PHI 78/15

This circular issued by the Private Health Insurance Branch contains information about the Prostheses List

Page last updated: 18 November 2015

Printable version of 78/15 (PDF 132 KB)

18 November 2015

Prostheses List – Applications For 2016

This circular provides information for stakeholders on the critical dates for submitting applications to list prostheses on the August 2016 and February 2017 Prostheses Lists.

These dates are correct at the time of publishing this circular, but may change due to unforeseen circumstances.

Panel of Clinical Experts

Applications to list prostheses that are considered by the Panel of Clinical Experts (PoCE) can be submitted at any time. There are no meetings of the PoCE, so applications are sent to clinicians for assessment as they are received and processed.

To provide sufficient time for applications to be assessed for consideration for the next Prostheses List, applications need to be submitted at least eight weeks before the last Prostheses List Advisory Committee (PLAC) meeting before the Prostheses List is made. This timeframe will allow for applications to be prepared and sent to clinicians, clinicians to assess the applications and return their assessments and for the assessments to be prepared for the PLAC to consider. If a sponsor applies to list a prosthesis in a grouping that is not currently listed on the Prostheses List, extra time should be allowed for the application to be submitted to the Health Economics SubCommittee of PLAC.

The dates for PLAC meetings in 2016 and early 2017 are planned at this stage, but not confirmed. On the basis of the planned dates, applications to list new PoCE prostheses in current groupings should be submitted no later than 26 May 2016 for the August 2016 Prostheses List, and 24 November 2016* for the February 2017 Prostheses List.

* This date allows extra time for processing over the Christmas/New Year period.

Clinical Advisory Groups

The Clinical Advisory Groups (CAGs) of the PLAC meet four times a year to consider applications and to provide expert clinical advice to the PLAC. Meeting dates for the CAGs for 2016 and the applicable cut-off dates for applications to list a product on the Prostheses List are outlined in the following tables.

August 2016 Prostheses List

CAGs
Date of


1st meeting

Cut-off for


1st meeting

Date of


2nd meeting

Cut-off for


2nd meeting


Hip
11 March
15 January
6 May
11 March

Knee
12 March
15 January
14 May
18 March

Spinal
26 February
8 January
20 May
24 March

Specialist Orthopaedic
4 March
8 January
3 June
8 April

Ophthalmic
29 February
8 January
6 June
8 April

Urogenital
15 April
19 February
17 June
22 April

Cardiothoracic
4 March
8 January
6 May
11 March

Cardiac
16 April
19 February
18 June
22 April

Vascular
4 April
12 February
27 June
6 May
February 2017 Prostheses List
CAGs
Date of


1st meeting

Cut-off for


1st meeting

Date of


2nd meeting

Cut-off for


2nd meeting


Hip
12 August
17 June
7 October
12 August

Knee
20 August
24 June
22 October
26 August

Spinal
19 August
24 June
14 October
19 August

Specialist Orthopaedic
2 September
8 July
28 October
16 September

Ophthalmic
5 September
8 July
7 November
16 September

Urogenital
16 September
22 July
18 November
23 September

Cardiothoracic
12 August
17 June
7 October
12 August

Cardiac
17 September
22 July
19 November
23 September

Vascular
22 August
1 July
24 October
2 September
If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to Private Health Insurance Branch.

For more information visit 2015 Private Health Insurance (PHI) Circulars.

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