Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 2)

EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health and Ageing

Private Health Insurance Act 2007

Private Health Insurance (Prostheses) Amendment Rules 2011 (No.2)

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Prostheses) Rules, providing for matters required or permitted by Part 3-3 of the Act, or necessary or convenient in order to carry out or give effect to Part 3-3 of the Act.

Item 4 of the table in subsection 72-1(2) of Part 3-3 of the Act provides for requirements that a complying health insurance policy that covers hospital treatment must meet.  There must be a benefit for the provision of a prosthesis, of a kind listed in the Private Health Insurance (Prostheses) Rules (i.e. a listed prosthesis), in specified circumstances and under any specified conditions. The specified circumstances are that the listed prosthesis is provided in circumstances in which a Medicare benefit is payable or those other circumstances which are set out in the Private Health Insurance (Prostheses) Rules.

If the complying health insurance policy also covers hospital-substitute treatment, the same requirements apply.

The Private Health Insurance (Prostheses) Rules 2011 (No. 2) (the Principal Rules) commenced on 22 August 2011.

The Schedule to the Principal Rules has three parts:

• Part A – Prostheses; and
• Part B – Human Tissue List;
• Part C – Other Prostheses.

The Private Health Insurance (Prostheses) Amendment Rules 2011 (No.2) (the Amendment Rules) commence on 5 September 2011 and amend the Schedule to the Principal Rules.

The Private Health Insurance (Prostheses) Amendment Rules 2011 (No.2) (the Amendment Rules) commence on 5 September 2011.

The purpose of the Amendment Rules is to amend Part A of the Schedule to the Principal Rules by:

•         inserting items that were incorrectly removed when the Principal Rules were made; and

•         making revisions to the listings of various items.  These revisions were inadvertently not made when the Principal Rules were drafted.  These revisions include the deletion of the listing of certain items or parts of items, the movement of the listing of certain items to new grouping schemes and the correction of typographical errors.

CONSULTATION

The Sponsors of each prosthesis affected by these amendments have been consulted and have no objections to the amendments.

Details of the Amendment Rules are set out in the Attachment.

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

Authority:  Section 333-20 of the

             Private Health Insurance Act 2007

ATTACHMENT

DETAILS OF THE PRIVATE HEALTH INSURANCE (PROSTHESES) AMENDMENT RULES 2011 (No. 2)

1.  Name of Rules

Rule 1 provides that the title of the Rules is the Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 2).

2.  Commencement

Rule 2 provides for the Rules to commence on 5 September 2011.

3.  Amendment of the Schedule to the Private Health Insurance (Prostheses)               Rules 2011 (No. 2)

Rule 3 provides for the amendments to the Schedule to the Private Health Insurance (Prostheses) Rules 2011 (No. 2).

The amendments:

•      delete seven (7) items, Billing Codes SM048, SN063, SN335, SN356, SN371,  SN852, and SN814;
•      reinstate one (1) item, Billing Code SM079 and removing the ‘maximum  benefit’, as outlined in the table below. This billing code was incorrectly               removed when the Principal Rules were made.

•      reinstate one (1) item, Billing Code BS198, as outlined in the table below. This  billing code was incorrectly removed when the Principal Rules were made.

• change the ‘size’ of two (2) items, Billing Codes DY556 and SN273, as outlined in the table below;

• change the ‘description’ and ‘size’ of one (1) item, Billing Code and SN271, as outlined in the table below;

• change the ‘description’ of three (3) items, Billing Codes DP956, JJ833 and JJ834 as outlined in the table below;

• removing the ‘maximum benefit’ of one (1) item, Billing Code SX051 as outlined in the table below;

• change the product name of one (1) item, Billing Code WR132 as outlined in the table below;

• removing the ‘maximum benefit’ of four (4) items, Billing Codes EA008, EA015, EA023 and EA024 and repositioning the Billing Codes to align with the correct new grouping scheme as outlined in the table below;

• reposition of five (5) items, Billing Codes, EA010, EA011, EA012, EA013 and JJ736 to align with the new grouping scheme as outlined in the table below;

• reposition one (1) item, Billing Code EA006 and change the minimum benefit amount as outlined in the table below;

• correct three (3) typographic errors for the suffix “Revision”;
• correct one (1) typographic error for the suffix “CS”;
• delete one (1) superfluous “CS” suffix;
• delete three (3) superfluous “Revision” suffixes;
• change the name of the sponsor for four (4) items, Billing Codes SL002, SL003, SL004 and SL005 as outlined in the table below;

• move the subheading “11.2.6 - Bipolar/Multipolar” to the correct position; and
• move the two (2) Billing Codes OO035 and OH398 to the correct position in subgroup “11.2.6.1 – Bipolar”.
• moving one (1) item to the correct position in subgroup “11.4.12 – Nut”, Billing Code GO019.