Statutory Rules 1995 No. 1091
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National Health Regulations2 (Amendment)
I, The Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the National Health Act 1953.
Dated 30 May 1995.
BILL HAYDEN
Governor-General
By His Excellency’s Command,
carmen lawrence
Minister for Human Services and Health
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1. Amendment
1.1 The National Health Regulations are amended as set out in these Regulations.
[NOTE: These Regulations commence on gazettal: see Acts Interpretation Act 1901, s. 48.]
2. New regulations 49A and 49B
2.1 After regulation 49, insert:
Hospital Casemix Protocol
“49A. (1) For the purposes of paragraph 73BD (2) (c) of the Act, a Hospital Casemix Protocol is set out in Schedule 7.
“(2) In the Hospital Casemix Protocol, a reference to a document is a reference to that document as in existence on the day on which this subregulation commences.
List of Australian National Diagnosis Related Groups
“49B. (1) For the purposes of subparagraph 73BD (4) (a) (i) of the Act, the List of Australian National Diagnosis Related Groups consists of the contents of the following documents:
(a) Australian National Diagnosis Related Groups Definitions Manual Version 1.0;
(b) Australian National Diagnosis Related Groups Definitions Manual Version 2.0;
(c) Australian National Diagnosis Related Groups Definitions Manual Version 2.1—Addendum to ANDRG V2.0 Definitions Manual;
(d) Australian National Diagnosis Related Groups Definitions Manual Version 3.0.
“(2) A reference in subregulation (1) to a document is a reference to that document as in existence on the day on which this subregulation commences.”.
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3. New Schedule 7
3.1 Add at the end of the Regulations:
SCHEDULE 7 Regulation 49A
HOSPITAL CASEMIX PROTOCOL
Part 1—Explanatory Notes
Hospital Casemix Protocol: object
1. The object of the Hospital Casemix Protocol is to specify the financial, clinical and demographic data that funds must give to the Department in respect of every episode of hospital treatment for which a charge is billed to a fund.
Hospital Casemix Protocol: definitions
2. In this Protocol:
“blank filled” means that where blank filling is a valid entry, the field is filled with blanks;
“CCU” means the Coronary Care Unit of a hospital;
“CMBS” means Commonwealth Medicare Benefits Schedule;
“contracted doctor” means a doctor who has entered into a medical purchaser-provider agreement under section 73BDA of the National Health Act 1953;
“contracted hospital” means a hospital that has entered into a purchaser-provider agreement under section 73BD of the National Health Act 1953;
“DRG” means Diagnosis Related Group;
“episode” means the period between admission and separation that a person spends in one hospital, and includes leave periods not exceeding 7 days;
[NOTE: This definition of “episode” differs from the definition set out in the NHDD.]
“fund” means a health benefits fund conducted by a registered organization;
“ICD-9-CM” means The International Classification of Diseases 9th Revision Clinical Modification (Australian Version);
“MAA” means mandatory for all, and fields identified with this flag must contain a valid entry regardless of whether the episode occurred in a contracted hospital or a non contracted hospital;
“MAC” means mandatory for contracted hospitals, and fields identified with this flag must contain a valid entry. Where the episode occurred in a non contracted hospital, the field becomes optional;
“NHDD” means version 3 of the National Health Data Dictionary, published in May 1994;
“OPA” means that fields identified with this flag are optional for all hospitals;
“OPH” means optional for public hospitals, and fields identified with this flag are optional for public hospitals, whether contracted or not, and mandatory for private hospitals;
“OPO” means optional for public hospitals overnight, and fields identified with this flag are optional for public hospitals, whether contracted or not, where the patient stayed overnight;
“overnight-stay patient” means a person who is admitted to, and who separates from, a hospital on different dates;
“sameday patient” means a person who is admitted to, and who separates from, a hospital on the same date;
“valid arrangement” means an arrangement made under section 4C of the National Health Act 1953.
[NOTE: “NHTP” (nursing home type patient) is defined in subsection 3 (1) of the Health Insurance Act 1973.]
How to use the Protocol: the Parts of the Protocol
3. The medical record supplied to the Department by a fund must comply with the specification set out in the File Structure: Medical Record in Part 2, and with the contents set out in Record Content: Medical Record in Part 4.
4. The hospital episode record supplied to the Department by a fund must comply with the specification set out in the File Structure: Hospital Episode Record in Part 3, and with the contents set out in Record Content: Hospital Episode Record in Part 5.
How to use the Protocol: format specifications and how the details must be sent
5. All fields are to be initialised to blanks.
6. Blanks are not a valid entry for some fields. These fields are identified in Column 5.
7. Where identified in Column 5, blanks are a valid entry under the following conditions:
(a) the data item is optional; or
(b) specific conditions apply and these are noted in Column 5.
8. A record will be rejected by the Department if any of the following data items is coded as blank:
(a) Fund identifier in either Part 4 or 5;
(b) Link Identifier in either Part 4 or 5;
(c) Provider (hospital) code in Part 5;
(d) Total charge in Part 5;
(e) Total benefit in Part 5;
(f) Date of birth in Part 5;
(g) Postcode in Part 5;
(h) Gender in Part 5;
(i) Date admitted in Part 5;
(j) Date separated in Part 5;
(k) Separation mode in Part 5;
(l) Principal Diagnosis Code in Part 5.
9. Records not containing valid entries for items in item 8 will be rejected.
10. If 10% of records in any transmission batch are rejected all records in that transmission batch will be returned to the fund. The fund will resubmit the rejected transmission within 4 weeks from the date of receipt of rejected records.
11. Where a hospital is required to provide data to a fund, the hospital episode record must comply with the specifications set out in the File Structure: Hospital Episode Record in Part 3. The hospital must reach an agreement with the fund as to the medium on which the data must be sent.
12. Where a fund gives data to the Department, the fund must give the data to the Department using:
(a) DOS formatted floppy disks; or
(b) magnetic tapes; or
(c) MVS cartridges; or
(d) other electronic media as agreed with the Department in writing.
How to use the Protocol: data structure and specifications
13. A fund must give data to the Department in ASCII format with a record length as stated in Parts 2 and 3 of the Protocol.
14. For the purpose of the field size column (Column 3 in Parts 4 and 5):
(a) D is a date field. Legal values are 0-9 and blanks. The format is DDMMCCYY;
(b) N is a numeric field. N fields must be right justified and left blank filled. Legal characters are 0-9 and blanks;
(c) C is a character field. C fields must be right justified and left blank filled. Legal characters are alpha, 0-9 and blanks;
(d) I is for ICD-9-CM codes. I fields must be left justified and right blank filled and should not include decimal points.
15. Data items requiring rounding are noted in Column 5 in Parts 4 and 5. Rounding takes fractions to the nearest whole number. If the fraction is 0.5 acceptable rounding is up for an odd number and down for an even number.
16. All data items should reflect the completed discharge data set.
How to use the Protocol: how will the data transfer work
17. A fund has the primary responsibility for giving the information set out in Column 2-Data item of Parts 4 and 5.
18. Where the fund gives data to the Department, the data must include all episodes, whether or not the episodes took place in a contracted hospital.
19. Where the hospital gives data to the fund:
(a) the data set out in items 27-56 in Part 5, Record Content: Hospital Episode Record must be sent; and
(b) the data sent in accordance with paragraph (a) must be sent using the structure set out in items 27-56 in Part 3, File Structure: Hospital Episode Record.
[NOTE: The NHDD is published by the Australian Institute of Health and Welfare and aims to set out uniform definitions and data items to be used in the collection of health and welfare data. The definitions set out in the NHDD are endorsed by the National Health Information Management Group through the National Health Information Agreement.]
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Part 2—File structure: medical record
Column 1 Item No. | Column 2 Data Item | Column 3 Start Position | Column 4 Field size | Column 5 Repetitions |
1 | Fund identifier | 1 | 3 | 1 |
2 | Link identifier | 4 | 24 | 1 |
3 | CMBS item | 28 | 5 | 1 |
4 | Medical charge | 33 | 5 | 1 |
5 | CMBS benefit | 38 | 5 | 1 |
6 | Fund benefit | 43 | 5 | 1 |
7 | CMBS date of service | 48 | 8 | 1 |
8 | Contracted doctor | 56 | 1 | 1 |
9 | Total record length | 56 | | |
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Part 6—Registered Health Benefits Organizations
Column 1 Item No. | Column 2 Name | Column 3 Identifier |
1 | A.C.A. Health Benefits Fund | ACA |
2 | A.M.A Health Fund Limited | AMA |
3 | Army Health Benefits Society | AHB |
4 | Australian Health Management Pty Ltd | AHM |
5 | Australian Unity Friendly Society** | AUF |
6 | C.D.H. Benefits Fund | CDH |
7 | Commonwealth Bank Health Society (Friendly Society) | CBH |
8 | C.P.S. Health Benefits Society | CPS |
9 | CUA Members’ Benefits Friendly Society | CUA |
10 | FAI Health Benefits Limited | FAI |
11 | Geelong Medical and Hospital Benefits Association Limited | GMH |
12 | Goldfields Medical Fund (Inc.) | GMF |
13 | Government Employees Health Fund Limited | GEH |
14 | Grand United Friendly Society | GUF |
15 | Health Care Insurance Ltd | HCI |
16 | Healthguard Health Benefits Fund Limited | HHB |
17 | Health Insurance Fund of WA | HIF |
18 | Hospital Benefits Association Limited* | HBA |
19 | Hospital Benefits Fund of Western Australia (Inc.), The | HBF |
20 | Hospitals Contribution Fund of Australia, Limited, The | HCF |
21 | Independent Order of Odd Fellows of Victoria | IOF |
22 | I.O.R. Australia Pty Ltd | IOR |
23 | Latrobe Health Services, Inc. | LHS |
24 | Lysaght Hospital and Medical Club, The | LHM |
25 | Manchester Unity Independent Order of Oddfellows Friendly Society in New South Wales | MUI |
26 | Medibank Private (Health Insurance Commission) | MBP |
27 | Medical Benefits Fund of Australia Ltd | MBF |
28 | Mildura District Hospital Fund | MDH |
29 | MIM Employees Health Fund | MIM |
30 | Mutual Community Ltd* | MCL |
31 | National Mutual Health Insurance Pty Ltd* | NMH |
32 | Naval Health Benefits Society | NHB |
33 | New South Wales Teacher’s Federation Health Society | NTF |
34 | N.I.B. Health Funds Limited | NIB |
35 | Over 50’s Friendly Society, The | OFF |
36 | Phoenix Welfare Association Limited, The | PWA |
37 | Queensland Teachers Union Health Society | QTU |
38 | Queenstown Medical Union Health Benefits | QMU |
39 | Railway & Transport Employees’ Friendly Society Health Fund | RTE |
40 | Reserve Bank Health Society | RBH |
41 | S.G.I.C. Health Pty Limited | SGI |
42 | South Australian Police Employees’ Health Fund Incorporated | SPE |
43 | South Australian Public Servants | SPS |
44 | St Luke’s Medical & Hospital Benefits Association | SLM |
45 | “The Sydney Morning Herald” Hospital Fund | SMH |
46 | Transport Friendly Society | TFS |
47 | United Ancient Order of Druids | UAD |
48 | United Ancient Order of Druids Registered Friendly Society Grand Lodge of New South Wales, The | UAF |
49 | Eastern District Health Fund Ltd | WDH |
50 | Yallourn Medical and Hospital Society, The | YMH |
[NOTES:
* Mutual Community is owned and operated by National Mutual. In Victoria, Mutual Community trades as HBA.
** Australian Natives’ Association and Manchester Unity Independent Order of Oddfellows Friendly Society in Victoria now trade as Australian Unity Friendly Society.]
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NOTES
1. Notified in the Commonwealth of Australia Gazette on 30 May 1995.
2. Statutory Rules 1954 No. 35 as amended by 1957 No. 71; 1958 No. 63; 1962 Nos. 55, 70 and 113; 1965 Nos. 17, 94 and 185; 1966 No. 99; 1967 No. 86; 1969 Nos. 91 and 220; 1970 Nos. 70 and 166; 1971 Nos. 28, 76, 103 and 138; 1972 No. 79; 1973 Nos. 17, 75, 111, 221, 225 and 267; 1974 Nos. 52, 104, 105, 113 and 263; 1975 Nos. 14, 49, 66, 100, 124, 165 and 207; 1976 Nos. 113, 217 and 227; 1977 Nos. 11, 34, 51 and 112; 1978 Nos. 66, 178, 208 and 266; 1979 Nos. 59, 107, 208 and 231; 1980 Nos. 84, 292 and 309; 1981 Nos. 43, 97, 115, 232 and 318; 1982 Nos. 38, 82, 84, 250 and 284; 1983 Nos. 45, 247 and 267; 1984 Nos. 66, 161, 200, 308, 322 and 427; 1985 Nos. 86, 136, 186, 187, 206 and 288; 1986 Nos. 47, 53, 208, 330, 353 and 360; 1987 Nos. 50, 76, 100 and 310; 1989 Nos. 291, 292 and 334; 1990 Nos. 24, 86, 114, 292, 335 and 396; 1991 Nos. 40, 41, 232, 262, 263, 310 and 339; 1992 Nos. 136 and 187; 1993 Nos. 48, 85, 153, 260, 261, 273, 280 and 284; 1994 Nos. 2, 9, 106, 139, 201, 253, 256, 296, 349 and 451; 1995 Nos. 1, 14, 34 and 52.