{"id":"F2022L01432","name":"Health Insurance (Section 3C Diagnostic Imaging Services – Conjunctive Gallium-67 Nuclear Medicine Imaging Service) Determination 2022","slug":"health-insurance-section-3c-diagnostic-imaging-services-conjunctive-gallium-67-nuclear-medicine-imag","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":102821,"registerId":"commonwealth-F2022L01432-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name","content":"#### 1 Name\n\n  This instrument is the Health Insurance (Section 3C Diagnostic Imaging Services – Conjunctive Gallium‑67 Nuclear Medicine Imaging Service) Determination 2022.","sortOrder":0},{"sectionNumber":"3","sectionType":"section","heading":"Authority","content":"#### 3 Authority\n\n  This instrument is made under subsection 3C(1) of the Health Insurance Act 1973.","sortOrder":1},{"sectionNumber":"4","sectionType":"section","heading":"Definitions","content":"#### 4 Definitions\n\n> Note: A number of expressions used in this instrument are defined in the definitions section of the Act, including the following:\n\n    (a) clinically relevant service;\n    (b) diagnostic imaging services table;\n    (c) item;\n    (d) professional service;\n\n  In this instrument:\n\n> Act means the Health Insurance Act 1973.\n\n  bulk‑billed means:\n    (a) a medicare benefit is payable to a person in relation to the service; and\n    (b) under an agreement entered into under section 20A of the Act:\n    (i) the person assigns to the practitioner, by whom the service is provided, the person’s right to the payment of the medicare benefit; and\n    (ii) the practitioner accepts the assignment in full payment of the practitioner’s fee for the service provided.\n\n> 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.\n\n> relevant service means a health service, as defined in subsection 3C(8) of the Act, that is specified in a Schedule.\n\n> Schedule means a Schedule to this instrument.\n\n  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.","sortOrder":2},{"sectionNumber":"5","sectionType":"section","heading":"Treatment of relevant services","content":"#### 5 Treatment of relevant services\n\n  (1) 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:\n    (a) it were both a professional service and a diagnostic imaging service; and\n    (b) there were an item in the diagnostic imaging services table that:\n    (i) related to the service; and\n    (ii) specified for the service a fee in relation to each State, being the fee specified in the Schedule in relation to the service.","sortOrder":3}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument implements subsection 3C(1) by classifying a specific Gallium‑67 conjunctive nuclear medicine imaging service as both a professional and diagnostic imaging service and by setting fees. It specifies treatment for that service rather than altering the broader statutory framework or expanding Medicare’s general scope."},"complexity_factors":["Authority and application depend on subsection 3C(1) of the Health Insurance Act 1973 (see section 3).","Multiple cross-references to defined terms and other statutes increase interpretation effort (definitions and ‘relevant provisions’ in section 4).","The instrument operates by treating a service as both a professional service and a diagnostic imaging service (mechanical effect in section 5(1)(a)).","State-specific fees are set in an external Schedule, requiring administrators to consult and maintain schedule data (section 5(1)(b)(ii)).","Bulk-billing and assignment mechanics affect cash flow and incentives for practitioners (definition of bulk‑billed in section 4).","References to provisions ‘as in force from time to time’ introduce dynamism and ongoing compliance checks (final paragraph of section 4).","Operational detail depends on the (unincluded) Schedule content, so practical effects require inspecting that Schedule (Schedule references throughout)."],"plain_english_summary":"This instrument, made under subsection 3C(1) of the Health Insurance Act 1973, declares that a specified conjunctive Gallium‑67 nuclear medicine imaging service will be treated for Medicare purposes as both a professional service and a diagnostic imaging service and sets state-by-state fees in a Schedule. It affects Medicare-eligible patients and practitioners who bill for the service: Medicare benefit rules (including bulk‑billing and assignment) and the Schedule fees determine who is paid and how much."},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument does exactly what its title suggests: it adds one specific diagnostic imaging service (Gallium-67 nuclear medicine imaging when used conjunctively) to Medicare coverage. There is no scope creep; it is a targeted, single-purpose determination."},"complexity_factors":["Very short instrument (only 5 sections, ~400 words)","Only 6 defined terms, most referencing existing definitions in the parent Act","Single operational provision (section 5) with straightforward conditional logic","No nested exceptions or complex cross-referencing beyond standard 'as in force from time to time' clauses","Purpose-built for one specific service addition—no broader scheme or multiple service types"],"plain_english_summary":"This legislation adds a specific type of nuclear medicine scan to Australia's Medicare system. **What it does:** It creates a new Medicare item for 'Gallium-67 nuclear medicine imaging' when used alongside other diagnostic imaging services. This means doctors can now bulk-bill (charge Medicare directly instead of the patient) this particular scan. **Who it affects:** Patients needing this specific scan—typically used to detect infections, inflammation, or certain cancers—and the doctors/radiologists who perform it. **Why it matters:** Before this determination, this service wasn't covered by Medicare in this way. Now patients can access it with Medicare rebates, reducing out-of-pocket costs. The instrument essentially 'slots' this service into the existing Medicare diagnostic imaging framework by treating it as if it were already listed in the official diagnostic imaging services table."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-conjunctive-gallium-67-nuclear-medicine-imag","history":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-conjunctive-gallium-67-nuclear-medicine-imag/history","analysis":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-conjunctive-gallium-67-nuclear-medicine-imag/analysis","conflicts":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-conjunctive-gallium-67-nuclear-medicine-imag/conflicts","importantCases":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-conjunctive-gallium-67-nuclear-medicine-imag/important-cases","documents":"/api/acts/health-insurance-section-3c-diagnostic-imaging-services-conjunctive-gallium-67-nuclear-medicine-imag/documents"}}