EXPLANATORY STATEMENT
National Health Act 1953
National Health (Pharmaceutical Benefits Scheme Hospital Medication Chart Paperless Claiming Trial) Special Arrangement 2017
PB 54 of 2017
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(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 the National Health (Pharmaceutical Benefits Scheme Hospital Medication Chart Paperless Claiming Trial) Special Arrangement 2017 (PB 54 of 2017) (the Special Arrangement) is to allow six private hospitals located in Victoria and Western Australia to use paper PBS Hospital Medication Charts (HMC) to prescribe and claim pharmaceutical benefits, without the provision of some data elements required for claiming from a PBS HMC.
The Special Arrangement sets out circumstances in which a medication chart is taken to be a written prescription for the purposes of regulation 40 of the National Health (Pharmaceutical Benefits) Regulations 2017 (not regulation 41 of the Regulation which sets out the requirements for medication chart prescriptions). If the circumstances are satisfied, 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 trial is necessary to enable the participating hospitals to adopt the PBS HMC while changes are being made to the software to enable PBS HMC functionality. The PBS HMC became available for use in public and private hospitals Australia-wide on 1 July 2016. This trial will assist in the roll out of the PBS HMC, which is expected to reduce the regulatory burden on prescribers, pharmacists and nurses, and improve medication safety for patients.
All references to legislative instruments in the Special Arrangement are to those instruments as they are in force from time to time, unless otherwise specified.
Consultation
The Department of Health consulted with the Department of Human Services, the participating hospitals and their approved suppliers during the development of the Special Arrangement. 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 the day after registration on the Federal Register of Legislation.
This Special Arrangement is a legislative instrument for the purposes of the Legislation Act 2003.
ATTACHMENT
Details of the National Health (Pharmaceutical Benefits Scheme Hospital Medication Chart Paperless Claiming Trial) Special Arrangement 2017 (PB 54 OF 2017)
Section 1 Name of Special Arrangement
This section provides that the Special Arrangement is the National Health (Pharmaceutical Benefits Scheme Hospital Medication Chart Paperless Claiming Trial) Special Arrangement 2017 and that it may also be cited as PB 54 of 2017.
Section 2 Commencement
This section provides that the Special Arrangement commences on the day after registration on the Federal Register of Legislation.
Section 3 Authority
This section provides that the Special Arrangement is made under subsection 100(1) of the National Health Act 1953.
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’.
A note to the definition of ‘in-patient’ confirms that an in-patient may include a public or private patient who is in the process of being discharged from in-patient care of a hospital.
Section 5 Application of Part VII of the Act
Subsection 5(1) provides that the pharmaceutical benefits supplied under this Special Arrangement are supplied under Part VII.
Subsection 5(2) confirms the effect of subsection 100(3) of the Act, which 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 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 by this Special Arrangement are all pharmaceutical benefits except those that are supplied only under another Special Arrangement. This Special Arrangement also does not apply to medication chart prescriptions, which are defined in subregulation 41(1) of the National Health (Pharmaceutical Benefits) Regulations 2017 (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 40 of the Regulations.
Section 8 Supply and Claiming of Pharmaceutical Benefits
Subsection 8(1) 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 same items 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 53 of the Regulations.
This section modifies the requirements in regulation 57 of the Regulations 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 an in-patient has received the pharmaceutical benefit/s prescribed on the medication chart.
Subsections 8(3) provides for the preparing and keeping of electronic pharmacy records of pharmaceutical benefits supplied under this Special Arrangement where an approved supplier is making a claim under section 99AAA of the Act. The electronic pharmacy records must be kept for two years.
Subsections 8(4) and (5) provide for the information to be contained in the electronic pharmacy record. A prescription record referred to in subsection (4) is exempt from particular information requirements in Schedule 1 to the rules made under subsections 99AAA(8) and 98AC(4) of the Act (the Rules). These information requirements include Hospital Provider Numbers (item 16), Medication Chart Period of Validity (item 19) and Medication Chart Start Date (item 19A).
When making claims for payment under the Act, subsection 8(6) provides that approved suppliers need not furnish the medication charts with the claim.
Subsections 8(7) and (8) provide that if Secretary of the Department of Health requests copies of electronic pharmacy records or medication charts from a hospital listed in the Schedule, the electronic pharmacy records or medication charts are to be provided to the Department by the corresponding approved supplier or hospital respectively.
Under subsection 8(9), approved suppliers are required to comply with the requirements of the Rules, including to submit claim and under co-payment data to the Chief Executive Medicare as required by the Rules where information is provided electronically.
Section 9 Transitionals
Subsection 9(1) provides that if a pharmaceutical benefit was prescribed under the old Arrangements, and the supply was not made prior to the commencement of this Special Arrangement, the supply of the pharmaceutical benefit is taken to have been validly prescribed under this Special Arrangement.
This applies in particular to Knox Private Hospital and Cotham Private Hospital, hospitals to which the old Arrangements previously applied.
Subsection 9(2) defines the old Arrangements as being the National Health (Multiple Hospitals Paperless Claiming Trial) Special Arrangement 2017 (PB 14 of 2017), as in force immediately before the commencement date of this Special Arrangement.
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. Each hospital receives supplies from an approved supplier listed in the same row as the hospital.