EXPLANATORY STATEMENT
National Health Act 1953
National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2016
PB 59 of 2016
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 instrument is to allow seven private hospitals located in Victoria to use paper medication charts to prescribe and claim pharmaceutical benefits.
This instrument sets out the circumstances in which a medication chart is taken to be a written prescription for the purposes of regulation 19 of the Regulations with respect to the Paperless Prescribing and Claiming Trial. If the circumstances are fulfilled, the approved suppliers of the specified 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 create electronic pharmacy records of the medication charts supplied and claimed which are to be stored for not less than two years. The Secretary of the Department of Health then has audit powers. If the claim is submitted electronically, the approved suppliers must conform to online claiming rules.
This Special Arrangement revokes and replaces the National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2015 (PB 37 of 2015). The difference between this instrument and the revoked instrument is that an additional hospital has been included in the trial; St Vincent’s private hospital located in Kew, Victoria. Also, the pharmacy approval numbers specified in Schedule 1 have been updated to align with pharmacies supplying pharmaceutical benefits to St Vincent’s Private Hospitals at East Melbourne and Fitzroy.
The Department expects that the results of the trial will contribute to the development of national digital health policy, and more specifically medication chart specifications which are currently being developed through the PBS Medication Charts for Public and Private Hospitals measure, announced by the Australian Government as part of the 2014-15 Budget.
Consultation
The Department of Health consulted with the Department of Human Services, the participating hospitals and their approved suppliers during the development of this instrument. As a result of these consultations all parties are satisfied with the process proposed in this Special Arrangement.
A provision by provision description of this Special Arrangement is contained in the Attachment.
This Special Arrangement commences on 1 July 2016 or the day after registration on the Federal Register of Legislation – whichever is later.
This instrument is a legislative instrument for the purposes of the Legislation Act 2003.
ATTACHMENT
Details of the National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2016 (PB 59 of 2016)
Section 1 Name of Special Arrangement
This section provides that the Special Arrangement is the National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2016 and that it may also be cited as PB 59 of 2016.
Section 2 Commencement
This section provides that the Special Arrangement commences on 1 July 2016 or the day after registration on the Federal Register of Legislation; whichever is later.
Section 3 Revocation
This section revokes instrument PB 37 of 2015, the Special Arrangement authorising the Multiple Hospitals Paperless Claiming Trial.
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. This Special Arrangement does not apply to medication chart prescriptions, which are defined in subregulation 19AA(1) of the National Health (Pharmaceutical Benefits) Regulations 1960
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 National Health (Pharmaceutical Benefits) Regulations 1960 (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:
This section provides that an approved supplier cannot defer the supply of any pharmaceutical benefit in accordance with regulation 26 of the Regulations.
This section 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 Secretary Department of Health 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 as 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 July 2016.
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.