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 2009
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) (as amended), 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 2009 (the Amendment Rules) amend Schedule 3 of the Rules to reflect changes in Medical Benefits Schedule (MBS) items which commenced 1 February 2009. The purpose of the amendments to Schedule 3 is to include new MBS item numbers in Part 3 - Type C Procedures.
Type C procedures are those procedures for which hospital treatment is not normally required. Minimum benefits for either overnight accommodation or day-only accommodation are payable for patients receiving certified Type C procedures where the certification requirements in the Rules have been satisfied.
Details of the Amendment 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 Schedule 3 are part of the ongoing management of the Private Health Insurance (Benefit Requirements) Rules.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
FEBRUARY 2009
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2009)
1. Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2009 (the Amendment Rules).
2. Commencement
Rule 2 provides that the Amendment Rules are to commence on the day after they are registered.
3. Amendment of Private Health Insurance (Benefit Requirements) Rules 2008 (No. 2)
Rule 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Benefit Requirements) Rules 2008 (No. 2) (the Rules) which commenced on 1 July 2008, and were subsequently amended on 18 July 2008, 20 September 2008, 1 November 2008 and 20 December 2008.
Schedule – Amendments
Item 1 – Schedule 3, Part 3, Clause 8 Interpretation, Items in the Diagnostic Imaging 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 1 of the Schedule of the Amending Rules amends clause 8, Part 3, Schedule 3 of the Rules to insert new MBS item numbers 61541, 61544, 61553, 61556, 61565 and 61568 at I4 – Nuclear Medicine Imaging. This insertion reflects new MBS item numbers that were created in the Health Insurance (Positron Emission Tomography) Determination 2008 (No.2) which was made under section 3C of the Health Insurance Act 1973 (HI Act). Under section 3C, these new MBS item numbers are to be treated as if they were items in the Health Insurance (Diagnostic Imaging Services Table) Regulations 2008 (Diagnostic Imaging Services Table). The new MBS items commenced on 1 December 2008.
Item 2 – Schedule 3, Part 3, Clause 8 Interpretation, Items in the Diagnostic Imaging 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 2 of the Schedule of the Amending Rules amends clause 8, Part 3, Schedule 3 of the Rules to insert new MBS item numbers 63464 and 63467 at I5 – Magnetic Resonance Imaging. This insertion reflects the new MBS item numbers in the Diagnostic Imaging Services Table. Under the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2008 (No.4), these new MBS items commenced on 1 February 2009.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
FEBRUARY 2009