Clarifying the claiming of MBS items with experimental stem cell treatments

Stem Cells - Factsheet (PDF 195 KB)
Stem Cells - Factsheet (DOC 497 KB)

What are the changes?

From 1 November 2018, the Department of Health will, subject to parliamentary scrutiny, introduce the following clause into the Health Insurance (General Medical Services Table) Regulations, the Health Insurance (Pathology Services Table) Regulations and the Health Insurance (Diagnostic Imaging Services Table) Regulations:

"An item in the table does not apply to a service mentioned in the item if the service is provided to a patient at the same time, or in connection with, the harvesting, storage, in-vitro processing or injection of non-haematopoietic stem cells".

Why are the changes being made?

The clause is being introduced to ensure correct use of the MBS, following consideration by the Medical Services Advisory Committee Executive and consultation with medical stakeholders. It will prevent the claiming of any MBS service that is provided in connection with experimental stem cell treatment.

This change also reflects recent changes made by the Therapeutic Goods Administration to regulate the importation, manufacture and supply of human cells and tissues, which came into effect on 1 July 2018. This also included a review of the regulation of autologous stem cell therapies.

What does this mean for providers?

This clause reinforces the appropriate use of the MBS. There is no service on the MBS that currently provides a rebate for non-haematopoietic stem cell treatment. Unless practitioners are misusing the MBS, this change will have no effect on providers.

What does this mean for patients?

There should be no impact on patients because there has been no change in services which are eligible for MBS funding. Patients will continue to have access to clinically relevant services.

When will this change be reviewed?

The Department of Health regularly reviews the usage of new and amended MBS items in consultation with the profession.

All MBS items may be subject to compliance processes and activities, including random and targeted audits which may require a provider to submit information about the services claimed.

Significant variation from forecasted expenditure may warrant review and amendment of fees, and incorrect use of MBS items can result in penalties including the health professional being asked to repay monies that have been incorrectly received.

Where can I find more information?

The full item descriptor and information on other changes to the MBS can be found at the MBS Online website or by calling the Department of Human Services on 132 150.

Additional information on the recent changes made to the regulation of human cells and tissues can be found at the Therapeutic Goods Administration website.