EXPLANATORY STATEMENT
Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (Removal of Prior Approval Requirement for Optical Coherence Tomography) Instrument 2011
EMPOWERING PROVISION
Subsection 16(7) of the Australian Participants in British Nuclear Tests (Treatment) Act 2006, (the Act).
PURPOSE
The attached instrument (R21/2011) amends the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (Principles).
The Principles is a legislative instrument made under subsection 16(7) of the Act and sets out the circumstances in which the Repatriation Commission (the Commission) may accept financial liability for treatment provided to entitled persons for malignant neoplasia. Entitled persons are Australian participants in British nuclear tests as described in the Act.
The purpose of the attached instrument is to remove the requirement in the Principles for health care providers to obtain the approval of the Repatriation Commission (in practice - the Commission’s delegate) before Optical Coherence Tomography (OCT) can be provided to the entitled person (prior approval requirement).
OCT is a medical procedure used for diagnosis and monitoring of retinal diseases in a specialist ophthalmologic setting.
Prior approval was required for OCT because it is an “un-listed treatment” under the Principles. This means it is not listed on the Medicare Benefits Schedule (MBS).
The attached instrument does not alter the status of OCT as an un-listed treatment, meaning that the rules in the Principles in relation to un-listed treatments apply to OCT except the rule that requires the Repatriation Commission’s prior approval before an un-listed treatment may be provided.
In any event although OCT is an un-listed treatment the Medical Services Advisory Council found it to be safe. Nevertheless at the time the attached instrument commenced the procedure was not listed on the MBS.
The problems with the prior approval requirement for OCT were that it was difficult in practice for health care providers to comply with the requirement because OCT is usually provided during a consultation and the short time frame between determining a need for the procedure and providing it did not normally enable prior approval to be obtained.
Further, because it was impractical to obtain prior approval, health care providers needed to obtain retrospective approval. But the rules governing retrospective approval are more stringent than those applying to prior approval.
In any event, the Department of Veterans’ Affairs (DVA) found that the requirement for health care providers to obtain approval for OCT, whether before providing the service or after, was unnecessary and therefore an administrative burden on both health care providers (need to request approval) and DVA (need to process requests for approval) and accordingly the requirement was removed by the attached instrument.
RETROSPECTIVE
Yes. The instrument is taken to have commenced on 1 May 2011 but for the purposes of subsection 12(2) of the Legislative Instruments Act 2003 it does not negatively affect any person. The instrument is benevolent in nature.
CONSULTATION
Yes – Medicare Australia in respect of processing claims for payment for OCT. Consultation was carried out via meetings, telephone communication and e-mail.
DOCUMENTS INCORPORATED-BY-REFERENCE
No.
FURTHER EXPLANATION
Attachment A.
Attachment A
Items Explanation
[1] sets out the name of the instrument.
[2] provides that the instrument is taken to have commenced on 1 May 2011.
Schedule
1. is a definition section.
2. amends 3.2.1(b) of the Principles (which covers un-listed treatments and is in the part of the Principles that sets out the treatments for which the Repatriation Commission’s prior approval is required) to make it clear that despite the general requirement that un-listed treatments need prior approval, the Principles may specify that prior-approval for a particular unlisted treatment is not necessary.
3. inserts new provisions in the Principles (4.2.6 and 4.2.7). These provisions identify OCT as a medical treatment and provide that the Repatriation Commission may accept financial responsibility for OCT where it is provided to an entitled person by an Ophthalmologist for the assessment or management of retinal disease.
The new provisions also provide that while OCT remains an unlisted treatment it is subject to all the requirements for an unlisted treatment except the requirement that prior approval be obtained before OCT is provided.
Overview
The Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (Removal of Prior Approval Requirement for Optical Coherence Tomography) Instrument 2011 was introduced to address the administrative burden associated with obtaining prior approval for Optical Coherence Tomography (OCT) from the Repatriation Commission for Australian participants in British nuclear tests. Enacted under subsection 16(7) of the Australian Participants in British Nuclear Tests (Treatment) Act 2006, this legislative instrument aims to streamline the treatment approval process for OCT, a medical procedure used for diagnosing and monitoring retinal diseases. The instrument removes the necessity for health care providers to secure prior approval for OCT, recognising the impracticality of obtaining such approval in the short time frame typically available for consultations. This change was motivated by the finding of the Medical Services Advisory Council that OCT is safe, despite it being an un-listed treatment under the Medicare Benefits Schedule (MBS). The policy objective behind this amendment is to reduce the administrative burden on both health care providers and the Department of Veterans’ Affairs by simplifying the approval process for OCT, thereby facilitating more timely and efficient care for entitled persons.
Scope and Application
The Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (Removal of Prior Approval Requirement for Optical Coherence Tomography) Instrument 2011 amends the Treatment Principles made under the Australian Participants in British Nuclear Tests (Treatment) Act 2006. This legislation applies to Australian participants in British nuclear tests, referred to as entitled persons, and governs the circumstances under which the Repatriation Commission may accept financial liability for their treatment, including the provision of Optical Coherence Tomography (OCT). OCT is a medical procedure for diagnosing and monitoring retinal diseases in a specialist ophthalmologic setting. Previously, the Repatriation Commission's prior approval was required before OCT could be provided due to it being an unlisted treatment under the Medicare Benefits Schedule (MBS), but this requirement has now been removed by the instrument. The removal of the prior approval requirement is intended to alleviate administrative burdens on both healthcare providers and the Department of Veterans' Affairs. This amendment applies retrospectively, effective from 1 May 2011, and does not negatively affect any person, being benevolent in nature.
Key Provisions
The main operative sections of this legislation, the Treatment Principles (Australian Participants in British Nuclear Tests) 2006 (Removal of Prior Approval Requirement for Optical Coherence Tomography) Instrument 2011, pertain to the removal of a prior approval requirement for a specific medical procedure, Optical Coherence Tomography (OCT), for entitled persons under the Australian Participants in British Nuclear Tests (Treatment) Act 2006. This amendment is detailed in Schedule 1 of the instrument. Section 2 of Schedule 1 modifies 3.2.1(b) of the Treatment Principles, clarifying that prior approval for certain unlisted treatments may not be necessary. Sections 4.2.6 and 4.2.7 are newly inserted, identifying OCT as a treatment for which the Repatriation Commission can accept financial responsibility, provided it is performed by an Ophthalmologist for the assessment or management of retinal disease. This change exempts OCT from the general requirement of prior approval for unlisted treatments, except that it remains subject to other unlisted treatment requirements.
The obligations and requirements imposed by this Act on the parties involved, primarily health care providers and the Repatriation Commission, have been significantly eased. Previously, health care providers had to obtain prior approval from the Repatriation Commission before providing OCT to entitled persons. This requirement was deemed impractical and burdensome due to the nature of the procedure, which is typically conducted during consultations. The new provisions allow for OCT to be performed without prior approval, although retrospective approval may still be required and is subject to stricter criteria than prior approval. The Repatriation Commission must now accept financial responsibility for OCT when provided under the specified conditions, while still adhering to the general rules for unlisted treatments.
The instrument introduces no new offences, penalties, or specific civil or criminal consequences for its breach. However, the overarching legislative framework, the Australian Participants in British Nuclear Tests (Treatment) Act 2006, might contain provisions that apply in the event of non-compliance with the treatment principles, including potential financial penalties or recovery of payments. The instrument's benevolent nature means it does not negatively affect any person, as stated in subsection 12(2) of the Legislative Instruments Act 2003. The amendments aim to streamline the approval process, reducing administrative burdens for both health care providers and the Department of Veterans’ Affairs.