DHA
Health Fund Rule Changes 2008
HypnosisAustralia,
May 2008
By
Dr Tracie O'Keefe DCH, Clinical Hypnotherapist, Psychotherapist &
Counsellor
Editorial Director of HypnosisAustralia Online.
On 1 July,
Minister for Health & Ageing, Nicola Roxon, made rule changes under
item 5 of the table in section 333-20 of the Private Health Insurance
Act 2007. It will introduce new federal rule changes into law affecting
repayment of claims by customers from their health funds. The rule changes
will affect two sectors of the healthcare industry, being those practitioners
who are required to be state or federally registered with the government,
and those who are what is commonly known as non-registered healthcare
practitioners.
The change
in the Australian Private Health Insurance (PHI) (accreditation) rules
2008 have been brought about for a number of reasons. Firstly it is to
create new benchmarks by which PHIs can identify bona fide healthcare
practitioners, government or non-government registered, from bogus untrained
and unregulated practitioners. It restricts PHIs from paying out claims
to healthcare practitioners who they believe not to have sufficient training,
professional association, supervision, and continuing professional education.
Secondly
it is meant to help the public identify those practitioners whom their
PHIs have already vetted. Unfortunately this is a pie in the sky idea
because the insurance companies are not really interested in vetting each
practitioner because it would be too time consuming and not cost effective
for them. They will have to resort to vetting the organisations that those
practitioners belong to, which is a process that many insurance companies
already undertake.
Thirdly these
changes are meant to clamp down on insurance fraud where clients are claming
for one service but are receiving another. Some practitioners have been
doing this for some considerable time in order to get around restrictions
on their areas of practice and increase their income. This is also not
as cut and dried as the theory predicts. The rule changes that each service
a clinician provides must be under the wistful eye of an association that
is specifically for that service cannot strictly be definable. Here we
run into very grey areas with hypnosis and hypnotherapy and classification
that would not stand up in court.
Hypnosis
and hypnotherapy is not only practised by clinical hypnotherapists but
also by psychologists, psychiatrists, social workers, dentists, nurses,
psychotherapists, counsellors and naturopaths, all who may have had some
training in hypnosis. The use of hypnosis may not be their primary discipline
but it can be said clinically that it is within the remit of their clinical
duties, and to make PHI claims for their primary discipline which includes
the use of hypnosis could be nothing less than genuine.
For those
practitioners who are in a government-registered profession, they can
continue to claim for hypnosis under their primary discipline. For hypnotherapists
who are members of organisations that put their name forward to PHI and
the PHI accepts those organisations for hypnotherapy, things will pretty
much carry on as normal. The fallout from these rule changes for non-government
registered practitioners, under rule 10, could be disastrous if their
professional associations do not take the PHI market seriously; and are
ensuring that their practitioners are put forward as suitably qualified
practitioners to those PHIs. Such practitioners may find themselves totally
at sea and not being able to get any PHI refund for their clients.
Bernadette
Blenkinron from the DHA said during in an interview with Hypnosis Australia
that, under the new rules, a practitioner who may have a secondary discipline,
other than hypnotherapy, who has valued training in hypnosis, would be
able to get their clients to claim for the secondary discipline, if hypnosis
was relevant to that discipline, through the PHI rebate rules. This must,
however, be a discipline in which hypnosis would normally be used as an
adjunct clinical tool.
The upside
is that the associations will now have a clearly identified benchmark
by which to prepare themselves for PHI inspection so that they can put
their members forward to be accepted as accredited practitioners so their
clients can get health fund rebates. This is not to say that insurance
companies will accept conforming associations' members. With PHIs becoming
bigger and merging together they are often looking to strike bargains
for using a smaller numbers of practitioners at a lower rate of fees,
than a larger numbers of practitioners at a standard fee. Should PHIs
move further into the private stock exchange listed sector they will be
looking towards profits, and only the largest professional healthcare
practitioner associations will have the power to negotiate.
The rule
changes will not affect psychotherapists, counsellors and hypnotherapists
until the 1st of July 2009 as article 10 of the new rule changes have
exempted that sector until that time. However, at that time any national
body or sub-associations really need to have got their house in order
and should they not have done, the table will be bare while the organised
professional associations reap the benefits.
DHA link
New rule link:
http://www.health.gov.au/internet/main/publishing.nsf/Content/health-phicirculars2008-16_08.htm
©HypnosisAustralia,
May 2008
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