EXPLANATORY STATEMENT

Veterans’ Affairs (Treatment Principles – Local Medical Officer) Amendment Instrument 2019 (Instrument No. R41/M42 of 2019)

EMPOWERING PROVISIONS

For Schedule 1 of the attached instrument which varies the Treatment Principles (VEA Treatment Principles) — section 90 of the Veterans’ Entitlements Act 1986 (the VEA).

For Schedule 2 of the attached instrument which varies the MRCA Treatment Principles (MRCA Treatment Principles) — section 286 of the Military Rehabilitation and Compensation Act 2004 (the MRCA).

PURPOSE

The attached instrument varies the VEA Treatment Principles and the MRCA Treatment Principles – collectively known as the “Treatment Principles”.

The Treatment Principles set out the circumstances in which treatment may be provided to clients of the Department of Veterans’ Affairs (DVA).

These variations to the Treatment Principles remove all references to ‘Local Medical Officer’ (LMO) and replace it with the commonly referred title of ‘General Practitioner’ (GP).

The Local Medical Officer Scheme was established in 1918. The intention was to recognise the enhanced services that LMOs provided to DVA clients through more generous payments.

Legislative changes and peak body registration processes since this time has necessitated the minimum standard of qualification being raised to that of a vocationally recognised GP.

The LMO code is now applied automatically to any vocationally recognised GP who registers with the Department of Human Services and who provides treatment to a DVA client. As such the term. LMO has become redundant and feedback has indicted that the term is confusing to the industry and the broader community.

The attached instrument also removes Part 6B of the Treatment Principles and related definitions which are now redundant. Part 6B provided for the In-Home Telemonitoring for Veterans initiative. This initiative was implemented as a trial which ceased in 2016.

The Treatment Principles are a disallowable instrument for the purposes of the Legislative Instruments Act 2003. The variations of the Treatment Principles are a legislative instrument. They will be effective upon registration on the Federal Register of Legislation and subject to the usual disallowance period of 15 sitting days for each House of Parliament.

The attached legislative instrument will take effect on 1 October 2019.

CONSULTATION

Section 17 of the Legislation Act 2003 requires a rule-maker to be satisfied, before making a legislative instrument that any consultation the rule-maker considered appropriate and reasonably practicable, has been undertaken.

The Australian Medical Association was consulted on the amendments to replace ‘LMO’ with ‘GP’. They indicated that the LMO term is confusing, especially to those that are new to the profession, as it is not used anywhere other than DVA.

Consultation was not undertaken in regard to removing references to the In-Home Telemonitoring for Veterans initiative. As the initiative has ceased, the changes do not substantially alter existing arrangements and are machinery in nature.

In these circumstances, the requirements of section 17 of the Legislation Act 2003 have been fulfilled.

RETROSPECTIVITY

None.

DOCUMENTS INCORPORATED BY REFERENCE

The variations to the Treatment Principles in the attached instrument will be supported by changes to the Provider Notes and Fee Schedules. The Provider Notes and Fee Schedules are incorporated by reference into the Treatment Principles in the form in which they exist from time to time under Schedule 1 of the Treatment Principles. The documents are freely accessible on the DVA website at: https://www.dva.gov.au/providers

REGULATORY IMPACT

None.

HUMAN RIGHTS STATEMENT

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

Human rights implications

The attached legislative instrument does not engage any of the applicable rights or freedoms.

Overview

The attached instrument varies the Treatment Principles and the MRCA Treatment Principles (collectively known as the Treatment Principles). The Treatment Principles set out the circumstances in which treatment may be provided to clients of DVA. The amendments in the attached instrument removes all references to ‘Local Medical Officer’ (LMO) and replaces it with the commonly referred title of ‘General Practitioner’ (GP). In practice, the terms LMO and GP are interchangeable. As such, the amendment does not alter existing arrangements so it does not engage any human rights.

The attached instrument also removes the provisions relating to the In-Home Telemonitoring for Veterans initiative. As this initiative ceased in 2016, the amendments are machinery and do not engage any human rights.

Conclusion

The attached instrument is compatible with human rights as it does not raise any human rights issues.

Darren Chester

Minister for Veterans and Defence Personnel

Rule Maker

FURTHER EXPLANATION OF PROVISIONS

See: Attachment A

Attachment A

FURTHER EXPLANATION OF PROVISIONS

Section 1

This section provides the name of the instrument is the Veterans’ Affairs (Treatment Principles – Local Medical Officer) Amendment Instrument 2019.

Section 2

This section provides the instrument commences on 1 October 2019.

Section 3

This section sets out the legislative authority for the making of this instrument, namely: section 90 of the Veterans’ Entitlements Act 1986 in respect of the variations to the Treatment Principles, and section 286 of the Military Rehabilitation and Compensation Act 2004 in respect of the variations to the MRCA Treatment Principles.

Section 4

This section provides that the VEA Treatment Principles and the MRCA Treatment Principles are varied as set out in each of the Schedules to the instrument.

Schedule 1 – Variations to the Treatment Principles under the Veterans’ Entitlements Act 1986

Item 1 omits “LMO” in the following definitions in paragraph 1.4.1 and substitutes “general practitioner”:

paragraph (b) of the definition of “Aboriginal Health Worker Care Co-ordination treatment”;
paragraph (b) of the definition of “Community Nurse Care Co-ordination treatment”;
paragraph (b) of the definition of “Practice Nurse Care Co-ordination treatment”.

Item 2 omits the definition of “admission date” in paragraph 1.4.1 and substitutes a new definition to replace references to “LMO” with “general practitioner”.

Item 3 omits the definition of “admitting LMO” in paragraph 1.4.1 and substitutes a new definition of “admitting general practitioner”.

Item 4 omits the definition of “Coordinated Veterans’ Care Program” in paragraph 1.4.1 and substitutes a new definition to replace references to “Local Medical Officer” and “LMO” with “general practitioner” or “GP”.

Item 5 omits “LMO” in the following definitions in paragraph 1.4.1 and substitutes “GP”:

paragraph (a) of the definition of “Coordinated Veterans’ Care Program treatment”;
paragraph (b) of the definition of “Veterans’ Home Care Program”.

Item 6 omits in paragraph 1.4.1 the following definitions - “Authorised Representative”,

“community patient”, “community services”, “consumable rehabilitation appliance”, “data repository”, “data repository controller”, “DVA Telemonitoring Practice Incentive”;

“enrolment day”, “in‑home telemonitoring equipment”, “In‑Home Telemonitoring for Veterans Initiative”, “internet carriage service”, “ISP Provider”, “Level A attendance”;

“limited VHC – type service”, “National Broadband Network”, “NBN”, “NBN wave site” and “nominated residence”. The definitions are not required.

Item 7 omits “an LMO” in the definition of “GPMP” in paragraph 1.4.1 and substitutes “a general practitioner”.

Item 8 omits the definition of “general practitioner” in paragraph 1.4.1 and substitutes a new definition., to provide that “general practitioner” has the same meaning as in the Health Insurance Act 1973.

Item 9 omits “an LMO Home Care service (category C) Referral” in paragraph (a) of the definition of “Home Care service (category C)” in paragraph 1.4. and substitutes “a GP Home Care service (category C) Referral”.

Item 10 omits the definition of “LMO” including the Note in paragraph 1.4.1.

Item 11 omits the definition of “LMO Care Leadership treatment” in paragraph 1.4.1 and substitutes a new definition of “GP Care Leadership treatment”.

Item 12 omits the definition of “LMO Home Care service (category C) Referral” in paragraph 1.4.1 and substitutes a new definition of “GP Home Care service (category C) Referral”.

Item 13 omits paragraph (a) of the definition of “Notes for Coordinated Veterans' Care Program Providers” in paragraph 1.4.1 and substitutes a new paragraph (a) which refers to a general practitioner.

Item 14 omits the definition of “Notes for Local Medical Officers” (including the Note) in paragraph 1.4.1 and substitutes a new definition of “Notes for General Practitioners”.

Item 15 omits the definition of “other GP” in paragraph 1.4.1 including the Notes.

Item 16 omits the definition of “participating LMO” in paragraph 1.4.1 including the Note.

Item 17 omits paragraph (a) of the definition of “period of care” in paragraph 1.4.1 and substitutes a new paragraph (a) which refers to a general practitioner. It also omits “LMO” (wherever occurring) and substitutes “general practitioner”.

Item 18 omits Notes 1 and 2 of the definition of “period of care” in paragraph 1.4.1 as the notes are no longer required.

Item 19 omits the definition of “practice nurse” in paragraph 1.4.1 and substitutes a new definition to replace references to “LMO” with “general practitioner”.

Item 20 omits “LMOs” in paragraphs (a) and (b) of the definition of “Rural Enhancement Scheme” in paragraph 1.4.1 and substitutes “general practitioners”.

Item 21 omits the definition of “subsequent period of care” including the Note in paragraph 1.4.1 and substitutes a new definition and a new Note to replace references to “LMO” with “general practitioner”.

Item 22 omits in paragraph 1.4.1 the following definitions - “telemonitoring care plan”, “telemonitoring equipment”, “telemonitoring initiative data”, “telemonitoring initiative participant”, “telemonitoring treatment”, “TRCP treatment” and “TRCP provider”. The definitions are not required.

Item 23 omits the definition of “Veteran Access Payment” including the Note in paragraph 1.4.1 and substitutes a new definition and a new Note.

Item 24 omits “LMO or other GP” in paragraph 3.3.2(a) and substitutes “a general practitioner”.

Item 25 omits paragraph 3.5.1(1)(h) and substitutes a new paragraph to replace references to “Local Medical Officer” and “LMO” with “general practitioner”.

Item 26 omits “LMOs” (twice occurring) in paragraph 3.5.1(1)(i) and substitutes “GPs”.

Item 27 omits paragraph 3.5.1(1)(o) relating to “other GPs”.

Item 28 omits “LMO or other GP” (wherever occurring) in Part 4 and substitutes “general practitioner”.

Item 29 omits the heading to paragraph 4.1 and substitutes a new heading “General Practitioners”.

Item 30 omits paragraph 4.1.3 and substitutes a new paragraph which explains how the Commission or the Department deals with medical practitioners on two levels to achieve the objective of ensuring so far as practicable that entitled persons have access to free, safe and cost-effective treatment.

Item 31 omits “an LMO, an other GP” in paragraph 4.1.4 and substitutes “a general practitioner”.

Item 32 omits “LMO, other GP” (wherever occurring) in paragraphs 4.3A.1 and 4.7.3 and substitutes “general practitioner”.

Item 33 omits “LMO or other GP’s” in paragraph 4.8.1(a) and substitutes “general practitioner’s”.

Item 34 makes the following amendments in Part 6A:

omits “the LMO” (wherever occurring) and substitutes “the general practitioner”;
omits “the LMO” (wherever occurring) and substitutes “the general practitioner”;
omits “LMO Care Leadership treatment” (wherever occurring) and substitutes “GP Care Leadership treatment”;
omits “an LMO” (wherever occurring) and substitutes “a general practitioner”;
omits “an LMO” (wherever occurring) and substitutes “a general practitioner”;
omits “LMO Home Care service (category C) Referral” (wherever occurring) and substitutes “GP Home Care service (category C) Referral”;
omits “The LMO”, and substitutes “The general practitioner”.

Item 35 makes the following amendments in paragraph 6A.1:

omits “LMO Care Leadership treatment” and substitutes “GP Care Leadership treatment”;
omits “LMO referral for social support service assessment” and substitutes “GP referral for social support service assessment”;
omits “Local Medical Officer (LMO)” and substitutes “general practitioner”;
omits “LMO’s practice nurse” (twice occurring) and substitutes “general practitioner’s practice nurse”.

Item 36 omits “LMO” (wherever occurring) in the heading to paragraphs 6A.2.1, 6A.3 6A.6 and 6A.8 and substitutes “GP”.

Item 37 omits paragraph 6A.2.2 and substitutes a new paragraph to replace references to “LMO” with “GP”.

Item 38 omits Note 1 in paragraph 6A.3.1 and substitutes a new Note to replace references to “LMO” with “GP”.

Item 39 omits “LMO” in subparagraph 6A.4A.1(a)(i) and substitutes “general practitioner”.

Item 40 omits “LMOs” in subparagraph 6A.4A.1(a)(iii) and paragraph 6A.4A.1(b) and substitutes “general practitioner”.

Item 41 omits paragraph 6A.5.1(4) (including the Note) and substitutes a new paragraph

which refers to an admitting general practitioner and a new Note.

(4) the person has consented to participation in the program and the admitting general practitioner has recorded the consent (which may be an electronic record); and

Note: under the Notes for Coordinated Veterans' Care Program Providers the general practitioner is to store the consent.

Item 42 makes the following amendments in paragraph 6A.8.2:

omits “The LMO” and substitutes “The general practitioner”;
omits “an LMO Home Care service (category C) Referral” and substitutes “a GP Home Care service (category C) Referral”.

Item 43 omits “An LMO” in paragraph 6A.9.1 and substitutes “A general practitioner”.

Item 44 omits “The LMO” in paragraphs 6A.9.2 and 6A.9.4 and substitutes “The general practitioner”.

Item 45 omits “LMO Home Care service (category C) Referral” in paragraph 6A.9.8 and substitutes “GP Home Care service (category C) Referral”.

Item 46 omits Part 6B which provides for the In-Home Telemonitoring for Veterans initiative. As the initiative ceased in 2016, Part 6B is no longer required.

Item 47 omits “an LMO or other GP” in paragraph 7.3.3(a) and substitutes “a general practitioner”.

Item 48 omits “a LMO Home Care service (category C) Referral” in subparagraph 7.3A.1(1)(a)(iii) and paragraph 7.3A.6B(2) and substitutes “a GP Home Care service (category C) Referral”.

Item 49 omits “an LMO” in paragraphs 7.3A.6B and 7.5.1 and substitutes “a general practitioner”.

Item 50 omits “LMO or other GP’s” in paragraph 7.5.2 and substitutes “general practitioner’s”.

Item 51 omits “LMO or other GP” in paragraphs 7.6.1 and 7.7.1 and substitutes “general practitioner”.

Item 52 omits “LMO, other GP” in paragraph 7.6A.1(a) and substitutes “general practitioner”.

Item 53 makes the following amendments to Schedule 1:

Omits:

“1. Notes for Local Medical Officers (paragraph 1.4.1)

https://www.dva.gov.au/providers/doctors#lmonotes”

Substitutes:

“1. Notes for General Practitioners (paragraph 1.4.1)

https://www.dva.gov.au/providers/notes-providers”.

Schedule 2 – Variations to the Treatment Principles under the Military Rehabilitation and Compensation Act 2004

Item 1 omits “LMO” in the following definitions in paragraph 1.4.1 and substitutes “general practitioner”:

paragraph (b) of the definition of “Aboriginal Health Worker Care Co-ordination treatment”;
paragraph (b) of the definition of “Community Nurse Care Co-ordination treatment”;
paragraph (b) of the definition of “Practice Nurse Care Co-ordination treatment”.

Item 2 omits the definition of “admission date” in paragraph 1.4.1 and substitutes a new definition to replace references to “LMO” with “general practitioner”.

Item 3 omits the definition of “admitting LMO” in paragraph 1.4.1 and substitutes a new definition of “admitting general practitioner”.

Item 5 omits “LMO” in the following definitions in paragraph 1.4.1 and substitutes “GP”:

paragraph (a) of the definition of “Coordinated Veterans’ Care Program treatment”;
paragraph (b) of the definition of “MRCA Home Care Program”.

Item 6 omits in paragraph 1.4.1 the following definitions - “Authorised Representative”,

“community services”, “consumable rehabilitation appliance”, “data repository”, “data repository controller”, “DVA Telemonitoring Practice Incentive”;

“enrolment day”, “in‑home telemonitoring equipment”, “In‑Home Telemonitoring for Veterans Initiative”, “internet carriage service”, “ISP Provider”, “Level A attendance”;

“limited MHC – type service”, “National Broadband Network”, “NBN”, “NBN wave site” and “nominated residence”. The definitions are not required.

Item 7 omits “an LMO” in the definition of “GPMP” in paragraph 1.4.1 and substitutes “a general practitioner”.

Item 8 inserts the definition of “general practitioner” in paragraph 1.4.1to provide that “general practitioner” has the same meaning as in the Health Insurance Act 1973.

Item 10 omits the definition of “Local Medical Officer” or “LMO” including the Note in paragraph 1.4.1.

Item 11 omits the definition of “LMO Care Leadership treatment” in paragraph 1.4.1 and substitutes a new definition of “GP Care Leadership treatment”.

Item 12 omits the definition of “LMO Home Care service (category C) Referral” in paragraph 1.4.1 and substitutes a new definition of “GP Home Care service (category C) Referral”.

Item 13 omits the definition of “MRCA Access Payment” including the Note in paragraph 1.4.1 and substitutes a new definition and Note.

Item 14 omits paragraph (a) of the definition of “Notes for Coordinated Veterans' Care Program Providers” in paragraph 1.4.1 and substitutes a new paragraph (a) which refers to a general practitioner.

Item 15 omits the definition of “Notes for Local Medical Officers” (including the Note) in paragraph 1.4.1 and substitutes a new definition of “Notes for General Practitioners”.

Item 16 omits the definition of “other GP” in paragraph 1.4.1 including the Notes.

Item 17 omits the definition of “participating LMO” in paragraph 1.4.1 including the Note.

Item 18 omits paragraph (a) of the definition of “period of care” in paragraph 1.4.1 and substitutes a new paragraph (a) which refers to a general practitioner. It also omits “LMO” (wherever occurring) and substitutes “general practitioner”.

Item 19 omits Notes 1 and 2 of the definition of “period of care” in paragraph 1.4.1 as the notes are no longer required.

Item 20 omits the definition of “practice nurse” in paragraph 1.4.1 and substitutes a new definition to replace references to “LMO” with “general practitioner”. .

Item 21 omits “LMOs” in paragraphs (a) and (b) of the definition of “Rural Enhancement Scheme” in paragraph 1.4.1 and substitutes “general practitioners”.

Item 22 omits the definition of “subsequent period of care” including the Note in paragraph 1.4.1 and substitutes a new definition and a new Note to replace references to “LMO” with “general practitioner”.

Item 23 omits in paragraph 1.4.1 the following definitions - “telemonitoring care plan”, “telemonitoring equipment”, “telemonitoring initiative data”, “telemonitoring initiative participant”, “telemonitoring treatment” and “TRCP treatment”. The definitions are not required.

Item 24 omits “Local Medical Officer or other GPs” in paragraph 3.3.2(a) and substitutes “a general practitioner”.