Federal Register of Legislation - Australian Government

Primary content

Determinations/Health as made
This determination lists two new Medicare Benefits Schedule items (14247 and 14249) for the treatment of cutaneous T-cell lymphoma with extracorporeal photopheresis.
Administered by: Health
Registered 28 Oct 2020
Tabling HistoryDate
Tabled HR29-Oct-2020
Tabled Senate09-Nov-2020
Table of contents.

Commonwealth Coat of Arms of Australia

 

Health Insurance (Section 3C General Medical Services – Extracorporeal Photopheresis) Determination 2020

I, Paul McBride, delegate of the Minister for Health, make the following determination.

Dated   27 October 2020        

 

 

 

 

 

Paul McBride

First Assistant Secretary

Medical Benefits Division

Health Resourcing Group

Department of Health

 

 

 

 

 

  

  


Contents

1.  Name....................................................................................................................................... 1

2.  Commencement....................................................................................................................... 1

3.  Authority................................................................................................................................. 1

4.  Definitions............................................................................................................................... 1

5.  Treatment of relevant services................................................................................................. 2

6.  Application of provisions of the general medical services table............................................... 2

Schedule 1 – relevant services                                                                                      3

 


1.  Name

              This instrument is the Health Insurance (Section 3C General Medical Services – Extracorporeal Photopheresis) Determination 2020.

2.  Commencement

(1)          Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  The whole of this instrument

1 November 2020

 

                Note:        This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

(2)       Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3.  Authority

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

4.  Definitions

 (1)        In this instrument:

Act means the Health Insurance Act 1973.

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

Pharmaceutical Benefits Scheme means the scheme for the supply of pharmaceutical benefits established under Part VII of the National Health Act 1953.

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

Schedule means a Schedule to this instrument.

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

·         clinically relevant service;

·         general medical services table;

·         item;

·         professional service.

Treatment cycle for a patient, means a single day of treatment, or consecutive days of treatment that is required to deliver extracorporeal photopheresis.

 (2)   Unless the contrary intention appears, a reference in this instrument 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 instrument 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 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.

 

6.  Application of provisions of the general medical services table

(1)          Clause 1.2.6 of the general medical services table shall have effect as if items 14247 and 14249 of this Determination were also specified in the clause.

(2)          Clause 1.2.7 of the general medical services table shall have effect as if items 14247 and 14249 of this Determination were also specified in the clause.

(3)          Clause 1.2.9 of the general medical services table shall have effect as if items 14247 and 14249 of this Determination were specified in the clause.

(4)          Clause 1.2.10 of the general medical services table shall have effect as if items 14247 and 14249 of this Determination were specified in the clause.

(5)          Clause 5.1.1 of the general medical services table shall have effect as if items 14247 and 14249 of this Determination were specified in the clause.

 

 

Schedule 1 – relevant services

 

Group T1—Miscellaneous therapeutic procedures

Subgroup 13 – Miscellaneous therapeutic procedures

Column 1

Item

Column 2

Description

Column 3

Fee ($)

14247

Extracorporeal photopheresis for the treatment of erythrodermic stage III-IVa T4 M0 cutaneous T-cell lymphoma; if

(a)     the service is provided in the initial six months of treatment; and

(b)     the service is delivered using an integrated, closed extracorporeal photopheresis system; and

(c)     the patient is 18 years old or over; and

(d)     the patient has received prior systemic treatment for this condition and experienced either disease progression or unacceptable toxicity while on this treatment; and

(e)     the service is provided in combination with the use of Pharmaceutical Benefits Scheme-subsidised methoxsalen; and

(f)      the service is supervised by a specialist or consultant physician in the speciality of haematology.

 

Applicable once per treatment cycle

1,908.35

14249

Extracorporeal photopheresis for the continuing treatment of erythrodermic stage III-IVa T4 M0 cutaneous T-cell lymphoma; if

(a)     in the preceding 6 months:

(i)       a service to which item 14247 applies has been provided; and

(ii)     the patient has demonstrated a response to this service; and

(iii)    the patient requires further treatment; and

(b)     the service is delivered using an integrated, closed extracorporeal photopheresis system; and

(c)     the patient is 18 years old or over; and

(d)     the service is provided in combination with the use of Pharmaceutical Benefits Scheme-subsidised methoxsalen; and

(e)     the service is supervised by a specialist or consultant physician in the speciality of haematology.

 

Applicable once per treatment cycle

1,908.35