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LEGAL UPDATE

LEGAL UPDATE. Dr D L Pearmain Head: Health Services and Legislation Board of Healthcare Funders 31st October 2006. National Credit Act. Current Status: Meeting held with Riana van der Westhuizen, National Credit Regulator Agrees with the points made in Critical Analysis document

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LEGAL UPDATE

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  1. LEGAL UPDATE Dr D L Pearmain Head: Health Services and Legislation Board of Healthcare Funders 31st October 2006

  2. National Credit Act Current Status: • Meeting held with Riana van der Westhuizen, National Credit Regulator • Agrees with the points made in Critical Analysis document • Undertook to send a letter to confirming this.

  3. National Credit Act Medical schemes as credit providers: • Medical schemes will not be affected unless they charge interest on loans to members or savings accounts in debit Medical schemes as credit consumers: • Contracts between schemes and providers could be affected if there are penalty clauses for late payment, provisions for interest on overdue payments etc • Contracts with credit providers who are not registered with the NCR are invalid

  4. Considerations for Medical SchemesRoad Accident Benefit Scheme “Strategy for The Restructuring of the Road Accident Fund As Compulsory Social Insurance in Relation to the Comprehensive Social Security System” This is still a policy document and will be more formally processed at a later stage by government. Must be drafted as a Bill and then put through Parliament

  5. Considerations for Medical SchemesRoad Accident Benefit Scheme Three Pillars of the Comprehensive Social Security System (CSSS): - Provides basic universal protection (includes grants and free healthcare) Provides for compulsory contributory cover for individuals in a positon to contribute to the protection of specific risks eg. road accidents

  6. Considerations for Medical SchemesRoad Accident Benefit Scheme Points to Ponder: - • How will proposed measures reduce liability of medical schemes for medical expenses of beneficiaries involved in road accidents? • In what way if any can the proposed measures regarding RABS reduce the cost to medical schemes for medical expenses of beneficiaries involved in car accidents?

  7. Considerations for Medical SchemesRoad Accident Benefit Scheme Points to Ponder – • What will the relationship be between RABS benefits and the diagnosis/treatment pairs in the PMB’s such as compound depressed fractures of the skull? • What synergies can be created between medical schemes and RAF in terms of tariffs or benefits payable in respect of injusries sustained in road accidents?

  8. Considerations for Medical SchemesRoad Accident Benefit Scheme Points to Ponder: • What changes if any would or should schemes make to their third party recovery systems or claims processing should the RABS come into effect? • How will this impact on the REF mechanism with regard to PMB’s? • Is the RABS likely to affect the access of scheme beneficiaries to public sector facilties in the context of DSP arrangements?

  9. Considerations for Medical SchemesRoad Accident Benefit Scheme Points to Ponder: • Do the proposals concerning RABS assist medical schemes, or make their business more onerous in terms of administration and management,or have no effect on them at all? • Is this an opportunity to make representations concerning collaborative arrangements between RABS and medical schemes so as to avoid duplication of claims by road accident victims who are also beneficiaries of medical schemes?

  10. Legality of the NHRPL SAMA has argued that publication by the DOH of the NHRPL is illegal because there are no regulations to allow it to do so in terms of the National Health Act. Section 90 of the National Health Act empowers the Minister to make regulations. The Minister is not obliged to make these regulations. The section says she MAY make regulations.

  11. National Heath Act s90(1)(v) The Minister may make the following regulations - The processes of determination and publication by the Director-General of one or more reference price lists for services rendered, procedures performed and consumable and disposable items utilised by categories of health establishments, health care providers or health workers in the private health sector which may be used- • by a medical scheme as a reference to determine its own benefits; and • by health establishments, health care providers or health workers in the private health sector as a reference to determine their own fees, • but which are not mandatory

  12. Legal Position of Medical Schemes • The Medical Schemes Act obliges schemes to reflect the benefits of the scheme inter alia according to a scale, tariff or recommended guide • Schemes may use the NHRPL for 2006 adjusted for inflation • They may use the draft NHRPl put out by the DOH for 2007 • They may use their own adaptations of the NHRPL • They may use their own scale of benefits or tariff

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