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2022-2023
THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA
HOUSE OF REPRESENTATIVES
HEALTH INSURANCE AMENDMENT (PRESCRIBED DENTAL PATIENTS
AND OTHER MEASURES) BILL 2023
EXPLANATORY MEMORANDUM
(Circulated by authority of the Minister for Health and Aged Care, the Hon Mark
Butler MP)
HEALTH INSURANCE AMENDMENT (PRESCRIBED DENTAL PATIENTS
AND OTHER MEASURES) BILL 2023
OUTLINE
The purpose of the Health Insurance Amendment (Prescribed Dental Patients and
Other Measures) Bill 2023 (the Bill) is to amend the Health Insurance Act 1973 (the
Act) to:
• improve access to the Medicare Benefits Schedule for eligible persons
requiring treatment for cleft and craniofacial conditions by removing the age
restrictions in Section 3BA of the Act, which defines 'prescribed dental
patients' (Schedule 1);
• enable Services Australia to use a computerised system to action decisions
made by a specified body to place doctors on, and remove doctors from, the
Register of Approved Placements (Schedule 2); and
• rectify inconsistencies between Part VD of the Act and the Health Insurance
(Bonded Medical Program) Rule 2020 in relation to the length of a bonded
participant's return of service obligation (RoSO), and make related
amendments to further enhance the administration of the Bonded Medical
Program to ensure it can achieve its original policy intent (Schedule 3).
Schedule 1 - Amendments relating to prescribed dental patients
Schedule 1 to the Bill amends the Act to improve access to Medicare benefits for
eligible persons requiring ongoing treatment for their cleft and craniofacial conditions.
To be eligible for Medicare benefits under current arrangements, people with cleft and
craniofacial conditions must satisfy specific age requirements defined by section 3BA
'Prescribed dental patients' of the Act. An age limit of 22 years was established on the
basis that patients with cleft and craniofacial conditions would generally have
completed most specialist dental work associated with their condition once their facial
maturation was complete. However, the age limitations have created difficulties for
some patients who do not reach facial maturity by the age of 22 years.
The removal of age limits does not change the policy intent of the scheme, as services
provided under the Medicare Benefits Schedule (MBS) must still be associated with a
course of major dental or skeletal treatment to correct or improve primary growth and
developmental irregularities, or if clinically relevant, undertake repairs that are in
connection with that course of treatment.
The Bill allows a small cohort of patients currently denied Medicare reimbursement
for treatment based on age alone, to access Medicare benefits for the treatment that
they need. The Bill also confers eligibility to Medicare benefits for disadvantaged
patients who have been unable to access treatment before reaching age 22, or those
who have had their treatment delayed beyond age the age of 22, for example due to
COVID-19.
The Bill will not significantly alter average patient numbers and will support
improvements to patient treatment plans.
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Schedule 2 - Amendments relating to register of approved placements
Schedule 2 to the Bill ensures that the Chief Executive Medicare can allow Services
Australia to develop a computerised system to action decisions made by a specified
body to place doctors on, and remove doctors from, the Register of Approved
Placements.
To be eligible to access a Medicare benefit, doctors who have made a permanent
commitment to Australia must either hold fellowship of an Australian medical college
or participate in an approved workforce or training program. A medical practitioner
who is granted entry into these programs must be placed on the Register of Approved
Placements.
Workforce and training programs are managed by a specified body who is also
responsible for determining eligibility. The specified bodies are listed in the
Regulations and include the Department of Health and Aged Care and the general
practice colleges.
Services Australia administers the Register of Approved Placements based on notices
provided by the specified body. Services Australia does not make an independent
assessment or decision, rather, they process the notices provided by the specified body
in order to facilitate Medicare access.
Schedule 3 - Amendments relating to the bonded medical program
The Bonded Medical Program provides a Commonwealth-supported place in a course
of study in medicine at an Australian university in exchange for a participant
completing a Return of Service Obligation (RoSO) working as a doctor in a regional,
rural, or remote community.
Schedule 3 to the Bill corrects the inconsistency between references to 'three years'
and '12 months' in Part VD of the Act and the definitions of how a participant can
accrue a 'week' of RoSO (as outlined in the definitions of a 'full-time basis', 'part-
time basis' and 'per-day basis' contained in section 4 of the Health Insurance
(Bonded Medical Program) Rule 2020), such that all references are expressed in
weeks.
The amendments will also ensure that the Minister has the authority to make 'Rules'
in relation to how a week of RoSO will be calculated. This will provide clarity to
bonded participants whilst also supporting the preferred mechanism of automated
RoSO calculation in the Bonded Return of Service System (BRoSS). BRoSS is the
online web portal that supports bonded participants to self-manage their participation
in the Bonded Medical Program.
Further minor amendments will enhance administrative arrangements, including that
an appropriate balance is struck between not having the administrative penalty
automatically apply to bonded participants seeking to comply with their reporting
obligations, whilst still allowing an administrative penalty to be applied to recalcitrant
bonded participants.
Financial Impact Statement
Nil.
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Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny)
Act 2011
HEALTH INSURANCE AMENDMENT (PRESCRIBED DENTAL PATIENTS
AND OTHER MEASURES) BILL 2023
This Bill is compatible with the human rights and freedoms recognised or declared in
the international instruments listed in section 3 of the Human Rights (Parliamentary
Scrutiny) Act 2011.
Overview of the Bill
The purpose of the Health Insurance Amendment (Prescribed Dental Patients and
Other Measures) Bill 2023 (the Bill) is to amend the Health Insurance Act 1973 (the
Act) to:
• improve access to the Medicare Benefits Schedule (MBS) for eligible persons
requiring treatment for cleft and craniofacial conditions (Schedule 1);
• enable Services Australia to use a computerised system to action decisions
made by a specified body to place doctors on, and remove doctors from, the
Register of Approved Placements (Schedule 2); and
• rectify inconsistencies between Part VD of the Act and the Health Insurance
(Bonded Medical Program) Rule 2020 in relation to the length of a bonded
participant's return of service obligation (RoSO), and make related
amendments to further enhance the administration of the Bonded Medical
Program, to ensure it can achieve its original policy intent (Schedule 3).
Human rights implications
The Bill engages the right to health through the following articles of the International
Covenant on Economic, Social and Cultural Rights (ICESCR):
• Article 12(1): The right of individuals to the enjoyment of the highest attainable
standard of physical and mental health.
• Article 6: The right to work, including the right of everyone to the opportunity to
gain a living by work which he/she freely chooses or accepts, and will take
appropriate steps to safeguard this right.
• Article 7(c): The right of everyone to the enjoyment of just and favourable
conditions of work, including equal opportunity for everyone to be promoted in
his/her employment to an appropriate higher level, subject to no considerations
other than those of seniority and competence.
The Bill assists with the progressive realisation of the right of all individuals to enjoy
the highest attainable standard of physical and mental health. This is achieved through
the obligation to provide timely and appropriate health care, which is 'available,
accessible, acceptable, and of a high quality'. Accessibility includes both physical
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accessibility to health services and economic accessibility, namely the provision of
health services which are affordable to all, through the MBS.
Schedule 1 - Prescribed dental patients
Schedule 1 to the Bill engages the right to health in Article 12(1) of the ICESCR.
Right to health
The Bill improves access to Medicare benefits for eligible persons requiring ongoing
treatment for cleft and craniofacial conditions and recognises the extent of clinical
conditions treated under the scheme. The Bill allows a small population of patients,
who are currently denied Medicare reimbursement for treatment based on age alone,
to access Medicare benefits for the treatment they require. This includes patients such
as those who, before reaching the age of 22 years, are denied treatment by their
parents, or patients whose treatment has been delayed; for example, due to the
COVID-19 pandemic.
Schedule 2 - Register of approved placements
Schedule 2 to the Bill engages the right to health in Article 12(1), the right to work in
Article 6, and the right of just and favourable conditions of work in Article 7(c) of the
ICESCR.
Right to health
The Bill amends the Act to provide an opportunity to streamline administrative
processes for medical practitioners placed on the Register of Approved Placements. It
also allows the Chief Executive of Medicare to correct any incorrect action that has
been identified or notified to Services Australia.
Medical practitioners who need to be placed on the Register of Approved Placements
will be restricted from accessing a Medicare benefit. Providing medical practitioners
with a digital option to replace the manual application process will reduce the
timeframe for access to Medicare benefits, thereby allowing medical practitioners to
provide services to the community sooner.
Right to work
The Bill will support the right to work under Articles 6 and 7(c) of the ICESCR by
supporting the rights of medical practitioners, specialists and consultant physicians to
gain equitable and timely access to Medicare rebates, which directly affects their
employability in private practice.
Medical practitioners who need to be placed on the Register of Approved Placements
will not be able to provide Medicare eligible services to patients until the placement is
granted. The vast majority of workforce and training programs on the Register of
Approved Placements support general practice. Due to the range of general practice
services available, patients are unlikely to attend a practice if a Medicare benefit is not
payable. This will have the practical effect of preventing these medical practitioners
from working.
The Bill will provide an opportunity to reduce the timeframes for access to Medicare
benefits, thereby supporting medical practitioners to gain or maintain employment in
general practice.
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Schedule 3 - Bonded medical program
Schedule 3 to the Bill engages the right to work in Article 6 and the right to health in
Article 12(1).
The Bill amends the Act to implement improvements to the Bonded Medical Program
established under Part VD of the Act.
The Government is committed to better distributing the medical workforce to
regional, rural and remote communities, which on average have less access to doctors
than people in metropolitan areas.
The Bonded Medical Program provides a Commonwealth-supported place in a course
of study in medicine at an Australian university in exchange for a participant
completing a Return of Service Obligation (RoSO) working as a doctor in a regional,
rural or remote community.
The Bonded Medical Program commenced on 1 January 2020, replacing legacy
contract-based schemes with new, simpler arrangements. Since 2020, new medical
students at Australian universities have entered directly into the Bonded Medical
Program. It is intended that participants in two legacy schemes - the Medical Rural
Bonded Scholarship (MRBS) Scheme and the Bonded Medical Places (BMP) Scheme
- can decide whether to opt in to the Bonded Medical Program, where many have.
The Bill will enhance implementation of the Program. The proposed amendments will
address unintended consequences - related to the application of the administrative
penalty - in the interests of participants and will also support achievement of the
Commonwealth's Program objectives.
Right to Work
In this context, the current Bonded Medical Program provides participants with
flexibility to work with limited restriction. It provides full opportunity for entrants to
voluntarily apply to register in the Bonded Medical Program or for legacy scheme
participants (includes existing MRBS Scheme and BMP Scheme participants) to
voluntarily opt in.
The amendments in the Bill address unintended consequences for participants and
simplify how they might complete their RoSO.
Due to the options available to participants to choose in which eligible location and
when to work over an 18 year period, there would be very limited restriction on the
participant's right to work. The limited restriction that will exist is in keeping with the
benefit provided to participants of a Commonwealth supported place in a course of
study in medicine at an Australian university and a medical career.
Right to Health
The Bill enhances the implementation of the Bonded Medical Program. It further
promotes equity of access to health services and, as such, supports the right to health
by facilitating greater access to essential medical services in geographic areas in
Australia identified as having less access to services.
Participants will be required to complete their RoSO in a regional, rural or remote
area or an area of workforce shortage which will improve health service delivery in
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these areas. In turn, this will provide greater opportunity for people in these areas to
access health services.
The requirement to complete the RoSO is a limitation that is considered minimal and
well balanced with the benefits to those living in regional, rural or remote areas and
the objective of the Program to provide more access to medical services in those
areas.
Conclusion
The Bill is consistent with Articles 6, 7(c) and 12(1) of the ICESCR. The Bill is
compatible with human rights.
The Hon Mark Butler MP, Minister for Health and Aged Care
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HEALTH INSURANCE AMENDMENT (PRESCRIBED DENTAL PATIENTS
AND OTHER MEASURES) BILL 2023
NOTES ON CLAUSES
Clause 1 - Short Title
Clause 1 provides that the title of the Act, once enacted, may be cited as the Health
Insurance Amendment (Prescribed Dental Patients and Other Measures) Act 2023.
Clause 2 - Commencement
Clause 2 provides that:
• Sections 1 and 2 of the Bill, and anything in the Bill not covered in Schedules 1, 2
and 3, commence on the day the Act receives the Royal Assent;
• Schedules 1 and 2 of the Bill commence on 1 November 2023; and
• Schedule 3 of the Bill commences, retrospectively, on 1 January 2020.
Clause 3 - Schedule(s)
Clause 3 provides that legislation specified in a Schedule to the Act is amended or
repealed as set out in the applicable items in the Schedule, and any other item has
effect according to its terms. This is a technical provision which gives operational
effect to the amendments contained in the Schedules.
SCHEDULE 1 -- PRESCRIBED DENTAL PATIENTS
Health Insurance Act 1973
Item 1 - Subsection 3(1) (definition of accredited dental practitioner)
Item 1 repeals the definition of an accredited dental practitioner in subsection 3(1),
which specifies a dental practitioner who is accredited by the Minister in writing for
the purposes of this definition. This is a consequential amendment subject to repealing
section 3BA of the Act (refer to Item 4 of Schedule 1).
Item 2 - Subsection 3(1) (definition of prescribed dental patient)
Item 2 repeals the definition of a prescribed dental patient in subsection 3(1). This is
a consequential amendment subject to repealing section 3BA of the Act (refer to Item
4 of Schedule 1).
Item 3 - Subsection 3(1) (paragraph (ba) of the definition of a professional
service)
Item 3 amends the definition of a professional service for a prescribed dental patient
by repealing paragraph (ba), which provides that a professional service specified in an
item that is expressed to relate to a professional attendance by an accredited dental
practitioner, being a clinically relevant service that is rendered by an accredited dental
practitioner to a prescribed dental patient. This is a consequential amendment subject
to repealing section 3BA of the Act (refer to Item 4 of Schedule 1).
Item 4 - Section 3BA
Item 4 repeals section 3BA which is in relation to prescribed dental patients. This
change will confer eligibility for Medicare benefits to patients who were unable to
attain treatment before reaching 22 years of age.
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Item 5 - Subsection 3C(8) (paragraph (c) of the definition of health service)
Item 5 amends the definition of a health service in subsection 3C(8) by repealing
paragraph (c), which specifies that a health service means the supply of prostheses in
connection with a service rendered by an accredited dental practitioner to a prescribed
dental patient. This is a consequential amendment subject to repealing section 3BA of
the Act (refer to Item 4).
Item 6 - Subsection 3C(8) (paragraph (d) of the definition of health service)
Item 6 amends the definition of a health service in subsection 3C(8) by amending
paragraph (d) to remove the reference to other circumstances described in paragraph
(c) of this subsection. This amendment specifies that a health service means the
supply of prostheses in connection with dental treatment. This is a consequential
amendment subject to repealing paragraph (c) of subsection 3C(8) (refer to Item 5 of
Schedule 1).
SCHEDULE 2 - USE OF COMPUTER PROGRAMS TO MANAGE
REGISTER OF APPROVED PLACEMENTS
Health Insurance Act 1973
Item 1 - After section 3GB
Item 1 inserts a new section 3GC Use of computer programs to manage Register of
Approved Placements after section 3GB of the Act to provide for the use of computer
programs to manage the Register of Approved Placements.
New subsection 3GC (1) provides the Chief Executive Medicare may arrange the use,
under the Chief Executive Medicare's control, of computer programs for taking
actions required by section 3GA (Register of Approved Placements) or section 3GB
(Removal of Approved Placements) of the Act.
Streamlining the processing of applications for Medicare Provider Numbers has been
identified as crucial to supporting doctors to take up training programs, particularly
general practitioner training. This commitment relates to the broader 2021-22 Budget
measure Guaranteeing Medicare- changes to the Medicare Benefits Schedule to
provide $33.5 million over four years from 2021-22 to respond to recommendations
from the Medicare Benefits Schedule (MBS) Review Taskforce to align the MBS
with contemporary practice, tighten clinical indicators, list new items, remove
obsolete items, and restrict inappropriate co-claiming.
This subsection allows advice regarding approval to place individual doctors on
approved programs by the authorised body to be transmitted to Services Australia
electronically, and for the Register of Approved Placements to be updated
electronically on the basis of this approval.
New subsection 3GC(2) states that an action completed electronically is taken to be an
action by the Chief Executive Medicare. The purpose of this new subsection ensures
electronic recording of an approved placement on, or removal from the Register of
Approved Placements remains within the delegation of the Chief Executive Medicare.
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New subsection 3GC(3) gives the Chief Executive Medicare discretion to substitute
an action made under subsection (2) if the Chief Executive Medicare is satisfied that
the action taken by the operation of the computer program is incorrect.
SCHEDULE 3 - BONDED MEDICAL PROGRAM
Health Insurance Act 1973
Item 1 - Subsection 124ZF(1)
Item 1 amends subsection 124ZF(1) of the Act by replacing "3 years" with "156
weeks". This change will provide that a bonded participant must work as a medical
practitioner in an eligible location for a period of 156 weeks, as opposed to 3 years.
Requiring bonded participants to complete their return of service obligation (RoSO) in
an amount of weeks rather than years simplifies this requirement by making it
consistent with how RoSO is calculated under the Health Insurance [Bonded Medical
Program] Rule 2020 and allows for automated calculation in the Bonded Return of
Service System (BRoSS) (which is referred to as the 'web portal' in Part VD of the
Act).
The number of weeks that will be required is to the benefit of the bonded participant,
noting that 156 weeks is slightly shorter than 3 years.
Item 2 - Paragraph 124ZG (1) (e)
Item 2 amends paragraph 124ZG(1)(e) by replacing "as soon as practicable after the
request is made" with "by the end of the period specified in the request or, if that
period is extended under subsection (4), by the end of the extended period". This
change will afford a bonded participant an appropriate period to respond to the request
for information from the Secretary.
Item 3 At the end of section 124ZG
Item 3 amends section 124ZG which relates to the conditions of the Bonded Medical
Program, by inserting two new subsections. New subsection 124ZG(3) provides that
for the purposes of paragraph 124ZG(1)(e) which relates to the Secretary requesting
information or documents from the bonded participant, the request must be made in
writing, and that the specified period must not end sooner than 14 days after the day
the request is made.
New subsection 124ZG(4) provides that the Secretary may, by written notice given to
the bonded participant, extend the period specified in a request made as mentioned in
paragraph (1)(e).
Item 4 Paragraph 124ZK(1)(b)
Item 4 amends paragraph 124ZK(1)(b) by removing "(d) or" . This change will
provide that a person is liable for an administrative penalty if the person is a bonded
participant, and breaches a condition mentioned in paragraph 124ZG(1)(e), which
relates to the Secretary requesting information or documents from the bonded
participant.
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Item 5 After paragraph 124ZT(3)(b)
Item 5 amends paragraph 124ZT(3) which provides for matters that the Bonded
Medical Program may include, to insert a new matter (ba) "how to calculate a week
for the purposes of the 156 week period mentioned in subsection 124ZF(1), including
when a week commences and the hours that constitute a week of work;".
This amendment clarifies that it is within the scope of the Minister's authority to
make a 'rule' specifying that a week, for the purposes of calculating RoSO, will
commence on a Sunday and finish on the following Saturday. Similarly, the
amendment clarifies that the Minister can make 'rules' defining the amount of effort
required, in any given period, that would constitute 'eligible work' to count towards
the RoSO.
Combined, these amendments will provide clarity to bonded participants on how the
Bonded Medical Program will be administered.
Item 6 Paragraph 124ZV(2)(a)
Item 6 amends paragraph 124ZV(2)(a) by replacing "3 years" with "156 weeks". This
change is consistent with the change outlined Item 1 above.
Item 7 Paragraph 124ZV(2)(b)
Item 7 amends paragraph 124ZV(2)(b) by replacing "3 years" with "156 weeks". This
change is consistent with the change outlined Item 1 above.
Item 8 - Paragraph 124ZV(2)(b)
Item 8 amends paragraph 124ZV(2)(b) by replacing "12 months" with "52 weeks".
Consistent with the change outlined Item 1 above, all bonded participants will have
their RoSO in an amount of weeks.
There are some bonded participants - being those described in s124ZE(2) that have
opted-in to the Bonded Medical Program from the Bonded Medical Places Scheme -
who, based on their personal circumstances of having joined that Scheme in the years
2016 through 2019, had a RoSO of 12 months, as opposed to a longer period for other
bonded participants described under s124ZE(1)-(3). Section 124ZV(2)(b) clarifies that
these bonded participants carry forward the shorter amount of RoSO into the Bonded
Medical Program.
The change simply converts that amount of RoSO from a period of '12 months', to a
period of '52 weeks'.
Item 9 - Paragraph 124ZW(2)(a)
Item 9 amends paragraph 124ZW(2)(a) by replacing "3 years" with "156 weeks". This
change is consistent with the change outlined Item 1 above.
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