Options for Reforms and Improvements to the Prostheses List

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In response to the Department’s Consultation Paper: Options for Reforms and Improvements to the Prostheses List MTAA has responded with a submission outlining strong recommendations to maintain the Prostheses List (PL). The context of the report includes:

• Key issues for reform
• Reasons for Reform
• The DRG model as a solution
• Retaining the PL
• Benefit Review Mechanism
• PL criteria
• Other PL Reforms
• The Nature and Status of Private Health Insurance
• Value and Purpose of the Prostheses List
• MTAA-Government Agreement
• Issues and goals for further reform
• Problems with the Diagnosis Related Group (DRG) Option
• Introduction to the MTAA Proposal
• Benefit Review Mechanisms on the PL
• MTAA Proposal – Modified Public-Private Referencing
• Implications for other aspects of PL reform
• Defining the scope of the PL
• Improving the Structure and Transparency of the PL
• Optimising Utilisation
• Improving listing processes
• Department Resource and Cost Recovery
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