EXPLANATORY STATEMENT

Select Legislative Instrument 2006 No. 168

Minute No. 18 of 2006 – Minister for Health and Ageing

Subject: National Health Act 1953

 National Health Amendment Regulations 2006 (No. 1)

Subsection 140(1) of the National Health Act 1953 (the Act) provides that the   Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.

The Act provides, in part, for hospital purchaser-provider agreements. Paragraph 73BD(2)(c) of the Act provides that these agreements require hospitals and day hospital facilities to give to registered health benefit organizations, the information specified in the Hospital Casemix Protocol (HCP) prescribed by regulation. The HCP provides the healthcare industry with a consistent method of classifying types of patients, their treatment and associated costs.

Regulation 49A of the National Health Regulations 1954 (the Principal Regulations) prescribes the HCP as set out in Schedule 7 to the Regulations. This specifies the financial, clinical and demographic data that registered health benefits organizations must give to the Department of Health and Ageing in respect of each episode of hospital treatment for which a charge is billed to a fund.

For the purpose of coding clinical data relating to episodes of care received by patients admitted to hospital, as reported in the HCP, the latest version of the Australian Refined Diagnosis Related Groups (AR-DRG) Definitions Manual must be used. Subparagraph 73BD(4)(a)(i) of the Act provides for a List of AR-DRG to be prescribed by the Regulations. Regulation 49B currently prescribes such a list.

The Regulations update all HCP references and terminology, align the data requirements with current data standards, improve data quality and meet current need.

This is achieved by substituting a new Schedule 7 to the Principal Regulations, which:

• Adds the latest available version of the AR-DRG Definitions Manual (paragraph 49B(1)(i));
• Updates terminology and definitions (Schedule 7, Part 1);
• Updates information on how to use the Protocol (such as formatting, data structure and data submission (Schedule 7, Part 1);
• Updates the file structure and record content specifications for hospital, medical and prosthetic episode records (Schedule 7, Parts 2–5), in particular:

-       standardising and simplifying the Parts;

-       removing data items that have not been found useful (e.g. marital status);

-       adding data items to capture further information on areas of interest such as outreach (hospital-in-the-home care) services and Coronary Care Unit/Special Care Nursery services;

-       clarifying data items to ensure they comply with the latest version of the National Health Data Dictionary and are interpreted/reported correctly;

-       expanding the size of all charge and benefit data items to enable reporting of  procedures that cost more than $99,999 and to collect amounts in dollars and cents for more accurate reporting; and

-       changing most optional data items to mandatory to improve reporting of these items; and

• Updates the list of registered health benefits organisations (Schedule 7, Part 6).

The Regulations have been developed after eight months of consultation with representatives of private hospitals, day surgeries, health benefit organisations, software providers, officers of the Private Health Industry Branch of the Department and participation on a national committee.

Details of the Regulations are set out in the Attachment.

The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised.

The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

The Regulations commence on 1 July 2006.

  Authority: Subsection 140(1) of the

           National Health Act 1953

ATTACHMENT

DETAILS OF THE NATIONAL HEALTH AMENDMENT REGULATIONS 2006 (No. 1)

Regulation 1 provides for the Regulations to be referred to as the National Health Amendment Regulations 2006 (No. 1).

Regulation 2 provides for regulations to commence on 1 July 2006.

Regulation 3 provides for Schedule 1 to amend the National Health Regulations 1954.

Items [1] and [2] 

These items provide for the latest version of the Australian Refined Diagnosis Related Groups Definitions Manual Version 5.1 to be added to the existing list. This manual is used for coding episodes of care received by patients admitted to hospital. For the purposes of HCP reporting, it is important that the latest version is used.

Item [3]

This item provides for Schedule 7 (Hospital Casemix Protocol) to be replaced with a simplified and updated version. Schedule 7 specifies the financial, clinical and demographic data that registered health benefits organizations must give to the Department of Health and Ageing in respect of each episode of hospital treatment for which a charge is billed to a fund.

Part 1: Explanatory notes

-            The Part has been simplified and sections and clauses have been re-aligned and re-numbered.

-            The definitions (section 2) have been updated to include new terms, delete terms no longer used and update existing definitions where they have changed or required clarification.

-            The parts of the protocol (section 3) have been updated to reflect the re-aligned and re-numbered Parts.

-            The data item format specifications (section 4) have been revised to reflect the re-aligned and re-numbered Parts, be easier to follow, and conform to the latest formatting standards from the Australian Institute of Health and Welfare.

-            The data transfer and acceptance details (section 5) have been updated.

Part 2: File structure and record content: hospital episode record

-            The file structure and record content Parts have been simplified and standardised (combining Parts 3 and 5 from the existing Schedule).

-            Data items that have not been found useful have been removed (items 64 and 67 from the existing Schedule—this also alters data item numbering from item 64 onwards).

-            Data items have been added to capture further information on areas of interest such as outreach (hospital-in-the-home care) services and Coronary Care Unit/Special Care Nursery services (items 67–83).

-            All charge and benefit data items have been expanded to enable reporting of procedures that cost more than $99,999 and to collect amounts in dollars and cents for more accurate reporting (items 7–28);

-            Most optional data items have been changed to mandatory (items 25, 26, 56, 59, 62–65) or mandatory for private hospitals and day surgeries (items 46, 53, 55, 60–61) to improve reporting of these items.  

-            All data items have been updated to comply with the latest version of the National Health Data Dictionary and/or clarified for better reporting.

-            The number of procedure codes (data item 49) and additional diagnosis codes (data item 48) that can be reported has been increased to align with other hospital data sets.

-            The formatting of data items has been updated to the latest standards from the Australian Institute of Health and Welfare.

Part 3: File structure and record content: medical record

-            The file structure and record content Parts have been simplified and standardised (combining Parts 2 and 4 from the existing Schedule).

-            Data item 10 has been added to capture Medicare Benefit Schedule fees.

-            All charge and benefit data items have been expanded to enable reporting of procedures that cost more than $99,999 and to collect amounts in dollars and cents for more accurate reporting (items 4–6).

-            All data items have been clarified to ensure they comply with the latest version of the National Health Data Dictionary and are interpreted/reported correctly.

-            The formatting of data items has been updated to the latest standards from the Australian Institute of Health and Welfare.

Part 4: File structure and record content: prosthetic record

-            The Part has been standardised with the other Parts and re-numbered (Part 7 in the existing Schedule).

-            All charge and benefit data items have been expanded to enable reporting of procedures that cost more than $99,999 and to collect amounts in dollars and cents for more accurate reporting (items 5 and 6).

-            All data items have been updated to comply with the latest version of the National Health Data Dictionary and/or clarified for better reporting.

-            The formatting of data items has been updated to the latest standards from the Australian Institute of Health and Welfare.

Part 5: Field size and record content: Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) record

-            The Part has been standardised with the other Parts and re-numbered (Part 8 in existing Schedule)

-            All data items have been updated to comply with the latest version of the National Health Data Dictionary and/or clarified for better reporting.

-            The formatting of data items has been updated to the latest standards from the Australian Institute of Health and Welfare.

Part 6: Registered health benefits organisations

-            The Part has been updated to reflect the current registration list. (i.e. removing organisations no longer registered, adding registered organisations that weren’t on the list and updating organisation registration names). This alters all item numbering.