EmailHospital Circular 03/2004
Date Issued: 9 February 2004
Distribution: Public Hospitals
Subject:
- The imposition of new benefits arrangements for Prostheses by Medibank Private Ltd
- Agreement between Department of Human Services and Medibank Private Ltd on a new determination process for benefits payable to Victorian public hospitals for prostheses.
1. The imposition of new benefits arrangements for Prostheses by Medibank Private Ltd ("MPL")
MPL corresponded directly with Victorian public hospitals on 6th August 2003 and 13th August 2003, advising that from 15 September 2003, MPL will not accept claims without the relevant supplier invoice and that a prostheses pricing schedule will no longer be issued.
This represented a significant change to previously agreed policy, established under the Commonwealth determination, namely that reimbursement for prostheses provided to insured inpatients will be at the rates agreed to between the fund and suppliers, as per the funds distributed schedules.
The Department of Human Services ("DHS") contacted MPL by letter on 11th September 2003 and subsequently met with MPL on 10th December 2003 expressing its concern that these new arrangements had not been discussed with DHS in the first instance. DHS also raised a number of other issues arising from the new arrangements.
2. Agreement between DHS and MPL on a new determination process for benefits payable to Victorian public hospitals for prostheses.
In acknowledgement of the administrative difficulties imposed by the new arrangements, MPL proposed that each hospital provide a statement of declaration that any claims by Victorian public hospitals for prostheses made under schedule 5 of the Commonwealth determination is on the basis of the true costs of providing prostheses by the hospital. The true costs incurred should include any direct discounts received by the hospital on purchase. Furthermore, that MPL have the right to periodically audit the compliance of this arrangement at any Victorian public hospital, but in doing so will keep DHS informed of all such activity.
Both DHS and MPL agreed that reimbursement should reflect the full and true costs of providing prostheses to the insured patients; this should be applied when invoicing MPL for reimbursement.
NOTE: DHS intends to take a similar approach should this issue arise with other Health Funds.
Shane Solomon
Executive Director
Metropolitan Health and Aged Care Services
