Health Insurance (General Medical Services Table) Amendment (Obstetrics) Regulations 2017 [F2017L01090]-Concluded matters [2017] AUSStaCSDLM 414 (15 November 2017)

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Instrument	Health Insurance (General Medical Services Table) Amendment (Obstetrics) Regulations 2017 [F2017L01090]
Purpose	Amends the medical services schedules relating to Medicare benefits coverage for obstetric care, to implement recommendations of the Medicare Benefits Schedule Review Taskforce
Authorising legislation	Health Insurance Act 1973
Portfolio	Health and Aged Care
Disallowance	15 sitting days after tabling (tabled Senate 4 September 2017) Notice of motion to disallow currently must be given by 16 November 2017
Scrutiny principle	Standing Order 23(3)(b)
Previously reported in	Delegated legislation monitor 13 of 2017

Personal rights and liberties: privacy

The committee previously commented as follows:

Scrutiny principle 23(3)(b) of the committee's terms of reference requires the committee to ensure that instruments of delegated legislation do not trespass unduly on personal rights and liberties, including the right to privacy.

The committee notes that two items scheduling obstetric services for the planning and management of a pregnancy have been amended to include, among other things, a new requirement that 'the service include a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient'. The ES states that this new requirement will improve mental health outcomes for patients by screening for perinatal anxiety and depression, consistent with Australian guidelines, and improving early detection and intervention.

The ES does not set out the nature of the alcohol and drug screening to be conducted, and does not address the connection between the alcohol and drug screening and the identified mental health objectives.

Further, the committee notes that the ES does not address whether patient consent is required for the mental health assessment, including the alcohol and drug screening. It is unclear to the committee whether the provisions would have the effect that a patient who did not consent to such screening may lose eligibility for Medicare benefits in relation to their obstetric care during pregnancy.

The committee requested the minister's advice in relation to:

• the nature of the mental health assessment required to be conducted under the regulations, including alcohol and drug screening;

• how patients' consent will be managed with regard to the screening and its connection to Medicare benefits; and

• any relevant safeguards in place.

Minister's response

The Minister for Health advised:

I note the Committee's request for information around the nature of the mental health assessment required to be conducted for amended antenatal items 16590 and 16591 and new postnatal item 16407.
The Government does not intend to prescribe the method by which practitioners undertake mental health assessments of their patients,
as this should be a matter of clinical judgement based on the individual needs of the patient. However, it is recommended that when conducting mental health assessment screening practitioners have regard to the appropriate and current Australian Clinical Practice guidelines.
Alcohol or drug misuse are significant risk factors that can negatively affect both the mental health of the patient and the wellbeing of infants. As part of an antenatal (16590 and 16591) or postnatal (16407) service, it is expected that a medical practitioner be required to enquire about the mental wellbeing of the patient and undertake a more comprehensive assessment where agreed to by the patient. This would include a discussion about factors that pose a significant risk to mental health,
such as drug and alcohol use and domestic violence. This would then enable monitoring or referral for appropriate assessment, support and treatment, and facilitate education about the inherent risks of drug and alcohol misuse in pregnancy.
It is not intended that the screening for drug and alcohol use would require diagnostic testing of the patient. It is also not intended that a patient would be ineligible for Medicare benefit if the patient declines to receive a comprehensive mental health assessment. In that scenario,
a Medicare benefit would still be payable providing the medical practitioner had enquired about the patient's mental wellbeing. This is outlined in the explanatory notes that are available on www.mbsonline.gov.au to assist practitioners when seeking information and guidance around the billing of items under Medicare. A copy of this note is attached.
I acknowledge that the explanatory statement for this instrument is not clear with regards to consent. My Department will look to correct this in the explanatory statement when the Health Insurance (General Medical Services Table) Regulations are remade in mid-2018.

Committee's response

The committee thanks the minister for his response.

The committee notes the advice that the method by which practitioners undertake mental health assessments of their patients is not prescribed, but should adhere to Australian Clinical Practice guidelines, and that it is not intended that the screening for drug and alcohol use would require diagnostic testing of patients, or that they would be ineligible for Medicare benefit if they declined to receive a comprehensive mental health assessment.

The committee notes the minister's undertaking to amend the ES when the regulations are remade in mid-2018, to provide a clarification of the issues that the committee has raised in relation to patients' consent.

The committee has concluded its examination of the instrument.