Private Health Insurance (Accreditation) Amendment Rules 2012

Administered by Department of Health, Disability and Ageing

Legislation au F2012L01289 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health

 

Private Health Insurance Act 2007

 

Private Health Insurance (Accreditation) Amendment Rules 2012

 

Authority

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Accreditation) Rules 2011 (the Principal Rules)  providing for matters required or permitted by section 81-1 of the Act, or necessary or convenient to be provided in order to carry out or give effect to section 81-1 of the Act.

 

Purpose

The Private Health Insurance (Accreditation) Amendment Rules 2012 (the Amendment Rules) amends the Principal Rules which commenced on 5 November 2011.  The Amendment Rules insert a new subrule 7(3) allowing private health insurers to continue to pay benefits in respect of treatment provided by Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners and occupational therapists who have not been registered by the Aboriginal and Torres Strait Islander Health Practice Board, the Chinese Medicine Board, the Medical Radiation Board and the Occupational Therapy Board (collectively referred to in this explanatory statement as the Boards).  This exemption will end on 1 January 2013.

 

Background

Section 81-1 of the Act provides that an insurance policy meets the quality assurance requirements in Division 81-1 of the Act if the policy prohibits the payment of private health insurance benefits for a treatment that does not meet the standards in the Principal Rules.

 

Each State and Territory has enacted model legislation relating to the accreditation of health professionals (the National Law). From 1 July 2012, under the National Law Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners and occupational therapists are required to be registered by the Boards. In accordance with rule 7 of the Principal Rules, private health insurers will not be able to provide benefits to members for treatment provided by Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners and occupational therapists who are not registered under the National Law by 1 July 2012.

 

There is a concern that there may be delays in the Boards accreditation process due to the large volume of initial applications for registration.  This may result in some appropriately qualified, but unregistered, Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners and occupational therapists providing services for which private health insurance benefits cannot be paid.

 

The six month extension of time, permitting private health insurers to continue to offer benefits for services rendered by all appropriately qualified Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners and occupational therapists, is deemed to be an appropriate transition period for the Boards to consider all applications for registration submitted before 1 July 2012.

Consumers who have been receiving benefits for Aboriginal or Torres Strait Islander health services, Chinese medicine, medical radiation and occupational therapy will be able to continue to receive benefits under the existing arrangements for this treatment until 1 January 2013.

 

This amendment will not increase safety risks to consumers.  Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners and occupational therapists whose application for registration has been rejected by the Boards during the six months transition period will be regulated by Australian Health Practitioner Regulation Agency (AHPRA) under the National Law and will be prevented from advertising or describing themselves as Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners and occupational therapists.

 

Details

Details of the Amendment Rules are set out in the Attachment.

 

Consultation

In accordance with section 17 of the Legislative Instruments Act 2003, the Department of Health and Ageing has consulted with the AHPRA, Private Healthcare Australia and private health insurers regarding this amendment.

 

The Amendment Rules commence on the day after registration.

 

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

Authority: Section 333-20 of the

Private Health Insurance Act 2007


ATTACHMENT

 

DETAILS OF THE PRIVATE HEALTH INSURANCE (ACCREDITATION) AMENDMENT RULES 2012

 

1. Name of Rules

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Accreditation) Amendment Rules 2012 (the Amendment Rules).

 

2. Commencement

 

Rule 2 provides that the Amendment Rules are to commence on the day after registration.

 

3.              Amendment of Private Health Insurance (Accreditation) Rules 2011

 

Rule 3 provides that the Schedule to the Amendment Rules amend the Private Health Insurance (Accreditation) Rules 2011 which commenced on 5 November 2011.

 

Schedule Amendments

 

Item 1 – Part 1, Rule 4

 

Item 1 inserts a definition for Chinese medicine practitioner. The definition of a Chinese medicine practitioner mirrors the definition of a Chinese medicine practitioner under the National Law.  A Chinese medicine practitioner includes a Chinese medicine practitioner, Chinese herbal dispenser, Chinese herbal medicine practitioner, Oriental medicine practitioner or acupuncturist.

 

Item 2 – Part 1, Rule 4

 

Item 2 inserts a definition for Medical radiation practitioner. The definition of a medical radiation practitioner mirrors the definition of a medical radiation practitioner under the National Law.  A medical radiation practitioner includes a diagnostic radiographer, medical imaging technologist, radiographer, nuclear medicine scientist, nuclear medicine technologist or radiation therapist.

 

It is noted that the Amendment Rules do not provide definitions for Aboriginal or Torres Strait Islander health practitioner or occupational therapists because there are no sub‑categories for these practitioner types under the National Law.


Item 3 - Part 2, Subrule 7

 

Item 3 inserts a new subrule 7(3) clarifying that private health insurers may pay benefits in respect of treatment provided by Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners and occupational therapists who are not yet registered under the National law (as defined in rule 4). This clause ceases to have effect on and from 1 January 2013.

 

 

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

MAY 2012

 


Overview

The Private Health Insurance (Accreditation) Amendment Rules 2012 were introduced to amend the Private Health Insurance (Accreditation) Rules 2011, which themselves were established under the Private Health Insurance Act 2007. This amendment was enacted by the Minister for Health and is intended to address potential delays in the accreditation process for certain health practitioners by the relevant health practitioner boards. Specifically, the amendment allows private health insurers to continue paying benefits for treatment provided by Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners, and occupational therapists who have not yet been registered by their respective boards, until 1 January 2013. This temporary measure aims to ensure that consumers continue to receive necessary benefits during a transitional period, while also allowing the accreditation boards sufficient time to process registration applications. The policy objective of these amendments is to provide a buffer period that mitigates the impact of potential delays in the accreditation process, thereby ensuring that appropriately qualified practitioners can continue to deliver services without interruption. This is deemed necessary to maintain continuity of care for consumers while safeguarding against any increased safety risks. The amendment reflects a pragmatic approach to managing the transition to a more stringent regulatory environment, ensuring that the health insurance system remains functional and accessible during this period of change.

Scope and Application

The Private Health Insurance (Accreditation) Amendment Rules 2012 applies to private health insurers, providing them with an extension period to continue paying benefits for treatment provided by certain health practitioners who have not yet been registered under the National Law. Specifically, these practitioners include Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners, and occupational therapists. The purpose of the Amendment Rules is to address potential delays in the registration process by the relevant Boards and to ensure that consumers can continue to receive benefits for the specified treatments until 1 January 2013. This amendment is geographically and jurisdictionally relevant to Australia, as it pertains to the national legislative framework for private health insurance. The Amendment Rules are subordinate instruments made under the authority of section 333-20 of the Private Health Insurance Act 2007, and they provide further detail and clarification to the Principal Rules, which commenced on 5 November 2011. The Amendment Rules themselves commence on the day after their registration.

Key Provisions

The Private Health Insurance (Accreditation) Amendment Rules 2012 (Amendment Rules) amend the Private Health Insurance (Accreditation) Rules 2011 (Principal Rules), providing a temporary exemption for private health insurers to continue paying benefits for certain treatments. These treatments are provided by Aboriginal or Torres Strait Islander health practitioners, Chinese medicine practitioners, medical radiation practitioners, and occupational therapists who have not yet been registered under the National Law by the respective Boards. The exemption period runs until 1 January 2013, as stated in rule 7(3) of the Principal Rules. This amendment addresses potential delays in the registration process for these health practitioners due to the volume of initial applications. The Amendment Rules impose certain obligations on private health insurers. Primarily, they must ensure that benefits are paid for treatments provided by the aforementioned health practitioners until 1 January 2013, even if these practitioners are not registered by the respective Boards. This requirement is intended to provide continuity of care for consumers who have been receiving these services. Additionally, insurers must adhere to the definitions and categories specified in the rules for clarity regarding which practitioners are covered by the exemption. The insurers must also ensure that any unregistered practitioners who are rejected by the Boards during this period are regulated under the Australian Health Practitioner Regulation Agency (AHPRA) and cannot advertise themselves as registered practitioners. Breach of the Amendment Rules could result in significant consequences for private health insurers. While specific penalties are not detailed in the Amendment Rules themselves, non-compliance with the requirements of the Private Health Insurance Act 2007 and the Principal Rules could lead to enforcement actions by the relevant authorities, including fines and other administrative penalties. The Act provides for substantial penalties for breaches of its provisions, and the Amendment Rules are intended to ensure that insurers do not inadvertently violate these broader statutory requirements by failing to adhere to the transitional provisions set out in the Amendment Rules.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.