EXPLANATORY STATEMENT
NATIONAL HEALTH ACT 1953
National Health (Claims and under co-payment data) Amendment Rules 2012 (No. 2)
PB 79 of 2012
Authority
Subsections 98AC(4) and 99AAA(8) of the National Health Act 1953 (the Act) provide for the Minister to make rules related to the supply of pharmaceutical benefits and concern transmission of claims data, and transmission of data for medicines priced at or below the patient co-payment threshold.
Purpose
The purpose of this legislative instrument, made under subsections 98AC(4) and 99AAA(8) of the Act, is to amend the National Health (Claims and under co-payment data) Rules 2012 (PB 19 of 2012) (the claims rules), to make changes to the rules related to the provision of claims and under co-payment data.
The Pharmaceutical Benefits Scheme (PBS) is established under Part VII of the Act. Under the PBS, approved suppliers provide pharmaceutical benefits to the Australian community. In situations where a Commonwealth subsidy is payable for a pharmaceutical benefit, an approved supplier may make a claim for payment.
Subsection 99AAA(8) of the Act provides that the Minister must make rules:
- specifying the information to be given to the Secretary by approved suppliers following their supply of pharmaceutical benefits;
- defining the procedures to be followed by approved suppliers in making claims for payment for their supply of pharmaceutical benefits; and
- defining the procedures to be followed by the Secretary in processing and determining claims and making payments.
Section 98AC of the Act mandates the provision of information where a pharmaceutical benefit is provided by an approved supplier but there is no Commonwealth subsidy paid because the item is priced at or below the co-payment threshold.
The amendments made by this Instrument are consequential changes to reflect amendments made to the Act by the National Health Amendment (Pharmaceutical Benefits Scheme) Act 2012 (the Amending Act), which commence 1 October 2012.
Schedule 3 of the Amending Act makes amendments to the Act to insert a new defined term ‘prescriber bag provisions’ and make other amendments in relation to prescriber bag supplies. The prescriber bag provisions are sections 93, 93AA and 93AB of the Act. These sections provide for supply of certain pharmaceutical benefits to medical practitioners, authorised midwives and authorised nurse practitioners for them to supply directly to patients at no cost in emergency situations. This Instrument makes consequential amendments to the claims rules to change references to ‘emergency drug supply form’ to ‘prescriber bag supply form’ to reflect that this form is related to supplies made under one of the prescriber bag provisions.
Item 16 of Schedule 1 of the Amending Act replaces section 85B of the Act so that subsection 85B(4) instead of subsection 85B(5) of the Act provides the power for the Minister to determine the circumstances in which the Commonwealth will pay a special patient contribution. This Instrument makes a consequential change to the definition of ‘authority prescription’ in the claims rules to reflect the changed power for the Minister to determine the circumstances in which the Commonwealth will pay a special patient contribution.
Consultation
No consultation occurred regarding these amendments. These are minor technical changes. They are not relevant to the industry agreements, do not substantially alter existing arrangements, and have no significant impact for consumers, pharmacy, industry or other users of the PBS.
This Instrument commences on 1 October 2012.
This Instrument is a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
National Health (Claims and under co-payment data) Amendment Rules 2012 (No.2)
PB 79 of 2012
This Legislative 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 Legislative Instrument
The purpose of this legislative instrument, made under subsections 98AC(4) and 99AAA(8) of the Act, is to amend the National Health (Claims and under co-payment data) Rules 2012 (PB 19 of 2012) (the claims rules), to make changes to the rules related to the provision of claims and under co-payment data.
Subsection 99AAA(8) of the Act provides that the Minister must make rules defining the procedures for making a claim and the information that needs to be provided.
Section 98AC of the Act mandates the provision of information where a pharmaceutical benefit is provided by an approved supplier but there is no Commonwealth subsidy paid because the item is priced at or below the co-payment threshold.
This Instrument makes changes to the claims rules to change references to ‘emergency drug supply form’ to ‘prescriber bag supply form’ to reflect that this form is related to supply under one of the defined prescriber bag provisions (sections 93, 93AA and 93AB of the Act). This Instrument also makes a consequential change to the definition of ‘authority prescription’ to reflect the change to the section reference in the Act for the power for the Minister to determine the circumstances in which the Commonwealth will pay a special patient contribution.
Human rights implications
This legislative instrument engages Articles 2 and 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) by assisting with the progressive realisation by all appropriate means of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
The Pharmaceutical Benefits Scheme (PBS) is a benefit scheme which assists with advancement of this human right by providing for subsidised access by patients to medicines.
Conclusion
This Legislative Instrument is compatible with human rights because it advances the protection of human rights.
Tanya Plibersek
Minister for Health