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Wednesday, 27 June 2012
Page: 8151


Ms PLIBERSEK (SydneyMinister for Health) (09:30): I move:

That this bill be now read a second time.

More than ever before, we are making the most of every precious health dollar.

We are being guided by the evidence and investing wisely.

We are finding efficiencies and returning the benefits to patients.

Where the evidence said things were not working, the government has done things differently. And the bill before the House is part of this. We have looked at the evidence on how the Extended Medicare Safety Net works, and it says we need to close a loophole to protect the integrity of the system.

This bill amends the Health Insurance Act 1973 to allow the application of Extended Medicare Safety Net benefit caps to apply where more than one Medicare service is performed on the same patient on the same occasion and is deemed to be 'one professional service'.

This bill makes an amendment to the Extended Medicare Safety Net program that was introduced through the Health Legislation Amendment (Medicare) Act 2004.

The Extended Medicare Safety Net provides individuals and families with an additional rebate for their out-of-hospital Medicare services once an annual threshold of out-of-pocket costs for out-of-hospital services is reached.

Out-of-hospital services include GP and specialist attendances and services provided in private clinics and private emergency departments.

Once the relevant annual threshold has been met, Medicare will pay for 80 per cent of any future out-of-pocket costs for Medicare eligible out-of-hospital services for the remainder of the calendar year, except for a number of services where there is an upper limit on the benefit payable through the Extended Medicare Safety Net, known as the 'EMSN benefit cap'.

The Extended Medicare Safety Net program was amended through the Health Legislation Amendment (Extended Medicare Safety Net) Bill 2009, which amended the Health Insurance Act 1973 to enable the minister to determine, by legislative instrument, the maximum benefit payable under the Extended Medicare Safety Net for a specified Medicare Benefits Schedule (MBS) item.

The items that carry an EMSN benefit cap and the cap amount for each item are set out in the Health Insurance (Extended Medicare Safety Net) Determination 2009. The Health Insurance Act 1973 specifies that a determination made by the minister to place or amend an existing EMSN benefit cap must be approved by the resolution of each house of parliament before it can become effective.

Since 1 January 2010, EMSN benefit caps have applied to selected MBS items. These include assisted reproductive technology services, obstetrics services, pregnancy related ultrasounds, cataract surgery, hair transplantation and varicose vein surgery. A further 16 items have since been introduced into the MBS with EMSN benefit caps. Caps were placed on these items to maintain consistency with the existing capped items, or based on recommendations made by the Medicare Services Advisory Committee regarding cost-effectiveness.

The current provisions of the Health Insurance Act 1973 do not allow EMSN benefit caps to apply where more than one item is claimed by the same patient on the same occasion and the items are deemed to constitute one professional service. An example of this occurs under Section 15 of the Health Insurance Act 1973 which describes the multiple operations rule.

There are, of course, many instances where claiming for multiple operations on the same occasion is appropriate. For instance, patients can benefit from having more than one operation at the same time because they do not need to have a second anaesthetic. An example is where a patient is having several skin cancers removed by surgical excision. Another is where varicose vein surgery is performed on both legs.

Under the multiple operations rule there is a reduction in the amount of Medicare benefit payable where two or more operations are performed on the same patient on the same occasion, to recognise the efficiencies gained when several procedures are provided on the one occasion. Under legislation, where the multiple operations rule applies, the operations are deemed to be one professional service, rather than a collection of MBS items. However, EMSN benefit caps can only apply to an MBS item and not a professional service.

This means that under the current legislation, where doctors perform multiple procedures on the same patient on the same occasion, any EMSN benefit caps that apply to the individual MBS items that are performed within the operation do not apply, and there is no limit to the Extended Medicare Safety Net benefits that are payable for that professional service. This is not what was originally intended when parliament approved selected MBS items to have an EMSN benefit cap.

As announced in the 2012-13 budget, it is proposed that the Extended Medicare Safety net benefit caps be applied to a further 39 selected MBS items and all consultation services from 1 November 2012. These items have been selected to reduce the government's exposure to subsidising excessive fee inflation by some doctors, or where there is a risk that practitioners may shift fees on to uncapped items. Thirty-five of the items selected to be capped on 1 November 2012 fall under the definition of an operation for the purposes of the multiple operations rule and therefore may be deemed to constitute 'one professional service'.

Currently a doctor can avoid EMSN benefit caps by performing other operations at the same time. If the government cannot be certain that EMSN benefit caps will apply to selected items, it may not be in a position to introduce funding for important new high cost technologies.

This bill will ensure that where items are deemed to constitute 'one professional service' and all of the original MBS items that are part of that service are capped, the Extended Medicare Safety Net benefit caps will apply. This will ensure that the full savings announced in the budget are realised.

Other provisions —f amily registration for the EMSN

This bill also includes the provision to reduce the administrative burden on patients by removing the requirement for families to confirm the members of their family for Extended Medicare Safety Net purposes in writing. Currently, when families are nearing the Extended Medicare Safety Net threshold, the Department of Human Services—Medicare—contacts the person who registered the family and asks them to confirm in writing the members of their family to ensure that the correct out-of-pocket costs have been attributed to the family Extended Medicare Safety Net threshold. Providing confirmation in writing increases the time families must wait to receive their Extended Medicare Safety Net benefits.

This amendment allows the chief executive of Medicare to determine the appropriate manner in which this information is provided and will allow families to confirm their family composition more quickly and easily. Patients will still be required to confirm their identity before this confirmation can take place to ensure the information provided is accurate.

This bill will allow the government to responsibly manage expenditure on Extended Medicare Safety Net and reduce the administrative burden on families. This is important for supporting the sustainability of the Extended Medicare Safety Net so singles and families can continue to receive additional assistance with their out-of-pocket costs.

Debate adjourned.