Private Health Insurance (Health Insurance Business) Rules 2013

Administered by Department of Health, Disability and Ageing

Legislation au F2013L02159 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 (Health Insurance Business) Rules 2013  

 

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Health Insurance Business) Rules providing for matters required or permitted by Part 4-2 of the Act, or necessary or convenient in order to carry out or give effect to Part 4-2 of the Act.

 

The Private Health Insurance (Health Insurance Business) Rules 2013 (the Rules) revoke and remake the Private Health Insurance (Health Insurance Business) Rules 2010 (the previous Rules).  The Rules update the kinds of statistical information to be provided by hospitals to private health insurers and by private hospitals to the Department of Health (the Department).

 

Section 121-5 of the Act enables the Minister to grant or revoke a declaration that a facility is a public or private hospital for the purposes of the Act.  The Act specifies a number of matters to which the Minister must have regard in granting or revoking a hospital declaration, including whether the facility has entered into or complied with undertakings to provide private health insurers with the kinds of information specified in the Rules relating to the treatment of insured persons (paragraph 121-5(7)(e)). 

 

The Rules specify that for paragraph 121-5(7)(e) of the Act, the kinds of information are those specified in the HCP Data from Hospitals to Insurers document (HCP document) approved on 16 December 2013 by the Assistant Secretary of the Financing and Analysis Branch of the Department (see rule 4). 

 

Section 121-7 of the Act provides that hospital declarations are subject to conditions specified in the Rules.  Rule 7 of the Rules provides that private hospital declarations are subject to the condition that the hospital provide the Department with the kinds of information specified in the PHDB Data from Private Hospitals to the Department document (PHDB document) approved 16 December 2013 by the Assistant Secretary of the Financing and Analysis Branch of the Department.  This information must be provided within 6 weeks from the time the insured person is discharged from hospital.

 

The HCP and PHDB documents replace the documents that were referred to in the previous Rules, and 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 revised data specifications are necessary to facilitate a move to data submission via the Data Submission Portal of the Department’s Enterprise Data Warehouse.  To facilitate the move, a number of minor ‘housekeeping’ type amendments have been made to the HCP and PHDB documents to improve clarity, remove ambiguities and standardise content, particularly in relation to definitions and error codes.

 

The Note to rule 3, which states that terms used in the Rules have the same meaning as in the Act, has also been moved from the start to the end of the rule to standardise drafting throughout the Rules.

 

There are no other changes from the previous Rules.

 

Consultation

In October 2013 the Department consulted with the private health insurance and private hospital industry through existing Working Group arrangements regarding the amendments required to the HCP and PHDB specifications.  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 have been managed in this way.  The amended data specifications are distributed to industry via Private Health Insurance Circulars.

 

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 the day after the Rules are registered.

 


Statement of Compatibility with Human Rights

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

 

Private Health Insurance (Health Insurance Business) Rules 2013

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 (Health Insurance Business) Rules provide for matters required or permitted by Part 4-2 of the Private Health Insurance Act 2007 (the Act), or necessary or convenient in order to carry out or give effect to Part 4-2 of the Act.

 

The Private Health Insurance (Health Insurance Business) Rules 2013 (the Rules) revoke and remake the Private Health Insurance (Health Insurance Business) Rules 2010 (the previous Rules) to update the kinds of statistical information to be provided by hospitals to insurers and by private hospitals to the Department of Health (the Department).

 

Under paragraph 121-5(7)(e) of the Act, when making or revoking a hospital declaration the Minister must have regard to whether the facility has entered into or complied with undertakings to provide private health insurers with information specified in the Rules relating to the treatment of insured persons. 

 

The Rules specify that for paragraph 121-5(7)(e) of the Act, the kinds of information are those specified in the HCP Data from Hospitals to Insurers document (HCP document) approved on 16 December 2013 by the Assistant Secretary of the Financing and Analysis Branch of the Department (see rule 4). 

 

Section 121-7 of the Act provides that hospital declarations are subject to any conditions specified in the Rules.  Rule 7 of the Rules provides that private hospital declarations are subject to the condition that the hospital provide the Department with the kinds of information specified in the PHDB Data from Private Hospitals to the Department document (PHDB document) approved on 16 December 2013 by the Assistant Secretary of the Financing and Analysis Branch of the Department. 

 

The revised 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 revised data specifications are necessary to facilitate a move to data submission via the Data Submission Portal of the Department’s Enterprise Data Warehouse. A number of minor ‘housekeeping’ type amendments have been made to improve clarity, remove ambiguities and standardise content, particularly in relation to definitions and error codes.

 

The Rules also:

  • provide for inclusions and exclusions to the definitions of ‘hospital treatment’ and ‘general treatment’ in the Act; and
  • specify certain treatment that is to be excluded from being ‘health insurance business’ – only registered private health insurers may carry on health insurance business and an insurer may only offer insurance as part of its health insurance business in the form of a complying health insurance product. 

 

However, no changes to these provisions have been made from the previous Rules.

 

Human rights implications

The Rules will engage the human right to privacy but will not result in any limitation of that right.

 

Supply of the HCP Data from Hospitals to Insurers involves the disclosure of sensitive personal information, including health information, from hospitals to private health insurers.  However the information supplied is provided by hospitals with the patient’s consent as part of the patient’s contractual relationship with their hospital and private health insurer.  There are protections for the information provided to insurers under the Privacy Act 1988 and State or Territory privacy laws.  

 

Supply of the PHDB Data from Private Hospitals to the Department involves the disclosure of de-identified statistical information about the treatment of insured persons, from private hospitals 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.

 

 

Gareth Sebar

Assistant Secretary, Financing and Analysis Branch

Department of Health

 

Overview

The Private Health Insurance (Health Insurance Business) Rules 2013 were enacted to provide for matters required or permitted by Part 4-2 of the Private Health Insurance Act 2007, or necessary or convenient to carry out or give effect to Part 4-2 of the Act. These Rules update the kinds of statistical information to be provided by hospitals to private health insurers and by private hospitals to the Department of Health. The rules were made under section 333-20 of the Private Health Insurance Act 2007 and were issued by the Minister for Health. The policy objective of the Act is to facilitate the provision of accurate and timely information to private health insurers and the Department of Health, ensuring better management and regulation of the private health insurance industry. The Rules update the specifications for the Health Casemix Program Data from Hospitals to Insurers and the Private Hospital Data from Private Hospitals to the Department, improving the clarity, removing ambiguities, and standardising content in these data specifications.

Scope and Application

The Private Health Insurance (Health Insurance Business) Rules 2013, made under section 333-20 of the Private Health Insurance Act 2007, apply to the provision of statistical information by hospitals to private health insurers and to the Department of Health. These Rules are designed to update the data specifications required for such information, facilitating a transition to data submission via the Department’s Enterprise Data Warehouse. They apply to all hospitals in Australia, whether public or private, and to private health insurers operating within the country. The Rules are subject to conditions that hospitals must meet to maintain their declarations, including providing specified information within six weeks of a patient's discharge. The Rules also outline the types of information that must be provided and clarify definitions and error codes to enhance data accuracy and consistency. There are no stated exclusions or thresholds within the Rules themselves, but the applicability of these rules is inherently tied to the provisions and definitions of the overarching Private Health Insurance Act 2007. The Rules are compatible with human rights, particularly the right to privacy, as they involve the disclosure of sensitive personal information, which is managed within the protections of the Privacy Act 1988 and state or territory privacy laws.

Key Provisions

The Private Health Insurance (Health Insurance Business) Rules 2013, made under section 333-20 of the Private Health Insurance Act 2007, establish the requirements and procedures for the provision of statistical information by hospitals to private health insurers and by private hospitals to the Department of Health. The Rules update the data specifications to facilitate data submission via the Department's Enterprise Data Warehouse. Section 121-5 of the Act mandates that when granting or revoking a hospital declaration, the Minister must consider whether the facility has complied with undertakings to provide specific information relating to the treatment of insured persons, as outlined in the HCP Data from Hospitals to Insurers document (HCP document). Rule 4 specifies the kinds of information required under this section, which are detailed in the HCP document approved by the Assistant Secretary of the Financing and Analysis Branch of the Department on 16 December 2013. Additionally, section 121-7 of the Act allows for conditions to be attached to hospital declarations, and Rule 7 stipulates that private hospital declarations are subject to the condition that the hospital provide the Department with information specified in the PHDB Data from Private Hospitals to the Department document (PHDB document), also approved by the Assistant Secretary on 16 December 2013. These Rules impose obligations on hospitals and private hospitals to ensure the timely and accurate provision of specified data to private health insurers and the Department. Hospitals must provide information to insurers within six weeks of an insured person being discharged, while private hospitals must supply the Department with the required data within the same timeframe. The Rules also clarify and standardise definitions and error codes to enhance the clarity and consistency of the data provided. The Rules are compatible with human rights as they do not limit the right to privacy; instead, they provide a framework for the disclosure of information that is already part of the patient's contractual relationship with their hospital and insurer, and they incorporate protections under the Privacy Act 1988 and State or Territory privacy laws. Breaching the obligations set out in the Private Health Insurance (Health Insurance Business) Rules 2013 may result in civil or criminal consequences. Non-compliance with the data provision requirements could potentially lead to enforcement actions by the Department of Health. Furthermore, any unauthorised disclosure of information obtained under the Act is an offence, as outlined in Part 6-8 of the Private Health Insurance Act 2007, which carries associated penalties. However, the specific penalties for breaches of the Rules are not detailed within the explanatory statement, and one would need to refer to the relevant sections of the Act for further information on the maximum penalties applicable.

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