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Thursday, 17 June 2010
Page: 5696

Mr SNOWDON (Minister for Indigenous Health, Rural and Regional Health and Regional Service Delivery) (9:08 AM) —I move:

That this bill be now read a second time.

The Professional Services Review (PSR) Scheme and the Medicare Participation Review Committee (MPRC) are important parts of the government’s efforts to ensure Medicare is used correctly and taxpayers’ money is not abused.

The PSR Scheme is a peer review process for investigating whether a practitioner has inappropriately rendered or initiated Medicare or Pharmaceutical Benefits Scheme (PBS) services.

This scheme also aims to protect patients from the risks associated with inappropriate practice and this bill enhances the protection of the public.

In 2008-09 Medicare Australia referred 136 matters to PSR.

This bill makes amendments to the provisions for the Professional Services Review (PSR) Scheme and the Medicare Participation Review Committee (MPRC) in the Health Insurance Act 1973 (the act).

The proposed amendments do not alter the purpose of the PSR Scheme or the MPRC process, but address the recommendations of the 2007 review of the PSR Scheme.

Change in requirement to refer to the MPRC

Practitioners who are found to have engaged in inappropriate practice may be reprimanded, counselled and/or disqualified through the PSR process from providing these services for up to three years.

At present, a practitioner must be referred to the MPRC if they have committed a relevant civil or criminal offence, or been found to have engaged in inappropriate practice by the PSR on two or more occasions.

The bill removes the requirement for the Director of PSR to refer practitioners who have been found to have engaged in inappropriate practice on two or more occasions to the MPRC and provides for the director and the determining authority to apply a disqualification period of up to five years to those practitioners.

Prescribed pattern of services

In 1999 the profession agreed that when high numbers of services are provided a possibility of poor quality arises.

The number agreed was 80 or more unreferred attendances on 20 or more days in a 12-month period.

This bill clarifies in legislation that a practitioner who performs this number of services is automatically deemed by the legislation to have practised inappropriately, unless they can provide evidence that exceptional circumstances existed.

The bill requires the Medicare Australia CEO to request a review by the Director of PSR, if the CEO becomes aware of a ‘prescribed pattern of services’.

The final determination that a ‘prescribed pattern of services’ constitutes inappropriate practice can only be made under the PSR Scheme. It is not a decision that can be taken by the Medicare Australia CEO.

Expanding the coverage of the PSR Scheme

At present the PSR Scheme and the MPRC apply only to medical practitioners, dentists, chiropractors, physiotherapists, podiatrists, optometrists and osteopaths who provide services under Medicare and the PBS.

In the 2009 calendar year, practitioners not covered by PSR and MPRC arrangements provided 3.6 million services at a cost to Medicare of $350 million.

These practitioners include audiologists, diabetes educators, dieticians, exercise physiologists, mental health nurses, occupational therapists, psychologists, social workers and speech pathologists.

The bill provides for a determination to be made that a health professional is a practitioner for the purposes of the PSR Scheme and the MPRC (recommendation 12 of the review committee). This will enable the PSR Scheme and the MPRC to be applied to allied health professionals who provide Medicare services.

Administration improvements

The bill provides for improvements to streamline the administration of the scheme related to recommendation 4 of the review committee by:

  • providing an extension of time for a PSR committee or the determining authority process in some circumstances, such as where a person is unable to participate in the process due to illness;
  • providing for a PSR committee or the determining authority to take no further action in some circumstances, such as where the person dies;
  • providing for a final determination to take effect seven days after the day on which an appeal is withdrawn or discontinued by the person.

Improving the protection of the public

The bill includes amendments to improve the protection of the public under the PSR Scheme.

If the conduct of a person under review poses a threat to patient life or health, the director must contact the relevant body—that is, the body in each state or territory that is authorised to recall patients for independent medical review, such as the Chief Medical Officer.

The bill also requires the director to notify the relevant registration body.

Other minor changes

The bill makes a number of other minor administrative changes to the scheme. These are:

  • clarifying that Medicare services which are requested may be reviewed by PSR, whether or not they have been rendered;
  • authorising the Director of PSR to give information about a person to the determining authority, on one occasion, up until the authority makes its draft determination;
  • protecting patients by requiring persons who are disqualified due to a PSR or MPRC process to display a notice to inform patients that services will not attract Medicare benefits; and
  • amending certain provisions to clarify that the instrument referred to is a legislative instrument under the Legislative Instruments Act 2003.

Unrelated amendment

The bill contains one amendment not directly related to the PSR Scheme or the MPRC.

Currently the Health Insurance Act provides for regulations to be made in relation to referrals to consultant physicians and specialists.

Over the last decade a broad range of health practitioners have become able to provide Medicare services.

This change will enable the current regulations applying to referrals to consultant physicians and specialists to be expanded so that they apply to any referral made for a Medicare service.

This bill will ensure that the PSR Scheme continues to operate effectively as part of the government’s efforts to protect the integrity of Medicare.

I commend the bill to the House.

Debate (on motion by Mr Coulton) adjourned.