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 2012 (No.7)
Authority
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.
Purpose
The Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No.7) (the Amendment Rules) make consequential amendments to Schedules 1 and 3 of the Principal Rules to reflect changes made to the Medical Benefits Schedule (MBS) item numbers, due to commence on 1 November 2012. The amendments also reflect an indexation of 1.9% to the MBS fees in Schedule 1 of the Principal Rules.
Background
The Private Health Insurance (Benefit Requirements) Rules 2011 (Principal Rules), which commenced on 1 November 2011, provide for the minimum benefit requirements for psychiatric, rehabilitation and palliative care and other hospital treatment. Schedules 1 to 5 of the Principal 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).
Schedule 1 categorises MBS item numbers into overnight patient classifications comprising ‘Advanced surgical patient’, ‘Obstetric patient’, ‘Surgical patient’, ‘Psychiatric patient’, ‘Rehabilitation patient’ and ‘Other patients’. Schedule 3 sets out MBS item numbers for the same day hospital accommodation benefits which are payable for privately insured patients in all states and territories.
Details
Details of the Amendment Rules are set out in the Attachment.
The Amendment Rules commence on 1 November 2012 or, if registered after 1 November 2012, the day after registration
The Amendment Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Consultation
The changes to Schedule 1 and Schedule 3 are a consequence of changes that have been made to the MBS with effect from 1 November 2012. These amendments to Schedules 1 and 3 are machinery in nature and do not substantially alter existing arrangements.
Medical advice was sought from within the Department regarding these amendments. No further consultation was undertaken because the amendments are minor in nature and do not significantly affect existing arrangements.
Authority: Section 333-20 of the
Private Health Insurance Act 2007
ATTACHMENT
Details of the Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No.7)
1. Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No.7) (the Amendment Rules).
2. Commencement
Rule 2 provides that the Amendment Rules are to commence on 1 November 2012, or if registered after 1 November 2012, the day after registration.
3. Amendment of Private Health Insurance (Benefit Requirements) Rules 2011
Rule 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules), which commenced on 1 November 2011.
Schedule – Amendments
Item 1– Schedule 1, Part 2 Type A procedures, Clause 4 Advanced surgical patient, subclause (3)
Item 1 amends Schedule 1, Part 2 Type A procedures, Clause 4 Advanced surgical patient, subclause (3) of the Principal Rules by deleting $837.05 and substituting $852.95 to reflect a 1.9% increase in MBS Schedule fees, and deletes MBS item 42731 as a result of the item being removed from the MBS. It is noted that all item numbers in the Advance surgical patient category were subject to the 1.9% increase in the MBS.
Item 1 also inserts MBS item 48694. This item is new and relates to cervical artificial intervertebral total disc replacement. It is expected that this item will be usually performed as an advanced surgical procedure due to its complex nature.
Item 2– Schedule 1, Part 2 Type A procedures, Clause 6 Surgical patient, subclause (3)
Item 2 amends Schedule 1, Part 2 Type A procedures, Clause 6 Surgical patient, subclause (3) of the Principal Rules by replacing the current fee range of $249.26 to $837.05 with $254.00 to $852.95 to reflect a 1.9% increase in MBS Schedule fees. It is noted that all item numbers in the Surgical patient category were subject to the 1.9% increase in the MBS except for 55135, 57351 and 57356. However these three items are not impacted because they still fall within the new price range and remain Type A surgical.
Item 2 also consequently deletes four MBS items (42560, 42566, 42722 and 42771) as a result of the items being removed from the MBS.
Item 3– Schedule 3, Part 2 Type B procedures, Clause 5 Non-band specific Type B day procedures, subclause (1)
Item 3 amends Schedule 3, Part 2 Type B procedures, Clause 5 Non-band specific Type B day procedures, subclause (1) of the Principal Rules by inserting MBS item 30687. This item relates to endoscopic surgical operations with radiofrequency ablation. It is expected that this item will be usually performed in a day surgery and will not usually require overnight hospital accommodation, unless the treating medical practitioner determines otherwise.
Item 4– Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 2 Diagnostic Procedures & Investigations, D1
Item 4 amends Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 2 Diagnostic Procedures & Investigations, D1 of the Principal Rules by deleting two MBS items (11203 and 11212) relating to diagnostic procedures, as a result of the items being removed from the MBS.
Item 5– Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 5 Diagnostic Imaging Services, I5
Item 5 amends Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 5 Diagnostic Imaging Services, I5 of the Principal Rules by inserting 13 MBS items (63507, 63510, 63513, 63516, 63519, 63522, 63525, 63526, 63527, 63528, 63529 and 63530). These MBS items relate to Magnetic Resonance Imaging (MRI) diagnostic imaging services which are not usually performed in hospital. However, it is recognised that these items may be performed, in rare cases, in isolation in hospital if determined by the treating medical practitioner.
Item 6– Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 6 Pathology Services, P7
Item 6 amends Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 6 Pathology Services, P7 of the Principal Rules by inserting three MBS items (73333, 73334 and 73335). These MBS items relate to pathology services relating to genetic detection of mutations of the von Hippel-Lindau which are not usually performed in hospital. However, it is recognised that these items may be performed, in rare cases, in isolation in hospital if determined by the treating medical practitioner.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
OCTOBER 2012
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 7)
This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Legislative Instrument
The Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No.7) amends Schedules 1 and 3 of the Private Health Insurance (Benefit Requirements) Rules 2011 (Principal Rules) to reflect changes in Medical Benefits Schedule (MBS) item numbers, due to commence on 1 November 2012. The amendments also reflect an indexation of 1.9% to the MBS Schedule fees in Schedule 1 of the Principal Rules.
Human rights implications
This Legislative Instrument does not engage any of the applicable rights or freedoms.
Conclusion
This Legislative Instrument is compatible with human rights as it does not raise any human rights issues.
Doug Fawns
Assistant Secretary
Private Health Insurance Branch
Department of Health and Ageing