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. 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.
The Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No. 7) (the Amendment Rules) consist of amendments which amend 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 Schedule to the Amendment Rules is to amend Schedule 1 and Schedule 3 of the Principal Rules to insert 70 new Medicare Benefits Schedule (MBS) item numbers and remove 54 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 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.
The minimum benefits payable per night for hospital treatment provided to NHTPs in Schedule 4 of the Principal Rules is subject to review and change twice annually, to reflect the indexation applied to the Adult Pension Basic Rate and Maximum Daily Rate of Rental Assistance.
Schedule 5 of the Principal Rules requires a health insurer to pay second tier default benefits for most episodes of hospital treatment provided in private hospital facilities that are specified in Schedule 5 if the health insurer does not have a negotiated agreement with the hospital. Schedule 5 sets a higher minimum level of benefit (for overnight treatment and day only treatment provided in specified facilities) than the minimum benefit set for such treatment by Schedules 1, 2 and 3 of the Principal Rules.
Details
Details of the Amendment Rules are set out in the Attachment.
Consultation
In accordance with changes to the
Health Insurance Legislation Amendment (2016 Measures No. 2) Regulation 2016, 70 new MBS item numbers have been added and 54 MBS item numbers have been removed. Medical advice was sought from within the Department regarding this amendment. No further consultation was undertaken because the amendment is minor in nature and does not significantly affect existing arrangements.
The Amendment Rules commence on 1 November 2016.
The Amendment Rules are a legislative instrument for the purposes of the
Legislation Act 2003.
Attachment
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2016 (No. 7)
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.7) (the Amendment Rules).
Section 2 Commencement
Section 2 provides that the Amendment Rules are to commence on 1 November 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
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 two new MBS items numbers (45201 and 45202).
Item 2 - Schedule 3, Part 2 – Type B Procedures, Clause 5 Non-band specific Type B day procedures, Subclause (1)
Item 2 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 16 new MBS item numbers (30658, 31356, 31358, 31359, 31360, 31361, 31363, 31364, 31367, 31369, 31371, 31372, 31373, 31374, 31375 and 31376) and deleting 48 items (30653, 30656, 30659, 30660, 31230, 31235, 31240, 31255, 31256, 31257, 31258, 31260, 31261, 31262, 31263, 31265, 31266, 31267, 31268, 31270, 31271, 31272, 31273, 31275, 31276, 31277, 31278, 31280, 31281, 31282, 31283, 31285, 31286, 31287, 31288, 31290, 31291, 31292, 31293, 31295, 31300, 31305, 31310, 31315, 31320, 31325, 31330, and 31335).
Item 3 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 1, Attendance, Subclause (A26)
Item 3 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 1, Attendance, Subclause (A26) of the Principal Rules by inserting 31 new MBS item numbers (6018, 6019, 6023, 6024, 6025, 6026, 6028, 6029, 6031, 6032, 6034, 6035, 6037, 6038, 6042, 6051, 6052, 6057, 6058, 6059, 6060, 6062, 6063, 6064, 6065, 6067, 6068, 6071, 6072, 6074 and 6075).
Item 4 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 2, Diagnostic procedures and investigations, Subclause (D1)
Item 4 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 2, Diagnostic procedures and investigations, Subclause (D1) of the Principal Rules by inserting five new MBS item numbers (12017, 12022, 12024, 12325 and 12326) and deleting two MBS item numbers (12015 and 12018).
Item 5 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 3, Therapeutic procedures, Subclause (T8)
Item 5 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 3, Therapeutic procedures, Subclause (T8) of the Principal Rules by inserting 12 new MBS item numbers (30072, 30654, 31206, 31211, 31216, 31221, 31357, 31362, 31365, 31366, 31368 and 31370) and deleting four MBS item numbers (31200, 31205, 31210 and 31215).
Item 6 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 5, Diagnostic Imaging Services, Subclause (I5)
Item 6 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 5, Diagnostic Imaging Services, Subclause (I5) of the Principal Rules by inserting four new MBS item numbers (63487, 63488, 63489 and 63490).
These new items included in the General Medical Services Table were registered on the Federal Register of Legislation on 14 October 2016.