National Health Act 1953 Amendment Rules under subsection 99AAA(8) 2010 (No. 1) (No. PB 113 of 2010) (Cth)
Amendment Rules under subsection 99AAA(8) 2010 (No.1)
PB 113 of 2010
National Health Act 1953
I, DAVID LEARMONTH, Deputy Secretary, Department of Health and Ageing, delegate of the Minister for Health and Ageing, make these rules under subsection 99AAA(8) of the National Health Act 1953.
Dated 28 November 2010
Signed by D Learmonth
Deputy Secretary
Department of Health and Ageing
_____________________________________________________
1 Name of Rules
(1) These Rules are the Amendment Rules under subsection 99AAA(8) 2010 (No.1).
(2) These Rules may also be cited as PB 113 of 2010.
2 Commencement
These Rules commence on 1 December 2010.
3 Amendment of Rules under subsection 99AAA(8) (PB 49 of 2008)
Schedule 1 amends the Rules under subsection 99AAA(8) (PB 49 of 2008).
Schedule 1 Amendments (section 3)
[1] paragraph 2(b), subparagraph (i) of definition of A section
substitute
(i) in respect of an authority prescription, a repeat authorisation, a deferred supply authorisation, or an emergency drug supply form – the section of the form upon which the prescription is written that is provided for the purpose of recording the information required in the provision in these Rules in which the expression occurs; and
[2] paragraph 2(b), definition of authority prescription
substitute
“authority prescription” means a prescription that prescribes a pharmaceutical benefit and that has been authorised:
(a) in accordance with subregulation 13(5) of the Regulations; or
(b) under authority required procedures that are part of the circumstances determined by the Minister for paragraph 85(7)(b) of the Act for the pharmaceutical benefit.
Note: A determination under subsection 85(7) of the Act contains procedures that are called ‘authority required procedures’ that are part of the circumstances determined by the Minister for paragraph 85(7)(b) of the Act and that only apply to certain pharmaceutical benefits specified in the determination.
[3] paragraph 2(b), definition of doctor’s bag form
substitute
“emergency drug supply form” means an order form for the purpose of regulation 16 of the Regulations or a notification form for the purpose of 18A of the Regulations.
[4] paragraph 2(b), definition of exceptional prescription
substitute
“exceptional prescription” means a prescription for an extemporaneously-prepared pharmaceutical benefit that is not a standard formula preparation and for which the price of the ingredients calculated in accordance with sections 19 to 21 of the determination made under paragraph 98B(1)(a) of the Act is not less than twice the amount calculated in accordance with section 30 of that determination, excluding the container price and dispensing fee;”
[5] paragraph 2(b), definition of prescriber
substitute
“PBS prescriber” means the PBS prescriber who wrote or prepared the prescription;
[6] paragraph 2(b), definition of prescription
substitute
“prescription” includes a paper-based prescription, an ePrescription, a repeat authorisation, a deferred supply authorisation and an emergency drug supply form;
[7] paragraph 2(b), subparagraph (i) of definition of S section
substitute
(i) in respect of an authority prescription, a repeat authorisation, a deferred supply authorisation or an emergency drug supply form, the section of the form upon which the prescription is written that is provided for the purpose of recording the information required in the provision in these Rules in which the expression occurs; and
[8] sub-subparagraph 3(g)(ii)
substitute
(ii) on each of which that is not an authority prescription, a repeat authorisation, a deferred supply authorisation or an emergency drug supply form, shall be marked a stamp format in the area on the extreme left of the prescription, horizontally aligned with the pharmaceutical benefit to which it relates in such a way as to avoid obliterating any other information on the prescription; and
[9] sub-subparagraph 3(g)(iii)(D)
substitute
(D) in respect of emergency drug supply forms – commencing at “1” in each claim and continuing consecutively in respect of that claim; and
[10] sub-subparagraph 3(g)(vi)(A)
substitute
(A) where the approved supplier has made an election pursuant to subsection 31(1) of the determination made under paragraph 98B(1)(a) of the Act and the prescription is in respect of an extemporaneously-prepared pharmaceutical benefit that is not a standard formula preparation, the price calculated by the approved supplier in accordance with section 18 of that Determination; or
[11] sub-subparagraph 3(g)(vi)(B)
substitute
(B) where the approved supplier has not made an election pursuant to subsection 31(1) of the determination made under paragraph 98B(1)(a) of the Act and the prescription is an exceptional prescription, the price calculated by the approved supplier in accordance with section 18 of that Determination; or
[12] sub-subparagraph 3(g)(vi)(C)
substitute
(C) where the prescription is in respect of extemporaneously-prepared ear drops, eye drops or nasal instillations and the supply of the benefit in a glass bottle container is specified by the PBS prescriber or considered necessary by the approved supplier, the words “glass bottle”;
[13] Schedule 1, Part 4 – Prescription Record
omit
| Form Category | 6 | 6 | One byte numeric, using the following values: |
| Payment Category | 7 | 7 | One byte numeric, using the following values: |
insert
| Form Category | 6 | 6 | One byte numeric, using the following values: |
| Payment Category | 7 | 7 | One byte numeric, using the following values: |
[14] Schedule 1, Part 4 – Prescription Record
omit
| Prescriber Number | 13 | 19 | Seven bytes numeric, right justified, zero filled, being the prescriber number of the prescribing medical practitioner, participating dental practitioner or authorised optometrist, issued by the Medicare Australia CEO in pursuance of the function set out at section 20 of the Medicare Australia (Functions of Chief Executive Officer) Direction 2005, except in respect of a prescription that was written by a medical practitioner where that prescriber number was not available to the approved supplier at the time of the supply of the pharmaceutical benefit, in which case the field shall be zero filled. |
insert
| Prescriber Number | 13 | 19 | Seven bytes numeric, right justified, zero filled, being the prescriber number issued by the Medicare Australia CEO to a PBS prescriber, except in respect of a prescription that was written by a medical practitioner where that prescriber number was not available to the approved supplier at the time of the supply of the pharmaceutical benefit, in which case the field shall be zero filled |
[15] Schedule 1, Part 4 – Prescription Record
omit
| Price | 45 | 50 | Six bytes numeric, right justified, zero filled, value in cents; for prescriptions priced by the approved supplier in accordance with |
| Pricing Election | 51 | 51 | One byte alphabetic; value “Y” where the approved supplier has made an election pursuant to paragraph 39 of the determination made under paragraph 98B(1)(a) of the Act; otherwise “N” |
insert
| Price | 45 | 50 | Six bytes numeric, right justified, zero filled, value in cents; for prescriptions priced by the approved supplier in accordance with an election pursuant to subsection 31(1) of the determination made under paragraph 98(1)(a) of the Act or priced by the approved supplier as exceptional prescriptions |
| Pricing Election | 51 | 51 | One byte alphabetic; value “Y” where the approved supplier has made an election pursuant to subsection 31(1) of the determination made under paragraph 98B(1)(a) of the Act; otherwise “N” |
[16] Schedule 1, Part 4 – Prescription Record
omit
| Glass Bottle | 58 | 58 | One byte alphabetic; value “Y” if, in a prescription for extemporaneously-prepared ear drops, eye drops or nasal instillations, a glass bottle is ordered by the prescriber or considered necessary by the approved supplier otherwise “N” |
insert
| Glass Bottle | 58 | 58 | One byte alphabetic; value “Y” if, in a prescription for extemporaneously-prepared ear drops, eye drops or nasal instillations, a glass bottle is ordered by the PBS prescriber or considered necessary by the approved supplier otherwise “N” |
[17] Schedule 2, Part 2 – Prescription Record
omit
| Form Category | 2 | 2 | 1 | A/N | One byte numeric, using the following values: |
| Payment Category | 3 | 3 | 1 | N | One byte numeric, batch category: |
insert
| Form Category | 2 | 2 | 1 | A/N | One byte numeric, using the following values: |
| Payment Category | 3 | 3 | 1 | N | One byte numeric, batch category: |
[18] Schedule 2, Part 2 – Prescription Record
omit
| Prescriber Id | 37 | 43 | 7 | A/N | Seven bytes numeric, right justified, space filled being the prescriber number of the prescribing medical or dental practitioner or authorised optometrist. |
insert
| Prescriber Id | 37 | 43 | 7 | A/N | Seven bytes numeric, right justified, space filled being the prescriber number of the PBS prescriber. |
[19] Schedule 2, Part 2 – Prescription Record
omit
| Price | 82 | 88 | 7 | N | Seven bytes numeric, right justified, zero filled, value in cents; for prescriptions priced by the approved pharmacist or approved medical practitioner in accordance with an election pursuant to paragraph 37 of the Determination under sub-section 98B(1) of the Act or priced by the approved pharmacist or approved medical practitioner as exceptional prescriptions or items that do not appear in the Schedules of PBS or RPBS Pharmaceutical Benefits and have been prior approved by the Department of Veterans’ Affairs must be priced. Valid values include: 0000000-9999999 |
insert
| Price | 82 | 88 | 7 | N | Seven bytes numeric, right justified, zero filled, value in cents; for prescriptions priced by the approved pharmacist or approved medical practitioner in accordance with an election pursuant to subsection 31(1) of the Determination under |
[20] Schedule 2, Part 2 – Prescription Record
omit
| Glass Bottle | 128 | 128 | 1 | A | One byte alphabetic, value ‘Y’ if, in a prescription for extemporaneously-prepared ear drops, eye drops or nasal instillations, a glass bottle is ordered by the prescriber or considered necessary by the approved pharmacist or approved medical practitioner; otherwise ‘N’. |
insert
| Glass Bottle | 128 | 128 | 1 | A | One byte alphabetic, value ‘Y’ if, in a prescription for extemporaneously-prepared ear drops, eye drops or nasal instillations, a glass bottle is ordered by the PBS prescriber or considered necessary by the approved pharmacist or approved medical practitioner; otherwise ‘N’. |
[21] Schedule 2, Part 2 – Prescription Record
omit
| Medicare Number | 146 | 156 | 11 | N | Eleven bytes numeric, being made up of the first nine digits of the Medicare card number (Medicare number stem). The tenth digit being the card issue number and the eleventh digit being the individuals reference number. The Medicare number can also be a special Medicare number which applies to the person for whose treatment the prescription was written. For RPBS prescriptions where an entitlement number is supplied or doctors’ bag order forms, this field is zero filled. |
| Entitlement id | 157 | 167 | 11 | A/N | For concessional benefit prescriptions, the entitlement number from the Health Care Card, Pensioner Concession Card, Repatriation Health Card (Specific Conditions), Repatriation Health Card (All Conditions), Commonwealth Seniors Health Card, Repatriation Pharmaceutical Benefits Card, or PBS Safety Net Entitlements Card or PBS Safety Net Concessional Card which applies to the patient. For general benefit prescriptions (Where Immediate Supply Necessary is not ‘S’) or doctors bag order forms, this field is space filled. |
| Family name | 168 | 207 | 40 | A | Alphabetic field, left justified, blank filled; being the surname of the person for whom the prescription was written. This being the name on the Medicare card or equivalent DVA card. For doctors’ bag order forms this field is space filled. |
| Given name | 208 | 247 | 40 | A | Alphabetic field, left justified, blank filled; being the given name, or the first letter of that name, of the person for whom the prescription was written. This being the name on the Medicare card or equivalent DVA card. For doctors’ bag order forms this field is space filled. |
insert
| Medicare Number | 146 | 156 | 11 | N | Eleven bytes numeric, being made up of the first nine digits of the Medicare card number (Medicare number stem). The tenth digit being the card issue number and the eleventh digit being the individuals reference number. The Medicare number can also be a special Medicare number which applies to the person for whose treatment the prescription was written. For RPBS prescriptions where an entitlement number is supplied or emergency drug supply forms, this field is zero filled. |
| Entitlement id | 157 | 167 | 11 | A/N | For concessional benefit prescriptions, the entitlement number from the Health Care Card, Pensioner Concession Card, Repatriation Health Card (Specific Conditions), Repatriation Health Card (All Conditions), Commonwealth Seniors Health Card, Repatriation Pharmaceutical Benefits Card, or PBS Safety Net Entitlements Card or PBS Safety Net Concessional Card which applies to the patient. For general benefit prescriptions (Where Immediate Supply Necessary is not ‘S’) or emergency drug supply forms, this field is space filled. |
| Family name | 168 | 207 | 40 | A | Alphabetic field, left justified, blank filled; being the surname of the person for whom the prescription was written. This being the name on the Medicare card or equivalent DVA card. For emergency drug supply forms this field is space filled. |
| Given name | 208 | 247 | 40 | A | Alphabetic field, left justified, blank filled; being the given name, or the first letter of that name, of the person for whom the prescription was written. This being the name on the Medicare card or equivalent DVA card. For emergency drug supply forms this field is space filled. |
[22] Schedule 3, Part 1 – PBS Input elements Reconciliation Statement
omit
| dateOfPrescribing | 8 | A | Preassessment: | Values: Date represented in string format as DDMMCCYY. Should not default to the current date. | Use: Preassessment, Claiming |
insert
| dateOfPrescribing | 8 | A | Preassessment: | Values: Date represented in string format as DDMMCCYY. Should not default to the current date. | Use: Preassessment, Claiming |
[23] Schedule 3, Part 2 – PBS Input elements
omit
| AuthorityApprovalNum | 8 | A/N | Preassessment: | THIS FIELD IS FOR FUTURE USE | Use: Preassessment, Claiming |
insert
| AuthorityApprovalNum | 8 | A/N | Preassessment: | THIS FIELD IS FOR FUTURE USE | Use: Preassessment, Claiming |
[24] Schedule 3, Part 2 – PBS Input elements
omit
| dateOfPrescribing | 8 | N | Preassessment: | Values: Date represented in numeric format as DDMMCCYY. Constraints: The Client System software should not default this field to the current date except for DBOF | Use: Preassessment, Claiming |
insert
| dateOfPrescribing | 8 | N | Preassessment: | Values: Date represented in numeric format as DDMMCCYY. Constraints: The Client System software should not default this field to the current date except for emergency drug supply form | Use: Preassessment, Claiming |
[25] Schedule 3, Part 2 – PBS Input elements
omit
| EntitlementId | 1 | A/N | Preassessment: | Values: Must match the appropriate format for the entitlement identifier being used. Constraints: This field is not required for payment categories 1 (General) and 5 (Doctor’s Bag Order Forms). | Use: Preassessment, Claiming |
| FamilyName | 40 | A | Preassessment: | Values: | Use: Preassessment, Claiming |
insert
| EntitlementId | 1 | A/N | Preassessment: | Values: Must match the appropriate format for the entitlement identifier being used. Constraints: This field is not required for payment categories 1 (General) and 5 (Emergency drug supply forms). | Use: Preassessment, Claiming |
| FamilyName | 40 | A | Preassessment: | Values: | Use: Preassessment, Claiming |
[26] Schedule 3, Part 2 – PBS Input elements
omit
| FormCategory | 1 | A/N | Preassessment: | Values: | Use: Preassessment, Claiming |
| GivenName | 40 | A | Preassessment: M/C | Values: The given name as per the Medicare or DVA card. Constraints: This field is not required for Doctor’s Bag Order Forms. | Use: Preassessment, Claiming Level: Prescription Record The given name of the person for whom the prescription was written sourced from their Medicare card or equivalent DVA card. |
insert
| FormCategory | 1 | A/N | Preassessment: | Values: | Use: Preassessment, Claiming |
| GivenName | 40 | A | Preassessment: M/C | Values: The given name as per the Medicare or DVA card. Constraints: This field is not required for Emergency drug supply forms. | Use: Preassessment, Claiming Level: Prescription Record The given name of the person for whom the prescription was written sourced from their Medicare card or equivalent DVA card. |
[27] Schedule 3, Part 2 – PBS Input elements
omit
| MedicareNum | 11 | N | Preassessment: M/C Claiming: M/C | Constraints: Not required for payment categories 5 (Doctor’s Bag Order Forms) and 4 (where a DVA File Number is used.) | Use: Preassessment, Claiming Level: Prescription Record The Medicare card number (including card issue number and individual reference number) of the person for whom the prescription was written. |
| NumberOfRepeats | 2 | N | Preassessment: | Use: Preassessment, Claiming Zero is an acceptable value for the field, if applicable. |
insert
| MedicareNum | 11 | N | Preassessment: M/C Claiming: M/C | Constraints: Not required for payment categories 5 (Emergency drug supply forms) and 4 (where a DVA File Number is used.) | Use: Preassessment, Claiming Level: Prescription Record The Medicare card number (including card issue number and individual reference number) of the person for whom the prescription was written. |
| NumberOfRepeats | 2 | N | Preassessment: | Use: Preassessment, Claiming Zero is an acceptable value for the field, if applicable. |
[28] Schedule 3, Part 2 – PBS Input elements
omit
| PaymentCategory | 1 | N | Preassessment: | Values: | Use: Preassessment, Claiming |
insert
| PaymentCategory | 1 | N | Preassessment: | Values: | Use: Preassessment, Claiming |
[29] Schedule 3, Part 2 – PBS Input elements
omit
| PrescriberId | 7 | A/N | Preassessment: | Use: Preassessment, Claiming |
insert
| PrescriberId | 7 | A/N | Preassessment: | Use: Preassessment, Claiming |
[30] Schedule 3 – PBS Output Elements – PBS Reconciliation Statement
omit
| FamilyName | 40 | A | Statement: P | This field is not retuned for Doctor’s Bag Order Forms of for a pended prescription | Level: Prescription Record The surname of the person for whom the prescription was written as supplied by the Approved Supplier. |
| GivenName | 40 | A | Statement: P | This field is not retuned for Doctor’s Bag Order Forms of for a pended prescription. | Level: Prescription Record The given name of the person for whom the prescription was written as supplied by the Approved Supplier. |
insert
| FamilyName | 40 | A | Statement: P | This field is not returned for emergency drug supply forms or for a pended prescription. | Level: Prescription Record The surname of the person for whom the prescription was written as supplied by the Approved Supplier. |
| GivenName | 40 | A | Statement: P | This field is not returned for emergency drug supply forms or for a pended prescription. | Level: Prescription Record The given name of the person for whom the prescription was written as supplied by the Approved Supplier. |
[31] Schedule 3, Part 3 – PBS Output Elements – PBS Reconciliation Statement
omit
| TotalDoctorsBag | 5 | N | Statement: Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary Record Total number of Doctor’s bag benefit items rebated. |
| TotalDoctorsBag | 11 | N | Statement:Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary Record Total value (Net Price) of Doctor’s Bag benefit rebates. |
insert
| TotalEmergency | 5 | N | Statement: Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary Record Total number of Emergency drug supply benefit items rebated. |
| TotalEmergency | 11 | N | Statement:Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary Record Total value (Net Price) of Emergency drug supply benefit rebates. |
[32] Schedule 3, Part 3 – PBS Output Elements – PBS Reconciliation Statement
omit
| PaymentCategory | 1 | N | Statement: Y | 0 = invalid category | Level: Prescription Record Payment category in which the prescription was claimed. |
insert
| PaymentCategory | 1 | N | Statement: Y | 0 = invalid category | Level: Prescription Record Payment category in which the prescription was claimed. |
0
0
0