EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Private Health Insurance Act 2007
Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No. 2)
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 2016 (No. 2) (the Amendment Rules) consist of the Schedule – Amendments, which amends Schedules 1 of the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on 1 November 2011.
Purpose
The purpose of the amendments to Schedules 1 of the Principal Rules is to insert 12 new Medicare Benefits Schedule (MBS) item numbers and to remove five MBS items.
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 1 categorises MBS item numbers into overnight patient classifications comprising ‘Advanced surgical patient’, ‘Obstetric patient’, ‘Surgical patient’, ‘Psychiatric patient’, ‘Rehabilitation patient’ and ‘Other patients’.
Details
Details of the Amendment Rules are set out in the Attachment.
Consultation
In accordance with changes to the Health Insurance (General Medical Services Table) Regulations (GMST), 12 MBS item numbers have been added and five MBS have been removed. 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.
The Amendment Rules commence on 1 May 2016.
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
APRIL 2016
Attachment
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2015 (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 2016 (No.2) (the Amendment Rules).
Section 2 Commencement
Section 2 provides that the Amendment Rules are to commence on 1 May 2016.
Section 3 Authority
Section 3 provides that the Amendment 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 – Amendments
The Schedule – Amendments provide that 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 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 inserting three new MBS items numbers (30640, 37040 and 37338). MBS item 30640 is a new item for the repair of large and irreducible scrotal hernias. MBS items 37040 and 37338 are new items for the insertion and removal of synthetic male sling system for the treatment of stress urinary incontinence.
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 inserting nine new MBS item numbers (32088, 32089, 47310, 47313, 47316, 47319, 47364, 47370 and 47373) and deleting five items (47333, 47345, 47366, 47372 and 47375).
MBS items 32088 and 32089 are new items for colonoscopy intended for participants of the National Bowel Cancer Screening Program, for follow up of a positive faecal occult blood test result.
MBS items 47310, 47313, 47316 and 47319 are new items for the treatment of finger fractures. The introduction of these new items has resulted in the redundancy and subsequent deletion of items 47333 and 47345. Changes to this suite of items will better reflect specific pathologies (as opposed to having an MBS item for every bone in the hand) and contemporary clinical practice.
MBS items 47364, 47370 and 47373 are new items for the treatment of wrist fractures. The introduction of these new items has resulted in the redundancy and subsequent deletion of items 47366, 47372 and 47375. Changes to this suite of items will better reflect specific pathologies (as opposed to having an MBS item for every bone in the hand) and contemporary clinical practice.