EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Health Insurance Act 1973
Health Insurance (Health Care Homes) Amendment Determination 2019
Subsection 3C(1) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by legislative instrument, determine that a health service not specified in an item in the general medical services table (the Table) shall, in specified circumstances and for specified statutory provisions, be treated as if it were specified in the Table.
The Table is set out in the regulations made under subsection 4(1) of the Act, which is repealed and re-made each year. The most recent version of the regulations is the Health Insurance (General Medical Services Table) Regulations 2019.
This instrument relies on subsection 33(3) of the Acts Interpretation Act 1901 (AIA). Subsection 33(3) of the AIA provides that where an Act confers a power to make, grant or issue any instrument of a legislative or administrative character (including rules, regulations or by-laws), the power shall be construed as including a power exercisable in the like manner and subject to the like conditions (if any) to repeal, rescind, revoke, amend, or vary any such instrument.
Purpose
The purpose of the Health Insurance (Health Care Homes) Amendment Determination 2019 (the Determination) is to amend the Health Insurance (Health Care Homes) Determination 2017 (the Principal Determination) to extend access to the Medicare benefit item 6087 from 30 November 2019 until 30 June 2021.
On 1 October 2017, the Stage One trial of the Health Care Homes Program commenced with an end date of 30 November 2019. A Health Care Home is a medical practice enrolled in the Commonwealth Government’s Health Care Homes Program that coordinates care for participating patients with chronic and complex conditions.
The Commonwealth subsidy for a patient’s primary health care provided as part of the Health Care Homes Program is principally paid through a bundled monthly payment to the Health Care Home, rather than through traditional fee-for-service Medicare benefits. Practices can choose to charge patients an out-of-pocket amount and must provide patients with information about the fees they intend to charge. Medicare item 6087 was introduced to ensure patients’ out-of-pocket costs are supported by their relevant Medicare safety net when a patient is participating in the Health Care Home Program.
In the 2018-19 Mid-year Economic and Fiscal Outlook, the Government announced the extension of the Health Care Homes program to 30 June 2021 under the Guaranteeing Medicare – strengthening primary care measure. The Determination extends item 6087 until 30 June 2021 to ensure patients’ out-of-pocket costs continue to contribute to the relevant Medicare safety net threshold(s).
This Determination also makes a consequential amendment to prevent the payment of Medicare benefits in certain circumstances. This amendment is consequential as it updates the list of prescribed circumstances in the Principal Determination to align with the most recent version of the Table.
Consultation
The Health Care Home model of care was developed on the basis of broad stakeholder consultation undertaken by the Primary Health Care Advisory Group as described in their December 2015 report Better Outcomes for People with Chronic and Complex Health Conditions.
During the making of the Principal Determination, stakeholders including the Australian Healthcare and Hospitals Association, Australian Medical Association and the Consumers Health Forum, provided feedback that Health Care Homes patients should be entitled to receive the benefits of the Medicare safety net(s), should they reach the required thresholds.
The Health Care Homes Program is supported by advice from the Implementation Advisory Group, which consists of general practice, allied health and consumer representatives (among others). This Group supported the extension of the Health Care Homes Program until 30 June 2021. Consultation was not undertaken on the nature of this Determination as it is a consequential part the Health Care Homes Program.
Details of the Determination are set out in the Attachment.
The Determination commences the day after it is registered.
The Determination is a legislative instrument for the purposes of the Legislation Act 2003.
Authority: Subsection 3C(1) of the
Health Insurance Act 1973
ATTACHMENT
Details of the Health Insurance (Health Care Homes) Amendment Determination 2019
Section 1 – Name
Section 1 provides for the Determination to be referred to as the Health Insurance (Health Care Homes) Amendment Determination 2019.
Section 2 – Commencement
Section 2 provides that the Determination commences the day after it is registered.
Section 3 – Authority
Section 3 provides that the Determination is made under subsection 3C(1) of the Health Insurance Act 1973.
Section 4 – Schedules
Section 4 provides that each instrument that is specified in a Schedule to this Determination is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Determination has effect according to its terms.
Schedule 1 – Amendments
Health Insurance (Health Care Homes) Determination 2017 (Principal Determination)
Item 1 – Section 2, paragraph (b)
Section 2 of the Principal Determination provides the repeal date of the instrument. Item 1 of the Determination provides that the repeal date of 30 November 2019 is omitted and substituted with a repeal date of 30 June 2021.
Item 2 – Section 8
Section 8 of the Principal Determination provides that item 6087 is to be treated as if it were an item in the general medical services table (the Table) for the purpose of clauses 1.2.7 and 1.2.7A. These clauses prescribed circumstances where a Medicare benefit would not be payable.
The Determination omits “Clauses 1.2.7 and 1.2.7A” and substitutes the renumbered clauses in the most recent version of the Table (1.2.7 and 1.2.8).
Clause 1.2.9 was inserted on 1 November 2018 to restrict services in the Table from being provided at the same time as, or in connection with, the harvesting, storage, in vitro processing or injection of non-haematopoietic stem cells. The reference to “1.2.9” in section 8 of the Determination treats item 6087 as if it was specified in the Table for the purpose of that limitation.
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Health Insurance (Health Care Homes) Amendment Determination 2019
This instrument 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 Determination
The purpose of the Health Insurance (Health Care Homes) Amendment Determination 2019 (the Determination) is to amend the Health Insurance (Health Care Homes) Determination 2017 (the Principal Determination) to extend access to the Medicare benefit item 6087 from 30 November 2019 until 30 June 2021.
On 1 October 2017, the Stage One trial of the Health Care Homes Program commenced with an end date of 30 November 2019. A Health Care Home is a medical practice enrolled in the Commonwealth Government’s Health Care Homes Program that coordinates care for participating patients with chronic and complex conditions.
The Commonwealth subsidy for a patient’s primary health care provided as part of the Health Care Homes Program is principally paid through a bundled monthly payment to the Health Care Home, rather than through traditional fee-for-service Medicare benefits. Practices can choose to charge patients an out-of-pocket amount and must provide patients with information about the fees they intend to charge. Medicare item 6087 was introduced to ensure patients’ out-of-pocket costs are supported by their relevant Medicare safety net when a patient is participating in the Health Care Home Program.
In the 2018-19 Mid-year Economic and Fiscal Outlook, the Government announced the extension of the Health Care Homes program to 30 June 2021 under the Guaranteeing Medicare – strengthening primary care measure. The Determination extends item 6087 until 30 June 2021 to ensure patients’ out-of-pocket costs continue to contribute to the relevant Medicare safety net threshold(s).
Human rights implications
This instrument engages Articles 9 and 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the rights to health and social security.
The Right to Health
The right to the enjoyment of the highest attainable standard of physical and mental health is contained in Article 12(1) of the ICESCR. The UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not a right for each individual to be healthy, but is a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.
The Committee reports that the ‘highest attainable standard of health’ takes into account the country’s available resources. This right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs, and conditions necessary for the realisation of the highest attainable standard of health.
The Right to Social Security
The right to social security is contained in Article 9 of the ICESCR. It requires that a country must, within its maximum available resources, ensure access to a social security scheme that provides a minimum essential level of benefits to all individuals and families that will enable them to acquire at least essential health care. Countries are obliged to demonstrate that every effort has been made to use all resources that are at their disposal in an effort to satisfy, as a matter of priority, this minimum obligation.
The Committee reports that there is a strong presumption that retrogressive measures taken in relation to the right to social security are prohibited under ICESCR. In this context, a retrogressive measure would be one taken without adequate justification that had the effect of reducing existing levels of social security benefits, or of denying benefits to persons or groups previously entitled to them. However, it is legitimate for a Government to re-direct its limited resources in ways that it considers to be more effective at meeting the general health needs of all society, particularly the needs of the more disadvantaged members of society.
Analysis
This instrument maintains the right to health and the right to social security. This instrument will ensure that patients participating in the Health Care Homes Program will continue to be able to be supported by their relevant Medicare safety net, and that their out-of-pocket costs associated with their treatment under the Health Care Homes Program would count towards their relevant Medicare safety net threshold(s).
Conclusion
This instrument is compatible with human rights as it maintains the right to health and the right to social security.
Elizabeth Dowd
Assistant Secretary
MBS Policy and Specialist Services Branch
Medical Benefits Division
Health Financing Group
Department of Health