EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under Schedule 1, paragraph (bj)
(HIB17/2005)
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 made on 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 sets out the benefits payable by RHBO’s in respect of Prostheses and Human Tissues.
The National Health Amendment (Prostheses) Act 2005 introduces new arrangements for listing and paying benefits for prostheses and human tissues. This Act received Royal Assent on 21 March 2005.
Schedule 1 to the National Health Amendment (Prostheses) Act 2005 will amend the Act to permit the Minister to determine:
- no gap prostheses, and the benefit amount for each no gap prosthesis; and
- gap permitted prostheses, and the minimum and maximum benefit amount for each gap permitted prosthesis.
The effect of these amendments is that Schedule 5 of Schedule 1, paragraph (bj) to the Act will be replaced, in its entirety, by a new determination made under subsections 73AAG(6) and (7) of the Act.
Schedule 1 to the National Health Amendment (Prostheses) Act 2005 will commence by proclamation on 31 October 2005. The Minister’s determination under subsections 73AAG(6) and (7) of the Act will also commence on 31 October 2005. Consequently, this determination removes Schedule 5 from the determination made under Schedule 1, paragraph (bj) to the Act on 24 June 2005 (as amended) with effect on 31 October 2005.
This determination also removes references to Schedule 5 contained in Schedule 6 of the determination made under Schedule 1, paragraph (bj) to the Act on 24 June 2005 (as amended), and replaces them with references to the new subsections 73AAG(6) and (7).
CONSULTATION
Extensive consultations have been carried out with major stakeholder groups in the development and implementation of the new arrangements for listing and setting benefits for prostheses. The major stakeholder groups are:
- the Australian Health Insurance Association;
- the Australian Private Hospitals Association;
- Catholic Health Australia;
- the Australian Medical Association;
- the Consumers’ Health Forum;
- the Medical Industry Association of Australia; and
- the Department of Veterans’ Affairs.
This determination takes effect on 31 October 2005. 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