HEALTH INSURANCE ACT 1973 - SECT 16F Medicare benefits not payable for certain radiation oncology services

HEALTH INSURANCE ACT 1973 - SECT 16F

  (1)   Unless the Minister otherwise directs, a medicare benefit is not payable in respect of a radiation oncology service rendered by or on behalf of a medical practitioner unless the service is:

  (a)   rendered using radiation oncology equipment that:

  (i)   is ordinarily located at registered radiation oncology premises; and

  (ii)   is of a type that, on the day on which the service is rendered, is listed for the premises; or

  (b)   rendered using radiation oncology equipment that:

  (i)   is ordinarily located at a registered base for mobile radiation oncology equipment when not in use; and

  (ii)   is not ordinarily located at radiation oncology premises; and

  (iii)   is of a type that, on the day on which the service is rendered, is listed for the base.

Meaning of radiation oncology service

  (2)   A radiation oncology service is a service prescribed as a radiation oncology service.

  (3)   Radiation oncology services may be prescribed by reference to items in the general medical services table.

Meaning of registered radiation oncology premises and registered base for mobile radiation oncology equipment

  (4)   Radiation oncology premises are registered at a particular time if a registration for the premises under Part   IIC is in effect at that time.

  (5)   A base for mobile radiation oncology equipment is registered at a particular time if a registration for the base under Part   IIC is in effect at that time.

What equipment is listed for premises or a base?

  (6)   Radiation oncology equipment is of a type listed for particular radiation oncology premises at a particular time if, at that time:

  (a)   the Radiation Oncology Register states that equipment of a particular type is ordinarily located at the premises; and

  (b)   the equipment is of that type.

  (7)   Radiation oncology equipment is of a type listed for a particular base for mobile radiation oncology equipment at a particular time if, at that time:

  (a)   the Radiation Oncology Register states that pieces of equipment of a particular type are ordinarily located at the base when not in use and not ordinarily located at radiation oncology premises; and

  (b)   the equipment is of that type.

Some circumstances in which radiation oncology equipment is taken to be ordinarily located at radiation oncology premises

  (8)   Radiation oncology equipment is taken to be ordinarily located at radiation oncology premises if:

  (a)   the equipment is:

  (i)   on trial at the premises for a period of not more than 3 months; and

  (ii)   of the same type as equipment listed for the premises during the period of the trial; or

  (b)   each of the following circumstances exist:

  (i)   the equipment (the substituted equipment ) is used, for a period of not more than 3 months, in substitution for radiation oncology equipment that is not in operation;

  (ii)   the substituted equipment is of the same type as the equipment that is not in operation;

  (iii)   the equipment that is not in operation is ordinarily located at the premises.

  (9)   Nothing in subsection   (8) limits the circumstances in which radiation oncology equipment is ordinarily located at radiation oncology premises for the purposes of this Part or Part   IIC.

Some circumstances in which radiation oncology equipment is taken to be ordinarily located at a base for mobile radiation oncology equipment when not in use and not ordinarily located at radiation oncology premises

  (10)   Radiation oncology equipment is taken to be ordinarily located at a base for mobile radiation oncology equipment when not in use, and not ordinarily located at radiation oncology premises, if:

  (a)   the equipment is:

  (i)   on trial through the base for a period of not more than 3 months; and

  (ii)   not ordinarily located, or taken to be ordinarily located, at radiation oncology premises during the period of the trial; and

  (iii)   of the same type as equipment listed for the base during the period of the trial; or

  (b)   each of the following circumstances exist:

  (i)   the equipment (the substituted equipment ) is used, for a period of not more than 3 months, in substitution for radiation oncology equipment that is not in operation;

  (ii)   the substituted equipment is of the same type as the equipment that is not in operation;

  (iii)   the equipment that is not in operation is ordinarily located at the base when not in use and not ordinarily located at radiation oncology premises.

  (11)   Nothing in subsection   (10) limits the circumstances in which radiation oncology equipment is ordinarily located at a base for mobile radiation oncology equipment, but not ordinarily located at radiation oncology premises, for the purposes of this Part or Part   IIC.