Private Health Insurance (Data Provision) Rules 2009

Administered by Department of Health, Disability and Ageing

Legislation au F2009L02410 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health and Ageing

 

Private Health Insurance Act 2007

 

Private Health Insurance (Data Provision) Rules 2009

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Data Provision) Rules (the 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.

 

These Rules 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 those set out in the new GT-Dental Data from Insurers to the Department, HCP1 Data from Insurers to the Department and HCP2 Data from Insurers to the Department documents that were signed on 27 May 2009 by the Assistant Secretary of the Private Health Insurance Branch of the Department of Health and Ageing. These documents replace the documents that were referred to in the Private Health Insurance (Data Provision) Rules 2008 (the previous Rules) and 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

 

The introduction of the new GT-Dental document requires insurers to report to the department information on 21 specific dental services, which are identified in the specification.

 

The initial scope of this collection was to include all general treatment services, including hospital-substitute treatment, chronic disease management programs, physiotherapy, chiropractic etc.  However, developing a robust data specification, addressing industry concerns and time constrains required the department to limit the scope to a specific set of dental item numbers.  As industry concerns are addressed the current general treatment services insurers are required to report on is likely to expand in the future to include other general treatment services.

 

The Act does not specify any conditions that need to be met before the power to make the Rules may be exercised.

 

Consultation

In 2008-09, the department consulted with the private health insurance industry regarding minor ‘housekeeping’ type amendments required for the HCP1 and HCP2 specifications.

 


Private health insurers were also consulted regarding the new GT-Dental data document.  Discussion papers on the proposed general treatment data collection were published on the Departmental website for comment on 12 September 2008, 10 October 2008 and

5 January 2009.  Industry feedback on the discussion papers were used to finalise the GT-Dental data specification. A PHI Circular releasing the final GT-Dental data specification was published on the Departmental website on 11 June 2009.

 

Regulation Impact Statement

A preliminary Regulation Impact Statement (RIS) was prepared for the Office of Best Practice Regulation to assess the need for a RIS. The Office of Best Practice Regulation has advised that a RIS is not required.

 

Details of the Rules are set out in the Attachment.

 

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

 

These Rules commence on 1 July 2009 or if the Rules are registered after 1 July 2009, on the day after they are registered.

 

 

Authority: Section 333-20 of the Private Health Insurance Act 2007.


ATTACHMENT

 

DETAILS OF THE PRIVATE HEALTH INSURANCE (DATA PROVISION) RULES 2009

 

1. Name of Rules

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Data Provision) Rules 2009.

 

2. Commencement and revocation

 

Subrule 2(1)(a) provides for the Rules to commence on 1 July 2009.

 

Subrule 2(1)(b) or if the Rules are registered after 1 July 2009, on the day after they are registered.

 

Subrule 2(1)( c) provides for reporting under the GT-Dental data from Insurers to the Department to commence on 1 January 2010.

Subrule 2(2) provides for the Rules to revoke the Private Health Insurance (Data Provision) Rules 2008.

 

3. Definitions

 

Rule 3 provides for the Definitions of these Rules.  The terms used in these Rules have the same meaning as in the Act.  Rule 3 of the Rules now also defines GT-Dental Data from Insurers to the Department

 

4. Information to be provided

 

Subrule 4 (1) provides, for the purpose of section 172-10 of the Act that the kinds of information, relating to the treatment of insured persons, that private health insurers are to give to the Secretary of the Department are the kinds of information specified in GT-Dental Data from Insurers to the Department, HCP1 Data from Insurers to the Department and HCP2 Data from Insurers to the Department. 

 

Subrule 4(2) now provides that for the purposes of interpreting the kinds of information to be provided with respect to “Data Specifications (GT-Dental)”, reference must be made to “Explanatory Notes (GT-Dental)”.

 

Subrule 4 (3) now provides that for the purposes of interpreting the kinds of information to be provided with respect to “Data Specifications (HCP1)”, reference must be made to “Explanatory Notes (HCP1)”.

 

Subrule 4 (4) now provides that for the purposes of interpreting the kinds of information to be provided with respect to “Data Specifications (HCP2)”, reference must be made to “Explanatory Notes (HCP2)”

Overview

The Private Health Insurance (Data Provision) Rules 2009, enacted under section 333-20 of the Private Health Insurance Act 2007, were introduced to specify the kinds of information that private health insurers must provide to the Secretary of the Department of Health and Ageing. This legislation addresses the need for accurate and comprehensive data to support health policy development and evaluation. The rules outline the types of data insurers must submit, including information on dental services, general treatment services, and hospital-substitute treatment, among others. The Department of Health and Ageing developed these rules to facilitate a more robust collection of health data, which is essential for assessing the effectiveness of health policies and ensuring the appropriate allocation of resources within the private health insurance sector. The rules also provide for the revocation of the previous Private Health Insurance (Data Provision) Rules 2008, ensuring that the most current and relevant data specifications are in use.

Scope and Application

The Private Health Insurance (Data Provision) Rules 2009, made under section 333-20 of the Private Health Insurance Act 2007, specify the kinds of information relating to the treatment of insured persons that private health insurers must provide to the Secretary of the Department. These Rules apply to private health insurers, who are obligated to report specific data concerning the treatment of insured persons, including data on 21 particular dental services as outlined in the GT-Dental Data document. The Rules also require insurers to submit data as detailed in the HCP1 and HCP2 Data documents, which were updated to replace the previous data provision rules from 2008. The geographic and jurisdictional reach of these Rules is effectively national, as they apply across Australia, governed by the overarching Private Health Insurance Act 2007. There are no stated exclusions or exemptions in the Rules themselves, though the scope of data collection may be subject to future expansions as industry concerns are addressed. The Rules do not impose any specific thresholds or conditions that must be met before they can be exercised, aligning with the enabling provisions of the Act. The Rules commence on 1 July 2009 or, if registered later, on the day following their registration, with reporting under the GT-Dental data from insurers to the Department scheduled to begin on 1 January 2010.

Key Provisions

The Private Health Insurance (Data Provision) Rules 2009, made under section 333-20 of the Private Health Insurance Act 2007, detail the specific information that private health insurers must provide to the Secretary of the Department of Health and Ageing. Rule 4(1) identifies that the information to be reported includes data on dental services (GT-Dental Data), general treatment services (HCP1 Data), and hospital services (HCP2 Data). These data specifications outline the types of information insurers must submit to the Department, as detailed in the GT-Dental Data, HCP1 Data, and HCP2 Data documents signed on 27 May 2009 by the Assistant Secretary of the Private Health Insurance Branch. The Rules impose obligations on private health insurers to accurately and timely provide the specified data to the Department. Rule 4(1) mandates that insurers submit information on 21 specific dental services as outlined in the GT-Dental Data document, which includes dental treatment details necessary for the Department to assess and monitor private health insurance practices. Rule 4(2) to (4) further clarify that explanatory notes accompanying these data specifications should be referenced to ensure proper interpretation and reporting of the required data. Failure to comply with the reporting requirements set out in the Rules may lead to penalties. Although the Rules themselves do not explicitly detail specific penalties, non-compliance with the Private Health Insurance Act 2007 may result in enforcement actions by the Department, including financial penalties, compliance orders, or other corrective measures. The overarching Act provides for a range of sanctions for non-compliance, which can include fines and other civil or criminal penalties as deemed appropriate by the relevant authorities.

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