Declaration of Quality Assurance Activities under section 124X of the Health Insurance Act 1973 – QAA 1/2015

Administered by Department of Health, Disability and Ageing

Legislation au F2015L00718 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

ISSUED BY THE AUTHORITY OF

 

THE MINISTER FOR HEALTH

 

HEALTH INSURANCE ACT 1973

 

DECLARATION OF QUALITY ASSURANCE ACTIVITIES

 

UNDER SECTION 124X

 

QAA No. 1/2015

 

Part VC of the Health Insurance Act 1973 (the Act) creates a scheme (known as the Commonwealth Qualified Privilege Scheme) to encourage efficient quality assurance activities. Those activities help to ensure the quality of health services that are funded by the Government, including through Medicare benefits, the Pharmaceutical Benefits Scheme and/or Health Program Grants. The scheme encourages participation in such activities by protecting certain information from disclosure, and also by providing some protection from civil liability to certain persons engaged in those activities in good faith, in respect of those activities.

 

In order for Part VC of the Act to apply to an activity, the Minister must make a Declaration pursuant to section 124X of the Act, that the activity described in the declaration is a quality assurance activity to which Part VC applies. Regulations
23C to 23G of the Health Insurance Regulations 1975 (the Regulations) set out the public interest criteria that must be met by quality assurance activities in order to be declared under section 124X of the Act.

 

This Declaration under subsection 124X(1) applies to Part VC of the Act to the following activities:

 

  1. Practice Visit Program (Activity 1); and
  2. Peer Review Groups (Activity 2).

 

An overview of the activities for which the Declaration pursuant to section 124X of the Act is made is contained in the Attachment.

 

Before the Minister can make a Declaration, certain requirements must be met:

 

  • Firstly, the Minister must be satisfied that the persons engaged in the activities are authorised to do so as described in paragraph 124X(3)(a) of the Act.

    Activities 1 and 2 meet the requirements of paragraph 124X(3)(a) in that the persons engaged in the activities are authorised to do so by the Royal Australian and New Zealand College of Psychiatrists (RANZCP), which is an association of health professionals.


 

  • Secondly, paragraph 124X(3)(b) of the Act provides that the Minister must be satisfied that it is in the public interest to have Part VC of the Act apply to the activities. In doing so, the Minister must have regard to criteria prescribed by the Regulations.

    Activity 1meets the criteria as follows:
     
    • As required by regulation 23C, the activity includes the disclosure of
      non-identifying information that concerns the quality of service assessed, evaluated or studied. Information from this activity will include by RANCZP annual reporting to the Department of Health, internal organisational reporting and circulation (as relevant and as required) to medical councils and government departments.
       
    • Regulation 23D does not apply as the activity will be engaged in more than one State or Territory.

 

  • Regulation 23E does not apply as the activity has previously been engaged in in Australia. The activity was previously declared to be a quality assurance activity to which Part VC applies in 2003 (QAA 3/2003) and 2009
    (QAA 2/2009).

 

  • Regulation 23F applies as the activity has previously been carried out in Australia. This is a re-declaration of QAA 3/2003 and QAA 2/2009. The Minister’s re-declaration will continue to encourage full participation in the activity by persons who provide health services and by providing participants with a greater degree of confidence and security that their participation is solely for the benefit of ensuring the continuation and enhancement of a valuable quality improvement strategy for psychiatrists in practice and improved outcomes for the community in mental health care.

 

  • Regulation 23G does not apply as the activity does not include the assessment or evaluation by a person of the services, skill or performance of a health practitioner for the purpose of determining the health care practitioner’s clinical practising rights.
     


Activity 2 meets the criteria as follows:
 

  • As required by regulation 23C, the activity includes the disclosure of
    non-identifying information that concerns the quality of service assessed, evaluated or studied. Information from this activity will include by RANCZP annual reporting to the Department of Health, internal organisational reporting, and circulation (as relevant and as required) to medical councils and government departments.

 

  • Regulation 23D does not apply as the activity will be engaged in more than one State or Territory.

 

  • Regulation 23E does not apply as the activity has previously been engaged in Australia. The activity was previously declared to be a quality assurance activity to which Part VC applies in 2003 (QAA 3/2003) and 2009
    (QAA 2/2009).

 

  • Regulation 23F applies as the activity has previously been carried out in Australia. This is a re-declaration of QAA 3/2003 and QAA 2/2009. The Minister’s re-declaration will continue to encourage full participation in the activity by persons who provide health services and by providing participants with a greater degree of confidence and security that their participation is solely for the benefit of ensuring continuous quality improvement in psychiatric practice, to achieve and to support the best attainable quality of psychiatric and mental health care.

 

  • Regulation 23G does not apply as the activity does not include the assessment or evaluation by a person of the services, skill or performance of a health practitioner for the purpose of determining the health care practitioner’s clinical practising rights.

 

Consultation

Consultation regarding the applications for declaration of these activities was undertaken in September 2014. This included obtaining advice on the potential value of declaring these activities as quality assurance activities for the purposes of the Act, the methodology used to conduct the activities, and whether the applications met the criteria required for declarations to be made, particularly the criteria relating to whether it is in the public interest to declare the activities.

 

Those consulted included members of the Qualified Privilege Advisory Group, which includes an external clinician; a legal expert; a quality manager working in the field of health care quality assurance; and a consumer representative.

 

The Declaration of these activities will not result in any direct or substantial indirect effect on business.

 

The Declaration has effect from the day after registration on the Federal Register of Legislative Instruments. This Declaration ceases to be in force at the end of 5 years after it is signed.

 

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

         ATTACHMENT

 

  1. PRACTICE VISIT PROGRAM

 

Purpose

This activity involves psychiatrists (trained as practice visitors) visiting host psychiatrists in order to conduct a review based on the College Guidelines for Outpatient Psychiatric Practice. Participants are encouraged to review and further develop their professional practice so that their knowledge, skills and performance standards are maintained and that the provision of adequate and safe medical care is optimised.

 

Objective/s

The primary objective of this activity is to provide context where participants may discuss clinical cases, service issues and other aspects of the work they do and to receive feedback on all aspects of their work.

 

This activity also involves:

  • facilitating discussion between host and visiting psychiatrists about avenues for practice improvement;
  • formulating goals and engaging in collaborative planning for implementing agreed improvements to practice; and
  • reviewing progress on goals formulated in the first visit in a follow up visit.

 

 

2.      PEER REVIEW GROUPS

 

Purpose

This activity provides psychiatrists, working in small groups, the opportunity to review their own work and receive feedback on their work, with the aim of continuous improvement of the quality of their practice and improving outcomes for individual patients.

 

Objective/s

The primary objective of this activity is to provide context where participants may present clinical cases, service issues and other aspects of their work and receive feedback on difficulties or concerns about their work and advice and assistance on practice improvement.

 

This activity also involves:

  • providing the opportunity for psychiatrists to engage in a quality improvement activity looking at their own clinical practice, their service systems or procedures, and other aspects of providing psychiatric assistance to encourage best possible evidence based practice; and
  • encouraging psychiatrists to seek the advice and assistance of their peers and to work together to improve their practice and outcomes for consumers.

 

 

 

Overview

The Health Insurance Act 1973 was enacted to address the need for a structured approach to ensuring the quality of health services funded by the government, including through Medicare benefits, the Pharmaceutical Benefits Scheme, and Health Program Grants. This Act creates the Commonwealth Qualified Privilege Scheme, which aims to encourage efficient quality assurance activities by protecting certain information from disclosure and providing some protection from civil liability to certain persons engaged in these activities in good faith. To facilitate this, the Minister for Health must make a declaration that certain activities are quality assurance activities to which Part VC of the Act applies. The Declaration of Quality Assurance Activities under section 124X of the Act was issued by the Minister for Health in 2015, applying to the Practice Visit Program and Peer Review Groups. These activities are overseen by the Royal Australian and New Zealand College of Psychiatrists (RANZCP), which authorises the participants. The declaration ensures that these activities meet the public interest criteria set out in the Health Insurance Regulations 1975, and it was made following consultations with relevant stakeholders, including members of the Qualified Privilege Advisory Group. This declaration is intended to foster continuous quality improvement in psychiatric practice, thereby supporting the best possible outcomes in mental health care.

Scope and Application

The Health Insurance Act 1973, through its Part VC, establishes a scheme known as the Commonwealth Qualified Privilege Scheme, aimed at fostering efficient quality assurance activities within the healthcare sector, particularly for services funded by the Government, including Medicare benefits, the Pharmaceutical Benefits Scheme, and Health Program Grants. This scheme provides protection from disclosure of certain information and from civil liability for those engaged in these activities in good faith. For the provisions of Part VC to apply, the Minister for Health must declare the specific activities as quality assurance activities under section 124X of the Act. This Declaration applies to two specific activities: the Practice Visit Program and Peer Review Groups, both of which involve psychiatrists engaging in quality assurance activities authorized by the Royal Australian and New Zealand College of Psychiatrists (RANZCP). The Minister's satisfaction that these activities meet the public interest criteria, as prescribed in the Health Insurance Regulations 1975, is a prerequisite for the declaration. These activities, which have been previously declared and re-declared, involve the disclosure of non-identifying information related to the quality of health services and have been deemed to be in the public interest. The declaration is effective from the day after registration on the Federal Register of Legislative Instruments and will cease to be in force at the end of five years after it is signed.

Key Provisions

The primary operative sections of the Health Insurance Act 1973 (the Act) relevant to this Declaration are sections 124X and those in Part VC, which establish the Commonwealth Qualified Privilege Scheme. Section 124X(1) allows the Minister to make a Declaration that certain quality assurance activities are subject to Part VC of the Act, thereby protecting information from disclosure and providing protection from civil liability for participants in good faith. The Declaration in QAA No. 1/2015 applies Part VC to the Practice Visit Program (Activity 1) and Peer Review Groups (Activity 2), which are designed to enhance the quality of health services funded by the government. To qualify, the Minister must be satisfied that the activities meet specific criteria, including being authorised by an appropriate professional body (section 124X(3)(a)) and being in the public interest (section 124X(3)(b)). The obligations and requirements imposed by the Act on the parties involved in the declared activities are primarily about ensuring that these activities are conducted in a manner that genuinely aims to improve the quality of health services. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is authorised to conduct these activities, and they must ensure that information disclosed is non-identifying and relates to the quality of services. The RANZCP is responsible for annual reporting to the Department of Health and internal reporting, as well as ensuring that the information is appropriately circulated to relevant medical councils and government departments. The activities must also adhere to the public interest criteria outlined in the Health Insurance Regulations 1975, such as including non-identifying information about service quality and being conducted in a manner that encourages participation and continuous improvement. Breach of the obligations set out in the Act or the Regulations could result in various consequences. While specific offences and penalties are not detailed in the explanatory statement, breaches could potentially lead to legal actions for disclosure of protected information or claims for civil liability. The Act’s protection from civil liability is contingent on participation in good faith, meaning any malicious or negligent actions could void this protection. Additionally, the Declaration itself stipulates that it ceases to be in force at the end of five years after it is signed, indicating a time-limited scope for these activities under the scheme. The failure to comply with the regulatory criteria could also lead to the activities no longer being recognised as quality assurance activities under Part VC of the Act.

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