Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p6
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 6/38)
Character Range: 56750–59698

the total days related to each episode, including days when no fund benefit is paid.

       (c)          Leave days from a hospital stay are excluded from reporting days.

       (d)          Where an episode has not been completed in a quarter (an incomplete episode) but a benefit has been paid in relation to the treatment because of an interim billing arrangement the following applies:

           i)              the episode should not be reported in the current quarter, the episode is counted as one episode in the quarter in which it is completed.

           ii)            days and benefits are reported in the quarter they are paid.

       It is recognised that this will result in some mismatching of data within quarters.

       (e)          Days for Day hospital, day only public hospitals, day only private hospitals and day only for hospital-substitute should equal Day only episodes in the respective categories.

       (f)           Medical benefits should equal the sum of medical benefits reported in Parts 3 and 4, and should equal the total fund benefits reported in Part 11 - Total Hospital Treatment Medical Service Statistics.

       (g)          Medical devices or human tissue products benefits should equal the sum of medical devices or human tissue products benefits reported in Parts 3 and 4.

       (h)          Hospital benefits, hospital-substitute benefits and Nursing Home Type Patients benefits reported in this part exclude Medical and medical devices or human tissue products Benefits.

    9.             High Cost Claimants Pool (HCCP)

    Report HCCP benefits in the state in which the person is resident at the end of the quarter, and associated HCCP data in the same state.

       (a)          Report the number of insured persons with a HCCP claim in the current quarter.

       (b)          Report the total (gross) benefit paid for HCCP claimants for the current and the preceding three quarters for the insured persons with a HCCP claim in the current quarter.

       (c)          Report the net benefit paid for HCCP claimants for the current and the preceding three quarters after Age Based Pooling (ABP) has been applied for the insured persons with a HCCP claim in the current quarter.

       (d)          Report the net benefit paid above the threshold for HCCP claimants for the current and the preceding three quarters after ABP has been applied. This amount will include any amounts already included in the HCCP.

       (e)          Report the total benefit to be included in HCCP for the current quarter after ABP has been applied, which is the amount from (d) less any amounts already reported in the HRF 601.1 for inclusion in the HCCP.

       (f)           Threshold in relation to the high cost claimant's pool means the designated threshold. The threshold is $50,000.

    The amount to be notionally allocated to the HCCP is to be calculated in accordance with the formula