Medicare Reform Medicare Benefits Schedule Review

Medicare, formerly known as Medibank, was introduced in 1984 as Australia’s national health insurance scheme1 and governed by the Health Insurance Commission (HIC). The MBS tax levy partly funds Medicare. Medicare provides universal health care to all Australian residents for hospital services and some medical services. Medicare rebates 85% of the fee for out-of-hospital service (medical and optometry). Private patients receive 75% rebate for professional medical services.

The Commonwealth Minister for Health, Hon Sussan Ley MP announced the establishment of a Medicare Bene t Schedule (MBS) Review Taskforce as part of the current Governments “Healthier Medicare” initiative that would review three priority areas:

  • Medicare Benefits Schedule (MBS) 5,500 items to reflect contemporary best clinical practice;
  • Investigate options to provide: better care for people with complex and chronic illness; innovative care and funding models; better recognition and treatment of mental health conditions; and greater connection between primary health care and hospital care; and
  • Medicare compliance rules and benchmarks.

The review will be conducted over two years and NACCHO will continue to liaise with the department on this matter. NACCHO has participated in scheduled review meetings and well as meeting with the Department of Health, Dr Steven Hambleton (Vice Chair MBS Taskforce) to discuss ACCHO model of care, MBS Section 19(2), MBS 715 Health Assessments and Aboriginal Health Workers as well as key issues such as After Hours items/services and incentive payments currently under MBS Practice Incentive Payments as part of chronic disease management.

There have been two previous extensive reviews commissioned by the Department of Health for access to major health programs for Aboriginal and Torres Strait Islander people conducted by Keys Young 1997 and Urbis Keys Young 2006. Both of these documents have been provided to the Department of Health for review and contribution.

3-year commitment for ACCHOs’ MBS Section 19.2
Aboriginal Community Controlled Health Organisations have had access to the Directions under section 19(2) of the Health Insurance Act 1973 as part of a previous Commonwealth Government’s commitment under the then Minister for Health, Hon Michael Woolridge. The Department of Health issued a 12 month extension for ACCHOs in 2013/14 as part of the DOH funding agreement. This financial year, NACCHO lobbied to ensure that the extension was granted for 3 years to align with the 3 year DOH Funding announcement. The lobbying was successful.

Formal correspondence from Senator the Hon Fiona Nash, Assistant Minister for Health at the time, was received on 27 May 2015 providing financial certainty for NACCHO Members to delivery, comprehensive primary health care to Aboriginal and Torres Strait Islander people nationally.

Non-Registered AHWs continue to assist in the delivery of MBS:715 Health Checks
NACCHO was notified by the Department of Health that there would be an amendment to the Medicare Benefits Schedule (MBS) Item 715 Health Assessment. The amendment would remove Aboriginal Health Workers being able to assist a General Practitioner in performing a health assessment for Aboriginal and Torres Strait Islander people (MBS item 715 – under the Explanatory Note A33) within the National Registration and Accreditations Scheme (NRAS).

NACCHO, QAIHC and VACCHO were quick to respond back to the Department of Health highlighting the impacts/change/amendments associated with the removal of Aboriginal Health Worker:

  • The ACCHO Sector model of care to Aboriginal and Torres Strait Islander people surrounding their health, social and emotional wellbeing and the role of the Aboriginal Health Worker as part of the clinical team is critical for ensuring key health issues or concerns are raised and managed appropriately;
  • National implementation for registration of Aboriginal Health Workers to Aboriginal Health Practitioners has not reached the policy target outside of the Northern Territory;
  • Health Insurance Regulation policy instrument only outlines the change of name;
  • Quali cation/s level for a suitable qualified Aboriginal and Torres Strait Islander Health Professional;
  • Minimum quali cation level for a non-registered AHW would be a Certificate III Aboriginal & Torres Strait Islander Primary Health care consistent with requirements;
  • Current criteria for an Aboriginal and Torres Strait Islander Health Assessment refers to “suitably qualified health professionals such as practice nurses or Aboriginal and Torres Strait Islander health practitioners employee and/or otherwise engaged by a general practice or health service may assist medical practitioners in performing this health assessment MBS 715;
  • Such assistance is in accordance with accepted medical practice and under the supervision of the medical practitioner;
  • There was a collaborative approach between NACCHO, QAIHC and VACCHO to the Commonwealth Minister for Health, Hon Sussan Ley MP, calling for a reinstatement and resolution to the amendments and proposed changes of the MBS 715.
    On the 18 June 2015 Department of Health responded formally to inform NACCHO, Affiliates and Member Services that, due to the extensive feedback opposing the amendment and the possibility of reducing the access to health assessments by Aboriginal and Torres Strait Islander people, the Minister for Health, the Hon Sussan Ley MP changed the quali cation level back to a Certificate III in Aboriginal and Torres Strait Islander Primary Health Care which would take effect from the 1 September 2015, allowing Aboriginal Health Workers to assist a GP in the delivery of health assessments.

    1 Australian Bureau of Statistics: Medicare: the first ten years