National Health Regulations (Amendment) 1997 No. 160
EXPLANATORY STATEMENT
STATUTORY RULES 1997 No. 160
Issued by the authority of the Minister for Health and Family Services
National Health Act 1953
National Health Regulations (Amendment)
Subsection 140(1) of National Health Act 1953 ("the Act") provides that the Governor-General may make regulations, prescribing all matters which by the Act are required or permitted to be prescribed.
Regulations 49A and 49B of the National Health Regulations established the Hospital Casemix g Protocol (11CP). Regulation 49A prescribes the HCP by reference to Schedule 7 of the Regulations, for the purposes of paragraph 73BD(2)(c) of the Act.
The HCP specifies and defines financial, demographic and clinical data to be provided by registered health benefits organisations (health funds) to the Commonwealth Department of Health and Family Services (the Department) and also sets out the information about patients and their treatment which hospitals must provide to health insurance funds.
Regulation 49B prescribes the list of Australian National Diagnosis Related Groups (AN-DRGs), for the purposes of sub paragraph 73BD(4) (a)(i) of the Act. The AN-DRGs are used to classify episodes of in-hospital care into clinically meaningful and resource homogenous groups. The AN-DRGs are published in the form of a manual prepared by the Department in conjunction with 3M Health Information Systems. Previously four versions of the manual were prescribed in the list contained in regulation 49B.
The amendment to regulation 49B added the new version of the AN-DRGs to the fist of manuals prescribed in that regulation (subregulation 3.1). The new manual keeps the HCP consistent with the latest developments in acute patient classifications and software, including new diagnosis codes.
The amendments to Schedule 7 of the National Health Regulations are intended to:
* keep the HCP consistent with latest Version of the National Health Data Dictionary (subregulations 4.2 to 4.11). The National Health Data Dictionary is a publication of the Australian Institute of Health and Welfare and is the preferred source of definitions of terms used in the HCP;
* improve data quality (subregulations 4.12 to 4.14);
* remove anomalies from the hospital episode record table (subregulation 4.14).
* Anomalies exist in relation to the data items 'Principal diagnosis' and 'Separation mode'. The effect of clauses 8 and 9 of the protocol in Schedule 7 is that the Department will reject a record if it contains blank or invalid entries for principal diagnosis and separation mode. However, Part 5 of Schedule 7, which contains coding specifications for principal diagnosis and separation mode, indicates that those data items are mandatory only for contracted hospitals (MAC). The amendments remove these inconsistencies to make those data items mandatory for all hospitals (MAA).
Details of the Regulations are set out in the Attachment.
The Regulations commenced on 1 July 1997.
ATTACHMENT
1. Commencement
Regulation 1 provides that the regulations will commence on 1 July 1997.
2. Amendment
Regulation 2 provides that the National Health Regulations are to be amended in accordance with these amendments.
3. Regulation 49B (List of Australian National Diagnosis Related Groups)
Subregulation 3.1 amended subregulation 49B(1) of the Regulations to add the Australian Diagnosis Related Groups Definitions Manual 3.1 to the list of manuals prescribed in that subregulation. Regulation 49B of the National Health Regulations prescribes certain manuals associated with casemix funding. The amendment prescribes a new manual that has been issued.
4. Schedule 7 (Hospital Casemix Protocol)
Subregulation 4.1 substituted a new definition of 'NHDD' in Schedule 7, Part 1, clause 2 of the Regulations. The effect of the amendment is to introduce a new version of the National Health Data Dictionary, namely, version 5. 0.
Subregulations 4.2 to 4.11 amended terms used to describe data items in the table entitled
Record content.. hospital episode record'. Those data items are located in Column 2 of that table which forms Part 5 of Schedule 7 of the Regulations. 'Fund identifier' becomes 'Fund/Payer identifier', Medical charges' becomes 'Items charges', Medical benefits' becomes 'Total CMBS and fund benefits', 'Gender' becomes 'Sex', Date admitted' becomes 'Admission date', 'Date separated' becomes 'Separation date', 'Separation mode' becomes 'Mode of separation', 'Secondary diagnosis codes' becomes 'Additional diagnosis' and 'Secondary procedure codes' becomes 'Additional procedures'. The changes update the language to keep the Hospital Casemix Protocol consistent with the latest version of the National Health Data Dictionary (version 5.0),
Subregulation 4.12 changed the 'Required status' of certain items in the table at Part 5 of Schedule 7 from MAA (Mandatory for All) to OPA (Optional for All). The items affected are 19 (Total charge), 20 (Total benefit), 38 (Age in years) and 45 (Acute days of stay).
Subregulation 4.13 changed the Required status' of certain items in the table at Part 5 of
Schedule 7 from MAC (Mandatory for Contracted hospitals) to OPA (Optional for All). The items affected are 37 (Admission transfer type), 39 (Age in days) and 44 (Separation transfer type).
Subregulation 4.14 changed the' Required status' of certain items in the table at Part 5 of Schedule 7 from MAC (Mandatory for Contracted hospitals) to MAA (Mandatory for All). The items affected are 42 (Separation mode) and 48 (Principal diagnosis).
The amendments in subregulations 4.12 to 4.14 are designed to improve data quality and remove inconsistencies from the table.
Subregulation 4.15 added four additional data items to the table at Part 5 of Schedule 7 of the Regulations, namely, item 57 'Bundled charges', item 58 'Bundled benefits', item 59 'Other charges' and item 60 'Other benefits'. These changes are intended to improve data quality by enabling hospitals and health insurance funds to provide more accurate and consistent financial information.
Subregulation 4.16 added the Transition Benefit Fund to the list of Registered Health Benefits Organisations contained in Part 6 of Schedule 7 of the Regulations.