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June 2014

CERTIFICATE OF NEED

The Department of Health has recently commenced with a consultation process with stakeholders affected by the Certificate of Need (CoN) legislation. It transpired at the meeting with the Director-General of Health and other senior officials in the Department of Health (DoH) that the Regulations that were required to support the legislative provisions had not been prepared to date. Furthermore, there was not agreement on the interpretation of the relevant sections in the National Health Act. It also appeared that the DoH wanted to use the CoN legislation to address the disease burden in South Africa, most notably maternal and child mortality, tuberculosis and HIV & AIDS.

It was stated by the Director-General that the process was not intended to be adversarial and invited stakeholders to make submissions in respect of the content of the Regulations.

Since a province such as the Western Cape already had a similar process in place, albeit mainly for hospitals and hospital based facilities, consultation also had to occur with the provinces to ensure alignment of the various pieces of legislation. It was therefore expected that the process that would be followed to finalise the Regulations could still take a fairly long time. In the meantime the 2-year period during which existing practices had to obtain CoNs started running on 1 April 2014. However, there was currently no process in place that would allow for practitioners to apply for a CoN.

HPCSA DENOUNCES CANCELLATION FEES

Although the Medical and Dental Professions Board (MDB) of the Health Professions Council of SA (HPCSA) approved the policy of the SA Medical Association in 2001, which allowed for medical and dental practitioners to charge fees for appointments not kept, a recent note on the HPCSA’s Blog advised that this practice was in breach of the Council’s Ethical Rules. The specific Ethical Rule related to the fact that practitioners were not allowed to charge or receive fees for services not personally rendered except for services rendered by an employed practitioner, partner, shareholder or locum. This ruling came despite the fact that the Consumer Protection Act also approved of the charging of cancellation fees in certain circumstances.

PRESCRIBED MINIMUM BENEFITS

The Council for Medical Schemes (CMS) has published further editions of CmScript, which dealt with the level of care and related entitlements of medical scheme beneficiaries in respect of the prescribed minimum benefit (PMB) conditions, Multiple Sclerosis and HIV. In respect of Multiple Sclerosis a recent ruling of the Appeal Committee of the CMS on the interpretation of the relevant algorithm was also explained. The Appeal Committee had ruled that betainterferon qualified as PMB level of care in both frequent relapse and secondary progressive disease. The treatment and care for Multiple Sclerosis also included rehabilitation services such as physiotherapy, occupational therapy and speech therapy.

ROAD ACCIDENT BENEFIT SCHEME BILL

The Road Accident Benefit Scheme Bill 2014 as well as the draft Regulations and draft Rules in terms of this Bill were published in May for comment. The Bill provided for benefits in respect of road accidents to be paid on a no-fault basis. This meant that accident victims would qualify for benefits regardless of who caused the accident and benefits would not be reduced based on the victim’s “contributory negligence”. The current Road Accident Fund (RAF) would be replaced by a new administrator, the Road Accident Benefit Scheme Administrator (RABSA) and would provide for a simpler and expedited claims process. Under the new scheme victims would be provided with a set of defined benefits in respect of the payment for health care services. RABSA would pay for all services reasonably required for the treatment and rehabilitation of accident victims. The Minister could prescribe a tariff for these services. The application of managed care tools such as protocol adherence, pre-authorisation and contracts with preferred providers were also contemplated. In addition, health practitioners would be able to claim payment for services directly from RABSA. The Bill still had to be tabled in parliament and complete a fairly lengthy parliamentary process before it would become law.

TRADITIONAL HEALTH PRACTITIONERS

Certain sections of the Traditional Health Practitioners Act were implemented on 1 May 2014. These related mainly to:

  • The establishment of the Interim Traditional Health Practitioners Council;
  • The appointment of a Registrar;
  • The determination of registration requirements for traditional health practitioners at the Council to be able to practise in the RSA, including the required qualifications and conditions relating to continuing education. According to the transitional period arrangements, practitioners had one year to become registered;
  • Complaints, inquiries, penalties and offences; and

The fees that could be charged, the rendering of accounts and related matters. Section 42 provided amongst other that:

  • A practitioner had to inform the patient (or the person responsible for the patient’s maintenance) of the fee he/she intended to charge for the traditional health services before rendering such services;
  • Where the practitioner claimed payment from any person (such as the patient), he/she had to furnish that person with a detailed account subject to the provisions of the Medical Schemes Act;
  • The patient could request the Council to determine the amount that should have been charged; and
  • The Council could determine and publish fees that would be used as a norm for the determination of amounts that should have been charged for services.

PHARMACY DISPENSING FEES

The Minister of Health has, on the recommendation of the Pricing Committee, published draft pharmacy dispensing fees on 13 June 2014 for a 3-month comment period. The proposed fees were as follows:

CURRENT PHARMACY DISPENSING FEES PROPOSED NEW PHARMACY DISPENSING FEES (JUNE 2014)
Single Exit Price (SEP) Maximum Dispensing Fee Single Exit Price (SEP) Proposed Maximum Dispensing Fee (Excl of VAT)
SEP<R81 R6.30 + 46% of SEP SEP<R85.70 R6.95 + 46% of SEP
R81 =SEP<R216 R16 + 33% of SEP R85.70 =SEP<R228.53 R18.55 + 33% of SEP
R216=SEP<R756 R55 + 15% of SEP R228.53=SEP<R790.85 R59 + 15% of SEP
SEP=R756 R131 + 5% of SEP SEP=R790.85 R140 + 5% of SEP