EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Private Health Insurance Act 2007
Private Health Insurance (Benefit Requirements) Amendment Rules 2008 (No. 4)
Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Benefit Requirements) Rules providing for matters required or permitted by Part 3-3 of the Act, or necessary or convenient to be provided in order to carry out or give effect to Part 3-3 of the Act.
The Private Health Insurance (Benefit Requirements) Rules 2008 (No. 2) (the Rules), which commenced on 1 July 2008, provide for the minimum benefit requirements for psychiatric, rehabilitation and palliative care and other hospital treatment. Schedules 1 to 5 of the Rules set out the minimum levels of benefit which are payable for hospital treatment. Namely, benefits for overnight accommodation (Schedules 1 and 2), same day accommodation (Schedule 3), nursing-home type patients (Schedule 4) and second tier default benefits (Schedule 5).
The Private Health Insurance (Benefit Requirements) Amendment Rules 2008 (No. 2) made on 17 July 2008 amended Schedules 1, 3 and 5 of the Rules. The purpose of those amendments was to reflect changes in the minimum benefits payable for overnight shared accommodation at public hospitals in Victoria and to ensure that a new facility was eligible for second tier default benefits. In order to carry out that purpose, it was necessary for minimum benefit rates for Victoria in clause 2, Table 2 of Schedule 1 and clause 2, Table 1 of Schedule 3 to be amended, and for the new facility to be inserted into the table at clause 4 of Schedule 5 of the Rules.
The Private Health Insurance (Benefit Requirements) Amendment Rules 2008 (No. 3) made on 20 September 2008, amended items in Schedule 3, Table 1 and Table 2 of Schedule 4, and further amended Schedule 5 of the Rules. The purpose of the amendments to Schedule 3 of the Rules was to reflect changes in Medical Benefits Schedule (MBS) items as of 1 July 2008. The purpose of the amendments to Schedule 4 of the Rules was to reflect the changes in the minimum benefits for hospital treatment for those patients who are classified as “nursing-home type patients” at public hospitals in the Northern Territory, Queensland, Tasmania and Victoria, and at private hospitals nationally. The purpose of the amendments to Schedule 5 of the Rules was to ensure that four new facilities are eligible for second tier default benefits.
The Private Health Insurance (Benefit Requirements) Amendment Rules 2008 (No.4) (the Amending Rules) amend Schedules 1 and 3 of the Rules to reflect changes in MBS items to commence 1 November 2008. The purpose of the amendments to Schedule 1 is to specify that advanced surgical patients are those patients undergoing procedures with a MBS fee greater that $788.01 and that surgical patients are classified as those patients undergoing procedures with a MBS fee within the range of $234.65 to $788.01.
The purpose of the amendments to Schedule 3 is to include new MBS item numbers in Part 3 - Type C Procedures. These amendments will ensure that, if private health insurers do not have contractual arrangements with hospitals, the insurers’ obligations to pay minimum
benefits for insured persons who receive hospital treatment with respect to those hospitals continue to align with the MBS.
Details of the Amending Rules are set out in the Attachment.
Consultation
The changes to the MBS resulted from reviews by the Medicare Benefit Consultative Committee (MBCC) and the Medicare Services Advisory Committee (MSAC). The MBCC is an advisory committee established by agreement between the Minister for Health and Ageing and the Australian Medical Association. MBCC’s major function is to review particular services or groups of services in the MBS, including consideration of appropriate fee levels. MSAC advises the Minister of new and emerging medical services and under what circumstances public funding, including listing on the MBS, should be supported.
No specific consultation was undertaken in relation to the amendments to Schedule 3 of the Rules because the changes were machinery in nature and did not substantially alter existing arrangements. The amendments to Schedules 1 and 3 are part of the ongoing management of the Private Health Insurance (Benefit Requirements) Rules.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
OCTOBER 2008
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2008 (No. 4)
1. Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2008 (No.4) (the Amending Rules).
2. Commencement
Rule 2 provides that the Amending Rules are to commence on 1 November 2008 or, if the Amending Rules are registered on a later date, the day after registration.
3. Amendment of Private Health Insurance (Benefit Requirements) Rules 2008 (No. 2)
Rule 3 provides that the Schedule to the Amending Rules amends the Private Health Insurance (Benefit Requirements) Rules 2008 (No. 2) (Rules) which commenced on 1 July 2008, and were subsequently amended on 17 July 2008 and 20 September 2008.
Schedule – Amendments
Item 1 – Schedule 1, Part 2, Subclause 4(3)
Subclause 4(3) of the Rules provides the item numbers in the Medical Benefits Schedule (MBS) for the purpose of clause 4 of the Rules, but indicates that a listing in subclause 4(3) only applies where an item has a fee in the MBS greater than the specified amount.
Item 1 of the Schedule of the Amending Rules amends subclause 4(3)Part 2, Schedule 1 of the Rules by increasing the specified amount from $770.29 to $788.01. This increase reflects an increase of 2.3% on items in the Health Insurance (General Medical Services Table) Regulations 2008 (GMST) which will commence on 1 November 2008.
Item 2 – Schedule 1, Part 2, Subclause 6(3)
Subclause 6(3) of the Rules provides the item numbers in the MBS for the purpose of clause 6 of the Rules, but indicates that a listing in subclause 6(3) only applies where an item has a fee in the MBS within the specified range.
Item 2 of the Schedule of the Amending Rules amends subclause 6(3), Part 2, Schedule 1 of the Rules by increasing the specified range from the previous range of $229.37 to $770.29, to the new range of $234.65 to $788.01. This increase reflects an increase of 2.3% on items in the GMST which will commence on 1 November 2008.
Item 3 – Schedule 3, Part 3, Clause 8 Interpretation, Items in the general medical services table
Clause 8 of the Rules provides that a Type C procedure is a procedure specified in clause 8 by reference to MBS items.
Item 3 of the Schedule of the Amending Rules amends clause 8, Part 3, Schedule 3 of the Rules to insert new MBS item numbers 603 and 696 at A11, Category 1 – attendances. This
insertion reflects new MBS item numbers in the GMST which commences on 1 November 2008.
Item 4 – Schedule 3, Part 3, Clause 8 Interpretation, Items in the pathology services table
Clause 8 provides that a Type C procedure is a procedure specified in clause 8 by reference to
MBS items.
Item 4 of the Schedule of the Amending Rules amends clause 8, Part 3, Schedule 3 of the Rules to insert new MBS item numbers 66831 and 66832 at P2, ‘Items in the pathology services table’. This insertion reflects the inclusion of new MBS item numbers in the Health Insurance (Pathology Services Table) Regulations 2008 (Pathology Services Table) which commences on 1 November 2008.
Item 5 – Schedule 3, Part 3, Clause 8 Interpretation, Items in the pathology services table
Clause 8 provides that a Type C procedure is a procedure specified in clause 8 by reference to
MBS items.
Item 5 of the Schedule of the Amending Rules amends clause 8, Part 3, Schedule 3 of the Rules to insert MBS item numbers 72827, 72828, 72849, 72850 and 73324 at P5, ‘Items in the pathology services table’. This insertion reflects the inclusion of new MBS item numbers in the Pathology Services Table which commences on 1 November 2008.
The Amending Rules commence on 1 November 2008 or the day after registration on the Federal Register of Legislative Instruments, if not registered by 1 November 2008.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
OCTOBER 2008