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Health Insurance (Section 3C General Medical Services – Vigilance Testing) Determination 2018

made under subsection 3C(1) of the

Health Insurance Act 1973

Compilation No. 1

Compilation date:    1 July 2019

Includes amendments up to: F2019L00605

Registered:    4 July 2019

 

About this compilation

This compilation

This is a compilation of the Health Insurance (Section 3C General Medical Services – Vigilance Testing) Determination 2018 that shows the text of the law as amended and in force on 1 July 2019 (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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

 

 

 

1. Name 1

2. Commencement 1

3. Authority 1

4. Definitions 1

5. Treatment of relevant services 1

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

Schedule 1 – relevant services 3

Endnotes

Endnote 1—About the endnotes 9

Endnote 2—Abbreviation key 10

Endnote 3—Legislation history 11

Endnote 4—Amendment history 12

 

 

 

 

1.        Name

This Determination is the Health Insurance (Section 3C General Medical Services – Vigilance Testing) 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.

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

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 Determination.

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

(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 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 1.2.10 of the general medical services table shall have effect as if item 12254, 12258, 12261, 12265, 12268 and 12272 were also specified in the clause.

 

(2)  Clause 2.36.2 of the general medical services table shall have effect as if item 12261 and 12265 were also specified in subclause 2.36.2(1).

 

(3) Clause 2.36.2 of the general medical services table shall have effect as if item 12268 and 12272 were also specified in subclause 2.36.2(2).

 

(4) Clause 2.36.2 of the general medical services table shall have effect as if item 12254 and 12258 were also specified in subclause 2.36.2(3).


Schedule 1 – relevant services

Category 2 – Diagnostic Procedures and Investigations

Group D1 – Miscellaneous Diagnostic Procedures And Investigations

Subgroup 10 – Other Diagnostic Procedures and Investigations

Item

Service

Fee ($)

12254

Multiple sleep latency test  for the assessment of unexplained hypersomnolence in a patient aged 18 years or more, if:

(a)     a qualified sleep medicine practitioner or neurologist determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria for drugs relevant to treat that condition under the Pharmaceutical Benefits Scheme are fulfilled; and

(b)    an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration is performed, with  continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;  

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(c)     immediately following the overnight investigation a daytime investigation is performed where at least 4 nap periods are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d)    a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e)     polygraphic records are:

(i)      analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii)    stored for interpretation and preparation of report; and

(f)     interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g)    the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items  11003, 12203, 12204, 12205, 12208, 12250 or 12258 is provided to the patient

Applicable only once in a 12 month period

928.30

12258

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness in a patient aged 18 years or more, if:

(a)     a qualified sleep medicine practitioner or neurologist determines that testing is necessary to objectively confirm the ability to maintain wakefulness; and

(b)    an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration is performed, with  continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;  

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(c)     immediately following the overnight investigation, a daytime investigation is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d)    a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e)     polygraphic records are:

(i)      analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii)    stored for interpretation and preparation of report; and

(f)     interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g)    the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003, 12203, 12204, 12205, 12208, 12250 or 12254 is provided to the patient

Applicable only once in a 12 month period

928.30

12261

Multiple sleep latency test for the assessment of unexplained hypersomnolence in a patient aged at least 12 years but less than 18 years, if:

(a)     a qualified sleep medicine practitioner determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria for drugs relevant to treat that condition under the Pharmaceutical Benefits Scheme are fulfilled; and

(b)   an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration where continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c)     immediately following the overnight investigation, a daytime investigation is performed where at least 4 nap periods are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d)    a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e)     polygraphic records are:

(i)      analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii)    stored for interpretation and preparation of report; and

(f)     interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g)    the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003,  12213, 12217 or 12265 is provided to the patient

Applicable only once in a 12 month period

973.35

12265

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness in a patient aged at least 12 years but less than 18 years, if:

(a)     a qualified sleep medicine practitioner determines that testing to objectively confirm the ability to maintain wakefulness is necessary; and

(b)    an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration where continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c)     immediately following the overnight investigation, a daytime investigation is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d)    a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e)     polygraphic records are:

(i)      analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii)    stored for interpretation and preparation of report; and

(f)     interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g)    the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003, 12213, 12217 or 12261 or is provided to the patient

Applicable only once in a 12 month period

973.35

12268

Multiple sleep latency test for the assessment of unexplained hypersomnolence for a patient less than 12 years of age, if:

(a)     a qualified sleep medicine practitioner determines that testing is necessary to confirm the diagnosis of a central disorder of hypersomnolence or to determine whether the eligibility criteria for drugs relevant to treat that condition under the Pharmaceutical Benefits Scheme are fulfilled; and

(b)   an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration where there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c)     immediately following the overnight investigation, a daytime investigation is performed  where at least 4 nap periods are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d)    a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e)     polygraphic records are:

(i)      analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii)    stored for interpretation and preparation of report; and

(f)     interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g)    the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003, 12210, 12215 or 12272 is provided to the patient

Applicable only once in a 12 month period

1,044.00

12272

Maintenance of wakefulness test for the assessment of the ability to maintain wakefulness for a patient less than 12 years of age, if:

(a)     a qualified sleep medicine practitioner determines that testing to objectively confirm the ability to maintain wakefulness is necessary; and

(b)    an overnight diagnostic assessment of sleep, for a period of at least 8 hours duration where there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(c)     immediately following the overnight investigation, a daytime investigation is performed where at least 4 wakefulness trials are conducted, during which there is continuous recording of EEG, EMG, EOG and ECG; and

(d)    a sleep technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e)     polygraphic records are:

(i)      analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii)    stored for interpretation and preparation of report; and

(f)     interpretation and preparation of a permanent report is provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g)    the diagnostic assessment is not provided to the patient on the same occasion that a service mentioned in any of items 11003,  12210, 12215 or 12268 is provided to the patient

Applicable only once in a 12 month period

1,044.00 

 

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 General Medical Services – Vigilance Testing) Determination 2018

25 Oct 2018 (F2018L01465)

1 Nov 2018 (s 2(1) item 1)

 

Health Insurance (Section 3C General Medical Services – Medicare Indexation) Amendment Determination 2019

11 Apr 2019 (F2019L00605)

Sch 1 (items 24–30): 1 July 2019 (s 2(1) item 1)

—

 

Endnote 4—Amendment history

 

Provision affected

How affected

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

rep LA s 48D

s 6.....................

am F2019L00605

Schedule 1

 

Schedule 1................

am F2019L00605