EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Private Health Insurance Act 2007
Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 3)
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.
The Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 3) (the Amendment Rules) amend the Private Health Insurance (Prostheses) Rules 2015 (No. 2) (the Principal Rules) to reflect decisions made since the Principal Rules were made to add a new listing criterion for a kind of prosthesis that can be listed in Part C of the Schedule, decisions on applications to list new products in Part A and Part C of the Schedule, and to correct minor drafting errors in the Principle Rules.
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 Principal 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 in or those other circumstances, which are set out in the Principal Rules.
If the complying health insurance policy also covers hospital-substitute treatment, the same requirements apply.
Subsection 72-10(6) of the Act provides that Private Health Insurance (Prostheses) Rules may set out listing criteria to be satisfied in order for a listing application to be granted.
The listing criteria for listing applications for a kind of prosthesis to be listed in Part C of the Schedule are currently set out in rule 10, Part 3 of the Principal Rules.
Listed prostheses are currently set out in the Schedules to the Principal Rules.
The Amendment Rules will vary the Principal Rules as follows:
- adding ‘cardiac home/remote monitoring system’ to the definitions in rule 4, Part 1;
- adding a new listing criterion – cardiac home/remote monitoring system – to rule 10, Part 3;
- adding 3 new items to Part A of the Schedule;
- adding 4 new items to Part B of the Schedule;
- adding 3 new items to Part C of the Schedule;
- reinstating 6 items to Part A of the Schedule that were deleted in error;
- deleting 24 billing codes for items no longer sold by the sponsor;
- transferring 30 billing codes to new sponsors of the items; and
- changing details of listing of 3 items.
The Amendment Rules will commence on 27 November 2015.
Consultation
The Amendment Rules have been made having regard to recommendations made by the PLAC, which is a ministerially appointed committee comprised of members from health insurers, hospitals, clinicians, prostheses sponsors and consumer representatives.
In accordance with section 17 of the Legislative Instruments Act 2003, the Department consulted with the sponsor of each kind of prosthesis affected by these amendments. There are no objections to the amendments. The Department has received a standing Regulatory Impact Statement exemption from the Department of Finance.
The 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
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 3)
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.
The Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 3) (the Amendment Rules) amend the Private Health Insurance (Prostheses) Rules 2015 (No. 2) (the Principal Rules) to reflect decisions made since the Principal Rules were made to add a new listing criterion for a kind of prosthesis that can be listed in Part C of the Schedule and on applications to list new products in Part C of the Schedule.
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 Principal 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 in or those other circumstances, which are set out in the Principal Rules.
If the complying health insurance policy also covers hospital-substitute treatment, the same requirements apply.
Subsection 72-10(6) of the Act provides that Private Health Insurance (Prostheses) Rules may set out listing criteria to be satisfied in order for a listing application to be granted.
The listing criteria for listing applications for a kind of prosthesis to be listed in Part C of the Schedule are currently set out in rule 10, Part 3 of the Principal Rules.
Listed prostheses are currently set out in the Schedules to the Principal Rules.
The Amendment Rules will vary the Principal Rules as follows:
- adding ‘cardiac home/remote monitoring system’ to the definitions in rule 4, Part 1;
- adding a new listing criterion – cardiac home/remote monitoring system – to rule 10,
- adding 3 new items to Part A of the Schedule;
- adding 4 new items to Part B of the Schedule;
- adding 3 new items to Part C of the Schedule;
- reinstating 6 items to Part A of the Schedule that were deleted in error;
- deleting 24 billing codes for items no longer sold by the sponsor;
- transferring 30 billing codes to new sponsors of the items; and
- changing details of listing of 3 items.
Human rights implications
The Amendment Rules engage the following human rights:
Right to Health
The right to health – the right to the enjoyment of the highest attainable standard of physical and mental health – is contained in article 12(1) of the International Covenant on Economic Social and Cultural Rights (ICESCR). Whilst the UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not to be understood as a right to be healthy, it does entail a right to a system of health protection, which provides equality of opportunity for people to enjoy the highest attainable level of health.
The Amendment Rules add a new listing criterion – cardiac home/remote monitoring systems – for a kind of prosthesis that can be listed in Part C of the Schedule and add three new prostheses of that kind to Part C of the Schedule. The Amendment Rules also add a number of new prostheses to Parts A and B of the Prostheses List and change the listing details of three items. Each of these changes has a beneficial impact on the right to health in Australia, ensuring that minimum benefits are required to be paid for the provision of these prostheses under private health insurance policies covering hospital treatment, where relevant conditions are met.
The Amendment Rules also delete 24 billing codes at the request of the sponsors or suppliers of these prostheses, as these products are no longer sold. Generally the prostheses removed from the Principal Rules have been replaced by newer models due to upgraded technologies or advancements in surgical procedures.
The amendments made by the Amendment Rules do not reduce the minimum benefit payable for any listed prosthesis.
Conclusion
The Amendment Rules are compatible with human rights because they advance the protection of human rights, specifically the right to health.
Michael Ryan
Acting Assistant Secretary
Private Health Insurance Branch
Medical Benefits Division
Department of Health