EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under Schedule 1, paragraph (bj)
(HIB 16/2005)
Schedule 1, paragraph (bj) to the National Health Act 1953 (the Act) provides that the Minister may determine the minimum levels of benefit payable by a Registered Health Benefits Organization (RHBO) for an episode of hospital treatment provided, other than in emergencies, in a hospital or day hospital facility with which the RHBO does not have a hospital purchaser-provider agreement which covers such treatment. These benefits are known in the industry as “default benefits”.
The current Determination dated 24 June 2005 (HIB11/2005) (as amended) comprises eight schedules setting out the minimum levels of benefit which are payable for a range of hospital treatment. These include benefits for overnight accommodation, day accommodation, prostheses and second tier default benefits.
Schedule 5 (Benefits Payable in Respect of Prostheses and Human Tissues) of the current Determination has two parts:
- Part A – Prostheses; and
- Part B – Human Tissues.
Schedule 5 prescribes the prostheses and human tissues that RHBOs must fully fund for their members who have taken out a policy under which benefits are payable for the items.
This determination makes amendments to Schedule 5 (Benefits Payable in Respect of Prostheses and Human Tissues).
Specifically, the following amendments are contained in the determination:
- Billing Code MC357 – AngioLink Vascular Closure System is deleted from the Schedule.
The deleted product was not the subject of a positive recommendation from the Prostheses and Devices Committee (PDC), and was inadvertently included in Schedule 5.
2. Billing Code KM001 – Endotine Forehead Fixation Device is added to the Schedule.
The inserted product was the subject of a positive recommendation from the PDC, and was inadvertently not included in Schedule 5.
3. Billing Codes MS020 – Infusa MPD, MS028 – Medical Specialties Microject Infusion Pump and MS029 – Medical Specialties Microject Drug Administration are deleted from the Schedule.
The Supplier had requested that these products be deleted from Schedule 5. The products were inadvertantly included in Schedule 5.
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4. Billing Codes MP020 – Gluteal Implants filled with Elastomer, MP028 and MP029 – Silicone Sheets are added to the Schedule.
The inserted products were the subject of a positive recommendation from the PDC and were inadvertently not included in Schedule 5.
CONSULTATION
This determination has been made having regard to advice provided by the Prostheses and Devices Committee (PDC), a ministerially appointed committee comprised of nominees from health funds, hospitals, clinicians, prostheses and devices suppliers, the Commonwealth, and consumer representatives. The PDC considered the applications for listing of new products and applications for changes to existing listings and made recommendations.
This determination 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
SEPTEMBER 2005