EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Private Health Insurance Act 2007
Private Health Insurance (Data Provision) Rules 2015
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.
The Private Health Insurance (Data Provision) Rules 2015 revoke and replace the Private Health Insurance (Data Provision) Rules 2013 (the previous Rules).
The 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 of Health (the Department) under section 172-10 of the Act.
The kinds of information specified by the Rules are those set out in the following documents, which were approved on XX April 2015 by the First Assistant Secretary of the Acute Care Division of the Department:
- Private Hospital Data Bureau (PHDB) (from Hospitals to the Department);
- HCP Data (from Insurers to the Department); and
- HCP1 Data (from Insurers to the Department).
These documents can be found on the Department of Health website at:
http://www.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-about-HCP.
The documents above replace the PHDB, HCP Data and the HCP1 Data document approved by the Assistant Secretary of the Financing and Analysis Branch on 16 December 2013 and were referred to in the previous Rules.
The changes consist of minor housekeeping type changes. They are as follows:
1. Adding support for ICD-10-AM version 9
2. Adding support for AR-DRG version 8
3. Raising ICU Charge Threshold (a warning is currently generated when the charges exceed $5000; inflation has made this unrealistic and the threshold is being raised to $8000)
4. Change to Prosthesis charge check in edit rule EW204 (This is to correct an issue of this error flagging episodes with no Theatre or Bundled charge where the member is having chemo in Hospital in the Home and the prosthesis charge is for an infuser device)
5. Remove ICU hours from edit rule EE203 (ICU Hours is listed as an optional field and as an optional field it should not be included in an edit rule check)
6. Remove provider number check from edit rule EE065 when mode of separation is “discharge/transfer to other health care accommodation” (some health care accommodation facilities are not declared and do not have provider numbers, ie some aged care facilities).
Consultation
The Department has consulted with the private health insurance and private hospital industry through existing working group arrangements regarding the minor ‘housekeeping’ type amendments required to the PHDB, HCP and HCP1 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 by this Working Group. 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 Act does not specify any conditions that need to be met before the power to make the Rules may be exercised.
The Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Rules commence on 1 July 2015.
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) Rules 2015
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 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 of Health (the Department) under section 172-10 of the Private Health Insurance Act 2007 (the Act).
The Private Health Insurance (Data Provision) Rules 2015 (the Rules) revoke and remake the Private Health Insurance (Data Provision) Rules 2013 (the previous Rules).
Section 172-10 of the Act enables the Rules to specify kinds of information, relating to the treatment of persons insured under complying health insurance products, that private health insurers are to give to the Secretary of the Department.
The Rules specify that the kinds of information that are required to be provided are set out in the following documents, each of which was approved on April 2015 by the First Assistant Secretary of the Acute Care Division of the Department:
- Private Hospital Data Bureau (PHDB) (from Hospitals to the Department);
- HCP Data (from Insurers to the Department); and
- HCP1 Data (from Insurers to the Department).
These documents replace prior versions of the documents specified in the previous Rules.
The changes consist of minor housekeeping type changes. They are as follows:
1. Adding support for ICD-10-AM version 9
2. Adding support for AR-DRG version 8
3. Raising ICU Charge Threshold (a warning is currently generated when the charges exceed $5000; inflation has made this unrealistic and the threshold is being raised to $8000)
4. Change to Prosthesis charge check in edit rule EW204 (This is to correct an issue of this error flagging episodes with no Theatre or Bundled charge where the member is having chemo in Hospital in the Home and the prosthesis charge is for an infuser device)
5. Remove ICU hours from edit rule EE203 (ICU Hours is listed as an optional field and as an optional field it should not be included in an edit rule check)
6. Remove provider number check from edit rule EE065 when mode of separation is “discharge/transfer to other health care accommodation” (some health care accommodation facilities are not declared and do not have provider numbers, ie some aged care facilities).
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 PHDB, HCP Data and HCP1 Data involves the disclosure of de-identified information about the treatment of insured patients, from private health insurers to the Department. The information supplied could not reasonably be used by the Department to identify a patient. Further, Part 6-8 of the Act creates an offence for the unauthorised disclosure of information obtained by any person in the course of performing duties or powers, or exercising functions, under the Act.
The revisions to the documents are essentially mechanical in nature, and do not substantively alter any legislative requirements.
Conclusion
This 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.
Janet Anderson
First Assistant Secretary, Acute Care Division
Department of Health