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Tuesday, 9 May 2000
Page: 14192


Senator IAN CAMPBELL (Parliamentary Secretary to the Minister for Communications, Information Technology and the Arts) (3:52 PM) —I table a revised explanatory memorandum relating to the bills and I move:

That these bills be now read a second time.

I seek leave to have the second reading speech incorporated in Hansard.

Leave granted.

The speech read as follows

The Health Legislation Amendment Bill (No 4) 1999 makes a number of amendments to the Health Insurance Act 1973, and will repeal the Health Insurance (Pathology) (Licence Fee) Act 1991. The Health Insurance (Approved Pathology Specimen Collection Centres) Tax Bill 1999, which will operate in place of the latter Act, is being considered cognately. I will deal firstly with the amendments relating to pathology specimen collection centres which involves both bills.

Approved Collection Centres

The principal Bill addresses the arrangements for the collection of pathology specimens for the performance of pathology services eligible for Medicare benefits. The Health Insurance Act requires such specimens to be collected at places such as at a person's home, a recognised hospital, private hospital, nursing home, or other institution where the person is a patient. Pathology specimens can also be collected at a licensed collection centre operated by an approved pathology authority. However, the present arrangements under the Act for the licensing of collection centres exclude the public sector, do not place sufficient emphasis on the quality of service and facilities at the centres, and are in general unnecessarily cumbersome in operation.

The proposed amendments address these issues to permit the introduction of a national approval system for specimen collection centres that is fair and open, emphasises quality collection services, and uses the level of Medicare pathology activity at laboratories of which an approved pathology authority is the proprietor as the normal basis for determining the number of collection centres that can be operated by it each year.

The Bill introduces a simplified procedure whereby approved pathology authorities apply for approvals for specimen collection centres as approved collection centres. This replaces the existing system involving the granting of units of entitlement. Approvals will be granted in respect of a financial year and the process will be subject to Approval Principles determined as a disallowable instrument under the Act.

The Approval Principles will be able to deal with matters such as the method for determining the maximum number of approvals that can be granted to an approved pathology authority in respect of a financial year, the giving of undertakings regarding compliance with quality guidelines, the duration of approvals, and the review of decisions made under the Principles. It is intended that the Approval Principles will prescribe a general method for the determination of maximum approvals for a financial year based on the experience of laboratories operated by an approved pathology authority over a specified 12 month period as reflected in Health Insurance Commission data. This is in contrast to the previous system of allocating units of entitlement by reference to a fixed pool. A four year phase in period is proposed to allow the industry time to adjust to a less regulated environment. The present policy of allowing additional approvals where collection centres are located in designated rural and remote areas will be continued.

The amendments will apply to both public and private sectors from 1 July 2000. State and Territory bodies, previously excluded from the licensed collection centre arrangements, will be able to apply as approved pathology authorities for approvals. The same regime will therefore apply to both public and private approved collection centres. At the same time, the provision which permits specimen collections to be made at a recognised hospital is being amended to make it clear that this only applies to collections at the main premises of the hospital where accommodation and nursing care is provided. Public and private approved pathology authorities that are the sole proprietors of a prescribed category of laboratory will be able to apply for approvals for approved collection centres. It is expected that laboratory categories GX and GY, which will be operative from 1 January 2000, will be prescribed for this purpose.

An approved collection centre will be required to comply with the Collection Centre Guidelines published by the National Pathology Accreditation Advisory Council and developed by the Council and the Royal College of Pathologists of Australasia. With the inclusion of the public sector in the new arrangements, the amendments require the same level of quality for all pathology specimen collection centres at which collections are made for Medicare eligible services.

The design of the new arrangements, which will be administered by the Health Insurance Commission, has been jointly agreed with the Royal College of Pathologists of Australasia and the Australian Association of Pathology Practices, and is based on the framework contained in the 1999 Pathology Quality and Outlays Agreement.

The granting of an approval for an approved collection centre will be subject to a tax which must be paid before the Minister can grant an approval to an approved pathology authority for an eligible collection centre. This will be imposed by the Health Insurance (Approved Pathology Specimen Collection Centres) Tax Bill 1999.

The Tax Bill excludes grants of approval for approved collection centres located on the same premises as a category GX or GY accredited pathology laboratory from the tax.

This measure will promote equity between specimen collection arrangements in the public and private sectors. Most public sector category GX and GY laboratories are on recognised hospital premises where pathology specimen collections are permitted for Medicare purposes under the Act without separate approval as an approved collection centre. Most private sector category GX and GY laboratories are not on recognised hospital premises and require an approval for collection centres on those premises. The exclusion of these collection centres from the requirement to pay the annual tax is considered to be a fairer and more uniform approach between the public and private sectors.

This tax Bill sets the tax payable by an approved pathology authority on the grant of an approval at the rate of $1000 for a full year (subject to pro-rata reduction). This is the same as that presently payable under the to be repealed Health Insurance (Pathology) (Licence Fee) Act 1991 in respect of the grant of a licence for a licensed collection centre.

This Bill therefore in substance will preserve the status quo in relation to the collection of revenue, which I am informed in relation to licensed collection centres in recent years amounted to approximately $1.3 million per annum.

Temporary Resident and Overseas Trained Doctors, and other minor amendments

Health Legislation Amendment Bill (No. 4) 1999 contains a number of other measures. It simplifies and clarifies the rules relating to temporary resident doctors (TRDs) and overseas trained doctors (OTDs) and the circumstances in which they can access Medicare. The Bill removes the 1 January 2002 sunset clause which requires that new medical practitioners be in an approved program or complete a recognised graduate program in order to provide services which attract Medicare. If this clause is not removed, there will be a significant financial impact on expenditure under the Medicare Benefits Scheme.

At present, temporary resident doctors are not medical practitioners for the purpose of the Act and are therefore not entitled to provide services which attract Medicare unless they obtain an exemption. Overseas trained doctors with Australian citizenship or permanent residence are subject to a ten year moratorium which restricts their access to Medicare benefits unless they are granted an exemption. However, the new legislation will reduce the inequities between the treatment of permanent and temporary resident doctors and streamlines the procedure to establish eligibility for Medicare benefits. The Bill will also reduce complexity of regulation regarding access to Medicare.

In addition the Bill makes a number of technical amendments. These include amending the definition of `quality assurance activity' to include a reference to the Health Care (Appropriation) Act 1998. The definition of `professional services' will be amended to clarify that a dental practitioner who is able to render a Medicare-payable service (in respect of oral and maxillofacial surgery) must have been approved for this purpose by the Minister in writing.

The definition of `relevant offence' will be broadened to include offences under sections 23DR and 23DS of the Act, and an obsolete reference to section 21 of the Crimes Act 1914 will be deleted.

Debate (on motion by Senator O'Brien) adjourned.