Update: Prostheses List Reform

On Thursday 17 March 2022, Minister Greg Hunt announced the signing of an agreement with the Medical Technology Association of Australia regarding commitments in relation to the reform of the Prostheses List.

The Australian Private Hospitals Association (APHA) has provided further detail in a bulletin to APHA members as below:

"While the agreement is between the Minister and MTAA, it sets out crucial undertakings which have been the result of APHA’s advocacy over many months: 

  • It delivers a much better outcome than reform proposals originally put out for consultation by the Department of Health and those advocated by health funds. 
  • It confirms the basis and timeline against which public sector reference pricing will be applied to the PL.
  • It confirms that “General Use” items will remain on the PL until Saturday 1 July 2023 “when bundling arrangements are intended to be implemented”.
  • It confirms a timeline and process for addressing the issue of a benefit for technical support services provided with Cardiac Implantable Electronic Devices (CIEDs).
  • It commits to continued work on the issue of pricing to hospitals including the proposed introduction of “a declaration by companies that there will not be extra charges for listed and necessary ancillary products beyond the PL benefit”.
  • The MOU stops short of mandating bundled benefits for “General Use” items but this was not unexpected as there is further work to be done before the Government would be in a position to make that commitment.

 
APHA immediately followed up by meeting in person with Minister Hunt to seek further assurances as to the next steps and have already received a favourable response. Specifically APHA have requested assurance: 

  • The Independent Hospital Pricing Authority will be commissioned immediately to work consultatively with the private hospital sector to design the proposed bundling arrangements for “General Use” items.
  • A formal mechanism for implementing the proposed bundling arrangement, ideally the regulation of bundled benefits as a mandatory minimum benefit, will be established to ensure that consumers are protected from out-of-pocket costs and continue to have access to these items. 
  • This work will be completed by the end of 2022 so the sector can receive published advice well in advance of the date of effect to allow an orderly transition to the new bundled funding arrangements.
  • Evaluation of the Prostheses List reforms will include consideration of both the direct and indirect impacts of the removal of “General Use” items from the Prostheses List and the implementation of “bundling arrangements” on the availability of safe, high-quality care for private health consumers.


APHA is also pressing for the release of full details of the PL benefits that will apply from Friday 1 July 2022 at the very earliest opportunity so that hospitals can commence engagement with manufacturers and clinicians and update their systems with the changes to benefits affecting every item on the PL.
 
For further information, access the following documents:


 


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