnostic Imaging Services—Multiparametric MRI of the prostate) Determination 2018

made under subsection 3C(1) of the

Health Insurance Act 1973

Compilation No. 1

Compilation date:                           1 May 2020

Includes amendments up to:         F2020L00518

Registered:                                      3 June 2020

 

About this compilation

This compilation

This is a compilation of the Health Insurance (Section 3C Diagnostic Imaging Services—Multiparametric MRI of the prostate) Determination 2018 that shows the text of the law as amended and in force on 1 May 2020 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self-repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

  

  

  


Contents

1.                             Name of Determination                                                                           4

3.                             Authority                                                                                                 4

4.                             Definitions                                                                                              4

5.                             Treatment of relevant services                                                                5

6.                             Application of items                                                                                5

7.                             Limitation of items                                                                                  6

Schedule – relevant services                                                               7

Endnotes                                                                                                                        8

Endnote 1—About the endnotes                                                                              8

Endnote 2—Abbreviation key                                                                                 9

Endnote 3—Legislation history                                                                            10

Endnote 4—Amendment history                                                                           11

 


1.         Name of Determination

This Determination is the Health Insurance (Section 3C Diagnostic Imaging Services—Multiparametric MRI of the prostate) Determination 2018.

3.         Authority

This Determination is made under subsection 3C(1) of the Health Insurance Act 1973.

4.         Definitions

(1)          In this Determination:

Act means the Health Insurance Act 1973.

clinical concern means a clinical decision that the prostate cancer has progressed, and includes prostate specific antigen progression.

eligible equipment has the meaning given by clause 2.5.5 of the diagnostic imaging services table.

eligible provider has the meaning given by clause 2.5.4 of the diagnostic imaging services table.

partial eligible equipment has the meaning given by clause 2.5.6 of the diagnostic imaging services table.

relevant family history means, for any particular patient, a first degree relative with prostate cancer, or suspected of carrying a BRCA 1 or BRCA 2 mutation.

relevant provisions means all provisions, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act, relating to medical services, professional services or items.

relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.

scan means a minimum of 3 sequences.

Schedule means the Schedule to this Determination.

Note:       The following terms are defined in subsection 3(1) of the Act:

·     clinically relevant service

·     diagnostic imaging services table

·     item

·     professional service

·     specialist

(2)    Unless the contrary intention appears, a reference in this Determination to a provision of the Act or the National Health Act 1953 or regulations made under the Act or 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.         Treatment of relevant services

                   For subsection 3C(1) of the Act a relevant service, provided in accordance with this Determination and as a clinically relevant service, is to be treated, for the relevant provisions, as if:

(a)          it were both a professional service and a diagnostic imaging service; and

(b)          there were an item in the diagnostic imaging 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.

6.         Application of items

 

(1)          For any particular patient, items in the Schedule apply to a service performed:

(a)          at the request of a specialist in the speciality of urology, radiation oncology, or medical oncology; and

(b)          in a permissible circumstance; and

(c)          using:

(i)           eligible equipment; or

(ii)          partial eligible equipment.

 

(2)          For the purposes of paragraph 6(1)(a), a request must be:

(a)          made in writing; and

(b)          identify the clinical indications for the service.

 

(3)          For the purposes of paragraph 6(1)(b), a service is performed in a permissible circumstance only if it is:

(a)        both:

(i)           performed under the supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; and

(ii)          reported by an eligible provider; or

 

(b)        performed in an emergency; or

(c)        performed because of medical necessity, in a remote location.

7.         Limitation of items

 

(1)     For any particular patient, item 63541 is applicable not more than once in a 12 month period.

 

(2)     For any particular patient, item 63543 is applicable:

(a)   at the time of diagnosis of prostate cancer; and

(b)   12 months following diagnosis; and

(c)   every third year thereafter; or

(d)   at any time if there is clinical concern from the specialist requesting the service in paragraph 6(1)(a).

 

(3)     Item 63543 is not applicable for the purposes of treatment planning or for monitoring after treatment of prostate cancer.


        Schedule – relevant services

 

Category 5 – Diagnostic Imaging Services

Group I5 – Magnetic Resonance Imaging

Sub Group 19 – Scan of Body – For Specified Conditions

Item

Service

Fee ($)

63541

Multiparametric Magnetic Resonance Imaging scan of the prostate for the detection of cancer, if the request for the scan identifies:

a)    that the patient is suspected of  developing prostate cancer, due to one    of the following:

(i)     a digital rectal examination which is suspicious for prostate cancer; or

(ii)    in a person under 70 years, at least two prostate specific antigen (PSA) tests performed within an interval of 1- 3 months are greater than 3.0 ng/ml, and the free/total PSA ratio is less than 25% or the repeat PSA exceeds 5.5 ng/ml; or

(iii)   in a person under 70 years, whose risk of developing prostate cancer based on relevant family history is at least double the average risk, at least two PSA tests performed within an interval of 1- 3 months are greater than 2.0 ng/ml, and the free/total PSA  ratio is less than 25%; or

(iv)   in a person 70 years or older, at least two PSA tests performed within an interval of 1- 3 months are greater than 5.5ng/ml and the free/total PSA ratio is less than 25%.

b)     using a standardised image acquisition protocol involving T2 Weighted Imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated)

 (R) (Anaes)

450.00

63543

Multiparametric Magnetic Resonance Imaging scan of the prostate for the assessment of cancer:

a)   if the request for the scan identifies:

(i)    the patient is under active surveillance following a confirmed diagnosis of prostate cancer by biopsy histopathology; and

(ii)   the patient is not planning or undergoing treatment for prostate cancer.

b)    using a standardised image acquisition protocol involving T2 Weighted Imaging, Diffusion Weighted Imaging, and Dynamic Contrast Enhancement (unless contraindicated)

 (R) (Anaes)

450.00

 


Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

 

Endnote 2—Abbreviation key

 

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

    /sub‑subparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

    effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

    effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

Sub‑Ch = Sub‑Chapter(s)

    cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

    commenced or to be commenced

 

Endnote 3—Legislation history

 

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Section 3C Diagnostic Imaging Services—Multiparametric MRI of the prostate) Determination 2018

14 June 2018 (F2018L00771)

1 July 2018 (s 2)

 

Health Insurance Legislation Amendment (Section 3C – Medical and Diagnostic Imaging Services) Determination 2020

29 Apr 2020 (F2020L00518)

Sch 1 (items 14–17): 1 May 2020 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

s 2...........................................

rep LA s 48D

s 7...........................................

am F2020L00518

Schedule

 

Schedule.................................

am F2020L00518

 

ed C1

 

Endnote 5—Editorial changes

In preparing this compilation for registration, the following kinds of editorial change(s) were made under the Legislation Act 2003.

 

Schedule

 

Kind of editorial change

 

Give effect to the misdescribed amendment as intended

 

Details of editorial change

 

Schedule 1 item 17 of the Health Insurance Legislation Amendment (Section 3C – Medical and Diagnostic Imaging Services) Determination 2020 instructs to repeal and substitute the table in Schedule 1.

 

Schedule 1 does not appear. However, Schedule does appear.

 

This compilation was editorially changed to repeal and substitute the table in the Schedule to give effect to the misdescribed amendment as intended.