Continence Aids Payment Scheme Variation 2011 (No. 2)

EXPLANATORY STATEMENT

Issued by the authority of the Minister for Mental Health and Ageing

National Health Act 1953

Continence Aids Payment Scheme Variation 2011 (No.2)

The National Health Act 1953 (the Act) is an act relating to the provision of pharmaceutical, sickness and hospital benefits, and of medical and dental services.

Section 12 of the Act provides that the Minister may, by legislative instrument, formulate a Continence Aids Payment Scheme, under which the Commonwealth makes payments as a contribution towards the cost of buying products that help manage incontinence.

Background

The Continence Aids Payment Scheme 2010 (CAPS) was introduced on 1 July 2010, replacing the former Continence Aids Assistance Scheme (CAAS). Assistance for eligible persons changed from the physical supply of subsidised continence aids under CAAS to a monetary payment under CAPS intended to contribute toward the purchase of continence aids.

Continence Aids Payment Scheme Variation 2011 (No.2) (the Variation)

The purpose of the Variation is to:

• extend eligibility to participate in the CAPS to Department of Veterans’ Affairs Pensioner Concession Card holders who meet the other eligibility criteria; and
• add seven additional neurological conditions and four additional other conditions to the Schedule of eligible conditions.

The Variation extends eligibility to participate in the CAPS to Department of Veterans’ Affairs Pensioner Concession Card holders who would have been eligible for the CAPS if their Pensioner Concession Card had been issued by Centrelink rather than by the Department of Veterans’ Affairs. This amendment corrects an anomaly in the CAPS eligibility criteria by recognising that not all holders of the Department of Veterans’ Affairs Pensioner Concession Card are necessarily eligible to receive assistance for continence aids through the Department of Veterans’ Affairs under the Rehabilitation Appliances Program.

Additionally, the Variation adds the following seven neurological and four other conditions to the table of eligible conditions in the Schedule:

Retrospective payment

This Variation allows for retrospective payment of the CAPS amount for applications received between the commencement of CAPS on 1 July 2010 and the commencement of the Variation from applicants who were ineligible because they held a Department of Veterans’ Affairs Pensioner Concession Card rather than a Centrelink Pensioner Concession Card, but who met all other eligibility criteria.

The retrospective payment does not prejudice the rights of, or impose additional liabilities on, any person or body, other than the Commonwealth.

Notes on clauses

Details of variations to the Continence Aids Payments Scheme 2010 are attached.

The Variation is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

Consultation

The Department has consulted Medicare Australia, Centrelink and the Department of Veterans’ Affairs on the extension of eligibility to Department of Veterans’ Affairs Pensioner Concession Card holders who meet the other eligibility requirements.

Health Services Australia Limited was also consulted regarding inclusion of the additional eligible conditions to the Schedule.  Health Services Australia Limited is party to a Memorandum of Understanding with the Department to, amongst other things, provide assistance (in particular a health professional with continence expertise) to determine whether the stated condition on an applicant’s health report is an eligible condition for the purposes of CAPS.

Regulation Impact Statement

The Office of Best Practice Regulation has advised that a Regulation Impact Statement is not required for this Variation.

ATTACHMENT

NOTES ON CLAUSES

Clause 1 – Name of Instrument

This clause states that the name of the Instrument is the Continence Aids Payment Scheme Variation 2011 (No.2).

Clause 2 – Commencement

This clause states that the Instrument commences on the day after it is registered.

Clause 3 – Amendment of the Continence Aids Payment Scheme 2010

This clause states that Schedule 1 varies the Continence Aids Payment Scheme 2010.

Schedule 1 – Amendments

Item 1 – Subsection 4(1)

This item inserts a new subparagraph 4(1)(a)(iii) extending eligibility for the CAPS to Department of Veterans’ Affairs Pensioner Concession Card holders who suffer from permanent and severe incontinence caused by an eligible other condition and who meet the other eligibility criteria.  Other eligibility criteria include the criterion specified in paragraph 4(2)(d) that people eligible to receive assistance for continence aids under the Rehabilitation Appliances Program through the Department of Veterans’ Affairs are not eligible to participate in the CAPS.

Item 2 – After subsection 4(2)

This item inserts two new subsections providing for retrospective payment to Department of Veterans’ Affairs Pensioner Concession Card holders who applied for a CAPS payment between the commencement of CAPS on 1 July 2010 and the commencement of the Variation and who would have been eligible if Item 1 of Schedule 1 to this Variation had commenced prior to their application.  The CAPS amount payable retrospectively is the amount calculated in accordance with section 9 as if the person was eligible at the time their application was received by Medicare Australia.  

Item 3 – Schedule

This item adds the following seven neurological and four other conditions to the list of eligible conditions in the Schedule to the Continence Aids Payment Scheme 2010: