EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Private Health Insurance Act 2007
Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 2)
Authority
Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Complying Product) Rules providing for matters required or permitted by Chapter 3 and/or section 188-1 of the Act, or necessary or convenient in order to carry out or give effect to Chapter 3 and/or section 188-1 of the Act.
The Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 2) (the Amendment Rules) amend Rule 8A of the Private Health Insurance (Complying Product) Rules 2010 (No. 2) (the Principal Rules) which commenced on 14 January 2011.
Purpose
The purpose of the amendments to Rule 8A is to change the patient contribution payable per night for nursing-home type patients (NHTPs) at public hospitals in the Australian Capital Territory (ACT) and Western Australia (WA).
Background
Rule 8A of the Principal Rules sets the patient contribution for privately insured NHTPs by restricting the amount of benefit that private health insurers pay for each day of NHTP hospital treatment at a hospital. The amount of benefit is restricted to the hospital’s charge less the patient contribution amount.
The Schedule to the Amendment Rules makes minor changes to Paragraph 8A(3)(a) of the Principal Rules by amending the NHTP contribution rate at public hospitals in the ACT and WA.
The NHTP contribution rate will be increased in the ACT from $50.95 to $53.55 and in WA from $52.05 to $53.55.
Changes to the NHTP contribution rate reflect increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates), which took effect on 20 March 2013.
Consultation
On 25 February 2013, states and territories were asked whether they would be increasing the NHTP contribution and accommodation rates in their jurisdiction in line with increases in the Pension and Rental Assistance Rates. New South Wales, Queensland, South Australia, Tasmania and Victoria advised that they would increase the NHTP contribution rates in their public hospitals from 20 March 2013. In March 2013, the ACT and WA advised that they were not increasing its NHTP contribution and accommodation rates at that time.
The ACT and WA have subsequently advised of their intention to increase NHTP contribution rates.
No advice was received from the Northern Territory.
The Amendment Rules commence on 1 July 2013 or, if registered after 1 July 2013, the day after registration.
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 AND AGEING
JUNE 2013
Overview
The Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 2) were introduced to amend Rule 8A of the Private Health Insurance (Complying Product) Rules 2010 (No. 2), which was enacted to regulate the patient contributions for nursing-home type patients (NHTPs) in public hospitals under the Private Health Insurance Act 2007. These amendments were made to reflect changes in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates), which took effect on 20 March 2013. The purpose of the changes was to align the NHTP contribution rates in the Australian Capital Territory (ACT) and Western Australia (WA) with those of other states and territories that increased their rates on the same date. This ensures consistency and fairness across all jurisdictions regarding the financial contributions expected from privately insured NHTPs. The rules were enacted by the Minister for Health under the authority of Section 333-20 of the Private Health Insurance Act 2007, and they commenced on 1 July 2013.
Scope and Application
The Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 2) amends Rule 8A of the Private Health Insurance (Complying Product) Rules 2010 (No. 2), which commenced on 14 January 2011, by adjusting the patient contribution payable per night for nursing-home type patients (NHTPs) at public hospitals in the Australian Capital Territory (ACT) and Western Australia (WA). The amendment is necessary to align the NHTP contribution rates with increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates) that took effect on 20 March 2013. The amendment increases the NHTP contribution rate in the ACT from $50.95 to $53.55, and in WA from $52.05 to $53.55. The amendment reflects the decision of the ACT and WA to increase the NHTP contribution rates following consultations in February and March 2013. The Amendment Rules are a legislative instrument made under Section 333-20 of the Private Health Insurance Act 2007 and will commence on 1 July 2013 or, if registered after that date, the day after registration.
Key Provisions
The Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 2) amend Rule 8A of the Private Health Insurance (Complying Product) Rules 2010 (No. 2), which commenced on 14 January 2011. The purpose of these amendments is to adjust the patient contribution payable per night for nursing-home type patients (NHTPs) at public hospitals in the Australian Capital Territory (ACT) and Western Australia (WA). Rule 8A originally set the patient contribution for privately insured NHTPs by limiting the benefit that private health insurers can pay for each day of NHTP hospital treatment at a hospital, with the benefit restricted to the hospital's charge less the patient contribution amount.
The obligations and requirements imposed by these Amendment Rules are primarily focused on ensuring that the patient contribution rates for NHTPs are updated in line with certain economic factors. Specifically, these amendments are necessary to reflect increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates), which came into effect on 20 March 2013. The changes to Rule 8A involve increasing the NHTP contribution rate at public hospitals in the ACT from $50.95 to $53.55, and in WA from $52.05 to $53.55. This adjustment ensures that the financial contributions expected from NHTPs are consistent with the broader economic adjustments occurring at that time.
There are no explicit offences, penalties, or civil/criminal consequences outlined in the Amendment Rules themselves for non-compliance with the updated patient contribution rates. However, private health insurers are required to adhere to the amended rates as set out in Rule 8A. Failure to comply with these provisions could potentially lead to issues in the reimbursement process or disputes with patients regarding the expected contributions. The rules are designed to ensure transparency and fairness in the contribution rates that NHTPs must pay for their hospital treatment, aligning them with the prevailing economic conditions. The Amendment Rules commence on 1 July 2013, or if registered after this date, the day after registration.