National Health (Indigenous Chronic Disease – PBS Co-payment Measure) Special Arrangement Amendment Instrument 2012 (No. 1)

Administered by Department of Health, Disability and Ageing

Legislation au F2012L01461 Not in force Legislative Instrument

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EXPLANATORY STATEMENT

Issued by Authority of the Minister for Health

NATIONAL HEALTH ACT 1953

NATIONAL HEALTH (INDIGENOUS CHRONIC DISEASE – PBS CO-PAYMENT MEASURE) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2012 (NO.1)

PB 43 of 2012

 

Authority

Subsection 100(1) of the National Health Act 1953 (the Act) enables the Minister to make special arrangements for the supply of pharmaceutical benefits. Subsection 100(2) of the Act provides that the Minister may vary or revoke a special arrangement made under subsection 100(1).

Subsection 100(3) of the Act provides that Part VII of the Act, and instruments made for the purposes of Part VII of the Act, have effect subject to a special arrangement made under subsection 100(1).

Purpose

The purpose of this legislative instrument, made under subsections 100(1) and 100(2) of the Act, is to amend the National Health (Indigenous Chronic Disease – PBS Co-payment Measure) Special Arrangement 2012 (PB 22 of 2012) (the Special Arrangement), to make changes to the Special Arrangement to assist eligible Indigenous patients to access Pharmaceutical Benefits Scheme (PBS) medicines with reduced patient co-payments.

On and from 1 July 2012 the Act provides, when Schedules 1 and 2 of the National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Act 2012 commence, for the determination of the conditions of supply and the eligible pharmaceutical benefits that can be supplied for the purposes of continued dispensing supplies (new section 89A), and supply from a medication chart in residential aged care facilities (section 93A), being two new initiatives referred to in the Fifth Community Pharmacy Agreement.

This Instrument makes consequential amendments to the Special Arrangement to provide that:

  • the reduced co-payment under this Special Arrangement is available for supply from a medication chart prescription for residents in residential aged care facilities;
  • the reduced co-payment under this Special Arrangement is not available for a continued dispensing supply; and
  • to ensure that it is clear when prescriptions are not required to be included in a claim, and, if so, when a supply certification form is required.

A provision by provision description of this Instrument is contained in Attachment 1.

Consultations

The changes made by this instrument are minor and mechanical and do not require consultation.

This legislative instrument commences on 1 July 2012.

This Instrument is a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

 


ATTACHMENT

ITEM BY ITEM DESCRIPTION OF THE NATIONAL HEALTH (INDIGENOUS CHRONIC DISEASE – PBS CO-PAYMENT MEASURE) SPECIAL ARRANGEMENT AMENDMENT INSTRUMENT 2012 (NO.1) (PB 43 OF 2012) 

Section 1         Name of Instrument

This section provides that the Instrument is the National Health (Indigenous Chronic Disease – PBS Co-payment Measure) Special Arrangement Amendment Instrument 2012 (No.1) and that it may also be cited as PB 43 of 2012.

Section 2         Commencement

This section provides that the Instrument commences on 1 July 2012.

Section 3         Amendments to PB 22 of 2012

This section provides that Schedule 1 amends the National Health (Indigenous Chronic Disease – PBS Co-payment Measure) Special Arrangement 2012 (PB 22 of 2012) (the Special Arrangement).

Schedule 1

Items 1 to 4 amend section 4 of the Special Arrangement to insert definitions for ‘medication chart prescription’, ‘paperless claim for payment’, ‘Regulations’ and ‘supply certification form’.

Item 5 amends section 6 of the Special Arrangement to make it clear that the reduced co-payment under this Special Arrangement is not available for continued dispensing supply under subsection 89A(1) of the Act, including where under normal Pharmaceutical Benefits Scheme (PBS) supply it would be an under co-payment situation. This does not prevent the use of a prescription annotated for the purposes of this Special Arrangement as the previous prescription for the purposes of continued dispensing.

Item 6 inserts a note after subsection 7(4) of the Special Arrangement to make it clear that the reduced co-payment under this Special Arrangement is available for supply under subsection 93A(4) of the Act based on a medication chart prescription to a person receiving residential care, including where under normal PBS supply it would be an under co-payment situation.

Item 7 inserts a new subparagraph 15(2)(b)(ii) to provide that where under normal PBS supply it would be an under co-payment situation and no claim would be made for supply, no prescription is required to be provided with a claim made under this Special Arrangement, the claim is a ‘paperless claim for payment’ (within the meaning of the Regulations), but the ‘supply certification form’ otherwise required by new regulation 31(4) of the Regulations on and from 1 July 2012 is not required.

Item 7 also inserts a new subparagraph 15(2)(b)(iii) to ensure that it is clear that supply from a medication chart prescription under subsection 93A(4) of the Act and this Special Arrangement does need to include a supply certification form, except where subparagraph 15(2)(b)(ii) applies.


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Overview

The National Health (Indigenous Chronic Disease – PBS Co-Payment Measure) Special Arrangement Amendment Instrument 2012 (No.1) was enacted by the Minister for Health under the authority of the National Health Act 1953. This legislative instrument was introduced to amend the National Health (Indigenous Chronic Disease – PBS Co-payment Measure) Special Arrangement 2012 (PB 22 of 2012) in order to make changes to the co-payment measures for Indigenous patients accessing Pharmaceutical Benefits Scheme (PBS) medicines. The policy objective of these amendments is to ensure that eligible Indigenous patients can access PBS medicines with reduced co-payments, while also clarifying the conditions under which prescriptions are required for claims and when a supply certification form is necessary. The changes are intended to streamline the process for providing reduced co-payment for Indigenous patients, particularly in the context of medication chart prescriptions and continued dispensing supplies.

Scope and Application

The National Health (Indigenous Chronic Disease – PBS Co-Payment Measure) Special Arrangement Amendment Instrument 2012 (No.1) is a legislative instrument made under the authority of the Minister for Health pursuant to the National Health Act 1953. It amends the National Health (Indigenous Chronic Disease – PBS Co-Payment Measure) Special Arrangement 2012 to adjust the conditions under which reduced co-payments for Pharmaceutical Benefits Scheme (PBS) medicines are applicable for Indigenous patients, particularly in relation to residential aged care facilities and continued dispensing supplies. This instrument applies to eligible Indigenous patients and healthcare providers who supply PBS medicines under this special arrangement. It specifies that reduced co-payments are available for medication chart prescriptions for residents in residential aged care facilities, but not for continued dispensing supplies. The changes outlined in this Instrument commenced on 1 July 2012 and are designed to ensure clarity in the application of the special arrangement, including the circumstances under which prescriptions and supply certification forms are required. This legislative instrument operates within the Commonwealth jurisdiction and does not include any exclusions, exemptions, or thresholds beyond those specified within its provisions.

Key Provisions

The main operative sections of this legislation are sections 1 to 4 in Schedule 1, which provide the definitions and amendments to the National Health (Indigenous Chronic Disease – PBS Co-payment Measure) Special Arrangement 2012 (PB 22 of 2012) (the Special Arrangement). Section 1 names the Instrument and provides an alternative citation. Section 2 specifies the commencement date of the Instrument, which is 1 July 2012. Section 3 outlines the amendments made to PB 22 of 2012. Schedule 1 provides specific amendments, including changes to definitions, clarifications on the availability of reduced co-payments, and requirements for paperless claims and supply certification forms. The obligations and requirements imposed by the Act on the parties governed by it include ensuring that reduced co-payment arrangements are only available under specific conditions. For example, under the amendments, the reduced co-payment is not available for continued dispensing supplies as per subsection 89A(1) of the Act (Item 5). Conversely, the reduced co-payment is available for supplies based on a medication chart prescription to a person receiving residential care, as per subsection 93A(4) of the Act (Item 6). Additionally, the legislation mandates that certain claims be made as "paperless claims for payment" under the Regulations when no prescription is required, but clarifies that a "supply certification form" is still needed unless the conditions of Item 7(ii) apply. The legislation also outlines consequences for non-compliance. While the Explanatory Statement does not detail specific offences or penalties, breaches of the National Health Act 1953 generally can result in civil or criminal penalties. Under the Act, penalties can include fines and imprisonment, depending on the nature and severity of the breach. For instance, supplying pharmaceutical benefits in a manner contrary to the Act could result in penalties under section 101 of the Act. The maximum penalties for breaches can vary widely, depending on the specific provision breached, and can include fines of up to $22,200 for individuals and up to $111,000 for bodies corporate, along with potential imprisonment terms. These penalties underscore the importance of adhering to the Act's requirements.

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