Financial Sector (Collection of Data) (reporting standard) determination No. 31 of 2015 - HRS 601.0 - Statistical Data by State
Part 8Benefits Paid for Chronic Disease Management Programs
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Part 8 Benefits Paid for Chronic Disease Management Programs
(NOTE see the section on Guidance for insurers for eligible CDMP benefits for risk equalisation in these reporting instructions for further information on CDMPs)
The data in this part is to be reported as cumulative totals over the quarter being reported and include both eligible and ineligible benefits. The data reported in this part should only be for programs that satisfy the criteria for CDMP as defined under the Act and associated Rules.
29. Benefits Paid for CDMPs - report the number of services, benefits and fees charged in each of the categories in the quarter they are paid. Note that only Planning, Coordination and Allied Health Services components are eligible for Risk Equalisation so it will be necessary for health insurers to identify “Other” goods and services involved in the delivery of the program.
30. Benefits Paid by Program Type - report the number of programs, benefits and fees charged for each of the program types.
31. Programs are reported in the quarter that they commenced. The commencement date of the program may be hard to determine due to the different ways benefits can be paid, as well as delays in this information being provided to health insurers. The first quarter that benefits are paid for a CDMP should be taken as the quarter in which the program commences.
Programs that run continuously for more than one year are classed as completed at the end of the calendar year from commencement and a new program is reported as commencing in the next quarter that benefits are paid for the program.
(a) The commencement date of the program, and thus the first quarter in which the program is deemed to have commenced, should be taken as the date on which benefits were first paid for under the program.
(b) The number of programs does not refer to the particular programs offered by the health insurer, but refers to the number of persons participating in a program.
(c) If a member participates in more than one program, each program they participate in is counted.
32. Benefits and fees charged are recorded in the quarter in which they are paid.