EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under Schedule 1, paragraph (bj)
(HIB 02/2006)
Schedule 1, paragraph (bj) of the National Health Act 1953 (“the Act”) provides that the Minister may determine the minimum benefit levels payable by registered health benefits organisations for hospital treatment provided, other than in emergencies, in a hospital or day hospital facility with which the organisation does not have a hospital purchaser-provider agreement covering such treatment. These benefits are known in the industry as “default benefits”.
The current Determination dated 24 June 2005 (HIB 11/2005) (as amended), is comprised of seven schedules setting out the minimum benefit levels payable for a range of hospital treatment. These include benefits for overnight accommodation, and day accommodation.
This Determination amends the Determination dated 24 June 2005 (as amended) by omitting Schedule 3 and substituting a new Schedule 3 (HIB 02/2006).
Schedule 3 sets the default benefit payable for same day accommodation by specifying the default benefits that are payable in relation to Medicare Benefits Schedule (MBS) item numbers.
The new Schedule 3 has been amended to correct an administrative oversight contained in Determination (HIB 21/2005) dated 24 October 2005 which inserted the previous Schedule 3. Changes are made in the Schedule 3 to a number of MBS item numbers contained under the headings “Category 3 - Therapeutic Procedures” and “Magnetic Resonance Imaging”.
These changes are necessary because Schedule 3 links the default benefits that are payable to the types of professional services rendered to admitted hospital patients. The types of professional services rendered are identified by reference to MBS item numbers and fees.
CONSULTATION
Changes to the MBS result from reviews by the Medicare Consultative Committee (MBCC). The MBCC is an informal consultative forum with representation drawn from the Department of Health and Ageing, Medicare Australia, the Australian Medical Association and relevant professional groups of the medical profession. The reviews conducted by the MBCC are designed to ensure that the MBS reflects current medical practice and encourages best practice.
The changes to Schedule 3 were necessary to ensure that health funds, at a minimum, pay the ‘default benefit’ for their members where members receive hospital treatment corresponding to one of the new MBS item numbers, in a hospital where that health fund does not have a contractual arrangement with that hospital. This amendment to Schedule 3 is of a machinery nature and does not substantially alter existing arrangements.
The Determination was made on 12 January 2006 and takes effect on the day following registration on the Federal Register of Legislative Instruments. The Determination and this explanatory statement have been lodged for registration on the Federal Register of Legislative Instruments.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
JANUARY 2006