EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Private Health Insurance Act 2007
Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (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 2017 (No. 3) (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 of the Principal Rules to insert two new Medicare Benefits Schedule (MBS) item numbers and amend Schedule 3 of the Principal Rules to insert one new MBS item number as a result of changes to the Health Insurance Legislation Amendment (2017 Measures No.1) Regulations 2017.
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 (NHTPs) (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 (2017 Measures No.1) Regulations 2017, three new MBS item numbers have been added.
This change was recommended by the Medical Services Advisory Committee (MSAC). MSAC reviews new or existing medical services or technology, and the circumstances under which public funding should be supported through listing on the MBS. This includes the listing of new items, or amendments to existing items on the MBS. As part of the MSAC process, consultation was undertaken with professional bodies, consumer groups, the public and clinical experts for proposals put forward for consideration by the Committee.
Consultation was undertaken by the Department with the following stakeholders:
- the Australian Society of Otolaryngology Head and Neck Surgery;
- the Royal Australasian College of Surgeons;
- the Urological Society of Australia and New Zealand;
- the Colorectal Surgical Society of Australia and New Zealand; and
- the Australasian College of Dermatologists.
No further consultation was undertaken because the amendment is machinery in nature and minor in nature and will not impact on patient or provider access.
The Amendment Rules commences on 1 May 2017.
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 2017 (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 2017 (No.3) (the Amendment Rules).
Section 2 Commencement
Section 2 provides that the Amendment Rules are to commence on 1 May 2017.
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 6 Surgical patient.
Item 1 amends Schedule 1, Part 2 Type A Procedures, Clause 6 Surgical patient of the Principal Rules by inserting two new MBS item numbers (35730 and 30642). MBS item 35730 is a new item listed for ovarian repositioning to preserve ovarian function, prior to gonadotoxic radiotherapy when the treatment volume and dose radiation have a high probability of causing infertility. MBS item 30642 is listed for radical orchidectomy; the surgical removal of the testicle and spermatic cord, generally as part of treatment for testicular cancer.
Item 2 - Schedule 3, Part 2 Type B Procedures, Clause 5 Non-band specific Type B day procedures.
Item 2 amends Schedule 1, Part 2 Type B Procedures, Clause 5 Non-band specific Type B day procedures of the Principal Rules by inserting one new MBS item number (41618).
MBS item 41618 is a new item listed for insertion of partially implantable active middle ear implants for patients with mild to severe sensorineural hearing loss.