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Determinations/Health as amended, taking into account amendments up to Health Insurance Legislation Amendment (Indexation) Determination 2022
Administered by: Health and Aged Care
Registered 13 Jul 2022
Start Date 01 Jul 2022
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Health Insurance (Poly Implant Prosthese MRI) Determination 2020

made under subsection 3C(1) of the

Health Insurance Act 1973

Compilation No. 1

Compilation date:                              1 July 2022

Includes amendments up to:            F2022L00553

Registered:                                         13 July 2022

About this compilation

This compilation

This is a compilation of the Health Insurance (Poly Implant Prosthese MRI) Determination 2020 that shows the text of the law as amended and in force on 1 July 2022 (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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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............................................................................................................................. 1

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

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

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

6............ Specification of relevant services................................................................................... 2

7............ Supervision and reporting of relevant services.............................................................. 2

8............ Requests for relevant services....................................................................................... 3

9............ Limitation on number of services.................................................................................. 3

10.......... Modifying items 63498 and 63499............................................................................... 3

11.......... Indexation...................................................................................................................... 3

Schedule – relevant services                                                                                                                       5

Endnotes                                                                                                                                                                 7

Endnote 1—About the endnotes                                                                                                        7

Endnote 2—Abbreviation key                                                                                                            8

Endnote 3—Legislation history                                                                                                         9

Endnote 4—Amendment history                                                                                                     10


1  Name

              This instrument is the Health Insurance (Poly Implant Prosthese MRI) Determination 2020.

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.

MRI means magnetic resonance imaging.

PIP implant means a silicone breast prosthesis manufactured by Poly Implant Prosthese.

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, other than clause 1.2.21 of the diagnostic imaging services table.

Note   Clause 1.2.21 of the diagnostic imaging services table sets out the ‘multiple services rule’, which provides for reductions in the fees for diagnostic imaging services where multiple services are provided to the same patient on the same day, for example 2 or more diagnostic imaging services or one or more R-type diagnostic imaging service and one or more consultation service.  The exclusion of clause 1.2.21 means that the services in the Determination will not be relevant in the application of the multiple services rule.

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

remote location means a place within Australia that is more than 30 kilometres by road from:

                (a)    a hospital that provides a radiology or computed tomography service under the direction of a specialist in the specialty of diagnostic radiology; or

               (b)    a free‑standing radiology or computed tomography facility under the direction of a specialist in the specialty of diagnostic radiology.

Schedule means a Schedule to this instrument.

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

·     clinically relevant service;

·     diagnostic imaging services table;

·     item;

·     medical practitioner;

·     professional service’ and

·     specialist.

 (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 that provision 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

(1)     For subsection 3C(1) of the Act, a relevant service in Part 1 of the Schedule, 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 diagnostic imaging service; and

(b)          there were an item in Group I5 of 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.

(2)     For subsection 3C(1) of the Act, a relevant service in Part 2 of the Schedule, provided in accordance with this instrument and as a clinically relvant 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 Subgroup 22 of Group I5 of the diagnostic imaging services table that:

                          (i)    related to the service; and

                         (ii)    specified for the service a fee for each State, being the fee mentioned in the item in the Schedule for the service.

Note   For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.

6  Specification of relevant services

(1)     Paragraph 1.2.19(1)(a) of the diagnostic imaging services table shall be taken to have effect as if the relevant services were also specified in that paragraph.

(2)     Clause 2.5.7 of the diagnostic imaging services table shall be taken to have effect as if the items in Part 1 of the Schedule were also specified in that clause.

7  Supervision and reporting of relevant services

          An item in Part 1 and Part 2 of the Schedule applies only to a service:

                (a)    both:

                        (i)         performed under the professional supervision of a specialist in

                        diagnostic radiology 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 a specialist in diagnostic radiology; or

                (b)    performed:

                        (i)         in an emergency; or

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

8  Requests for relevant services

(1)     An item in Part 1 and Part 2 of the Schedule applies only to a service provided at the request of a medical practitioner.

(2)     A request must be in writing and specify:

(a)      that the patient is a person who has or is suspected of having a PIP implant; and

(b)     whether the patient displays symptoms indicating that the implant has or may have ruptured.

9  Limitation on number of services 

          Items 63501 and 63502 do not apply to the service described in the item if a patient has been provided with the service described in either item in the previous 24 months. 

10  Modifying items 63498 and 63499

 

(1)     Subject to subsections (2), (3) and (4), if item 63498 or 63499 applies to a service in this instrument, the fee specified in the item applies in addition to the fee specified in the other item in this instrument that applies to the service.

 

(2)     If 2 or more services described in item 63498 are performed for a person on the same day, the fee specified in that item applies to one of those services only.

 

(3)     If 2 or more services described in item 63499 are performed for a person on the same day, the fee specified in that item applies to one of those services only.

 

(4)     If:

                (a)    one or more services described in item 63498; and

               (b)    one or more services described in item 63499;

are performed for a person on the same day, the fee specified in item 63498 or item 63499, but not both those items, applies to one of those services only.

11  Indexation

(1)   On 1 July 2022 (the indexation day), each amount covered by subsection (2) is replaced by the amount worked out using the following formula:

(2)   The amounts covered by this subsection are the fee for each item in a Schedule of this Determination.

(3)   An amount worked out under subsection (1) is to be rounded up or down to the nearest 5 cents (rounding down if the amount is an exact multiple of 2.5 cents).


 

Schedule – relevant services

Part 1

 

Group I5 – Magnetic Resonance Imaging

 

Subgroup 32 – Magnetic resonance imaging – PIP breast implant

 

Item

Service

Fee ($)

63501

MRI – scan of one or both breasts for the evaluation of implant integrity where:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that the patient:

(i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and

(ii) the result of the scan confirms a loss of integrity of the implant (R)

500.00

63502

MRI – scan of one or both breasts for the evaluation of implant integrity where:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that the patient:

(i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and

(ii) the result of the scan does not demonstrate a loss of integrity of the implant (R)

500.00

63504

MRI – scan of one or both breasts for the evaluation of implant integrity where:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that the patient:

(i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and

(ii) presents with symptoms where implant rupture is suspected; and

(iii) the result of the scan confirms a loss of integrity of the implant (R)

500.00

63505

MRI – scan of one or both breasts for the evaluation of implant integrity where:

(a) a dedicated breast coil is used; and

(b) the request for the scan identifies that the patient:

(i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and

(ii) presents with symptoms where implant rupture is suspected; and

(iii) the result of the scan does not demonstrate a loss of integrity of the implant (R)

500.00

 

Part 2

 

Group I5 – Magnetic Resonance Imaging

Subgroup 22 – Modifying items

Item

Service

Fee ($)

63498

MRI service to which item 63501, 63502, 63504 or 63505 applies if the service is performed on a person using intravenous or intra muscular sedation

44.80

63499

MRI service to which item 63501, 63502, 63504 or 63505 applies if  the service is performed on a person under anaesthetic in the presence of a medical practitioner who is qualified to perform an anaesthetic

156.80

 


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 how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.

If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to 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 (Poly Implant Prosthese MRI) Determination 2020

29 Apr 2020 (F2020L00513)

1 May 2020 (s 2(1) item 1)

 

Health Insurance Legislation Amendment (Indexation) Determination 2022

7 Apr 2022 (F2022L00553)

Sch 1 (item 5): 1 July 2022 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

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

rep LA s 48D

s 11...........................................

ad F2022L00553