National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2015 (PB 37 of 2015)

EXPLANATORY STATEMENT

National Health Act 1953

National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2015

PB 37 of 2015

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).  

Purpose

The purpose of this instrument is to allow six private hospitals located in Victoria to use paper based medication charts to prescribe and claim pharmaceutical benefits under the Multiple Hospitals Paperless Claiming Trial (the Trial).

On receipt of a valid medication chart, the approved suppliers of those private hospitals can supply pharmaceutical benefits as if medication charts are original prescriptions.  The approved suppliers can then submit claims to the Chief Executive Medicare, without having to provide paper copies of the medication charts.  The approved suppliers must then create electronic pharmacy records of the medication charts supplied and claimed which are to be stored for not less than two years.

This Special Arrangement revokes and replaces the National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2012.  The revoked special arrangement authorised trial participation by an additional hospital, Epworth Richmond Private Hospital, which has ceased participation in this Trial and is now operating under a different paperless claiming trial.

This Special Arrangement also facilitates amendments consequential to changes to the National Health (Pharmaceutical Benefits) Regulations 1960 (the Regulations), as amended by the National Health (Pharmaceutical Benefits) Amendment (Medication Chart Prescriptions) Regulation 2015 on 1 April 2015.

The Regulations provide for a transitional period for Pharmaceutical Benefit Scheme (PBS) hospital medication chart prescriptions.  This supports testing through trial access.  The Special Arrangement relates to the Trial, a different hospital medication chart prescribing trial.

The amendments in this instrument:

• make minor drafting changes including to the definitions of approved supplier and hospital;
• clarify that the Special Arrangement does not apply to the new PBS hospital medication chart prescriptions;
• increase the obligation on approved suppliers to retain electronic pharmacy records to two years, to align with the requirement to retain medication chart prescriptions for two years under the Regulations; and
• remove Epworth Hospital as a hospital operating under the Special Arrangement.  Epworth Hospital continues to use medication charts for claiming PBS subsidy under another special arrangement being the National Health (Epworth and Cabrini Private Hospitals Paperless Claiming Trial) Special Arrangement 2015 (PB 18 of 2015).

Consultation

The Department of Health consulted with the Department of Human Services regarding the amendment of this instrument.  

Since the announcement of the PBS Medication Charts for Public and Private Hospitals measure in 2014, the Department of Health has undertaken an extensive consultation process involving all key health stakeholders.  These consultations indicate widespread and strong support for the trial of the PBS Hospital Medication Chart and amendments required to the Regulations and associated legislative instruments to support the measure.  Consulted stakeholders include States and Territories, Australian Private Hospital Association, Society of Hospital Pharmacists of Australia, Pharmaceutical Society of Australia, Pharmacy Guild of Australia, Australian Medical Association, Cancer Voices Australia, Consumers Health Forum of Australia, National Prescribing Service, the Australian Commission on Safety and Quality in Health Care, and the National E-Health Transition Authority. 

Further consultation with each participating hospital and approved supplier will be conducted over the coming weeks to ensure they understand the claiming changes, enabled by the National Health (Pharmaceutical Benefits) Amendment (Medication Chart Prescriptions) Regulation 2015.

A provision by provision description of this Special Arrangement is contained in the Attachment.

This Special Arrangement commences on 1 April 2015.

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

ATTACHMENT

Details of the National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2015 (PB 37 of 2015)

Section 1 Name of Special Arrangement

This section provides that the Special Arrangement is the National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2015 and that it may also be cited as PB 37 of 2015.

Section 2 Commencement

This section provides that the Special Arrangement commences on 1 April 2015.

Section 3 Revocation

This section revokes the National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2012 PB 26 of 2012.

Section 4 Definitions

This section defines a number of expressions that are used in the Special Arrangement, including ‘approved supplier’, ‘hospital’ and ‘in-patient of the hospital’.

Section 5 Application of Part VII of the Act

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

Section 5 provides that the pharmaceutical benefits supplied under this Special Arrangement are supplied under Part VII.  This is the situation under the Act and this section confirms that this is not intended to be modified by the Special Arrangement.

Section 6 Pharmaceutical benefits covered by this Special Arrangement

This section provides for the pharmaceutical benefits that are covered by this Special Arrangement.  The pharmaceutical benefits covered are all pharmaceutical benefits except those that are supplied only under another special arrangement.

Subsection 6(3) provides that this Special Arrangement does not apply to pharmaceutical benefits prescribed using a medication chart prescription (under regulation 19AA of the National Health (Pharmaceutical Benefits) Regulations 1960 (the Regulations).

Section 7 Prescribing of Pharmaceutical Benefits

This section provides for the circumstances in which a medication chart prepared and signed by a PBS prescriber will be taken to be a validly written prescription and sets out the information that the PBS prescriber needs to include on that medication chart.  This modifies the requirements for a prescription from those set out in regulation 19 of the Regulations.

This section also provides limitations on prescribing using medication charts.  PBS prescribers are not allowed to direct a repeated supply or supply all on one occasion. If they direct a repeated supply that direction is invalid.  If they direct supply all on one occasion on a medication chart, this direction is deemed to be a direction to supply the maximum quantity for that pharmaceutical benefit determined under paragraph 85A(2)(a) of the Act.  PBS prescribers are also not allowed to prescribe a pharmaceutical benefit requiring an authority prescription using a medication chart.

Section 8 Supply and Claiming of Pharmaceutical Benefits

This section provides that this Special Arrangement applies to approved suppliers listed in column 2 of the Schedule to this Special Arrangement when supplying pharmaceutical benefits to in-patients of the hospitals listed in column 1 of the Schedule.

Subsection 8(2) allows approved suppliers to supply pharmaceutical benefits when presented with medication charts as if they were original prescriptions.  There are two qualifications to this allowance:

Paragraph 8(2)(a) provides that an approved supplier must not defer the supply of any pharmaceutical benefit in accordance with regulation 26 of the Regulations. 

Paragraph 8(2)(b) modifies the requirements in regulation 31 of the Regulations (Receipt of pharmaceutical benefit) allowing eligible persons to confirm receipt of pharmaceutical benefits and date of supply. The section requires the approved supplier to certify on a medication chart that the in-patient of the hospital has received the pharmaceutical benefit/s prescribed on the medication chart.

Subsections 8(3) and (4) provide for the preparing and keeping of electronic pharmacy records of pharmaceutical benefits supplied under this Special Arrangement where the approved supplier is making a claim under section 99AAA of the Act.  The electronic pharmacy records must be kept for two years.  Under subsections 8(6) and (7), the Chief Executive Medicare can request the electronic pharmacy records or copies from the approved supplier, and medication charts or copies from the hospital, respectively.

When making claims for payment under the Act, subsection 8(5) provides that approved suppliers need not furnish the medication charts with the claim. 

Under subsection 8(8), approved suppliers are required to submit claim and under co-payment data to the Chief Executive Medicare in the manner required by the rules under subsections 99AAA(8) and 98AC(4) of the Act.

Section 9 Transitionals

This section provides transitional arrangements so that participating approved suppliers can make a valid claim where pharmaceutical benefits prescribed under the previous special arrangement have not been supplied prior to 1 April 2015.

The Schedule

The Schedule provides the name and address of the hospitals participating in this Special Arrangement and the name, address and approval number of the approved suppliers associated with the hospitals participating in this Special Arrangement.

Statement of Compatibility with Human Rights