Prostheses List Reforms - Mixed Benefit Groups

Overview

Following the mixed benefits webinar held on Tuesday 14 February 2023, the Department of Health and Aged Care is publishing the following documents for stakeholders to review the regrouping work as part of the Prostheses List (PL) Reforms. The documents that can be found include:

• Rationale for the restructure of the PL proposed by hereco including an overview of the structure to subgroup level (accepted by the Department in December 2022);
• Webinar presentation and recording regarding the Department’s approach to mixed benefit groups which provides an overview of the mixed benefit approach and a worked example (enter password: PhVTxhk3);
• The Adjusted PL Structure resulting from the mixed benefit approach – this document can be used to help sponsors understand how the proposed regroupings affects their PL listings. The Adjusted PL Structure includes all proposed billing codes, associated groups/subgroups and the proposed associated SBV under the proposed PL structure. The spreadsheet can be filtered by sponsor as well as categories and groups/subgroups.

The documents can be found at the bottom of the page for stakeholders to access.

What happens next

Affected sponsors should refer to the email they received regarding how to respond and the required evidence by COB Thursday 2^nd of March. The Department will then seek to hold direct meetings with sponsors from the week starting the 6^th of March.