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. 3)
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. 3)
(the Amendment Rules) consist of the Schedule – Amendments, which amends Schedules 1 and 3 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 and 3 of the Principal Rules is to reclassify two MBS items (32088 and 32089) from Type A to Type B procedures to correct an error in the previous classification.
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’. Schedule 3 categorises MBS item numbers for day admission comprising ‘Band 1’, ‘non-band specific’, and requirements for Band 2,
Band 3, and Band 4 benefits.
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), two items (32088 and 32089) will be revised from Type A to Type B procedures to correct an error in the previous classification. 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 the day after they are registered.
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
MAY 2016
Attachment
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2016 (No.3)
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.3) (the Amendment Rules).
Section 2 Commencement
Section 2 provides that the Amendment Rules are to commence on the day after they are registered.
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 6 Surgical patient, Subclause (3)
Item 1 amends Schedule 1, Part 2 – Type A Procedures, Clause 6 Surgical patient, Subclause (3) of the Principal Rules by removing MBS items 32088 and 32089. These items were incorrectly classified as Type A, and therefore will be removed from Type A and reclassified as Type B.
Item 2 – Schedule 3, Part 2 – Type B Procedures, Clause 4 Band 1, Subclause (1)(a)
T8: Surgical Operations
Item 2 amends Schedule 3, Part 2 – Type B Procedures, Clause 4 Band 1, Subclause (1)(a) T8: Surgical Operations of the Principal rules by inserting item 32088. This is an item for Fibreoptic Colonoscopy examination of the colon beyond the hepatic flexure with or without biopsy, following a positive faecal occult blood test for a participant registered on the National Bowel Cancer Screening Program.
Item 3 – Schedule 3, Part 2 – Type B Procedures, Clause 5 Non-band specific Type B day procedures, Clause 1
Item 3 amends Schedule 3, Part 2 – Type B Procedures, Clause 5 Non-band specific Type B day procedures, Clause 1 of the Principal Rules by inserting item 32089. This is an item for Endoscopic examination of the colon beyond the hepatic flexure by Fiberoptic Colonoscopy for the removal of 1 or more polyps, following a positive faecal occult blood test for a participant registered on the National Bowel Cancer Screening Program.