{"id":"F2023L00660","name":"Health Insurance (Section 3C General Medical Services — Artificial Bowel Sphincter Services) Determination 2023","slug":"health-insurance-section-3c-general-medical-services-artificial-bowel-sphincter-services-determinati","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":104379,"registerId":"commonwealth-F2023L00660-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 General Medical Services — Artificial Bowel Sphincter Services) Determination 2023.","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":"Cessation","content":"#### 4 Cessation\n\n Unless revoked earlier, this instrument will cease on 30 June 2028.","sortOrder":2},{"sectionNumber":"5","sectionType":"section","heading":"Definitions","content":"#### 5 Definitions\n\n (1) In this instrument:\n\n> Act means the Health Insurance Act 1973.\n\n> (Anaes.) has the meaning given by subclause 5.9.4(1) of the general medical services table.\n\n> (H) has the meaning given by clause 1.1.7 of the general medical services table.\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> Note: The following terms are defined in subsection 3(1) of the Act\n\n>  clinically relevant service;\n\n>  general medical services table;\n\n>  item;\n\n>  professional service.\n\n (2) Unless the contrary intention appears, a reference in this instrument to a provision of the Act of 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":3},{"sectionNumber":"6","sectionType":"section","heading":"Treatment of relevant services","content":"#### 6 Treatment of relevant services\n\n 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 medical service; and\n (b) there were an item in the general medical 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":4},{"sectionNumber":"7","sectionType":"section","heading":"Application of provisions of the general medical services table","content":"#### 7 Application of provisions of the general medical services table\n\n (1) Clause 1.2.6 of the general medical services table shall have effect as if the item in the Schedule of this instrument were specified in subsection (1) of that clause.\n (2) Clause 1.2.7 of the general medical services table shall have effect as if the item in the Schedule of this instrument were specified in subsection (1) of that clause.\n (3) Clause 5.1.1 of the general medical services table shall have effect as if the item in the Schedule of this instrument were specified for the purposes of that clause.","sortOrder":5},{"sectionNumber":"8","sectionType":"section","heading":"When artificial bowel sphincter is contraindicated for item 32221","content":"#### 8 When artificial bowel sphincter is contraindicated for item 32221\n\n (1) An artificial bowel sphincter under item 32221 is contraindicated in:\n (a) patients with inflammatory bowel disease, pelvic sepsis, pregnancy, progressive degenerative diseases or a scarred or fragile perineum; and\n (b) patients who have had an adverse reaction to radiopaque solution; and\n (c) patients who engage in receptive anal intercourse.","sortOrder":6},{"sectionNumber":"9","sectionType":"section","heading":"Schedules","content":"#### 9 Schedules\n\n Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.\n\nSchedule 1—Relevant Services\n\n```html\n

Group T8—Surgical operations

Column 1

Item

Column 2

Description

Column 3

Fee ($)

Subgroup 2—Colorectal

32221

Removal or revision of an artificial bowel sphincter (with or without replacement) for severe faecal incontinence in the treatment of a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed (H) (Anaes.) (Assist.)

1,054.45

\n```","sortOrder":7}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This determination expands the set of services treated as insured under subsection 3C(1) by specifying item 32221 for removal/revision of an artificial bowel sphincter and a corresponding national fee, and by prescribing clinical contraindications; it therefore changes practical Medicare coverage and billing for that specific colorectal surgical operation (see clauses 6, Schedule item 32221, clause 8, clause 4)."},"complexity_factors":["Cross-references to the Health Insurance Act 1973 (subsection 3C(1)) and the general medical services table (clauses 1.2.6, 1.2.7, 5.1.1) increase legal integration complexity (see clauses 3, 6, 7).","Incorporation of an item into existing fee schedules with a single national fee ($1,054.45) requires coordinated billing across States (see Schedule item 32221).","Clinical contraindications require clinician judgement and create potential verification/compliance burdens (see clause 8).","Temporary cessation date (30 June 2028) imposes a time-limited policy window and potential need for renewal or transition (see clause 4).","Amendment/repeal mechanism for other instruments via schedules requires attention to interactions with existing instruments (see clause 9).","References to terms defined elsewhere (Act, general medical services table, National Health Act) mean interpretation depends on external provisions (see clause 5)."],"plain_english_summary":"This instrument directs that removal or revision of an artificial bowel sphincter for severe faecal incontinence be treated by Medicare as both a medical and a professional service and sets a national fee of $1,054.45 (item 32221). Made under s3C of the Health Insurance Act, it lists clinical contraindications (including inflammatory bowel disease, pregnancy and receptive anal intercourse) and runs until 30 June 2028; the practical effect is to enable Medicare billing for the specified procedure subject to the stated clinical limits."},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument performs exactly the function suggested by its title and enabling provision (subsection 3C(1) of the Health Insurance Act 1973). It adds one specific surgical item to the Medicare Benefits Schedule using the standard Section 3C mechanism. There is no scope creep — it does not expand into unrelated policy areas or create broad regulatory frameworks beyond the specific artificial bowel sphincter service described."},"complexity_factors":["Only 6 substantive sections plus a single-item Schedule","7 defined terms, most referencing external instruments rather than creating new definitions","Heavy reliance on incorporated definitions from the Health Insurance Act 1973 and the 'general medical services table' (a technical schedule that sets out all Medicare item numbers)","Simple conditional logic: one contraindications list in section 8 with three straightforward exclusion categories","No nested exceptions or recursive cross-references — the instrument essentially 'plugs in' one new item to existing machinery","Standard 'template' structure common to many Section 3C determinations, making it predictable for those familiar with the scheme"],"plain_english_summary":"This law adds Medicare item 32221, a $1,054.45 rebate for removal or repair of an artificial bowel sphincter, giving subsidised access to surgery for Australians with severe faecal incontinence who have exhausted conservative treatments. It affects patients, colorectal surgeons, private insurers and Medicare, and includes safety-based exclusions (e.g., certain inflammatory, infectious, pregnancy and device-risk situations). The determination expires 30 June 2028 for review."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-section-3c-general-medical-services-artificial-bowel-sphincter-services-determinati","history":"/api/acts/health-insurance-section-3c-general-medical-services-artificial-bowel-sphincter-services-determinati/history","analysis":"/api/acts/health-insurance-section-3c-general-medical-services-artificial-bowel-sphincter-services-determinati/analysis","conflicts":"/api/acts/health-insurance-section-3c-general-medical-services-artificial-bowel-sphincter-services-determinati/conflicts","importantCases":"/api/acts/health-insurance-section-3c-general-medical-services-artificial-bowel-sphincter-services-determinati/important-cases","documents":"/api/acts/health-insurance-section-3c-general-medical-services-artificial-bowel-sphincter-services-determinati/documents"}}