|Title:||Fees chargeable for the supply of surgically implanted prostheses fitted in public hospitals and health services|
|Document ID:||Operational Directive OD 0159/08|
|Date of issue:||Tuesday, 9 December 2008|
|Status:||NO LONGER APPLICABLE|
|Description:||This directive is to inform administrators at Health Corporate Network and public hospitals and health services of the Australian Government's Department of Health and Ageing Private Health Insurance (PHI) revised web-page, which releases PHI circular updates on benefit levels payable for medical items scheduld in the Prostheses List.|
|Legal requirements:||Hospitals and Health Services Act 1927
Hospitals (Services Charges for the Supply of Surgically Implanted Prostheses) Determination 2006
|Period of effect:||from 4 December 2008 to 4 December 2013|
|Review date:||4 December 2013|
|Authorised by:||Dr Peter Flett, DIRECTOR GENERAL, WA HEALTH, 05-Dec-2008|
|Print version:||View print version|
Fees chargeable for the supply of surgically implanted prostheses fitted in public hospitals and health services
The Commonwealth introduced legislative amendments on 10 March 2005 necessary for the implementation of new prostheses arrangements.
The amendments require registered health funds to offer a “no gap” and “gap” permitted range of prostheses in relation to every admitted hospital procedure on the Medicare Benefits Schedule (MBS) for which they provide cover.
At least one clinically effective no-gap prosthesis will be available for each admitted hospital MBS procedure specified in the Prosthesis List.
Under the new legislation, if the product has only a Minimum Benefit Level then a gap payment is not required (no gap prosthesis) and the health fund will cover the full cost. In these circumstances the health fund member (if covered) will not incur any out of pocket costs for that prosthesis.
If a listed product has a Minimum Benefit Level and a Maximum Benefit Level then a gap payment may be required (gap prosthesis). The health fund will cover the cost of the gap prosthesis to at least the minimum benefit level and the health fund member will be responsible for any outstanding amount up to, but not exceeding, the difference between the maximum and the minimum.
The new prostheses arrangements implemented on 31 October 2005 include the new Prostheses List, which itemises the benefits payable against all no-gap and gap products.
Dr Peter Flett
This circular last updated: Tuesday, 9 December 2008 at 3:18pm