EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Subject: National Health Amendment (Prostheses) Act 2005
Proclamation
Section 2 of the National Health Amendment (Prostheses) Act 2005 (the Act) provides the commencement details for the provisions contained in the Act. The table in subsection 2(1) of the Act provides that Schedule 1 to the Act will commence on a single day to be fixed by proclamation, or, if not within the period of nine months after Royal Assent, then on the day following the end of that period.
The Act amends the National Health Act 1953, and introduces new arrangements for listing of, and setting benefits for, prostheses which registered health benefits organisations (health funds) must fund when provided as part of an episode of hospital treatment. The Act received Royal Assent on 21 March 2005, thus the Act would automatically commence on 22 December 2005.
The purpose of the Proclamation is to implement provisions that:
- give the Minister for Health and Ageing (the Minister) the power to determine, in writing, the prostheses for which health funds are required to pay benefits for and the benefit amounts payable for those prostheses; and
- regulate the payment of benefits for prostheses.
Benefits for prostheses will fall under two categories:
- no gap prostheses – where the listed benefit amount is the amount to be paid by the health fund and the patient will not be required to pay any gap amount for the prosthesis; and
- gap permitted prostheses – which will have a minimum and a maximum benefit amount listed. The health fund must pay the listed minimum benefit amount, but may cover up to the maximum benefit amount. Any difference between the minimum and maximum benefit amounts is known as the gap. Any portion of the gap not covered by the health fund will be payable by the patient.
The effect of the Proclamation is to fix 31 October 2005 as the day on which Schedule 1 to the Act commences. The Minister’s determination of no gap and gap permitted prostheses will take effect on 31 October 2005.
Commencement on 31 October 2005 is to provide sufficient time to enable health funds and hospitals to establish new systems to support the new arrangements. It is also to allow time for patients to be appropriately informed by doctors, hospitals and health funds of the health fund benefit they can expect for their prosthesis, on and after 31 October 2005.
The Act does not specify any conditions that need to be met before the power to make the Proclamation may be exercised.
The Proclamation is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Consultation
Extensive consultation was undertaken with the major stakeholder groups on the development and implementation of the provisions of the Act. The major stakeholders 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.