Health Insurance (MRI Crohn's disease) Determination 2014

Link to law: https://www.comlaw.gov.au/Details/F2014L01452

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Health Insurance (MRI Crohn’s disease) Determination 2014
__________________________________________________________________
I, Kirsty Faichney, Acting First Assistant Secretary, Medical Benefits Division, Department of Health, delegate of the Minister for Health, make this Determination under subsection 3C(1) of the Health Insurance Act 1973.
Dated 27 October 2014         
 
 
KIRSTY FAICHNEY
A/g First Assistant Secretary
Medical Benefits Division
Department of Health
_________________________________________________________________
 
 
 
 
 
 
Contents
 
1.               Name of Determination                                                                           3
2.               Commencement                                                                                      3
3.               Cessation                                                                                               3
4.               Authority                                                                                                3
5.               Interpretation                                                                                          3
6.               Treatment of a relevant service                                                                3
7.               Specification of relevant services                                                            4
Schedule        MRI Crohn’s disease Items                                                             5
 
 

1.               Name of Determination
This Determination is the Health Insurance (MRI Crohn’s disease) Determination 2014.
2.               Commencement
This Determination commences on 1 November 2014. 
3.               Cessation
This Determination is repealed at 23:59, 30 June 2015. 
4.               Authority
 
This Determination is made under the Health Insurance Act 1973.
5.               Interpretation
(1)        In this Determination, unless the contrary intention appears:
Act means the Health Insurance Act 1973.
diagnostic imaging services table means the table prescribed under section 4AA of the Act.
item means an item in the Schedule.
MRI means magnetic resonance imaging.
relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act.
relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in the Schedule.
Schedule means the Schedule to this Determination.
Note Unless the contrary intention appears, expressions used in this Determination have the same meanings as in the Act—see section 13 of the Legislative Instruments Act 2003.
(2)        For the avoidance of doubt, in this Determination:
(a)    a reference to the Act includes a reference to regulations made under the Act; and
(b)    a reference to the National Health Act 1953 includes a reference to regulations made under that Act; and
(c)    a reference to any legislation shall be construed as a reference to that legislation as in force from time to time.
6.               Treatment of a relevant service
A relevant service provided in accordance with this Determination 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 Group I5 of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2014 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.
7.               Specification of relevant services
The following provisions of the diagnostic imaging services table shall be taken to have effect as if the relevant services were also specified in the provision:
(a)         paragraph 1.2.10(1)(a);
(b)        subclause 2.5.1(1); and
(c)         clause 2.5.7
 
Schedule                MRI Crohn’s disease Items
 
Item
Health Service
Fee ($)

Group I5- Magnetic Resonance Imaging

63740
MRI – scan to evaluate small bowel Crohn’s disease if the service is provided to a patient for:
(a) Evaluation of disease extent at time of initial diagnosis of Crohn’s disease;
(b) Evaluation of exacerbation/suspected complications of known Crohn’s disease;
(c) Evaluation of known or suspected Crohn’s disease in pregnancy; or
(d) Assessment of change to therapy in a patient with small bowel Crohn’s disease.
                             
This item applies only once in a 12 month period where the service is provided for assessment of change to therapy in a patient with small bowel Crohn’s disease. (R) (K) (Contrast)
 
457.20

63741
MRI – scan with enteroclysis for Crohn’s disease if the service is related to item 63740. (R) (K)
 
265.25

63743
MRI – scan for fistulising perianal Crohn’s disease if the service is provided to a patient for:
(a)   Evaluation of pelvic sepsis and fistulas associated with established or suspected Crohn’s disease; or
(b)   Assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease.
 
This item applies only once in a 12 month period where the service is provided for assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease. (R) (K) (Contrast)
 
403.20

63744
MRI – scan to evaluate small bowel Crohn’s disease if the service is provided to a patient for:
(a) Evaluation of disease extent at time of initial diagnosis of Crohn’s disease;
(b) Evaluation of exacerbation/suspected complications of known Crohn’s disease;
(c) Evaluation of known or suspected Crohn’s disease in pregnancy; or
(d) Assessment of change to therapy  in a patient with small bowel Crohn’s disease.
 
This item applies only once in a 12 month period where the service is provided for assessment of change to therapy in a patient with small bowel Crohn’s disease. (R) (NK) (Contrast)
 
228.60

63746
MRI – scan with enteroclysis for Crohn’s disease if the service is related to item 63744. (R) (NK)
 
132.65

63747
MRI – scan for fistulising perianal Crohn’s disease if the service is provided to patients for:
(a)   Evaluation of pelvic sepsis and fistulas associated with established or suspected Crohn’s disease; or
(b)   Assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease.
 
This item applies only once in a 12 month period where the service is provided for assessment of change to therapy of pelvis sepsis and fistulas from Crohn’s disease. (R) (NK) (Contrast)
 
201.60