PHI 25/17 Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No. 4)

Page last updated: 29 May 2017

PDF version: PHI 25/17 Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No. 4) (PDF 51 KB)

The Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No.4) (the Amendment Rules) were registered with the Federal Register of Legislation (FRL) and commence on 26 May 2017. These Amendment Rules amend the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules).

SUMMARY OF CHANGES

Item 1 - Schedule 1, Part 2 Type A procedures, Clause 4 Advanced surgical patient

Item 1 amends Schedule 1, Part 2 Type A procedures, Clause 4 Advanced surgical patient of the Principal Rules by reclassifying an existing MBS item number (41618). MBS item 41618 is an existing item (currently listed as a Type B procedure) for insertion of partially implantable active middle ear implants for patients with mild to severe sensorineural hearing loss.

Item 2 - Schedule 1, Part 2 Type A procedures, Clause 6 Surgical patient

Item 2 amends Schedule 1, Part 2 Type A procedures, Clause 6 Surgical patient of the Principal Rules by inserting a current MBS item number (42705). MBS item 42705 lists a new cataract surgery item to allow it to be claimed with the insertion of eye stent devices with the same fee as existing cataract surgery item 42702. This will allow the service to be available on the MBS on an interim basis for patients with glaucoma who are not adequately responsive to topical anti-glaucoma medications or who are intolerant of anti-glaucoma medication. The listing of this service will remain until 31 December 2017 to allow time for Medical Services Advisory Committee (MSAC) to consider funding of the service. This MBS item was listed on the MBS as of 1 May 2017, however this number was not included in the 1 May 2017 Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No. 3) due to a timing error within the Department.

Item 3 - Schedule 3, Part 2 Type B procedures, Clause 5 Non-band specific Type B day procedures

Item 3 amends Schedule 3, Part 2 Type B procedures, Clause 5 Non-band specific Type B day procedures of the Principal Rules by removing one MBS item number (41618). MBS item 41618 has been moved to Schedule 1, Part 2 – Type A procedures, Clause 4 Advanced surgical patient.

Item 4 - Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 3 – Therapeutic procedures, T8

Item 4 amends Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 3 – Therapeutic procedures, T8 of the Principal Rules by inserting a current MBS item number (30406). MBS item 30406 is a procedure where a needle is inserted in the abdomen to drain excess fluid (ascites). The item has been in operation since 1 November 1992, however never included in the Principle Rules because it has been highly unlikely this procedure would be the primary reason for hospitalisation, until now.