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2019-2020
THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA
HOUSE OF REPRESENTATIVES
HEALTH INSURANCE AMENDMENT (CONTINUING THE OFFICE OF
THE NATIONAL RURAL HEALTH COMMISSIONER) BILL 2020
EXPLANATORY MEMORANDUM
(Circulated by authority of the Minister for Regional Health, Regional
Communications and Local Government, the Hon Mark Coulton MP)
HEALTH INSURANCE AMENDMENT (CONTINUING THE OFFICE OF
THE NATIONAL RURAL HEALTH COMMISSIONER) BILL 2020
OUTLINE
The National Rural Health Commissioner Office (the Office) is currently due to cease
on 1 July 2020. The Bill amends the Health Insurance Act 1973 (the HIA) to
continue the Office and amend the functions of the Office.
It is essential that the Office continues to function to give rural communities
confidence that the enduring challenges of health workforce shortages, higher burden
of disease, and the ever present threat of external shocks such as droughts and
bushfires, are central to health policy formulation and implementation.
The new Office will be a key source of advice to the Minister, the Department of
Health and other agencies in the development of policies and programs. It will take a
strategic view of rural-focused initiatives, ensuring they are joined up and
complementary. The new Office will provide practical implementation support to
Government initiatives - guiding them to work efficiently, effectively and predictably
to deliver their intended outcomes for rural health professionals and communities.
The Office will have the capacity to undertake projects to improve rural health access,
sustainability and quality. In undertaking projects, the Office will have a strong
outcomes focus, considering the practical implementation aspects of reform proposals.
Building on the success of the Office since 2017, the new Office will have the
capacity to conduct evidence-based research into issues relating to rural health,
providing Government insights from the sector, lived experience of communities and
individuals, and evidence from academic and other literature. The Office's strong
research capacity will enable it to provide robust, cutting-edge advice to Government.
The Office will drive innovation in policy and delivery. This will include an initial
focus on co-design of implementable primary care models that respond to the specific
challenges faced by rural communities, assisting Government to identify opportunities
for practical trials, to be evaluated by the Office.
The new Office will be able to take a broader perspective in providing advice and
support to Government. It will consider the entire health workforce - medical,
nursing, allied health and all other health workforce members - in its work. The
Office will have a key role in strengthening the rural training pathway, considering
innovations to achieve a sustainable and accessible workforce, and will have patient
needs at the heart of its work.
The Office will continue to support Government's commitment to progress the Rural
Generalist Pathway, in addition to contributing to significant reforms already
underway in the Health portfolio including Primary Health Care Reform, development
of the National Medical Workforce Strategy and supporting consideration of the
outcomes of the Review of the Rural Health Multidisciplinary Training Program.
In taking a broader focus to its work, an expanded Office will incorporate non-
statutory Deputy Commissioners, who will play a critical role supporting the National
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Rural Health Commissioner and will enable the Office to have expertise across a
range of vital rural health disciplines, including nursing, allied and Indigenous Health.
The team based approach will ensure the Office is well placed to provide guidance on
best practice, multidisciplinary approaches for improving regional, rural and remote
health outcomes.
The Office will:
a) provide advice to the Rural Health Minister about matters relating to health in
rural, regional and remote areas, including in relation to:
(i) developing, aligning and implementing Commonwealth strategies, priorities or
measures so as to improve health outcomes in those areas; and
(ii) developing and promoting innovative and integrated approaches to the
delivery of health services in those areas so as to improve the quality and
sustainability of, and access to, health services in those areas; and
(iii) identifying opportunities to strengthen and align health workforce training in
those areas; and
(iv) strengthening and promoting regionally-based, patient-centred approaches to
the delivery of health services in those areas that take into account the needs of
the communities, families and individuals in those areas;
b) undertake projects specified by the Rural Health Minister.
c) inquire into and report on matters specified by the Rural Health Minister.
d) support the implementation of Commonwealth strategies, priorities and measures
for improving the quality and sustainability of, and access to, health services in
those areas.
e) undertake research, and collect, analyse, interpret and share information, about
approaches for improving the quality and sustainability of, and access to, health
services in those areas.
f) consult with stakeholders about matter relating to health in rural, regional or
remote areas.
g) build and maintain effective working relationships with the persons, groups and
bodies referred to in (f).
Additional functions relating to regional, rural and remote health are able to be
conferred on the National Rural Health Commissioner by legislative instrument. This
will enable the National Rural Health Commissioner to be tasked with taking a more
active role in implementing rural health initiatives, delivering on-the-ground change
to support communities.
The Office will be reviewed after five years of operation to assess its effectiveness
and achievements, and to identify the appropriateness or required improvements to
legislated functions, operations and governance.
The amendments in the Bill are required to enable the extension of the Office and
continued appointment of a National Rural Health Commissioner as an independent
statutory office position under the HIA. Statutory authority will assure stakeholders
that the Office is protected as an independent body that will advise Government.
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This continues the 2016 election commitment to establish a National Rural Health
Commissioner and builds on the $550 million Stronger Rural Health Strategy
investment, the National Medical Workforce Strategy, Primary Health Care Reform
and changes to the training system to provide more opportunities to work and train
rurally. Work to develop innovative models of care will build on the Office's
achievements to date, which have included delivering advice on establishing a
National Rural Generalist Pathway and advice on improving the accessibility, quality
and distribution of rural allied health services.
Financial Impact Statement
The financial impact of extending the Office is cost neutral, funded from existing
program funding.
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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 (CONTINUING THE OFFICE OF
THE NATIONAL RURAL HEALTH COMMISSIONER) 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 Office of the National Rural Health Commissioner (the Office) currently has a
sunset date of 1 July 2020. The Bill amends the Health Insurance Act 1973 (the HIA)
to continue the Office and to amend its functions.
The Office will:
a) Provide independent and impartial advice to the Minister about matters relating to
health in rural, regional and remote areas, including in relation to:
(i) Developing, aligning and implementing Commonwealth strategies, priorities
or measures so as to improve health outcomes in those areas; and
(ii) Developing and promoting innovative and integrated approaches to the
delivery of health services in those areas so as to improve the quality and
sustainability of, and access to, health services in those areas; and
(iii) Identifying opportunities to strengthen and align health workforce training in
those areas; and
(iv) Strengthening and promoting regionally-based, patient-centred approaches to
the delivery of health services in those areas that take into account the needs of
the communities, families and individuals in those areas.
b) Undertake projects specified by the Rural Health Minister.
c) Inquire into and report on a matter specified by the Rural Health Minister.
d) Support the implementation of Commonwealth strategies, priorities and measures
for improving the quality and sustainability of, and access to, health services in
those areas.
e) Undertake research, and collect, analyse, interpret and share information, about
approaches for improving the quality and sustainability of, and access to, health
services in those areas.
f) Consult with stakeholders about matter relating to health in rural, regional or
remote areas.
g) Build and maintain effective working relationships with the persons, groups and
bodies referred to in (f).
Human rights implications
This Bill promotes the right to health, as contained in article 12(1) of the International
Covenant on Economic Social and Cultural Rights (ICESR). The World Health
Organisation constitution states that 'the right to health includes access to timely,
acceptable, and affordable health care of appropriate quality'.
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Data shows that people living in rural and remote areas have higher rates of
hospitalisation, mortality, injury and poorer access to, and use of, health care services
compared with those living in metropolitan areas.
In recognition of this, it is essential that the National Rural Health Commissioner
Office continues, so that it can place rural and remote issues at the forefront of
Government decision making. The Office, through its key functions will improve the
right of access for rural communities to a variety of health services, programs and
conditions necessary for the highest attainable standard of health. A key function will
involve identifying opportunities to strengthen health workforce training in rural,
regional and remote areas, contributing to strengthening Australia's rural training
pipeline. A practical focus of this will include supporting the delivery of a National
Rural Generalist Pathway.
The Office will consider the wide range of socio-economic factors that promote
conditions in which people can lead a healthy life, including the underlying
determinants of health, such as food and nutrition, housing, and safe working
conditions.
The continuation of the Office is compatible with human rights legislation and will
provide an informed and independent mechanism to facilitate access to the right
medical professionals, with the right skills, in the right place at the right time.
Conclusion
This Bill is compatible with human rights and promotes the right to health.
The Hon Mark Coulton MP, Minister for Regional Health, Regional
Communications and Local Government
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HEALTH INSURANCE AMENDMENT (CONTINUING THE OFFICE OF
THE NATIONAL RURAL HEALTH COMMISSIONER) BILL 2020
NOTES ON CLAUSES
Clause 1 - Short Title
Clause 1 provides for the short title of the Act to be the Health Insurance Amendment
(Continuing the Office of the National Rural Health Commissioner) Act 2020.
Clause 2 - Commencement
Subclause 2(1) provides that each provision of the Act specified in column 1 of the
table commences or is taken to have commenced in accordance with column 2 of the
table. Any other statement in column 2 of the table has effect according to its terms.
The commencement will be the later of immediately after the commencement of
Schedule 2 to the Health Insurance Amendment (National Rural Health
Commissioner) Act 2017; and the day this Act receives Royal Assent.
Subclause 2(2) provides that any information in column 3 of the table is not part of
the Act. It also clarifies that any information may be inserted in column 3, or
information in it may be edited, in any published version of the Act.
Clause 3 - Schedule(s)
This clause provides that legislation that is specified in a Schedule to this Act is
amended or repealed as set out in the applicable items in the Schedule concerned, and
any other item in a Schedule to this Act has effect according to its terms. Schedule 1
amends the Health Insurance Act 1973 (HIA) to continue the statutory position of the
National Rural Health Commissioner.
SCHEDULE 1 -- National Rural Health Commissioner
Health Insurance Act 1973
Item 1 - Subsection 3(1)
This item inserts in subsection 3(1) of the HIA definitions clarifying that paid work
means work for financial gain or reward (whether as an employee, self-employed
person or otherwise); and Rural Health Minister means the Minister responsible for
health in rural, regional or remote areas.
Item 2 - Before Part VAA
This item inserts a new part to the HIA 'Part VA - National Rural Health
Commissioner'.
79AA Object of this Part
Subsection 79AA provides that the object of this Part is to establish the National
Rural Health Commissioner (the Commissioner) to assist in improving health
outcomes in rural, regional and remote areas, particularly in relation to improving the
quality and sustainability of, and access to, health services in those areas.
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79AB Simplified outline of this Part
Subsection 79AB provides a simplified explanation of the Bill noting that the
Commissioner will provide advice to the Rural Health Minister about matters relating
to health in rural, regional and remote areas; undertake specified projects about those
matters; inquire into and report on specified aspects of those matters; support the
implementation of Commonwealth strategies, priorities and measures; consult with a
broad range of rural, regional and remote stakeholders about those matters; build and
maintain effective working relationships with these stakeholders ; and other functions
conferred on the Commissioner by a Commonwealth law.
The Commissioner must perform those functions in an independent and impartial
manner.
The Rural Health Minister must cause an independent review of the Office within six
months of the fifth anniversary of the Office commencing.
79AC National Rural Health Commissioner
Subsection 79AC provides that a Commissioner position is to be established.
79AD Functions of the National Rural Health Commissioner
Subsection 79AC(1) provides that the functions of the Commissioner are:
(a) to provide advice to the Rural Health Minister about matters relating to health in
rural, regional or remote areas, including in relation to:
(i) developing, aligning and implementing Commonwealth strategies, priorities or
measures so as to improve health outcomes in those areas; and
(ii) developing and promoting innovative and integrated approaches to the
delivery of health services in those areas so as to improve the quality and
sustainability of, and access to, health services in those areas; and
(iii) identifying opportunities to strengthen and align health workforce training in
those areas; and
(iv) strengthening and promoting regionally-based, patient-centred approaches to
the delivery of health services in those areas that take into account the needs of
the communities, families and individuals in those areas;
(b) to undertake projects specified by the Rural Health Minister under subsection (3);
(c) to inquire into and report on matters specified by the Rural Health Minister under
subsection (4);
(d) to support the implementation of Commonwealth strategies, priorities and
measures for improving the quality and sustainability of, and access to, health
services in those areas;
(e) to undertake research, and to collect, analyse, interpret and share information,
about approaches for improving the quality and sustainability of, and access to,
health services in those areas;
(f) to consult with the following persons, groups and bodies about matters relating to
health in those areas:
(i) health professionals;
(ii) State and Territory governmental bodies;
(iii) industry, non-profit and other community groups;
(iv) other health stakeholders;
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(g) to build and maintain effective working relationships with the persons, groups
and bodies referred to in paragraph (f);
(h) to perform any function conferred on the Commissioner under a law of the
Commonwealth.
Subsection 79AD(2) provides that the Commissioner must perform those functions in
an independent and impartial manner.
Subsection 79AD(3) provides that for the purposes of paragraph (1)(b), the Rural
Health Minister may give a written notice to the Commissioner requesting that they
undertake a project that relates to health in rural, regional or remote areas; and is
specified in the notice; and completes the project within the timeframe specified in the
notice.
Subsection 79AD(4) provides that for the purposes of paragraph (1)(c) that the Rural
Health Minister may give a written notice to the Commissioner requesting the
Commissioner to inquire into a matter that related to health in rural, regional or
remote areas; and is specified in notice; and give a written report on the matter to the
Rural Health Minister within the timeframe specified in the notice. .
Subsection 79AD(5) provides that the Commissioner must comply with a notice given
under subsection (3) or (4).
Subsection 79AD(6) provides that the written notice is not a legislative instrument.
This subsection is declaratory of the law and does not represent an exclusion from the
requirements of the Legislation Act 2003.
Subsection 79AC(7) provides that as additional functions, the Rural Health Minister
may by legislative instrument, confer on the Commissioner a function that relates to
health in rural, regional or remote areas.
79AE Keeping the Rural Health Minister Informed
Subsection 79AE(1) provides that the Commissioner must keep the Rural Health
Minister informed of the activities of the Commissioner and provide the Rural Health
Minister with any information specified under subsection 79AE(2).
Subsection 79AE(2) provides that for the purposes of paragraph (1)(b)the Rural
Health Minister may issue a written notice to the Commissioner requesting that the
Commissioner provides information relates to the Commissioner's activities; and is
specified in the notice; and is provided to the Rural Health Minister within the
timeframe specified in the notice.
Subsection 79AE(3) provides that the Commissioner must comply with a notice given
under subsection 79AE(2).
Subsection 79AE(4) clarifies that a notice under subsection 79AE(2) is not a
legislative instrument. This subsection is declaratory of the law and does not represent
an exclusion from the requirements of the Legislation Act 2003.
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79AF Appointment
Subsection 79AF(1) provides that the Commissioner is to be appointed by the Rural
Health Minister by written instrument, on a full-time basis or a part-time basis.
A note under Subsection 79AF(1) provides that the Commissioner may be re-
appointed, as provided for by section 33AA of the Acts Interpretation Act 1901.
Subsection 79AF(2) provides that the Commissioner will hold the term of office for
the period specified in the instrument. The period must not exceed 2 years.
Subsection 79AF(3) provides a person is only eligible to be appointed as the
Commissioner if the person has experience in rural health. Experience in rural health
may include time practising as a health professional in a rural area; having extensive
knowledge/academic research of rural health issues or other relevant experience in
rural health able to be demonstrated.
79G Acting appointments
Subsection 79AG provides that the Rural Health Minister may, by written instrument,
appoint a person to act as the Commissioner on a full time or part time basis. This is
during a vacancy in the office of the Commissioner (whether or not an appointment
has previously been made to the office); or during any period, or during all periods,
when the Commissioner is absent from duty or from Australia or is for any reason
unable to perform the duties of the office.
A note under Subsection 79AG provides that for rules applying to acting
appointments, see sections 33AB and 33A of the Acts Interpretation Act 1901.
79AH Terms and Conditions
Subsection 79AH provides that the Commissioner holds office on the terms and
conditions (if any) in relation to matters not covered by this Part that are determined
by the Rural Health Minister.
79AI Remuneration
Subsection 79AI(1) provides that the Commissioner is to be paid the remuneration
that is determined by the Remuneration Tribunal. If no determination of that
remuneration by the Tribunal is in operation, the Commissioner is to be paid the
remuneration that is prescribed by the instrument under subsection (4).
Subsection 79AI(2) provides that the Commissioner is to be paid the allowances that
are prescribed by the instrument under subsection (4).
Subsection 79AI(3) provides that this section has effect subject to the Remuneration
Tribunal Act 1973.
Subsection 79AI(4) provides that the Rural Health Minister may, by legislative
instrument, prescribe remuneration for the purposes of subsection (1) and allowances
for the purposes of subsection (2).
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79AJ Leave of Absence
Subsection 79AJ(1) provides that if the Commissioner is appointed on a full-time
basis, he or she has the recreation leave entitlements that are determined by the
Remuneration Tribunal.
Subsection 79AJ(2) provides that if the Commissioner is appointed on a full time
basis, the Rural Health Minister may grant him or leave of absence, other than
recreation leave, on the terms and conditions as to remuneration or otherwise that the
Rural Health Minister determines.
Subsection 79AJ(3) provides that if the Commissioner is appointed on a part-time
basis, the Rural Health Minister may grant him or leave of absence on the terms and
conditions that the Rural Health Minister determines.
79AK Other paid work
Subsection 79AK(1) provides that if the Commissioner is appointed on a full-time
basis, he or she must not engage in paid work outside the duties of his or her office
without the Rural Health Minister's approval.
Subsection 79AK(2) provides that if the Commissioner is appointed on a part-time
basis, he or she must not engage in any paid work that, in the Rural Health Minister's
opinion, conflicts or could conflict with the proper performance of his or her duties.
79AL Resignation
Subsection 79AL(1) provides that the Commissioner may resign his or her
appointment by notifying the Rural Health Minister in writing.
Subsection 79AL(2) provides that the resignation takes effect on the day it is received
by the Rural Health Minister or, if a later day is specified in the resignation, on that
later day.
79AM Termination of appointment
Subsection 79AM(1) provides that the Rural Health Minister may terminate the
Commissioner's appointment for misbehaviour; or if the Commissioner is unable to
perform his or her duties because of physical or mental incapacity.
Subsection 79AM(2) provides that the Rural Health Minister may terminate the
appointment of the Commissioner if he or she:
(i) becomes bankrupt; or
(ii) applies to take the benefit of any law for the relief of bankrupt or insolvent
debtors; or
(iii) compounds with his or her creditors; or
(iv) makes an assignment of his or her remuneration for the benefit of his or her
creditors; or
(v) if the Commissioner is appointed on a full-time basis--the Commissioner is
absent, except on leave of absence, for 14 consecutive days or for 28 days in any
12 months; or
(vi) if the Commissioner is appointed on a full-time basis--the Commissioner
engages, except with the Rural Health Minister's approval, in paid work outside
the duties of his or her office [see subsection 79AK(1)];
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(vii) if the Commissioner is appointed on a part-time basis--the Commissioner
engages in paid work that, in the Rural Health Minister's opinion, conflicts or
could conflict with the proper performance of his or her duties [see subsection
79AK(2)];
(viii) the Commissioner fails, without reasonable excuse, to comply with section
79AN.
79AN Disclosure of interests
Subsection 79AN provides that the Commissioner must disclose to the Rural Health
Minister the details of any direct or indirect financial or monetary interests that the
Commissioner has or acquires that conflict or could conflict with the proper
performance of the National Rural Health Commissioner's functions.
This would include, for example, notification of any interests in, including financial
interests or membership of a rural health professional/peak body. It would include if
the Commissioner provides clinical based health services in a rural area.
79AO Application of the finance law
Subsection 79AO(1) provides that for the purposes of the finance law, as meant by the
Public Governance, Performance and Accountability (PGPA Act), the Commissioner
is an official of the Department.
A note under subsection 79AO(1) provides that the Commissioner's responsibilities
as an official under finance law include duties in relation to exercising due care and
diligence, acting in good faith and for a proper purpose, and not misusing information
or position. The note refers to Division 3, of Part 2-2 of the PGPA Act.
Subsection 79AO(2) provides that section 29 of the PGPA Act dealing with the duty
to disclose interests does not apply to the Commissioner.
A note under subsection 79AO(2) provides that section 29 of the PGPA Act does not
apply to the Commissioner because a duty is imposed on the Commissioner under
subsection 79AN of the HIA.
79AP Annual report
Subsection 79AP(1) provides that the Commissioner must prepare and give to the
Rural Health Minister, for presentation to the Parliament, an annual report on the
Commissioner's activities during the previous financial year.
A note at the end of 79AP(1) draws the reader's attention to section 34C of the Acts
Interpretation Act 1901 which provides additional rules regarding annual reports.
Subsection 79AP(2) provides that the annual report must contain the details of the
Commissioner's activities during the reporting period, and any other matters that the
Rural Health Minister would direct the Commissioner to include in the report under
subsection 79AQ.
Subsection 79AP(3) provides that the report must be given to the Rural Health
Minister by the 15th day of the fourth month after the end of the reporting period, or
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the end of any further period granted under subsection 34C(5) of the Acts
Interpretation Act 1901.
Subsection 79AP(4) provides that the report may be included in a report prepared in
relation to the Department and given to the Minister administering the Health
Insurance Act under section 46 of the PGPA Act 2013.
79AQ Minister may give directions to the National Rural Health Commissioner
Subsection 79AQ(1) provides that the Rural Health Minister may, by notifiable
instrument, give written directions to the Commissioner about the performance of the
Commissioner's functions; and matters to be included in the report under section
79AP.
Subsection 79AQ(2) provides that the Commissioner is obliged to comply with a
direction provided by the Rural Health Minister under 79AQ(1).
79AR Assistance from APS employees
Subsection 79AR(1) provides that the Secretary of the Department of Health may
enter into an arrangement with the Commissioner for the services of APS employees
in the Department to be made available to assist the Commissioner.
Subsection 79AR(2) provides that staff made available to the Commissioner under
arrangements made between the Commissioner and the Secretary will be subject to
the directions of the Commissioner.
79AS Review of the operation of this Part
Subsection 79AS(1) provides that the Rural Health Minister must cause an
independent review of the work of the Commissioner within six months after the fifth
anniversary of the date that Part VA commences.
Subsection 79AS(2) provides that whoever undertakes the review must provide the
Rural Health Minister with a written report of their findings.
Subsection 79AS(3) provides that the Rural Health Minister must table a copy of the
review findings in each House of the Parliament within 15 sitting days of that House
after the report is received.
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