EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Private Health Insurance Act 2007
Private Health Insurance (Benefit Requirements) Amendment Rules 2018 (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 2018 (No. 2) (the Amendment Rules) consist of amendments which 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 Schedule to the Amendment Rules is to amend Schedule 3 of the Principal Rules to insert 12 new Medicare Benefits Schedule (MBS) item numbers as a result of changes to the Health Insurance (General Medical Services Table) Regulations 2017 and the Health Insurance (Diagnostic Imaging Services Table) 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 (General Medical Services Table) Regulations 2017 and the Health Insurance (Diagnostic Imaging Services Table) Regulations 2017, 12 new MBS item numbers have been added.
In the 2017-18 Mid-Year Economic and Fiscal Outlook (MYEFO), the Government announced that the following changes be made to the MBS from 1 May 2018:
- Four new items for Magnetic Resonance Imaging (MRI) of the cardiovascular system for the diagnosis of Arrthymogenic Right Ventricular Cardiomyopathy;
- Two new MRI services for Breast Implant-Associated Anaplastic Large Cell Lymphoma;
- One new item for whole body Positron Emission Tomography using 68Gallium DOTA peptide for diagnosis of gastoenteropancreatic neuroendocrine tumour;
- One new ophthalmology item for the treatment of progressive corneal ectatic disease;
- Two new items for the treatment of varicose veins caused by chronic venous insufficiency; and
- Two items for diagnosis of atrial fibrillation in patients with cryptogenic stroke using implantable loop recorder.
The Regulations make a number of changes to the MBS as recommended by the Medical Services Advisory Committee (MSAC) or the MSAC Executive. 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. 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.
Additional consultation was undertaken by the Department of Health with the following stakeholders:
- the Royal Australian and New Zealand College of Radiologists;
- the Australian Society of Ophthalmologists;
- the Royal Australian and New Zealand College of Ophthalmologists;
- the Royal Australian College of Surgeons; and
- the Cardiac Society of Australia and New Zealand.
The Amendment Rules commences on 1 May 2018.
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 2018 (No.2)
Section 1 Name of Rules
Section 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2018 (No.2) (the Amendment Rules).
Section 2 Commencement
Section 2 provides that the Amendment Rules are to commence on 1 May 2018.
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 3, Part 2 Type B Procedures, Clause 5 Non-band specific Type B day procedures, Subclause 1
Item 1 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 two new MBS items (38288, 42652). 38288 is a new MBS item for diagnosis of atrial fibrillation in patients with cryptogenic stroke using an implantable loop recorder. 42652 is a new ophthalmology MBS item for the treatment of progressive corneal ectatic disease.
Item 2 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 2 Diagnostic procedures and investigations, Subclause D1
Item 2 amends Schedule 3, Part 3 – Type C procedures, Clause 8 Interpretation, Category 2 Diagnostic procedures and investigations, Subclause D1of the Principal Rules by inserting one new MBS item (11728). 11728 is a new MBS item for diagnosis of atrial fibrillation in patients with cryptogenic stroke using an implantable loop recorder.
Item 3 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 3 Therapeutic Procedures, Subclause T8
Item 3 amends Schedule 3, Part 3 – Type C procedures, Clause 8 Interpretation, Category 3 Therapeutic Procedures, Subclause T8 of the Principal Rules by inserting two new MBS items (32528, 32529). 32528 and 32529 are new MBS items for the treatment of varicose veins caused by chronic venous insufficiency.
Item 4 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 5 Diagnostic Imaging Services, Subclause I4
Item 4 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 5 Diagnostic Imaging Services, Subclause I4 of the Principal Rules by inserting one new MBS item (61647). 61647 is a new MBS item for whole body Positron Emission Tomography using 68Gallium DOTA peptide for diagnosis of gastoenteropancreatic neuroendocrine tumour.
Item 5 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 5 Diagnostic Imaging Services, Subclause I5
Item 5 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 5 Diagnostic Imaging Services, Subclause I5 of the Principal Rules by inserting six new MBS items (63395, 63396, 63397, 63398, 63547, and 63548). The four new MBS items (63395, 63396, 63397, 63398) are for Magnetic Resonance Imaging (MRI) of the cardiovascular system for the diagnosis of Arrthymogenic Right Ventricular Cardiomyopathy, and the two new MBS items (63547, 63548) are for MRI services for Breast Implant-Associated Anaplastic Large Cell Lymphoma.