Private Health Insurance (Data Provision) Amendment Rules 2022

Administered by Department of Health, Disability and Ageing

Legislation au F2022L00698 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Private Health Insurance Act 2007

 

Private Health Insurance (Data Provision) Amendment Rules 2022  

 

Authority

 

Subsection 333-20(1) of the Private Health Insurance Act 2007 (the Act) authorises the Minister of Health to, by legislative instrument, make Private Health Insurance Rules. The types of rules are specified in the second column of the table provided in subsection 333-20(1). In particular, the Minister is authorised to make Private Health Insurance (Data Provision) Rules as specified in item 9 of the table in subsection 333-20(1). The rules provide 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. Part 4-5 of the Act imposes miscellaneous notification and other obligations on private health insurers.

 

Subsection 33(3) of the Acts Interpretation Act 1901 provides that where an Act confers a power to make, grant or issue any instrument of a legislative or administrative character (including rules, regulations or by-laws), the power shall be construed as including a power exercisable in the like manner and subject to the like conditions (if any) to repeal, rescind, revoke, amend, or vary any such instrument.

 

Purpose

 

The Private Health Insurance (Data Provision) Amendment Rules 2022 (the Amendment Rules) amend the Private Health Insurance (Data Provision) Rules 2018 (the Rules) to update the information, relating to the treatment received by insured persons, that private health insurers must give to the Secretary of the Department of Health (the Department) under subsection 172‑10(1) of the Act. 

 

Background

 

The Rules apply and incorporate the following instruments without modifications:

  • the matters contained in the document titled “GT-Dental Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2022);
  • the matters contained in the document titled “HCP1 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2022); and
  • the matters contained in the document titled “HCP2 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2022),

 

     from the time the Amendment Rules commence.

 

The documents referred to above can be accessed on the Department’s website using the following link: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-about-HCP (Hospital Casemix Protocol (HCP)).

 

Data specifications are reviewed routinely every year by the Department. Following consultation with external stakeholders changes are generally introduced effective 1 July in each financial year.

Changes to the 2022/23 data specifications are designed to align with national metadata standards published in METeOR, the Australian Institute of Health and Welfare’s Metadata online registry, and to improve data quality.

Supply of the GT-Dental Data, HCP1 Data and HCP2 Data involves private health insurers disclosing to the Department de-identified information about the treatment received by insured patients. This information is protected by subsection 323-1(1) of the Act, which makes it an offence to disclose the information where the disclosure is not authorised by the Act. The Act allows for a limited set of circumstances to be considered as authorised disclosures, one of which is to enable a person to perform functions in connection with a Medicare program (subsection 323-5(b)). The collective effect of these provisions limit the purposes for which protected information may be used or disclosed.

Commencement

The Amendment Rules commence on 1 July 2022.

Consultation

 

The Department has consulted with the private health insurance and private hospital industry about the Amendment Rules through existing working group arrangements. The working groups are comprised of representatives from the Department and industry stakeholders. Private health insurance and private hospital stakeholder representatives interested in developing the amendments also participated in the process. Feedback received from industry is that it is appropriate for amendments to be managed by the existing working group arrangements. Previous amendments to the data specifications have also been managed in this way. The amended data specifications are distributed to industry via a Private Health Insurance Circular published by the Department. Private Health Insurance Circulars can be accessed at the following link: https://www.health.gov.au/news/phi-circulars.

The Amendment Rules are a legislative instrument for the purposes of the Legislation Act 2003.

 


Attachment

 

Details of the Private Health Insurance (Data Provision) Amendment Rules 2022

Section 1         Name

Section 1 provides that the name of the instrument is the

Private Health Insurance (Data Provision) Amendment Rules 2022.

Section 2         Commencement

Section 2 provides that the instrument commences on 1 July 2022.

Section 3         Authority

Section 3 provides that the Amendment Rules are made under section 333-20 of the Private Health Insurance Act 2007.

Section 4         Schedules

Section 4 provides that each instrument that is specified in a Schedule to the instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to the instrument has effect according to its terms.

All Schedule changes come into effect from 1 July 2022.

Schedule 1—Amendments

Private Health Insurance (Data Provision) Rules 2018

Item 1 provides for the definition of GT-Dental Data from Insurers to the Department to be updated to the protocol set out in the document approved by the Assistant Secretary of the Data and Analytics Branch of the Department of Health on 6 May 2022 which consists of “Data Specifications (GT-Dental)” and “Explanatory Notes (GT-Dental)”.

Item 2 provides for the definition of HCP1 Data from Insurers to the Department to be updated to the protocol set out in the document approved by the Assistant Secretary of the Data and Analytics Branch of the Department of Health on 6 May 2022 which consists of “Data Specifications (HCP1)” and “Explanatory Notes (HCP1)”.

Item 3 provides for the definition of HCP2 Data from Insurers to the Department to be updated to the protocol set out in the document approved by the Assistant Secretary of the Data and Analytics Branch of the Department of Health on 6 May 2022 which consists of “Data Specifications (HCP2)” and “Explanatory Notes (HCP2)”. 

 

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 2022

This Disallowable 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 Disallowable Legislative Instrument

Private Health Insurance (Data Provision) Rules provide for matters required or permitted by Part 4‑5 of the Private Health Insurance Act 2007 (the Act), or necessary or convenient in order to carry out of give effect to Part 4-5 of the Act.

The Private Health Insurance (Data Provision) Amendment Rules 2022 (the Amendment Rules) amend the Private Health Insurance (Data Provision) Rules 2018 (the Rules) to update the information, relating to the treatment received by insured persons, that private health insurers must give to the Secretary of the Department under subsection 172-10(1) of the Act.

The Rules apply and incorporate the following instruments without modifications:

  • the matters contained in the document titled “GT-Dental Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department) on 6 May 2022 ;
  • the matters contained in the document titled “HCP1 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2022); and
  • the matters contained in the document titled “HCP2 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2022),

 

from the time the Amendment Rules commence.

 

The amendments to the Rules requiring that the information requirements set out in those documents to be provided to the Department commence on 1 July 2022.

 

These documents can be found on the Department’s website using the following link: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-about-HCP (Hospital Casemix Protocol (HCP)).

 

Human rights implications

This Disallowable Legislative Instrument engages the human right to privacy under Article 17 of the International Covenant on Civil and Political Rights, but does not result in any limitation of that right.

Supply of the GT-Dental Data, HCP1 Data and HCP2 Data involves private health insurers disclosing to the Department de-identified information about the treatment received by insured patients. This information is protected by subsection 323-1(1) of the Act, which makes it an offence to disclose the information where the disclosure is not authorised by the Act. The Act allows for a limited set of circumstances to be considered as authorised disclosures, one of which is to enable a person to perform functions in connection with a Medicare program (subsection 323-5(b)). The collective effect of these provisions limit the purposes for which protected information may be used or disclosed.

Conclusion

This Disallowable Legislative Instrument is compatible with human rights as although it engages the right to privacy in relation to the disclosure of personal information, it does not derogate from that right.

 

Rebecca Fealy

 Assistant Secretary

Data and Analytics Branch

Department of Health

 

 

Overview

The Private Health Insurance (Data Provision) Amendment Rules 2022 were introduced to amend the Private Health Insurance (Data Provision) Rules 2018, and they were enacted by the Parliament of Australia under the authority of subsection 333-20(1) of the Private Health Insurance Act 2007. The primary objective of these Amendment Rules is to update the information that private health insurers must provide to the Secretary of the Department of Health regarding the treatment received by insured persons. This update aims to ensure that the data provided aligns with national metadata standards and improves data quality. The Amendment Rules came into effect on 1 July 2022 and were developed through consultations with private health insurance and hospital industry stakeholders, ensuring that the changes were appropriate and manageable within existing frameworks. The data provided, including GT-Dental Data, HCP1 Data, and HCP2 Data, remains protected under the Act, with authorised disclosures limited to specific functions related to Medicare programs.

Scope and Application

The Private Health Insurance (Data Provision) Amendment Rules 2022 amend the Private Health Insurance (Data Provision) Rules 2018 to update the data specifications for information on treatment received by insured persons that private health insurers must provide to the Department of Health. The rules apply to private health insurers operating in Australia and require them to supply de-identified information about patient treatment in line with the updated data specifications. The amendment rules incorporate the GT-Dental Data, HCP1 Data and HCP2 Data protocols approved by the Department on 6 May 2022. The updated data specifications aim to align with national metadata standards and improve data quality. The disclosure of the data is protected by the Private Health Insurance Act 2007 and can only be used for authorised purposes such as enabling functions related to the Medicare program. The amendment rules commence on 1 July 2022 and were developed in consultation with the private health insurance and hospital industry through existing working groups. The rules are compatible with human rights as they engage the right to privacy but do not result in any limitation of that right. The Private Health Insurance (Data Provision) Amendment Rules 2022 update the information requirements for private health insurers to provide de-identified data on patient treatment to the Department of Health. The rules apply to all private health insurers in Australia and incorporate the updated GT-Dental, HCP1 and HCP2 data protocols. The amendment rules aim to align the data specifications with national standards and improve data quality. While the rules engage the right to privacy, they do not result in any limitation of that right as the use of the data is restricted to authorised purposes. The rules were developed in consultation with industry and commence on 1 July 2022.

Key Provisions

The Private Health Insurance (Data Provision) Amendment Rules 2022 (the Amendment Rules) modify the Private Health Insurance (Data Provision) Rules 2018 (the Rules) to update the information, related to the treatment received by insured persons, that private health insurers must provide to the Secretary of the Department of Health under subsection 172-10(1) of the Private Health Insurance Act 2007 (the Act). Specifically, the Amendment Rules update the definitions of GT-Dental Data, HCP1 Data, and HCP2 Data from insurers to the Department to align with the latest data specifications approved by the Assistant Secretary of the Data and Analytics Branch of the Department of Health on 6 May 2022. These changes aim to harmonise with national metadata standards and enhance data quality. The obligations imposed by the Amendment Rules on private health insurers include the provision of de-identified information about the treatment received by insured patients to the Department. The data must adhere to the updated specifications outlined in the approved documents titled “GT-Dental Data from Insurers to the Department”, “HCP1 Data from Insurers to the Department”, and “HCP2 Data from Insurers to the Department”. These documents are incorporated by reference in the Amendment Rules and are accessible on the Department’s website. Private health insurers are required to ensure the accuracy and timeliness of the information provided, in compliance with the updated data specifications. The Act imposes several obligations and requirements on private health insurers regarding the handling of protected information. For instance, subsection 323-1(1) of the Act makes it an offence to disclose the protected information where the disclosure is not authorised by the Act. Authorised disclosures include those necessary to enable a person to perform functions in connection with a Medicare program, as outlined in subsection 323-5(b) of the Act. Consequently, the collective effect of these provisions limits the purposes for which the protected information may be used or disclosed. Furthermore, the data must be de-identified to safeguard the privacy of insured persons. Breach of the obligations or requirements imposed by the Amendment Rules can result in civil or criminal consequences. Specifically, subsection 323-1(1) of the Act criminalises the unauthorised disclosure of protected information, with potential penalties including fines and imprisonment. The maximum penalties for such offences are not explicitly stated in the Amendment Rules but would be determined by the courts in accordance with the relevant provisions of the Act and other applicable laws. Additionally, non-compliance with the data specifications or failure to provide the required information may lead to administrative penalties, including fines or other sanctions as determined by the Department of Health.

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Area of Law
Privacy Law
Health Law
Instrument
Regulation
Concepts
Definitions & Interpretation
Reporting & Disclosure Obligations
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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.