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1998-1999-2000
THE PARLIAMENT OF
THE COMMONWEALTH OF AUSTRALIA
HOUSE OF
REPRESENTATIVES
NATIONAL HEALTH AMENDMENT (IMPROVED MONITORING OF
ENTITLEMENTS TO PHARMACEUTICAL BENEFITS) BILL
2000
SUPPLEMENTARY EXPLANATORY
MEMORANDUM
Amendments to be Moved on Behalf of the
Government
(Circulated by the
authority of the Minister for Health and Aged Care,
the Hon Dr
Wooldridge MP)
ISBN: 0642 453802
NATIONAL HEALTH AMENDMENT (IMPROVED MONITORING OF
ENTITLEMENTS TO PHARMACEUTICAL BENEFITS) BILL 2000
OUTLINE
This amendment will amend the National Health Amendment (Improved
Monitoring of Entitlements to Pharmaceutical Benefits) Bill 2000 (‘the
Bill’).
In broad terms, the Bill amends the National Health
Act 1953 (‘the Act’) to require the inclusion of medicare
numbers on prescriptions for pharmaceutical benefits. This will help to ensure
that only those persons entitled to pharmaceutical benefits under Part VII of
the Act will receive them.
The purpose of this amendment is to address
concerns expressed by stakeholders regarding the administrative obligations of
approved suppliers under the Bill. The amendment provides that a
medicare number or special number may be endorsed on a prescription, or inserted
in a claim made under the electronic Claims Transmission System
(‘CTS’) in order to obtain payment from the Commonwealth for the
supply of pharmaceutical benefits. This amendment ensures consistency with the
Electronic Transactions Act 1999 by addressing the possibility of
electronic transmission of claims.
The amendment also provides for a
Ministerial discretion where a medicare number ultimately supplied to the Health
Insurance Commission in relation to a prescription for the supply of a
pharmaceutical benefit does not match that held by the Health Insurance
Commission in respect of the person to whom the prescription relates. In
certain circumstances determined by the Minister, an approved supplier may be
entitled to payment in respect of the supply of pharmaceutical benefits despite
there being no match between the medicare number ultimately supplied to the
Health Insurance Commission and the number held by the Health Insurance
Commission in relation to that particular person.
The amendment also
enables a date later than 1 July 2001 to be prescribed as the date from which
payments to approved suppliers will be prevented in relation to the dispensing
of prescriptions for pharmaceutical benefits where there has been a failure to
collect medicare numbers and endorse those numbers (or special numbers) on
prescriptions or insert them in CTS claims relating to those prescriptions, or
where the numbers so endorsed or inserted do not match the numbers held by the
Health Insurance Commission. This ensures flexibility in case approved
suppliers do not have the appropriate software in place by 1 July 2001 to comply
with the new provisions.
FINANCIAL IMPACT STATEMENT
The amendments to the Bill have no significant financial
impact.
NOTES ON CLAUSES
This amendment adds to subsection 84(1) a definition of CTS
claim to mean a claim made to the Health Insurance Commission using the
procedures of the claims transmission system provided for in section 99AAA of
the National Health Act 1953.
The amendment substitutes subsections 86B(3), (4) and (5) for new
subsections 86B(3), (4) and (5) to take account of medicare numbers or special
numbers inserted in CTS claims, as well as medicare numbers or special numbers
endorsed on prescriptions. The amendment enables an approved supplier to
note on the CTS claim where there is a discrepancy between the medicare number
endorsed on the prescription and the medicare number provided to him or her by
the person or contained in the approved supplier’s
records.
Amendment (4)
The amendment substitutes
subsections 86C(3) to (7) inclusive for new subsections 86C(3) to (7) to take
account of medicare numbers or special numbers inserted in CTS claims, as well
as medicare numbers or special numbers endorsed on prescriptions. The amendment
enables an approved supplier to note on the CTS claim where there is a
discrepancy between the medicare number endorsed on the prescription and the
medicare number provided to him or her by the person or contained in the
approved supplier’s records.
The amendment also substitutes note 1
at the end of section 86C for a new note 1 which addresses the consequences of a
failure ultimately to supply a medicare number or special number to the Health
Insurance Commission, or, in the case of a medicare number that is so supplied,
of a discrepancy with a medicare number held in the records of the Health
Insurance Commission.
Amendment (5)
This amendment substitutes
new subsections 99(7) and (8) for those in item 10.
The new subsection
99(7) takes account of medicare numbers or special numbers inserted in CTS
claims, as well as medicare numbers or special numbers endorsed on
prescriptions. It also enables a date later than 1 July 2001 to be prescribed
as the date from which payments to approved suppliers will be prevented in
relation to the dispensing of prescriptions for pharmaceutical benefits where
there has been a failure to collect medicare numbers and endorse those numbers
(or special numbers) on prescriptions or insert them in CTS claims relating to
those prescriptions, or where the numbers so endorsed or inserted do not match
the numbers held by the Health Insurance Commission.
The new subsection
99(8) provides for a Ministerial discretion where a medicare number ultimately
supplied to the Health Insurance Commission in relation to a prescription for
the supply of a pharmaceutical benefit does not match that held by the Health
Insurance Commission in respect of the person to whom the prescription relates.
In certain circumstances determined by the Minister, an approved supplier may be
entitled to payment in respect of a claim for the supply of a pharmaceutical
benefit despite there being no match between the medicare number ultimately
supplied to the Health Insurance Commission and the number held by the Health
Insurance Commission in relation to that particular person.