EXPLANATORY STATEMENT

MRCA Treatment Principles (Minor & Technical Variations) Determination 2011

EMPOWERING PROVISION

Subsection 286(3) of the Military Rehabilitation and Compensation Act 2004 (the Act).

PURPOSE

The attached instrument (M33/2011) amends the MRCA Treatment Principles (Principles).  The MRCA Treatment Principles is a legislative instrument made under subsection 286(3) of the Act and sets out the circumstances in which the Military Rehabilitation and Compensation Commission (Commission) may accept financial liability for treatment provided to entitled persons (members of the Defence Force (including former members) or their dependants).

The purpose of the attached instrument is to:

• replace references to Medicare Australia in the Principles with “Department of Human Services” because on 1 July 2011 the functions of Medicare Australia, among other entities, was transferred to the Department of Human Services (see: Human Services Legislation Amendment Act 2011) (Medicare Australia issue).

• incorporate-by-reference into the Principles the new Notes for Allied Health Providers (Notes for Allied Health Providers issue).

• update prior approval requirement for “diagnostic imaging/pathology referral” (Prior Approval issue);

• rectify drafting errors (Drafting Error issue).

Medicare Australia issue

The Human Services Legislation Amendment Act 2011 transferred Medicare Australia’s functions to the Department of Human Services.  The Principles contain numerous references to Medicare Australia mainly in relation to health care providers claiming payment for treating entitled persons.  Under the Principles health care providers are to bill Medicare Australia.  The attached instrument (Schedule Part C) replaces references to Medicare Australia with “Department of Human Services”.

Notes for Allied Health Providers issue

Notes for Providers are documents that set out the fine detail of the arrangement whereby health care providers may treat entitled persons at the expense of the Department of Veterans’ Affairs (DVA). 

Prior to the current Notes for Allied Health Providers there were 11 separate sets of notes each relating to a particular category of allied health provider.  The various sets of notes have been consolidated into one set of notes for allied health providers and the attached instrument incorporates the document into the Principles.  The attached instrument (Schedule Part A) deals with the “Notes for Allied Health Providers issue”.

Prior Approval issue

The Principles (4.7.3) stated that the prior approval of the Commission is not required for a referral to a medical specialist for diagnostic imaging or pathology (not requiring admission) where the specialist would bill DVA at 85% or less of the Medicare Benefits Schedule fee for the services. 

Because DVA now pays medical specialists at 100% of the Medicare fee for diagnostic imaging/pathology, prior approval for a referral to a specialist for the services in question should only be required where the specialist would bill DVA at above 100% of the Medicare fee for the services. 

Accordingly the Principles have been updated by the attached instrument (Schedule Part B) to achieve the result that prior approval for a referral to a medical specialist for diagnostic imaging/pathology (not requiring admission) is only required where the specialist would bill DVA at more than 100% of the Medicare fee for the services.

Drafting Error issue

Paragraph 4.7.2(a) of the Principles (the prior approval of the Commission is required for the treatment of pregnancy or pregnancy-related conditions) should have been omitted as part of the exercise that removed the prohibition on the Commission accepting financial responsibility for in-vitro treatment.  The attached instrument (Schedule Part B) omits paragraph 4.7.2(a).

Paragraph 3.4.6 of the Principles previously stated that the Commission will not pay or reimburse taxation levies for Medicare or for health insurance fund payments.  The paragraph was unclear as to its meaning.  The attached instrument (Schedule Part C item 5) replaces paragraph 3.4.6 with a new and clearer paragraph 3.4.6.

RETROSPECTIVE

No.

CONSULTATION

Partly.

There was consultation in respect of the Notes for Allied Health Providers issue.  DVA consulted Medicare Australia.  Consultation took the form of meetings, e-mails, provision of draft Notes for comments.

There was no consultation in respect of the remaining issues because they involved matters that were “minor and technical”.

DOCUMENTS INCORPORATED-BY-REFERENCE

Yes.  The following non-legislative documents are incorporated in the Principles by the attached instrument as they exist on 1 August 2011:

1. Notes for Local Medical Officers (paragraph 1.4.1);

2. Department of Veterans’ Affairs Fee Schedules for Medical Services (paragraph 3.5.1);

3. Notes for Allied Health Providers (paragraphs 3.5.1 and 7.1A.1);

4. Optometrist Fees for Consultation (paragraph 3.5.1);

5. DVA Schedule of Fees Orthoptists (paragraph 3.5.1);

6. Pricing Schedule for visual aids (paragraph 3.5.1);

7. The fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (commonly known as DSM-IV) (paragraph 2.4.2A);

8. Fee Schedule of Dental Services for Dentists and Dental Specialists (paragraph 3.5.1);

9. Fee Schedule of Dental Services for Dental Prosthetists (paragraph 3.5.1);

 10. Chiropractors Schedule of Fees (paragraph 3.5.1);

11. Diabetes Educators Schedule of Fees (paragraph 3.5.1);

12. Dietitians Schedule of Fees (paragraph 3.5.1);

13. Exercise Physiologists Schedule of Fees (paragraph 3.5.1);

14. Occupational Therapists Schedule of Fees (paragraph 3.5.1);

15. Osteopaths Schedule of Fees (paragraph 3.5.1);

16. Physiotherapists Schedule of Fees (paragraph 3.5.1);

17. Psychologists Schedule of Fees (paragraph 3.5.1);

18. Podiatrists Schedule of Fees (paragraph 3.5.1);

19. Social Workers Schedule of Fees (paragraph 3.5.1);

20. Clinical Counsellors Schedule of Fees (paragraph 3.5.1);

21. Speech Pathologists Schedule of Fees (paragraph 3.5.1);

22. Australian Government Department of Veterans’ Affairs  Classification System and Schedule of Item Numbers and               Fees — Community Nursing Services;

23. Notes for Coordinated Veterans' Care Program Providers;

24. Rehabilitation Appliances Program (RAP) National Guidelines (paragraph 11.2A.1);

25. RAP National Schedule of Equipment (paragraph 11.2A.1);

At the time the attached instrument was made, all the documents, except the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, were available on the Internet (Department of Veterans’ Affairs web page – under Health – Doctors/Health Care Professionals):

http://www.dva.gov.au/

and at the time the attached instrument was made all the documents were available, or could be made available, at:

Department of Veterans’ Affairs (ACT Office), Lovett Tower, 13 Keltie St, Woden ACT 2606 / GPO Box 9998 Woden ACT 2606. 

Tel.no:(02) 6289 6243.

Any State or Territory Office of the Department of Veterans’ Affairs:

Tel.no: 133 254.

FURTHER EXPLANATION

Attachment A.

Attachment A

Items    Explanation

[1] sets out the name of the instrument.

[2] provides that the instrument commences immediately after the MRCA Treatment Principles (Retirement Villages and Rehabilitation Appliance Schedule) Instrument 2011, apart from section 5, commences (i.e. the day after the day it is registered on the Federal Register of Legislative Instruments).

[3] is a transitional provision which ensures that a person in the following situations is not negatively affected because the person lodged a claim, or had some other dealing, with Medicare Australia, before the attached instrument commenced:

(a) person lodged a claim, or had some other dealing, under the Principles, with Medicare Australia which had not been finalised before the attached instrument commenced (the instrument varies the Principles so that references to Medicare Australia are references to the Department of Human Services).

(b) person purportedly lodged a claim, or purportedly had some other dealing, under the Principles, with Medicare Australia on or after 1 July 2011 (date Medicare Australia ceased to exist) and before the attached instrument commenced (the instrument varies the Principles so that references to Medicare Australia are references to the Department of Human Services.).

In both situations the person is taken to have lodged a claim or dealt with the Department of Human Services.

Schedule

Part A revokes the various references to separate notes for allied health providers and refers to the one consolidated Notes for Allied Health Providers.

Part B rectifies drafting errors (item 1) and updates the prior approval requirement for referrals to medical specialists for diagnostic imaging/pathology services (item 2).

Part C replaces references to Medicare Australia with references to the Department of Human Services and rectifies a drafting error (item 5)