The private health insurance (prostheses) rules (no. 3) 2022
This circular provides information for stakeholders about the November 2022 Prostheses List.
The delegate of the Minister for Health and Aged Care has made the Private Health Insurance (Prostheses) Rules (No. 3) 2022, to replace the Private Health Insurance (Prostheses) Rules (No. 2) 2022.
The Private Health Insurance (Prostheses) Rules (No. 3) 2022 were registered on the Federal Register of Legislation on 19 October 2022 and commence on 1 November 2022.
The changes effected in the Rules
The Private Health Insurance (Prostheses) Rules (No. 3) 2022 give effect to all changes resulted from completion of the Prostheses List applications (new, amendment, deletion and sponsors’ transfers).
Further, the Department previously advised about some technical errors occurring in the Prostheses Rules in August 2022, refer PHI Circular 49/22.
Accordingly, among other things, the Private Health Insurance (Prostheses) Rules (No. 3) 2022 correct these errors and give effect to the respective amendments as required.
The Prostheses List (Part A, Part B, Part C and Part D) and reports on changes from the August 2022 are provided in Excel and Portable Document Format at Prostheses List | Australian Government Department of Health and Aged Care.
Further decisions - removal of microcatheters from the Prostheses List on 1 March 2023
This circular also provides advanced notice to stakeholders concerning the decision that the microcatheters will be removed from the Prostheses List with effect on 1 March 2023.
For a device to be eligible for listing on the PL Part A, the device must meet all criteria for listing, including the requirement that the device is either a surgically implantable prosthesis, or essential to and specifically designed as an integral single-use aid for implanting a prosthesis, or critical to the continuing function of the surgically implanted prosthesis.
In 2018-2019, the Department undertook the review of microcatheters that concluded that these devices do not satisfy the criteria for listing. The Prostheses List Advisory Committee (PLAC) supported these findings. The implementation of the recommendation to delete the billing codes for microcatheters from the Prostheses List was paused in 2020-2021 due to the COVID-related hibernation and the commitments made under the Strategic Agreement with the Medical Technology Association of Australia (MTAA).
The decision has now been made to implement this recommendation with the date of effect on 1 March 2023.