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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 28 Jul 2022
Start Date 01 Jul 2022
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Health Insurance (Section 3C Diagnostic Imaging – Cardiac MRI for Myocarditis) Determination 2021

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:                                         28 July 2022

About this compilation

This compilation

This is a compilation of the Health Insurance (Section 3C Diagnostic Imaging – Cardiac MRI for Myocarditis) Determination 2021 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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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 ...................................................................................................................................... 2

2.  Commencement....................................................................................................................... 2

3.  Authority................................................................................................................................. 2

4.  Definitions............................................................................................................................... 2

5.  Treatment of relevant services................................................................................................. 3

6.  Application of provisions from the diagnostic imaging services table..................................... 3

7.  Application of contrast............................................................................................................ 4

8.  Indexation................................................................................................................................ 4

Schedule – relevant services                                                                                         5

Endnotes                                                                                                                        6

Endnote 1—About the endnotes                                                                              6

Endnote 2—Abbreviation key                                                                                 7

Endnote 3—Legislation history                                                                              8

Endnote 4—Amendment history                                                                             9

 


1.  Name

              This instrument is the Health Insurance (Section 3C Diagnostic Imaging – Cardiac MRI for Myocarditis) Determination 2021.

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 January 2022

 

                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.

(Anaes.) has the meaning given by subclause 5.9.4(1) of the general medical services table.

MRI has the meaning given by the term in the diagnostic imaging services table.

(R) has the meaning given by subclause 1.2.15(1) of the diagnostic imaging services table.

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.

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;

·         diagnostic imaging services table;

·         general medical services table;

·         item;

·         professional service.

 (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 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 provisions from the diagnostic imaging services table

(1)     The item in the Schedule applies to an MRI service if all of the following apply:

(a)                    it is performed in a permissible circumstance, as described in clause 2.5.3 of the diagnostic imaging services table;

(b)                    it is performed by an eligible provider, as described in clause 2.5.4 of the diagnostic imaging services table;

(c)                    it is performed using equipment that is:

                                                              i.      eligible equipment, as described in clause 2.5.5 of the diagnostic imaging services table; or

                                                            ii.      partial eligible equipment, as described in clause 2.5.6 of the diagnostic imaging services table.

(2)     Subject to paragraph (1)(b), clause 2.5.4 of the diagnostic imaging services table shall have effect as if the item in the Schedule were also specified in column 1 of item 1 and 2 of table 2.5.4.

7.  Application of contrast

(1)   If a service to which an item in the Schedule applies is performed using a contrast agent, the fee specified in that item applies in addition to the schedule fee in item 63491 of the diagnostic imaging services table.

Note:    Clause 2.5.12 of the diagnostic imaging services table sets out the application of modifying items in subgroup 22 of Group I5 to other items in Group I5.

8.  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

 

Group I5 – Magnetic Resonance Imaging

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 14 - Scan of cardiovascular system—for specified conditions

63399

MRI–scan of cardiovascular system for the assessment of myocardial structure and function, if the service is requested by a consultant physician who has assessed the patient, and the request for the scan indicates:

(a)    the patient has suspected myocarditis after receiving a mRNA COVID-19 vaccine; and

(b)   the patient had symptom onset within 21 days of a mRNA COVID-19 vaccine administration; and

(c)    the results from the following examinations are inconclusive to form a diagnosis of myocarditis:

(i)       echocardiogram; and

(ii)     troponin; and

(iii)    chest X-ray.

Applicable not more than once in a patient’s lifetime (R) (Anaes.) (Contrast)

855.20


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 (Section 3C Diagnostic Imaging – Cardiac MRI for Myocarditis) Determination 2021

17 Dec 2021 (F2021L01810)

1 Jan 2022 (s 2(1) item 1)

 

Health Insurance Legislation Amendment (Indexation) Determination 2022

7 Apr 2022 (F2022L00553)

Sch 1 (item 16): 1 July 2022 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

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

rep LA s 48D

s 8........................................

ad F2022L00553