Commonwealth of Australia Explanatory Memoranda Commonwealth of Australia Explanatory Memoranda[Index] [Search] [Download] [Bill] [Help]
2019-2020
THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA
HOUSE OF REPRESENTATIVES
HEALTH INSURANCE AMENDMENT (GENERAL PRACTITIONERS AND
QUALITY ASSURANCE) BILL 2020
EXPLANATORY MEMORANDUM
(Circulated by authority of the Minister for Health, the Hon Greg Hunt MP)
HEALTH INSURANCE AMENDMENT (GENERAL PRACTITIONERS AND
QUALITY ASSURANCE) BILL 2020
OUTLINE
The Health Insurance Amendment (General Practitioners and Quality Assurance)
Bill 2020 has two schedules.
The Bill simplifies Medicare administrative processes for recognition as a specialist
general practitioner (GP) for Medicare purposes under the Health Insurance Act 1973
(HI Act) and will align Medicare eligibility for GPs with the National Registration
and Accreditation Scheme (NRAS) registration requirements.
The Bill also removes references to repealed legislation in relation to the definition of
a quality assurance activity by amending subsection 124W(1)(a) of Part VC of the
HI Act.
Schedule 1 simplifies Medicare administrative processes by aligning Medicare
eligibility for GPs with the NRAS registration requirements under the Health
Practitioner Regulation National Law Act 2009 (Qld) (National Law).
The current Commonwealth legislative framework for recognition as a GP for
Medicare purposes is implemented in legislation that includes the following:
HI Act;
Health Insurance Regulations 2018 (HIR); and
General Services Medical Table 2019.
The HI Act provides various pathways for recognising GPs for Medicare purposes.
The current pathways necessitate direct communication exchange between Services
Australia and relevant organisations (Royal Australian College of General
Practitioners (RACGP) and Australian College of Rural and Remote Medicine
(ACRRM)) to determine eligibility for Medicare rebates. In determining eligibility for
Medicare rebates, the RACGP or ACRRM (the colleges) confirm the medical
practitioner holds a valid fellowship with their college and is a specialist GP. Every
three years, the colleges advise Services Australia that GPs are compliant with
Continuing Professional Development (CPD) requirements to maintain patient access
to higher Medicare rebates.
Under the NRAS, the Medical Board of Australia (MBA) and the Australian Health
Practitioner Regulation Agency (Ahpra) are responsible for maintaining a public
register of health practitioners regulated under the NRAS.
Under the National Law, all specialist practitioners are required to make an annual
declaration to the Ahpra to state they are compliant with mandatory CPD
requirements. This Ahpra data provides information on those practitioners who hold
registration in the specialty of general practice with the MBA and will be used to
determine a GP's access to Medicare rebates. The Bill therefore provides a new
definition of GP as a medical practitioner who is registered under the National Law in
the specialty of general practice or a medical practitioner prescribed by the HIRs. As a
consequence of the new definition of a 'general practitioner' provided in the Bill, the
Chief Executive Medicare will no longer be required to make determinations in
relation to a GP, simplifying processes for specialist recognition as a general
1
practitioner for Medicare purposes. There will be no need for Services Australia to
liaise with bodies like the RACGP and ACRRM and instead will rely on the Ahpra
public register to determine eligibility to access higher Medicare rebates. This is
consistent with other specialities under the National Law.
The Bill also provides for a new definition of GP for the purposes of the HIR. These
changes acknowledge GPs who are not fellows of the RACGP or ACRRM, but are
still entitled to higher Medicare rebates. This cohort involves older medical
practitioners who were working in general practice prior to it becoming a specialty in
its own right in 1996.
This change amends the HI Act and will result in the repeal of the Health Practitioner
Regulation (Consequential Amendments) Act 2010 (Consequential Amendments Act)
and require consequential amendments to the HIR and the GMST.
Amendments to the definitions for medical practitioner, midwife, nurse practitioner,
optometrist, osteopath, chiropractor, dental practitioner, physiotherapist, and
podiatrist are also required to align with the National Law.
Schedule 2 of the Bill removes references to repealed legislation in relation to the
definition of a quality assurance activity by amending subsection 124W(1)(a) of Part
VC of the HI Act. The Bill removes the reference to the Health Care (Appropriation)
Act 1998, which was repealed on 1 July 2009, and replaces it with the reference to the
Federal Financial Relations Act 2009 (FFRA), which is the current legislative vehicle
for Commonwealth payments to States and Territories for public hospital services.
Financial Impact Statement
The financial impact of the Bill to the Commonwealth includes changes to Services
Australia payments systems. While there will be administrative savings within
Medicare from a reduction in staffing resources to process specialist recognition
applications from general practitioners, the cost of changes to the payment system is
$1.4 million over two years. Funding was announced as part of the 2018 -19 Budget,
Stronger Rural Health Strategy.
The amendment to the statutory protective framework for quality assurance activities
in Part VC of the HI Act is cost-neutral.
2
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny)
Act 2011
HEALTH INSURANCE AMENDMENT (GENERAL PRACTITIONERS AND
QUALITY ASSURANCE) BILL 2020
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 Bill simplifies Medicare administrative processes for recognition as a specialist
general practitioner (GP) for Medicare purposes under the Health Insurance
Act 1973 (HI Act) and will align Medicare eligibility for GPs with the National
Registration and Accreditation Scheme requirements.
The Bill provides for a new definition of GP as a medical practitioner who is
registered under the National Law in the speciality of general practice or a medical
practitioner prescribed by the HIR. Currently once a GP acquires fellowship with the
RACGP or ACRRM, the GP must apply to Services Australia to be recognised as a
specialist GP and to gain higher Medicare rebates for their patients. In determining
ongoing eligibility for higher Medicare rebates, the RACGP or ACRRM (the
colleges) confirm to Services Australia every three years that their fellows holds valid
fellowship with their college, are a specialist GP and are compliant with CPD
requirements.
Under the National Law, all specialist practitioners are required to make an annual
declaration to Ahpra to state they are compliant with mandatory CPD requirements.
Under the HI Act, Services Australia uses this declaration to confirm specialist
practitioners are, and remain, eligible for higher Medicare rebates. This Bill amends
the HI Act to align the requirements for GPs to access higher Medicare rebates with
those of other specialist practitioners.
The Bill also provides for a new definition for GPs who are not fellows of the
RACGP or ACRRM but are still entitled to higher Medicare rebates. This cohort
involves older GPs who were working in general practice prior to it becoming a
speciality in its own right in 1996.
Amendments to the definitions for medical practitioner, midwife, nurse practitioner,
optometrist, osteopath, chiropractor, dental practitioner, physiotherapist, and
podiatrist are also to be made to align them with the National Law.
Schedule 2 of the Bill removes references to repealed legislation in relation to the
definition of a quality assurance activity under the Qualified Privilege Scheme (QPS).
It removes reference to a now repealed Act and replaces it with the current Act which
provides for Commonwealth payments to States and Territories for public hospital
services.
3
Human rights implications
This Bill promotes the following articles of the International Covenant on Economic,
Social and Cultural Rights (ICESCR):
The right of individuals to the enjoyment of the highest attainable standard of
physical and mental health (Article 12);
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 6)
The right to 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 (Article 7(c))
The Bill also engages the right to protection of the law against interference with
privacy under Article 17(2) of the International Covenant on Civil and Political Rights
(ICCPR).
Article 12 of the ICESCR
The right to health includes the obligation to provide timely and appropriate health
care, which is 'available, accessible, acceptable and of a high quality'. Furthermore,
accessibility includes both physical accessibility to health services and economic
accessibility, namely the provision of health services which are affordable to all.
This Bill amends the HI Act to remove administrative processes that may impede or
delay GP access to higher Medicare rebates, which in turn limits patients'
accessibility to full Medicare benefits for health services available under the HI Act.
By removing the additional administrative process for recognition as a specialist GP,
GPs can be registered for higher Medicare rebates as soon as they are registered with
Ahpra; and are no longer reliant on information provided by the colleges to Services
Australia every three years to continue to access higher Medicare rebates. This means
that GPs anywhere in Australia can access higher Medicare rebates more simply and
efficiently in a single registration process.
The amendments also ensure that GPs provide high quality health services by
continuing to link access to higher Medicare rebates to GP compliance with CPD
requirements.
Articles 6 and 7 of the ICESCR
The Bill supports the right to work under Articles 6 and 7(c) of the ICESCR by
supporting the rights of GPs to gain equitable and timely access to Medicare rebates,
which directly affects their employability in private practice. Many practices seek GPs
who hold and maintain access to higher Medicare rebates as their patients are unable
or unwilling to pay out of pocket costs for eligible health services. At present, access
to higher Medicare rebates is conditional on completing administrative processes that
are duplicative. Additionally, such processes can result in delays in accessing rebates,
which can impact a GPs ability to gain and retain work.
The Bill removes this duplicate process and streamlines access to higher Medicare
rebates for all GPs registered as specialist GPs with Ahpra. This information is
4
electronically transferred to Services Australia annually and ensures that GPs are able
to access and maintain Medicare rebates more simply.
The Bill also provides simplified and clearer administrative arrangements for medical
practitioners who wish to pursue higher qualifications, specifically the attainment of
Fellowship, and to access Medicare rebates commensurate to this additional
qualification.
Article 17(2) of the ICESCR
Part VC of the HI Act limits the right to no interference with a person's privacy as
contained in Article 17(2) through the collection, storage, security, use, disclosure or
publication of personal information relating to individual health where provided for
the purposes of the QPS.
A quality assurance activity under the HI Act involves measuring the effectiveness of
a procedure or process carried out by health professionals and making evidence based
improvements in relation to the particular health care services.
Qualified privilege arrangements are intended to address concerns by clinicians that
information or data they provide may be attributed directly to them. Qualified
privilege addresses these concerns by encouraging health care professionals to
participate openly in quality assurance activities by:
ensuring the confidentiality of information that may identify individuals, either
directly or indirectly, where this information is provided solely as a result of a
declared quality assurance activity; and
protecting individuals from the risk of civil proceedings in relation to a
committee, whose members or a majority of the members are health professionals
that are the subject of a declared quality assurance activity.
When making a decision to accept a qualified privileged activity and thus a limitation
on the right to no interference with personal privacy, the Minister, or delegate of the
Minister, must be satisfied it is in the public interest to declare the activity on the
grounds that the activity will:
encourage participation in the activity, or in the case of an activity having
previously been undertaken, encourage participation to a greater extent than in
the previous activity; and
encourage acceptance, implementation and monitoring of any recommendations
which arise from the activity.
Each declaration of Qualified Privilege is a disallowable legislative instrument.
Conclusion
This Bill promotes Articles 6, 7(c) and 12 of the ICESCR and limits the rights in
Article 17(2) of the ICCPR. The limitation on the rights in Article 17(2) is confined
by legislated decision criteria and each declaration is a disallowable instrument. The
Bill is compatible with human rights.
The Hon Greg Hunt MP, the Minister for Health
5
HEALTH INSURANCE AMENDMENT (GENERAL PRACTITIONERS AND
QUALITY ASSURANCE) BILL 2020
NOTES ON CLAUSES
Clause 1 - Short Title
This clause provides that the Bill, once enacted, may be cited as the Health Insurance
Amendment (General Practitioners and Quality Assurance) Act 2020.
Clause 2 - Commencement
Subclause 2(1) provides that each provision of the HI Act specified in column 1 of the
table set out in the subclause commences or is taken to have commenced in
accordance with column 2 of the table. Sections 1 to 3 commence on the day this Act
receives Royal Assent. Schedule 1 commences 12 months after Royal Assent, unless
an earlier date is fixed by proclamation. Data analysis indicates 7,700 GPs may be
required to take some form of administrative action to update their registration details
with the MBA or apply for Medicare recognition with Services Australia.
Commencement 12 months after Royal Assent will provide time for these GPs to
comply with the new requirements and maintain their access to higher rebates.
Consequential amendments are also intended to be made to the HIR, to take effect at
the same time as the commencement of the amendments in Schedule 1 to this Act.
Schedule 2 commences on the day after this Act receives Royal Assent.
Clause 3 - Schedules
This clause provides that each Act that is specified in a Schedule to this Bill is
amended or repealed as set out in the applicable items in the Schedule concerned, and
any other item has effect according to its terms.
Schedule 1 amends the HI Act to provide a new definition GP as a medical
practitioner who is registered under the National Law in the specialty of general
practice which will make them eligible for access to higher Medicare rebates.
Prior to commencement, details of the grandfathering provisions to ensure continued
access to higher Medicare rebates will be included in the HIR.
Schedule 1 also aligns the definitions for medical practitioner, midwife, nurse
practitioner, optometrist, osteopath, chiropractor, dental practitioner, physiotherapist,
and podiatrist with the National Law.
Schedule 2 amends the definition of a 'quality assurance activity' in Part VC of the
Act, with the updated reference to the current FFRA, which is the current legislative
vehicle for Commonwealth payments to States and Territories for public hospital and
other healthcare services. The amendment provides for validation of declarations of
quality assurance activities made that involved the assessment or evaluation of public
hospital services that were not funded under the repealed Health Care (Appropriation)
Act 1998.
6
Schedule 1 - General Practitioners
Items 1, 3, 5, 6, and 8 to 13 Subsection 3(1) definitions
Items 1, 3, 5, 6, and 8 to 13 amend subsection 3(1) of the HI Act, to ensure definitions
of health practitioners are consistent with definitions of health practitioners regulated
under the National Law. Current definitions relating to health practitioners in the
HI Act refer to registration or "licencing" under a State and Territory law which have
been superseded by the National Law.
Item 2 Subsection 3(1) (definition of consultant physician)
Item 2 amends the definition of a consultant physician to exclude general practitioners
and prevent GPs accessing Medicare items that are the domain of specialties other
than general practice under the HI Act.
Item 4 Subsection 3(1) (definition of general practitioner)
Item 4 repeals the current definition of 'general practitioner' in subsection 3(1) and
substitutes a new definition. As a consequence of this amendment, sections 3EA and
3F of the HI Act are repealed (item 25 refers). The new definition of a 'general
practitioner' is (a) a medical practitioner who is registered under the National Law in
the specialty of general practice; or (b) a medical practitioner of a kind prescribed by
the HIR.
Paragraph (b) of the definition is intended to capture a medical practitioner who is not
on the MBA's specialist register as a specialist general practitioner. GPs who are not
registered as a specialist GP by the MBA but who are currently eligible for higher
rebates by virtue of being on the Vocational Register are intended to be defined in the
HIR.
Item 7 Subsection 3(1)
Item 7 provides a definition of the National Law in relation to a State or Territory as
the Health Practitioner Regulation National Law set out in the Schedule to the Health
Practitioner Regulation National Law Act 2009 (Qld) as it applies as a law of a State
or Territory. For Western Australia, the National Law is the Health Practitioner
Regulation National Law (WA) Act 2010 (WA) so far as it corresponds to the
Queensland Health Practitioner Regulation National Law.
Items 14, 16, and 23 Subsection 3(1) (definition of a specialist) and Subsection
3(1)
Items 14, 16, and 23 insert the words '(other than general practice)' after the words
'particular specialty', items 14, 16 and 23 insert the words '(other than general
practice)' to prevent GPs accessing Medicare rebates that are the exclusive domain of
other specialities under the HI Act.
Item 15 Subsection 3(1) (definition of vocationally registered general practitioner)
Item 15 repeals the definition of 'vocationally registered general practitioner' as there
will no longer be a Vocational Register of General Practitioners, as a consequence of
the new definition of general practitioner (refer to Item 4 and Item 25).
7
Items 17, 18 and 24 Paragraph 3D(2)(b), Subsection 3D(3) and Subsection
3DC(1) and 3E(1)
Items 17, 18 and 24 insert the words '(other than general practice)' after the word
'specialty', to prevent GPs accessing Medicare rebates that are the exclusive domain
of other specialities under the HI Act.
Item 19 Subsection 3D(5)
Item 19 inserts the words '(other than general practice)' after the words 'a specialty',
to prevent GPs accessing Medicare rebates that are the exclusive domain of other
specialities under the HI Act.
Item 20 Subsections 3DA(1) and (3)
Item 20 removes 'speciality under' and substitutes 'speciality (other than general
practice) under', to prevent GPs accessing Medicare rebates that are the exclusive
domain of other specialities under the HI Act.
Item 21 Subsections 3DB(1)
Item 21 removes 'speciality if' and substitutes 'speciality (other than general practice)
if', to prevent GPs accessing Medicare rebates that are the exclusive domain of other
specialities under the HI Act.
Item 22 Paragraph 3DB(1)(b)
Item 22 repeals paragraph (1)(b) and substitutes '(b) the medical practitioner is
registered under the National Law as a specialist in a particular specialty (other than
general practice', to prevent GPs accessing Medicare rebates that are the exclusive
domain of other specialities under the HI Act.
Item 25 Sections 3EA, 3EB, 3F, 3G and 3H
Item 25 repeals the following sections of the HI Act:
Section 3EA: 'Recognised Fellows of the Royal Australian College of General
Practitioners'
Section 3EB: 'Revocation of determinations'
Section 3F: 'Vocationally registered general practitioners'
Section 3G: 'Removal from the register'
Section 3H 'References to RACGP may be varied'
The HI Act currently contains three pathways to recognition as a general practitioner:
(a) a medical practitioner in respect of whom a determination under section 3EA is
in force (holds fellowship with the RACGP); or
(b) a person registered under section 3F as a vocationally registered general
practitioner; or
(c) a medical practitioner of a kind specified in the HIR.
Under the NRAS, the MBA and Ahpra are responsible for maintaining a public
register of health practitioners regulated under the NRAS. This Ahpra register
provides information on those practitioners who hold registration in the specialty of
general practice with the MBA and will be used to determine a GP's access to
Medicare rebates. As a consequence of the new definition of a 'general practitioner'
provided in the Bill, the Chief Executive Medicare will no longer be required to make
determinations in relation to a GP, simplifying processes for specialist recognition as
a general practitioner for Medicare purposes. There will be no need for Services
8
Australia to liaise with bodies like the RACGP and ACRRM and instead will rely on
the Ahpra public register to determine eligibility to access higher Medicare rebates.
This is consistent with other specialities under the National Law.
In 2010, the MBA transitioned those practitioners who were vocationally registered
general practitioners to appear on the public register as specialists without fellowship
of the RACGP or ACRRM.
There are small groups of medical practitioners who may be affected by these changes
and who are intended to be dealt with in the HIR, through grandfathering provisions
or transitional provisions. The intention of these provisions is that no medical
practitioner who currently has access to higher rebates will be disadvantaged. The
Vocational Register of General Practitioners provides for medical practitioners from
1989 to 1996 who worked predominately in general practice and whom the RACGP
certifies have met CPD requirements to be vocationally registered to allow access to
higher rebates. The second cohort of practitioners' post 1996 must additionally hold
fellowship of the RACGP or ACRRM.
Grandfathering and transitional provisions are intended to be included in the HIR for
the purposes of the definition of a general practitioner under subsection 3(1) of the HI
Act (Item 4 refers) will include a medical practitioner who:
a) holds registration with the MBA;
b) has been previously approved by the General Practice Recognition Eligibility
Committee to be placed on the vocational register; and
c) has met minimum requirements for taking part in CPD activities for the 2017-19
triennium which are the requirements for specialist GP registration under the
NRAS.
Section 3H is also repealed as a consequence of the repeal of sections 3EA, 3EB, 3F,
and 3G that has made section 3H redundant.
Items 26 to 28 and 30 Paragraphs 19AA(1)(a) and (2)(a), Subsections 19AA(4),
Subsection 19AA(5) (definition of intern) and Subsections 19AB(1) and (2)
Items 26 to 28 and 30 amend paragraphs 19AA (1)(a) and (2)(a), subsection 19AA(4),
the definition of intern under subsection 19AA(5) and subsections 19AB(1) and (2) to
insert 'registered' as a consequence of the amendments under Items 29 and 31 below,
to provide for when a registered medical practitioner (refer to item 29 and 31) is not
eligible for a Medicare benefits under 19AA and 19AB.
Items 29 and 31 Subsection 19AA(5) and Subsection 19AB(7)
Items 28 and 30 insert a definition of 'registered medical practitioner' in sections
19AA and 19AB.
Section 19AA provides that a Medicare benefit is not payable in respect of a
professional service rendered by a specified medical practitioner. Section 19AB
provides that a Medicare benefit is not payable in respect of a professional service by
a person who is an overseas trained doctor or who is a foreign graduate of an
accredited medical school, subject to certain exemptions.
These amendments protect current arrangements in restricting access to general
practice Medicare rebates by applying a specific definition of 'registered medical
9
practitioner' which only applies to sections 19AA and 19AB of the HI Act. A medical
practitioner referred to in these sections is either registered under the National Law or
registered or licensed as a medical practitioner under a law of a State or Territory that
provided for the registration or licensing of medical practitioner before the
commencement of the National Law. This definition is necessary as these provisions
cover periods prior to the commencement of the National Law.
Item 32 Subsection 19C(2)
Item 32 repeals subsection 19C(2) which provides for the definition of 'practitioner's
licence', because a medical practitioner is now required to be registered under the
National Law.
Item 33, 34 and 35 Paragraphs 19C(3)(a) and (b), Paragraphs 19C(4)(a) and (b)
and Paragraphs 19CB(1)(a) and (b)
Section 19C provides that a Medicare benefit is not payable where the medical
practitioner in question is not authorised to render a service, or authorised only in
circumstances specified in their registration to render that service and renders such
services in other circumstances. Section 19C allows the Minister to make a direction
to allow for the payment of a Medicare benefit in relation to the rendering or a
particular service even though the person rendering the service is not authorised or
authorised only to provide the services in particular circumstances and has provided
the service in other circumstances.
Section 19CB provides that it is an offence for a medical practitioner to render a
service not authorised by his or her registration as a medical practitioner.
Consistent with the amendments relating to the registration of a medical practitioner
under the National Law, items 33, 34 and 35 repeal paragraphs 19C(3)(a) and (b),
paragraphs 19C(4)(a) and (b) and paragraphs 19CB(1)(a) and (b), and substitute them
with amended paragraphs to now refer to registration under the National Law and
authorisation (or no authorisation) under the medical practitioner's registration under
the National Law to render a particular professional service. The current paragraphs
refer to licenses granted under a State or Territory law.
Item 36 Subsection 19CB(1)
Item 36 removes the words 'in that State and Territory' as this is no longer referred to
in paragraphs 19CB(1)(a) and (b) (refer Item 35) which now refers to registration
under the National Law as the source of the authorisation to render a professional
service for the purposes of Medicare.
Item 37 Paragraph 19CB(1)(d)
Item 37 is a minor technical amendment as a consequence of the changes to refer to
the registration of a medical practitioner under the National Law. Item 36 omits the
term 'the practitioner's licence' and replaces this term with 'the practitioner's
registration' under the National Law.
Item 38 Subsection 19CB(3)
Item 38 repeals subsection (3) and substitutes a new subsection (3) that refers to
authorisation under the medical practitioner's registration to render a particular
professional service under the National Law. The current subsection refers to a
practitioner's licence which under state and territory law is no longer relevant.
10
Item 39 Subsection 19DA(1)
Item 39 repeals subsection 19DA(1) as the definition of 'deregistered practitioner' is
now provided in subsection (2) (refer item 41).
Item 40 Subsection 19DA(2)
Item 40 repeals subsection (1) at item 39 and replaces it with subsection 19DA as sub
paragraph (1). Item 38 repeals subsection 19DA(1) and item 40 renames the current
s19DA(2) as 19DA(1) as a consequence.
Item 41 At the end of section 19DA
Section 19DA of the HI Act provides that a deregistered medical practitioner or a
person acting on his or her behalf must not render any medical service to which an
item relates, unless the practitioner (or a person acting on his or her behalf) takes
reasonable steps to inform the patient (or the patient's carer) that a Medicare benefit
would not be payable in respect of the medical service.
Item 41 adds a new subsection (2) that provides for a new definition of 'deregistered
practitioner' to recognise registration under the National Law. The deregistered
practitioner is a medical practitioner who was previously registered as a medical
practitioner under the National Law but is not currently registered under the National
Law at the particular time. For example, the registration of the particular practitioner
may have been revoked under the National Law.
Item 42 At the end of section 20
Item 42 adds a new subsection (7) that provides for a definition of 'general
practitioner' under Section 20 which was previously defined in the HIR. This
definition is used to determine what constitutes a GP for the purpose of the 90 day
Pay Doctor Via Claimant (PDVC) arrangements. The definition of 'general
practitioner' includes vocationally registered GPs, GP trainees, and other medical
practitioners working in GP practice (overseas trained doctor and domestic trained
doctors who registered prior to 1996 and did not pursue vocational training). The
definition in the HIR will be repealed.
Items 43 and 44 Paragraph 93(8)(b) and Subsection 93(8)
Section 93 of the HI Act authorises the Director of the Professional Services Review
Panel to set up a Committee in accordance with Division 4 of Part VAA of the Act
and make a referral to the Committee to investigate whether a person under review
engaged in inappropriate practice in providing the services specified in the referral.
Subsection 93(8) requires the Director to include in the referral any statement of his or
her concerns that was sent to a person or body under section 106XA or section 106XB
arising from opinions that the Director formed in the course of the review. The
concern can be that any conduct by the person under review caused or was causing, or
was likely to cause a significant threat to life or health of any person (paragraph
93(8)(a) and section 106XA), or that the person failed to comply with professional
standards (paragraph 93(8)(b) and section 106XB).
Item 43 substitutes 'body' for 'bodies,' and item 44 substitutes 'the person, body or
bodies' for 'the person or body,' to recognise that there may be more than one
appropriate body specified in the regulations for new subsection 106XB(3) (see Item
46).
11
Item 45 and 46 Paragraphs 106XB(2)(c) and (d) and Subsection 106XB(3)
Division 5A of Part VAA of the HI Act relates to the referral of professional issues to
regulatory and other bodies. Subsection 106XB(1) requires a Committee or the
Determining Authority to give to the Director of the Professional Services Review a
written statement of its concerns if it forms the opinion that a practitioner under
review failed to comply with professional standards. Materials or copies of materials
on which the opinion was based are also provided with the written statement. The
Director must send the statement to the 'appropriate body'.
Similarly, under subsection 106XB(2), if the Director forms the opinion that a
practitioner under review has failed to comply with professional standards, the
Director must prepare a statement of his or her concerns, attach to the statement
materials or copies of materials on which his or her concerns were based and send that
statement with the attached documents to the 'appropriate body'.
Item 46 repeals the current subsection 106XB(3) and substitutes a new subsection
providing for the appropriate body or bodies, who would need to be advised when a
registered practitioner fails to comply with professional standards for the National
Law, to be specified by the regulations. Item 45 substitutes 'body' for 'bodies' to
recognise that there may be more than one appropriate body specified in the
regulations for new subsection 106XB(3).
Item 47 Subsection 130(5C) and (5D)
Section 130 prohibits a specified person to make records of, or divulge or
communicate to any person any information with respect to the affairs of another
person acquired by the first person in the performance of his or her duties or in the
exercise of his or her powers or functions under the HI Act, subject to certain
exemptions.
Item 47 repeals sub-sections 130(5C) and (5D) as these provisions refer to the
RACGP and are now redundant because of the repeal of sections 3F and 3G
(Item 24 refers).
Item 48 and 49 Paragraph 130(6)(e) to (eb), Paragraphs 130(7)(c) to (cb)
Items 48 and 49 repeal the paragraphs (6) to (eb) in subsections (6) and (7)
respectively, and replace with amended paragraphs that refer to the registration of the
specified healthcare professionals under the National Law as defined in subsection
3(1) as amended.
Item 50 At the end of paragraphs 130(7)(e), (f) and (fa)
Item 50 adds the word 'or' at the end of sections 130(7)(e), (f) and (fa). This is a
technical amendment.
Item 51 Paragraphs 130(7)(g) to (gb)
Item 51 repeals paragraphs 130(7)(g) to (gb) and substitutes a new paragraph (g) to
refer to and specifically recognise requirements under the National Law applying to
these health practitioners as defined under the amended definitions under subsection
3(1) of the HI Act.
12
Item 52 Paragraph 130(9)(c)
Item 52 is a consequential amendment and omits references to repealed paragraphs in
subsections 130(6) and (7) and reflects amendments implemented by new paragraphs
130(6)(e) and (7)(g) (Items 48 and 51 refer).
Item 53 Paragraph 130(9)(c)
Item 53 is a consequential amendment and omits the words 'law referred to in that
paragraph' and substitutes with the words 'National Law' to specifically refer to the
National Law, consistent with the changes made under subsection 3(1) relating to the
definitions of healthcare practitioners.
Part 2 - Application Provisions
Item 54 Alternative method of recognition as a specialist or consultant physician
The Bill amends section 3DB to exclude from its operation a specialist in general
practice and provide that registration requirements for a medical practitioner applying
for a determination by the Minister of Health are those applying under the National
Law (refer to Items 21 to 23). Item 52 provides that section 3DB as amended applies
in relation to an application that is made before, on or after the commencement of this
Schedule. Thus on commencement, applications by a medical practitioner to be
recognised as a specialist GP under section 3DB, that are made before, on or after the
commencement of Item 54 will no longer be within the scope of section 3DB and the
Minister will not have the power to make that particular determination.
Item 55 Divulging of certain information
Item 55 provides that section 130 of the HI Act as amended by Schedule 1, applies in
relation to information acquired before, on or after the commencement of this
Schedule (that is, commencement of amendments made to section 130 of the HI Act).
This is a consequential amendment to ensure there are no gaps in the powers to share
information directly at hand or acquired prior to the Schedule 1 updates to reflect
changes under the National Law.
Part 3 - Repeals
Item 56 repeals the Health Practitioner Regulation (Consequential Amendments) Act
2010 (the Consequential Amendments Act).
In May 2010, the Australian Parliament passed the Consequential Amendments Act.
Schedule 1 of the Consequential Amendments Act amends the HI Act to make
references to categories of medical practitioners under the HI Act consistent with the
arrangements under the National Law. Schedule 1 of the Consequential Amendments
commences on a day to be fixed by Proclamation
.
Due to complexities in ensuring translation of HI Act specialties and consultant
physician categories with MBA specialties and the costs of Services Australia system
changes, Schedule 1 of the Consequential Amendments Act was not proclaimed.
Schedule 1 of the Bill will align GP recognition for Medicare rebates with NRAS
requirements, reducing red tape for GPs and Services Australia.
Aligning of the other medical specialties with MBA specialties is proposed to occur at
a later date, after successful completion of the GP changes and engagement with
relevant stakeholders.
13
The Bill will implement the changes proposed in the Consequential Amendments Act
for general practitioners making the unproclaimed Consequential Amendments
outdated and redundant.
Schedule 2 - Quality assurance confidentiality
Part 1 - Amendments
Item 1 Subsection 124W(1) (subparagraph (a)(iii) of the definition of quality
assurance activity)
Repeals subsection 124W(1) subparagraph (a)(iii) to substitute the outdated reference
to 'the former Health Care (Appropriation) Act 1998' with the correct reference to
hospital services funded by the Commonwealth through Part 3A of the FFRA.
This item removes the ambiguity by making it clear that an assessment or evaluation
of public hospital related services that received payments, or are eligible to receive
payments under the FFRA, are specifically included in the definition of a quality
assurance activity.
Part 2 - Validation
Item 2 Validation of declarations
Subsection (1) ensures that activities declared on or after 1 July 2009 are taken to
have been valid declarations if at the time the declaration was made, it was a quality
assurance activity within the meaning of subsection 124W(1) of the HI Act, as
amended by this bill.
Subsection (2) ensures the validity of any existing declarations made under the
provisions of the HI Act is not affected by the outdated reference to the former Health
Care (Appropriation) Act 1998 remaining in the definition of a quality assurance
activity, before that reference was corrected by this bill.
This item is retrospective in its application because the delay in amending item 1 to
reference the correct legislation is an administrative delay. Participants of the QPS
believe in good faith that their declarations are valid and it was the Commonwealth's
intention that they be so. There has been no breach of privacy in relation to public
disclosure in the period on or after 1 July 2009.
Item 3 Compensation for acquisition of property
Item 3 applies in the event that the validation provision at item 2 would result in an
acquisition of property from a person otherwise than on just terms, the
Commonwealth is liable to pay that person a reasonable amount of compensation. If
the Commonwealth and the person do not agree on the amount of the compensation,
the person may institute court proceedings for the recovery from the Commonwealth
of such reasonable amount of compensation as the court determines.
14