Health Insurance (Radioactive Seed Implantation of Prostate) Determination 2010

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Health Insurance (Radioactive Seed Implantation of Prostate) Determination 2010
 
I, Richard Bartlett, First Assistant Secretary, Medical Benefits Division, Department of Health and Ageing, make this Determination under subsection 3C(1) of the Health Insurance Act 1973.
Dated              16 July  2010
 
 
Richard Bartlett
__________________________
 
Richard Bartlett
First Assistant Secretary
Medical Benefits Division
Department of Health and Ageing
 
 
 
 
 
Contents
 
1.            Name of Determination                                                                               3
2.            Commencement and term                                                                            3
3.            Interpretation                                                                                           3
4.            Treatment of relevant services                                                                     3
5.            Certain relevant services—items and specifications                                          3
6.            Meaning of amount under section 6                                                              6
SCHEDULE – SPECIFIED HEALTH SERVICES                                                                         7
 
 

1.                       Name of Determination
This Determination is the Health Insurance (Radioactive Seed Implantation of Prostate) Determination 2010.
2.                       Commencement and term
This Determination will be taken to have commenced on 1 November 2001 and shall remain in force until midnight 31 July 2010.
3.                       Interpretation
(1)    In this Determination:
         Act means the Health Insurance Act 1973.
         relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in 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)    Unless the contrary intention appears, in this Determination a reference to a provision of the Act or regulations made under the Act or the National Health Act 1953 or regulations made 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.
4.                       Treatment of relevant services
A relevant service shall be treated for the purposes of the provisions of the Act and of regulations made under the Act and the provisions of the National Health Act 1953 and of regulations made under the National Health Act 1953 that make provision in respect of professional services or medical services as if:
(a)     it was both a professional service and a medical service; and
(b)     there was an item in Group T8 of the general medical services table:
(i)      that related to the relevant service; and
(ii)      specified in respect of the relevant service a fee in relation to the State specified.
5.                       Certain relevant services—items and specifications
(1)    For the relevant service specified in item 37222 of the Schedule:
(a)     when provided from 1 November 2001 until midnight 31 October 2002:
(i)      subrule 9(2) of the Health Insurance (General Medical Services Table) Regulations 2001; and
(ii)     subrule 10(3) of the Health Insurance (General Medical Services Table) Regulations 2001; and
(iii)     rule 57 of the Health Insurance (General Medical Services Table) Regulations 2001;
shall be taken to have had effect as if the item was also specified in the provision; and
(b)     when provided from 1 November 2002 until midnight 31 October 2003:
(i)      subrule 10(2) of the Health Insurance (General Medical Services Table) Regulations 2002; and
(ii)     subrule 11(3) of the Health Insurance (General Medical Services Table) Regulations 2002; and
(iii)     rule 58 of the Health Insurance (General Medical Services Table) Regulations 2002;
shall be taken to have had effect as if the item was also specified in the provision; and
(c)     when provided from 1 November 2003 until midnight 31 October 2004:
(i)      subrule 10(2) of the Health Insurance (General Medical Services Table) Regulations 2003; and
(ii)     subrule 11(3) of the Health Insurance (General Medical Services Table) Regulations 2003; and
(iii)     rule 58 of the Health Insurance (General Medical Services Table) Regulations 2003;
shall be taken to have had effect as if the item was also specified in the provision; and
(d)    when provided from 1 November 2004 until midnight 31 October 2005:
(i)      subrule 11(2) of the Health Insurance (General Medical Services Table) Regulations 2004; and
(ii)     subrule 12(3) of the Health Insurance (General Medical Services Table) Regulations 2004; and
(iii)     rule 64 of the Health Insurance (General Medical Services Table) Regulations 2004;
shall be taken to have had effect as if the item was also specified in the   
 provision.
(2)     For the relevant service specified in item 37225 of the Schedule:
(a)     when provided from 1 November 2005 until midnight 31 October 2006:
(i)      subrule 11(2) of the Health Insurance (General Medical Services Table) Regulations 2005; and
(ii)     subrule 12(3) of the Health Insurance (General Medical Services Table) Regulations 2005; and
(iii)     rule 64 of the Health Insurance (General Medical Services Table) Regulations 2005;
shall be taken to have had effect as if the item was also specified in the provision; and
(b)    when provided from 1 November 2006 until midnight 31 October 2007:
(i)      subrule 11(2) of the Health Insurance (General Medical Services Table) Regulations 2006; and
(ii)     subrule 12(3) of the Health Insurance (General Medical Services Table) Regulations 2006; and
(iii)     rule 64 of the Health Insurance (General Medical Services Table) Regulations 2006;
shall be taken to have had effect as if the item was also specified in the provision; and
(c)     when provided from 1 November 2007 until midnight 31 October 2008:
(i)      subrule 12(2) of the Health Insurance (General Medical Services Table) Regulations 2007; and
(ii)     subrule 13(3) of the Health Insurance (General Medical Services Table) Regulations 2007; and
(iii)     rule 86 of the Health Insurance (General Medical Services Table) Regulations 2007;
shall be taken to have had effect as if the item was also specified in the provision; and
(d)     when provided from 1 November 2008 until midnight 31 October 2009:
(i)      subrule 12(2) of the Health Insurance (General Medical Services Table) Regulations 2008; and
(ii)     subrule 13(3) of the Health Insurance (General Medical Services Table) Regulations 2008; and
(iii)     rule 86 of the Health Insurance (General Medical Services Table) Regulations 2008;
shall be taken to have had effect as if the item was also specified in the provision; and
(iv)     when provided from 1 November 2008 until midnight 31 October 2009, rule 78A of the Health Insurance (General Medical Services Table) Regulations 2008 shall be taken to have had effect as if the item was an item in the range between items 13020 and 51318; and
(e)     when provided from 1 November 2009 until midnight 28 Ferbruary 2010:
(i)      subrule 12(2) of the Health Insurance (General Medical Services Table) Regulations 2009; and
(ii)     subrule 13(3) of the Health Insurance (General Medical Services Table) Regulations 2009; and
(iii)     rule 86 of the Health Insurance (General Medical Services Table) Regulations 2009; and
shall have effect or be taken to have had effect as if the item was also specified in the provision; and
(iv)     when provided from 1 November 2009 until midnight 28 February 2010, rule 78A of the Health Insurance (General Medical Services Table) Regulations 2009 shall be taken to have had effect as if the item was an item in the range between items 13020 and 51318.
6.                       Meaning of amount under section 6
For relevant services specified in the Schedule:
amount under section 6 means the fee mentioned in column 4 of this table which relates to the period during which the relevant service was provided.
 
Item
Item of Schedule
Period during which relevant service provided
Fee for all States

1
37222
1 November 2001 – midnight 31 October 2002
826.00

2
37222
1 November 2002 – midnight 31 October 2003
846.65

3
37222
1 November 2003 – midnight 31 October 2004
867.80

4
37222
1 November 2004 – midnight 31 October 2005
886.00

5
37225
1 November 2005 – midnight 31 October 2006
903.70

6
37225
1 November 2006 – midnight 31 October 2007
922.70

7
37225
1 November 2007 – midnight 31 October 2008
943.00

8
37225
1 November 2008 – midnight 31 October 2009
964.70

9
37225
1 November 2009 – midnight 28 February 2010
986.90

 
 
SCHEDULE – SPECIFIED HEALTH SERVICES

Item
Health Service
Fee for all States

37222
 
Prostate, radioactive seed implantation of, urological component, using transrectal ultrasound guidance, for localised prostatic malignancy at clinical stages T1, T2A or T2B, with a Gleason score of 6 or less and a prostate specific antigen (PSA) of 10ng/ml or less at the time of diagnosis, where the procedure is performed by a urologist at an approved site in association with a radiation oncologist, and being associated with a service to which item 55603 applies, and being provided from 1 November 2001 until midnight 31 October 2005.  (H) (Anaes.)
Amount under section 6

37225
 
Prostate, radioactive seed implantation of, urological component, using transrectal ultrasound guidance, for localised prostatic malignancy at clinical stage T1 (clinically inapparent tumour that is not palpable or visible by imaging) or clinical stage T2 (tumour confined within prostate), with a Gleason score of not more than 7 and a prostate specific antigen (PSA) of 10ng/ml or less at the time of diagnosis, where the procedure is performed by a urologist at an approved site in association with a radiation oncologist, and being associated with a service to which item 55603 applies, and being provided from 1 November 2005 until midnight 28 February 2010. (H) (Anaes.)
Amount under section 6

 
Note  Subsection 3C(7) of the Act deems an internal territory to form part of the State of New South Wales.
 
 

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