EXPLANATORY STATEMENT
MRCA Treatment Principles (Removal of Prior Approval Requirement for Optical Coherence Tomography) Instrument 2011
EMPOWERING PROVISION
Subsection 286(3) of the Military Rehabilitation and Compensation Act 2004 (the Act).
PURPOSE
The attached instrument (M20/2011) 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 (MRCC) 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 remove the requirement in the Principles for health care providers to obtain the approval of the MRCC (in practice - the MRCC’s delegate) before Optical Coherence Tomography (OCT) can be provided to the entitled person (prior approval requirement).
OCT is a medical procedure used for diagnosis and monitoring of retinal diseases in a specialist ophthalmologic setting.
Prior approval was required for OCT because it is an “un-listed treatment” under the Principles. This means it is not listed on the Medicare Benefits Schedule (MBS).
The attached instrument does not alter the status of OCT as an un-listed treatment, meaning that the rules in the Principles in relation to un-listed treatments apply to OCT except the rule that requires the MRCC’s prior approval before an un-listed treatment may be provided.
In any event although OCT is an un-listed treatment the Medical Services Advisory Council found it to be safe. Nevertheless at the time the attached instrument commenced the procedure was not listed on the MBS.
The problems with the prior approval requirement for OCT were that it was difficult in practice for health care providers to comply with the requirement because OCT is usually provided during a consultation and the short time frame between determining a need for the procedure and providing it did not normally enable prior approval to be obtained.
Further, because it was impractical to obtain prior approval, health care providers needed to obtain retrospective approval. But the rules governing retrospective approval are more stringent than those applying to prior approval.
In any event, the Department of Veterans’ Affairs (DVA) found that the requirement for health care providers to obtain approval for OCT, whether before providing the service or after, was unnecessary and therefore an administrative burden on both health care providers (need to request approval) and DVA (need to process requests for approval) and accordingly the requirement was removed by the attached instrument.
RETROSPECTIVE
Yes. The instrument is taken to have commenced on 1 May 2011 but for the purposes of subsection 12(2) of the Legislative Instruments Act 2003 it does not negatively affect any person. The instrument is benevolent in nature.
CONSULTATION
Yes – Medicare Australia in respect of processing claims for payment for OCT. Consultation was carried out via meetings, telephone communication and e-mail.
DOCUMENTS INCORPORATED-BY-REFERENCE
No.
FURTHER EXPLANATION
Attachment A.
Attachment A
Items Explanation
[1] sets out the name of the instrument.
[2] provides that the instrument is taken to have commenced on 1 May 2011.
Schedule
1. is a definition section.
2. amends 3.2.1(b) of the Principles (which covers un-listed treatments and is in the part of the Principles that sets out the treatments for which the MRCC’s prior approval is required) to make it clear that despite the general requirement that un-listed treatments need prior approval, the Principles may specify that prior-approval for a particular unlisted treatment is not necessary.
3. inserts new provisions in the Principles (4.2.6 and 4.2.7). These provisions identify OCT as a medical treatment and provide that the MRCC may accept financial responsibility for OCT where it is provided to an entitled person by an Ophthalmologist for the assessment or management of retinal disease.
The new provisions also provide that while OCT remains an unlisted treatment it is subject to all the requirements for an unlisted treatment except the requirement that prior approval be obtained before OCT is provided.
Overview
The MRCA Treatment Principles (Removal of Prior Approval Requirement for Optical Coherence Tomography) Instrument 2011 was enacted to address administrative inefficiencies and practical challenges in the provision of Optical Coherence Tomography (OCT) to entitled persons under the Military Rehabilitation and Compensation Act 2004. The Military Rehabilitation and Compensation Commission (MRCC) administers the Act, and the instrument was created under subsection 286(3) of the Act. The primary policy objective was to streamline the treatment approval process by removing the prior approval requirement for OCT, which was deemed unnecessary by the Department of Veterans’ Affairs (DVA). This change alleviated the administrative burden on both health care providers and the DVA, as obtaining prior approval for OCT was often impractical due to the short timeframe between determining the need for the procedure and its actual provision. Despite OCT remaining an unlisted treatment, the instrument ensures that all other requirements for unlisted treatments still apply, except for the prior approval stipulation.
Scope and Application
The MRCA Treatment Principles (Removal of Prior Approval Requirement for Optical Coherence Tomography) Instrument 2011 applies to the Military Rehabilitation and Compensation Commission (MRCC), health care providers, and entitled persons, who are members of the Defence Force (including former members) or their dependants, under the Military Rehabilitation and Compensation Act 2004. The instrument modifies the treatment principles to specifically address the use of Optical Coherence Tomography (OCT), a medical procedure used for diagnosing and monitoring retinal diseases. The legislation removes the prior approval requirement for OCT, which was considered burdensome and impractical as it often had to be provided during a consultation, leaving insufficient time for prior approval to be obtained. By amending the treatment principles, the instrument ensures that while OCT remains an un-listed treatment under the Medicare Benefits Schedule (MBS), it is no longer subject to the prior approval requirement. Instead, the MRCC may accept financial responsibility for OCT when provided by an Ophthalmologist for the assessment or management of retinal disease, subject to other unlisted treatment requirements. The instrument's changes are effective from 1 May 2011 and are designed to be benevolent, with no negative impact on any person, as confirmed through consultation with relevant parties.
Key Provisions
The main operative sections of the MRCA Treatment Principles (Removal of Prior Approval Requirement for Optical Coherence Tomography) Instrument 2011, as referenced in the explanatory statement, involve significant amendments to the Military Rehabilitation and Compensation Act 2004 (MRCA). Section 2 of the instrument establishes that it is taken to have commenced on 1 May 2011, while ensuring that it does not negatively affect any person, thereby characterising it as benevolent in nature. Schedule 1 of the instrument amends the existing treatment principles to clarify that prior approval from the Military Rehabilitation and Compensation Commission (MRCC) is not necessary for certain un-listed treatments, specifically Optical Coherence Tomography (OCT), despite OCT being classified as an un-listed treatment. Additionally, new provisions (4.2.6 and 4.2.7) are inserted into the Principles to specifically address OCT, allowing the MRCC to accept financial responsibility for OCT when provided by an Ophthalmologist for the assessment or management of retinal diseases.
The Act imposes several obligations and requirements on parties governed by the instrument. Primarily, health care providers who offer OCT to entitled persons, such as members of the Defence Force or their dependants, are no longer required to obtain prior approval from the MRCC before providing this treatment. Instead, OCT is identified as a medical treatment under the new provisions, meaning it remains subject to all other requirements applicable to un-listed treatments, except for the prior approval stipulation. This change aims to streamline the process, making it more practical for health care providers to offer OCT without undue administrative burdens. Additionally, the MRCC must adhere to the new provisions when determining financial responsibility for OCT treatments provided to entitled persons.
In terms of potential breaches and consequences, the instrument does not explicitly outline specific offences or penalties for non-compliance. However, the overarching requirements and obligations established by the MRCA and the Treatment Principles suggest that failure to comply with these provisions could result in the MRCC declining to accept financial responsibility for OCT treatments provided without adherence to the specified conditions. This could potentially lead to disputes over the reimbursement of costs incurred by health care providers. It is important to note that while specific penalties are not mentioned, non-compliance with the MRCC's treatment principles could have administrative and financial repercussions for both health care providers and the MRCC itself.