Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p17
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 17/38)
Character Range: 84995–87721

payment or in instalments) or by directly employing staff to deliver programs.

    When to report on CDMPs

    Information on CDMPs should be reported in the quarter that benefits were paid for the program, regardless of whether the benefits are paid on a per service, or per program, basis.

    In the case where the health insurer employs their own staff to deliver services, benefits should be reported in the quarter that the services were delivered.

    How to report the amount of benefits paid for CDMPs

    Part 8 of HRF 601.1 calls for benefits paid for planning, coordination and allied health services to be reported separately, as these are the only components of a CDMP that are eligible benefits for risk equalisation.

    Part 8 also contains a field for 'other' benefits paid for the program that are ineligible for risk equalisation. In the future, this data will inform decisions about extending the risk equalisation arrangements to other costs for CDMPs.

    If benefits are paid on a per program basis, or the program is delivered by a salaried employee of the health insurer, the health insurer must attribute specific amounts for planning, coordination, allied health services and 'other' so that the amount of benefit paid is accurately reported.

    The amount of benefit reported depends upon the way benefits are paid for the CDMP.

1. Benefits paid on a per-service basis for components of a CDMP

If benefits are paid on a per service basis for planning, coordination, and any allied health and/or other goods and services as part of a CDMP on the basis of separate accounts rendered by providers, the completion of HRF 601.1 is straightforward.

2. Benefits paid on a per program basis

If benefits are paid on a per program basis in a single payment, the amount of the benefit must be disaggregated for each of the service components and the number of times services were delivered, and reported against the relevant field in Part 8 of HRF 601.1.

If benefits are paid in instalments, disaggregated benefits should be apportioned to the amount of the instalment.

It is expected that when negotiating the cost of the program with a provider, health insurers would identify the various cost components and the expected frequency of the services to be delivered.

3. Health insurer employs staff to deliver a CDMP

If a health insurer employs staff to deliver CDMPs (e.g. to plan and coordinate programs), the costs that are directly related to the employment of staff can be risk equalised. These costs are the salaries plus on-costs (or overheads).

The fields under the column 'benefits paid' should be reported by taking the total cost of employing staff in the quarter and dividing it