A 16-MEMBER task team has been established by the Council for Medical Schemes (CMS), together with other roleplayers in the health industry, to tackle issues concerning compliance with prescribed minimum benefits (PMBs) legislation following a workshop held in Johannesburg this week. The team will also have to come up with a code of conduct for the health sector that will provide more clarity and detail on how and why PMBs must be implemented. The code will be binding on all industry roleplayers. The CMS has previously said almost all the medical aid schemes and administrators were not complying fully with the Medical Schemes Act as far as payment for PMBs was concerned. However, having the task team in place does not mean that the CMS will back down on its decision taken last year to penalise schemes and administrators for non-compliance. The penalties announced by the regulator included a threat to deregister culprits. Aleksandra Serwa, a spokeswoman for the CMS, said that full compliance with the Medical Schemes Act was non-negotiable. She said the process of establishing a PMB task team and drafting a more detailed code of conduct did not change anything. It would not change the current legislation, it would not change what was required or expected of the industry, and it would not change the council's statutory mandate as a regulator, Serwa said. The task team will have delegations from four groups: the regulators, which will include representatives from the Department of Health, the CMS and the Health Professions Council of SA; the schemes and administrators; healthcare providers; and consumer groups or beneficiary trustees. Each group will consist of four members mandated to represent the interests of that particular group on the task team. The names of the members will be finalised this week. Serwa said the cause of non-compliance appeared to be commercial in nature. She said that that non-compliance had little to do with protecting the sustainability of schemes as there was no indication that schemes faced differential pricing of PMBs by providers. She added that there was little evidence of schemes taking considered action to manage the PMB-related liabilities separately from their other benefits. The Board of Healthcare Funders (BHF) has approached the Minister of Health because it wants regulation 8 of the Medical Schemes Act, which governs the payment of PMBs, to be rewritten because it feels this gives too much power to the service providers at the moment.

Slindile Khanyile: Business Report, 13 May 2010