Private Health Insurance (Data Provision) Amendment Rules 2013 (No. 1)

Administered by Department of Health, Disability and Ageing

Legislation au F2013L00771 Rules Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health

 

Private Health Insurance Act 2007

 

Private Health Insurance (Data Provision) Amendment Rules 2013 (No. 1)

 

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Data Provision) Rules providing for matters required or permitted by Part 4-5 of the Act, or necessary or convenient in order to carry out or give effect to Part 4-5 of the Act.

 

The Private Health Insurance (Data Provision) Rules 2012 (the Principal Rules) which commenced on 1 November 2012, specify the kinds of information, relating to the treatment of insured persons, that private health insurers are to give to the Secretary of the Department under section 172-10 of the Act. 

 

The kinds of information specified are set out in the following documents, which were approved on 13 May 2012 by the Assistant Secretary of the Private Health Insurance Branch of the Department of Health and Ageing:

 

  •       GT-Dental Data from Insurers to the Department;
  •       HCP1 Data from Insurers to the Department; and
  •       HCP2 Data from Insurers to the Department.

 

The Private Health Insurance (Data Provision) Amendment Rules 2013 (No. 1) (the Amendment Rules) amends the Definitions of the Principal Rules. The Definitions of the Principal Rules specify the meaning of the above kinds of information that are required to be provided by insurers to the Department.  

 

The purpose of the Amendment Rules is to incorporate in the Definitions section reference to the revised HCP1 Data from Insurers to the Department document which was approved on           9 May 2013 by the Assistant Secretary of the Financing and Analysis Branch of the Department of Health and Ageing.  This document replaces the document of the same name that was previously referred to in the Principal Rules.  The revised document can be found on the Department of Health and Ageing website at:

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-about-HCP.

 

These amendments are necessary due to the introduction, on 1 July 2013, of new versions of the ICD-10-AM (v8) and AR-DRG (v7.0) classification systems used to describe and group admitted patient care episodes, and to improve clarity and data handling.

 

Consultation

 

In early 2013, the Department consulted with the private health insurance and private hospital industry through existing working group arrangements regarding minor amendments required to the HCP, HCP1 and PHDB specifications.  The working groups are comprised of Department and industry stakeholder representatives.  Private health insurance and private hospital stakeholder representatives interested in developing the amendments participated in the process.  Industry is of the view that it is appropriate for minor amendments to be managed through the working group arrangements.  Previous minor amendments to the data specifications have been managed in this way.  The amended data specifications are distributed to industry via a Private Health Insurance Circular.

 

The Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003. 

 

The Rules commence on 1 July 2013.

 

           


Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

 

Private Health Insurance (Data Provision) Amendment Rules 2013 (No. 1)

This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny)      Act 2011.

 

Overview of the Legislative Instrument

The Private Health Insurance (Data Provision) Rules 2012 (the Principal Rules) specify kinds of information that private health insurers are required to give to the Secretary of the Department of Health and Ageing under section 172-10 of the Private Health Insurance Act 2007. 

The Definitions of the Principal Rules specify the meaning of the kinds of information that are required to be provided by insurers to the Secretary contained in the following documents:

  •       GT-Dental Data from Insurers to the Department;
  •       HCP1 Data from Insurers to the Department; and
  •       HCP2 Data from Insurers to the Department.

 

The Private Health Insurance (Data Provision) Amendment Rules 2013 (No. 1) (the Amendment Rules) amend the Definitions section of the Principal Rules to incorporate the revised HCP1 Data from Insurers to the Department document which was approved on 9 May 2013 by the Assistant Secretary of the Financing and Analysis Branch of the Department of Health and Ageing. 

 

The amendment is required because of to the introduction, on 1 July 2013, of new versions of the ICD-10-AM (v8) and DRG (v7.0) classifications systems used to describe and group admitted patient care episodes, and to improve clarity and data handling.  

 

The specified information required to be provided to the Secretary does not include identified patient information. 

 

Human rights implications

This Legislative Instrument will engage the human right of privacy but will not result in any limitation of that right.

Supply of the HCP1 Data from Insurers to the Department involves the disclosure of                  de-identified personal information, including health information, from private health insurers to the Department of Health and Ageing. However, the information supplied could not reasonably be used by the Department to identify a patient.

The amendments are essentially mechanical in nature, and do not substantively alter any legislative requirements.

 

Conclusion

 The Legislative Instrument is compatible with human rights as, although it engages the right of privacy in relation to personal information, it will not result in any limitation of that right.

 

 

Gareth Sebar

Assistant Secretary, Financing and Analysis Branch

Department of Health and Ageing

 

 

Overview

The Private Health Insurance (Data Provision) Amendment Rules 2013 (No. 1) were enacted to amend the Private Health Insurance (Data Provision) Rules 2012, which specify the kinds of information private health insurers are required to provide to the Department of Health and Ageing under section 172-10 of the Private Health Insurance Act 2007. The amendment rules were introduced to incorporate reference to the revised HCP1 Data from Insurers to the Department document, which was approved on 9 May 2013 by the Assistant Secretary of the Financing and Analysis Branch of the Department of Health and Ageing. These amendments were necessary due to the introduction of new versions of the ICD-10-AM (v8) and AR-DRG (v7.0) classification systems on 1 July 2013, which are used to describe and group admitted patient care episodes, and to improve clarity and data handling. The rules were made under the authority of the Minister for Health and are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

Scope and Application

The Private Health Insurance (Data Provision) Amendment Rules 2013 (No. 1) is a legislative instrument that amends the definitions section of the Private Health Insurance (Data Provision) Rules 2012. This amendment is necessitated by the introduction of new versions of the ICD-10-AM (v8) and AR-DRG (v7.0) classification systems, which are used to describe and group admitted patient care episodes, as well as to improve clarity and data handling. The amendment pertains to the kinds of information that private health insurers are required to provide to the Secretary of the Department of Health and Ageing under section 172-10 of the Private Health Insurance Act 2007. Specifically, it incorporates a reference to the revised HCP1 Data from Insurers to the Department document, which was approved on 9 May 2013 by the Assistant Secretary of the Financing and Analysis Branch of the Department of Health and Ageing. This amendment does not substantively alter any legislative requirements but is essentially mechanical in nature. The specified information required to be provided to the Secretary does not include identified patient information, thus engaging the human right of privacy without resulting in any limitation of that right.

Key Provisions

The Private Health Insurance (Data Provision) Amendment Rules 2013 (No. 1) amend the existing Private Health Insurance (Data Provision) Rules 2012 by updating the definitions section. These rules, established under section 333-20 of the Private Health Insurance Act 2007, require private health insurers to provide certain types of information to the Secretary of the Department of Health and Ageing. The amendment specifically updates the definition of HCP1 data to reflect the new ICD-10-AM (v8) and AR-DRG (v7.0) classification systems, which were introduced on 1 July 2013. This update aims to improve the clarity and handling of the data provided. The amendment rules impose obligations on private health insurers to ensure that the information they provide to the Department is accurate and aligns with the revised specifications. Insurers must comply with the updated definitions set forth in the HCP1 Data from Insurers to the Department document, which was approved on 9 May 2013. This involves providing de-identified personal and health information in a format that adheres to the new classification systems. The rules are designed to facilitate better data collection and analysis, which can lead to more informed health policy decisions. Failure to comply with these rules may not directly result in criminal or civil penalties under the Private Health Insurance Act 2007. However, non-compliance could lead to administrative actions or the Department's refusal to accept the data, which might impact the insurer's ability to participate in government health programs or initiatives. The rules themselves do not specify financial penalties but underscore the importance of adhering to the defined data specifications for effective data collection and analysis.

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