EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Private Health Insurance Act 2007
Private Health Insurance (Benefit Requirements) Amendment Rules 2013 (No. 6)
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.
The Private Health Insurance (Benefit Requirements) Amendment Rules 2013 (No. 6) (the Amendment Rules) amend Schedule 3 of the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on 1 November 2011.
Purpose
The purpose of the amendment to Schedule 3 of the Principal Rules is to add four new Medicare Benefits Schedule (MBS) item numbers.
Background
The 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 3 sets out MBS item numbers for 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.
Consultation
MBS items 63551, 63554, 63557 and 63560 will commence on 1 November 2013 under a Health Insurance Determination (the Determination) made under section 3C of the Health Insurance Act 1973. Advice was sought from the Departmental Medical Advisor in regard to the Amendment Rules regarding these amendments. No further consultation was undertaken because the amendments are minor in nature and do not significantly affect existing arrangements. Broader consultation was undertaken by the Department in relation to the items as part of the Determination.
The Amendment Rules commence on 1 November 2013 or, if registered after 1 November 2013, 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
MEDICAL BENEFITS DIVISION
DEPARTMENT OF HEALTH
OCTOBER 2013
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2013 (No. 6)
Section 1 Name of Rules
Section 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2013 (No. 6) (the Amendment Rules).
Section 2 Commencement
Section 2 provides that the Amendment Rules are to commence on 1 November 2013 or, if registered on a later date, the day after registration.
Section 3 Authority
These rules are made under item 3A of the table in section 333-20 of the Private Health Insurance Act 2007.
Section 4 Schedule
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
Schedule
The Schedule provides that Schedule 3 to the Amendment Rules amend the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on 1 November 2011.
Schedule – Amendments
Item 1 – Schedule 3, Part 3 Type C procedures, Category 5 (I5) – Diagnostic Imaging Services
Patients are taken to be Type C patients if they meet the criteria of Schedule 3, Part 3, subclause 8 of the Principal Rules. Schedule 3, Part 3, category 5 of the Principal Rules sets out the MBS item numbers for the purposes of diagnostic imaging services.
Item 1 amends Schedule 3, Part 3, Category 5 (I5) by inserting four new MBS items (63551, 63554, 63557 and 63560) into Schedule 3 of the Principal Rules to reflect that they should be classified as Type C procedures.
MBS items 63551, 63554, 63557 and 63560 will commence on 1 November 2013 under a Health Insurance Determination made under section 3C of the Health Insurance Act 1973.