Commonwealth Numbered Regulations - Explanatory Statements

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NATIONAL HEALTH AMENDMENT REGULATIONS 1999 (NO. 6) 1999 NO. 236

EXPLANATORY STATEMENT

Statutory Rules 1999 No. 236

Issued by the Authority of the Minister for Health and Aged Care

National Health Act 1953

National Health Amendment Regulations 1999 (No. 6)

Section 140 of the National Health Act 1953 (the Act) provides that the Governor-General may make regulations for the purposes of the Act.

Paragraph 73BD(2)(c) of the Act provides for the Hospital Casemix Protocol (HCP) to be prescribed by regulation. Regulation 49A of the National Health Regulations 1954 (the Regulations) prescribes the HCP as set out in Schedule 7 of the Regulations. The HCP enables the Department to obtain financial, demographic and clinical information from registered health benefit organisations in respect of every episode of hospital treatment for which a charge is billed to the organisation.

Subparagraph 73BD(4)(a)(i) of the Act provides for a List of Australian National Diagnosis Related Groups to be prescribed by the Regulations. Regulation 49B prescribes such a list.'

Regulation 49A(2) provides that in the HCP a reference to a document is a reference to that document as in existence on the day on which the subregulation commences.

Regulation 49B(2) provides that a reference to a document in 49B(1) is a reference to that document as in existence on the day on which the subregulation commences.

The amending Regulations:

*       redefine the documents referred to in subparagraphs 49A(2) and 49B(2) of the Regulations (Schedule 1, Items 1 and 4);

*       add two new versions of the Australian National Diagnosis Related Groups Definitions Manuals to the list of manuals prescribed by Subregulation 49B(1) (Schedule 1, Items 2 and 3);

*       amend Schedule 7 of the Regulations by:

> accommodating the national change to coding patients using the new ICD-10-AM classification system and new Diagnosis Related Groups (DRG) classifications (Schedule 1, Items 5, 6, 9, 13 and 17);

> amending the definition of the National Health Data Dictionary (Schedule 1, Item 7),

> improving the consistency between the various Items of Schedule 7 of the Regulations (Schedule 1, Items 8, 11, 12 14-16);

> amending definitions, deleting items no longer required, introducing new items to improve the data quality and usefulness of the collection, locating related items in the same areas of Parts 3 and 5 of Schedule 7 of the Regulations, and making consequential changes to item numbering and positions in the specified formats (Schedule 1, Items 10, 13 and 17); and

> updating the list of registered health benefits organisations (Schedule 1, Item 18)

The amending Regulations have been developed in consultation with the HCP Update Committee which comprises representatives from the Commonwealth, health insurance funds, the Australian Private Hospitals Association, the Australian Institute of Health and Welfare and the Private Hospitals Data Bureau.

Details of the amending Regulations are set out in the Attachment.

The amending Regulations commence on 1 November 1999 and apply to hospital separations occurring after 30 June 1999.

ATTACHMENT

Details of the National Health Amendment Regulations 1999 (No. 6)

Regulation 1 provides that the name of the regulations are the National Health Act Amendment Regulations 1999 (No. 6).

Regulation 2 provides that the regulations will commence on 1 November 1999.

Regulation 3 provides that the National Health Regulations 1954 are amended by Schedule 1 of the amending Regulations.

Proposed changes to the Regulations detailed in Schedule 1

Item 1 amends subregulation 49A (2) to provide a clearer definition of documents referred to in the Hospital Casemix Protocol.

Items 2 and 3 amend subregulation 49B(1) of the Regulations to add the Australian Refined Diagnosis Related Groups Definitions Manuals 4.0 and 4.1 to the list of manuals prescribed in that subregulation. Regulation 49B of the National Health Regulations prescribes certain manuals associated with casemix funding. The amendment prescribes new manuals that have been issued that describe the latest versions of the DRG patient classification.

Item 4 amends Subregulation 49B (2) to provide a clearer definition of documents referred to in Subregulation 49B (1).

Items 5 and 6 replace the definition of ICD-9-CM with ICD-10-AM in clause 2 of Part 1 of Schedule 7 to the Regulations. This is required following the national implementation of the new ICD-10-AM classification system for coding patient episodes in Australian hospitals from 1 July 1999.

Item 7 substitutes a new definition of 'NHDD' in Schedule 7, Part 1, clause 2 of the Regulations. The effect of the amendment is to introduce the latest version of the National Health Data Dictionary. namely, version 8.0.

Item 8 amends the names of data items that are mandatory in Clause 8, Part 1 of Schedule 7. When changes to these items in the tables that form Parts 2-5 of the Schedule were made as part of changes to the Regulations in 1997, these were inadvertently omitted from Part 1. The 1997 Regulation changes also removed the requirement to provide Total charge and Total benefit but failed to delete them from the list of mandatory items in Part 1. Proposed amendment 8 deletes them and also makes consequent numbering changes.

Item 9 substitutes 'ICD-10-AM' for 'ICD-9-CM' in Part 1, clause 14(d) to reflect the new classification system that has been introduced into Australian hospitals from 1 July 1999.

Item 10 amends the number of items specified in Part 1, clause 19 (a) and (b) to read '29-67' to reflect the changed number of items on which hospitals are required to submit data resulting from these Regulation changes.

Item 11 amends the name for item 1 from 'Fund identifier' to 'Fund/payer identifier' in Part 2 of Schedule 7. This change was inadvertently omitted when changes to the same item in Parts 3 and 5 of Schedule 7 were made as part of changes to the Regulations in 1997.

Item 12 amends items in the table in Part 2 of Schedule 7 as follows:

*       Item 3 becomes 'CMBS item/ Miscellaneous service code' in recognition of the use by health funds of codes in addition to the CMBS items.

*       The field size (Column 4) for Item 3 is increased from 5 to 14 to accommodate the field size of electronically-transmitted miscellaneous service codes.

*       Item 4 becomes 'Item charge' to be consistent with the same item in other Parts of Schedule 7

*       The start positions (Column 3) for items 4 to 9 are adjusted as a result of the increased size of item 3.

Item 13 replaces the table in Part 3 of Schedule 7 with a new table.

The majority of the data items in the new table are unchanged from the existing table, but some items no longer required have been deleted, similar types of items have been grouped together, and a number of new items included. This has necessitated significant changes in the numbering of items and their starting positions, and in the overall file structure.

Data items that have been deleted as they are no longer required are Total charge, Total benefit, Admission transfer type, Age in years, Age in days, Separation transfer type and Acute days of stay.

Data items for Bundled charges, Bundled benefits, Other charges and Other benefits, which were at the end of the file structure, have now been moved next to other charge and benefit data items.

Items 43, 44 and 55-67 of the table are new items whose inclusion has been agreed with health funds and hospital organisations in order to improve the usefulness of collected data.

Item 14 amends the name for item 1 from 'Fund identifier' to 'Fund/payer identifier' in Part 4 of Schedule 7. This change was inadvertently omitted when changes to the same item in Parts 3 and 5 of Schedule 7 were made as part of changes to the Regulations in 1997.

Item 15 amends the name, field size and description of item 3 in the table in Part 4 of Schedule 7. The change recognises that some services provided that do not have a CMBS item number can be coded using a Miscellaneous services code or an Australian Dental Association code and may be eligible for a claim on the health fund. The field size is increased from 5 to 14 to accommodate the field size of electronically-transmitted miscellaneous service codes.

Item 16 amends the name and description of item 4 in the table in Part 4 of Schedule 7. The name is changed to 'Item charge' to maintain consistency with other parts of Schedule 7, and the description is modified by including 'health service provider' as a person raising a bill, in recognition that not all medical bills are raised by doctors.

Item 17 replaces the existing table in Part 5 of Schedule 7 with a new table. The majority of the data items in the new table are unchanged from the existing table, but some items no longer required have been deleted, similar types of items have been grouped together, and a number of new items have been included. This has necessitated significant changes in the numbering of items and their starting positions, and in the overall file structure. There have also been changes to the size of some items to meet the requirements for recording new classification codes. Data items that are needed for the allocation of an episode to a Diagnosis Related Group (DRG) have been made mandatory for all episodes.

The specific changes are:

*       Data items that have been deleted as they are no longer required are Total charge (existing item 19), Total benefit (existing item 20), Admission transfer type (existing item 37), Age in years (existing item 38), Age in days (existing item 39), Separation transfer type (existing item 44) and Acute days of stay (existing item 45). The information these items provided can either be derived from other items (items 19, 20, 38, 39 and 45) or was poorly reported and not useful for analyses (items 37 and 44);

*       Data items for Bundled charges, Bundled benefits, Other charges and Other benefits, which were at the end of the file structure, have now been moved next to other charge and benefit data items;

*       Items 43, 44 and 55-67 are new items whose inclusion has been agreed with health funds and hospital organisations in order to improve the usefulness of collected data. It is understood that they are generally collected by hospitals. However, the items have been made optional to avoid imposing additional requirements on hospitals that do not currently collect them. The new items are:

-       Source of referral (item 43);

-       Service category on admission (item 44);

-       Total days spent at home (hospital-in-the-home episodes only) (item 55);

-       Total psychiatric care days (item 56);

-       Mental health legal status (item 57);

-       ICU hours (item 58);

-       Admission status (item 59);

-       Contract status on admission (item 60);

-       Palliative care status (item 61);

-       Unplanned readmission within 28 days (item 62);

-       Unplanned theatre visit during episode (item 63);

-       Marital status (item 64);

-       Provider number of hospital from which transferred (item 65);

-       Provider number of hospital to which transferred (item 66); and

-       Discharge intention on admission (item 67);

*       Data items for ICU days, Neonatal admission weight, Hours of mechanical ventilation, Additional diagnosis, Procedure codes and Sameday status have been made mandatory for all episodes;

*       The field sizes of DRG code (item 36), Procedure codes (item 49) and Principal (item 51) and Secondary (item 54) CMBS item number/Miscellaneous service code have been increased to accommodate new classification codes;

*       The description of DRG version (item 37) has been amended to include new versions developed since the Regulations were previously updated. The descriptions for Principal diagnosis code (item 47), Additional diagnosis (item 48) and Procedure codes (item 49) have been amended to recognise the introduction and use of the ICD-10-AM classification system in hospitals from 1 July 1999; and

*       The names and definitions of items 51 and 54 have been modified to recognise that some services provided that do not have a CMBS item number can be coded using a Miscellaneous services code or an Australian Dental Association code and may be eligible for a claim on the health fund.

Item 18 replaces the table of Registered health benefits organisations in Part 6 of Schedule 7 with an up-to-date list of such organisations.


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