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2016-2017
THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA
HOUSE OF REPRESENTATIVES
HEALTH INSURANCE AMENDMENT (NATIONAL RURAL HEALTH
COMMISSIONER) BILL 2017
EXPLANATORY MEMORANDUM
(Circulated by authority of the Assistant Minister for Health, the Hon Dr David
Gillespie MP)
HEALTH INSURANCE AMENDMENT (NATIONAL RURAL HEALTH
COMMISSIONER) BILL 2017
OUTLINE
National Rural Health Commissioner
The Bill will amend the Health Insurance Act 1973 (the HIA) to provide for the
appointment of a National Rural Health Commissioner (the Commissioner).
The Bill is required to establish the appointment of the Commissioner as a statutory
office holder.
The Government committed to establish the Commissioner during the 2016 election.
The Commissioner will work with rural, regional and remote communities, the health
sector, universities, specialist training colleges and across all levels of Government to
improve rural health policies and champion the cause of rural practice.
In addition, the Commissioner will assist to better target Australian Government
interventions to support access to services and quality of services.
The Commissioner will be responsible for:
• the development of a new National Rural Generalist Pathway to increase
access to training for doctors in regional, rural and remote Australia;
• working with Government and the health sector to enhance policy and
promote opportunities of a career in rural health; and
• developing options for increased access to training and appropriate
remuneration for rural generalists.
The rural health workforce and communities living in rural and remote areas will
benefit from the introduction of the Commissioner by placing rural and remote issues
at the forefront of government decision making.
The Commissioner will develop a National Rural Generalist Pathway and provide a
report back to Government about the pathway reform. Rural generalists are general
practitioners with skills in areas such as general surgery, obstetrics, anaesthetics and
mental health. Rural generalists provide a bridge between the general practitioner and
the advanced skills of specialists, which are often not available in rural and remote
areas. Despite the need for these additional skills in many rural and remote
communities, there is not currently a national scheme in place to recognise their
substantial scope of practise and extended working hours.
The Commissioner will work with the health sector and training providers to define
what it is to be a rural generalist. The Commissioner will also develop options for
increased access to training and appropriate remuneration for rural generalists,
recognising their extra skills and hours.
Repeal of section 19AD of the HIA
The intended operation of s19AD of the HIA was to allow the Government to review
the regulatory burden of the Medicare provider number legislation at five year
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intervals. Section 19AB, which covers workforce distribution measures, was
deliberately excluded from the scope of s19AD, which allows only for a review of
ss19AA, 3GA and 3GC. There is no capacity to review the impact of s19AB, both as
an individual legislative requirement, and as a key determinant of the effectiveness of
ss19AA, 3GA and 3GC.
Since their inception, ss19AA, 3GA and 3GC have not changed. Reviews conducted
under s19AD in 2002, 2005 and 2010 have not identified any anomalies, unintended
consequences or points of contention with the quality standards governing access to
the Medicare Benefits Schedule. It is anticipated that future reviews will continue to
provide no additional information. More recent developments in the systems
supporting Medicare provider number legislation and processes are also not captured
by s19AD. By repealing s19AD, a resource intensive and ineffective process will be
discontinued.
The legislative requirement to conduct limited scope reviews under s19AD places a
regulatory burden on the Commonwealth and key stakeholder organisations who
would be expected to submit to the review process, noting that limits in scope prevent
a genuine analysis of:
The potential regulatory burden that is created by the current operation and
application of both the quality and distribution components of the Medicare
provider number legislation; and
Potential stakeholder concerns over the full suite of Medicare provider number
requirements that are applied to doctors seeking to progress to a private
practice career in Australia, at any stage of their career.
The Government remains committed to effective application of the Medicare
legislation.
Repeal of section 3GC of the HIA
Section 3GC provides for the establishment and functions of the Medical Training
Review Panel (MTRP). The main function of the MTRP is to provide a
comprehensive overview of medical education and training, supplemented with other
data on the medical workforce supply, through the annual MTRP report.
In October 2014, MTRP members identified an overlap between its functions and
those of the National Medical Training Advisory Network (NMTAN). It was agreed
that the MTRP could be ceased with the NMTAN reporting on the matters reported on
by the MTRP, including the responsibility to oversee the production of an annual
report on medical education and training.
The NMTAN is a non-statutory body that was transferred to the Department of Health
from the former Health Workforce Australia. Its main function is to provide advice on
medical workforce planning and to produce medical training plans to inform
government, employers and educators. Members of the NMTAN have agreed to
undertake the functions of the MTRP.
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Financial Impact Statement
The financial impact of establishing the position of National Rural Health
Commissioner is $4.4 million up to 30 June 2020.
Financial
2016-17 2017-18 2018-19 2019-20 2020-21 Total
Year ($m)
Budget (a) 0.5 1.3 1.3 1.3 0.0 4.4
Repeal of section 3GC
There are no regulatory costs or savings associated with the proposal to repeal section
3GC of the HIA.
Repeal of section 19AD
There are no costs associated with the measure, however there are small regulatory
savings associated with the measure.
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Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny)
Act 2011
HEALTH INSURANCE AMENDMENT (NATIONAL RURAL HEALTH
COMMISSIONER) BILL 2017
This Bill is compatible with the human rights and freedoms recognised or declared in
the international instruments listed in section 3 of the Human Rights (Parliamentary
Scrutiny) Act 2011.
Overview of the Bill
The Bill will amend the Health Insurance Act 1973 to provide for the appointment of
a National Rural Health Commissioner (the Commissioner).
The Government committed to establish the Commissioner during the 2016 election.
The Commissioner will work with regional, rural and remote communities, the health
sector, universities, specialist training colleges and across all levels of Government to
improve rural health policies and champion the cause of rural practice. In addition, the
Commissioner will assist to better target Australian Government interventions to
support access to services and quality of services.
The Commissioner will be responsible for:
• the development of a new National Rural Generalist Pathway to increase
access to training for doctors in rural, regional and remote Australia;
• working with Government and the health sector to enhance policy and
promote opportunities of a career in rural health; and
• developing options for increased access to training and appropriate
remuneration for rural generalists.
Human rights implications
This Bill does not interfere with the right of individuals to the enjoyment of the
highest attainable standard of physical and mental health (Articles 2 or 12 of the
International Covenant on Economic, Social and Cultural Rights (ICESCR). In
relation to health and human rights, the World Health Organisation constitution states
that "the highest attainable standard of health as a fundamental right of every human
being." It also states that that the right to health includes access to timely, acceptable,
and affordable health care of appropriate quality.
The establishment of the Commissioner is compatible with human rights legislation
and will provide an informed and independent mechanism to facilitate access to the
right medical professionals, with the right skills, in the right places at the right time.
Conclusion
This Bill is compatible with human rights as it does not raise any human rights issues.
The Hon Dr David Gillespie MP, the Assistant Minister for Health
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HEALTH INSURANCE AMENDMENT (NATIONAL RURAL HEALTH
COMMISSIONER) BILL 2017
NOTES ON CLAUSES
Clause 1 - Short Title
This clause provides that the Bill, once enacted, may be cited as the Health Insurance
Amendment (National Rural Health Commissioner) Act 2017.
Clause 2 - Commencement
Subclause 2(1) provides that each provision of the Act specified in column 1 of the
table set out in the subclause commences or is taken to have commenced in
accordance with column 2 of the table. Any other statement in column of that table
has effect according to its terms. The commencement will be by Proclamation or
within six months of Royal Assent if Proclamation has not occurred, as this is the
most appropriate timeframe to ensure effective appointment arrangements. The
abolition of the Commissioner will occur on 1 July 2020, when the functions are
expected to be complete.
Subclause 2(2) provides that any information in column 3 of the table is not part of
the Act. It also clarifies that any information may be inserted in column 3, or
information in it may be edited, in any published version of the Act.
Clause 3 - Schedule(s)
This clause provides that each Act that is specified in a Schedule to this Bill is
amended or repealed as set out in the applicable items in the Schedule concerned, and
any other item has effect according to its terms. Schedule 1 amends the Health
Insurance Act 1973 (HIA) to create a statutory position for the National Rural Health
Commissioner. Schedule 2 abolishes the National Rural Health Commissioner
position on 1 July 2020. Schedule 3 repeals section 3GC and section 19AD of the
HIA.
SCHEDULE 1 -- National Rural Health Commissioner
Item 1 - After Part V
This item inserts a new part to the HIA 'Part VA - National Rural Health
Commissioner'.
79AA Simplified outline of this Part
Subsection 79AA provides a simplified explanation of the Bill noting that the
National Rural Health Commissioner will advise the Minister in relation to rural
health. It provides that the National Rural Health Commissioner will work with health
professionals and other rural stakeholders, and with the state and territory
governments, to define what it means to be a rural generalist and develop a National
Rural Generalist Pathway. The Commissioner will report to the Minister in regard to
these matters. If requested by the Minister, the National Rural Health Commissioner
may also advise the Minister on matters relating to rural health reform.
The National Rural Health Commissioner position will terminate on 1 July 2020 with
completion of functions at that time.
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79AB National Rural Health Commissioner
Subsection 79AB provides that a National Rural Health Commissioner position is to
be established. The clause provides that the position will terminate on 1 July 2020
with further information regarding the abolition of the position provided in Schedule
2. This allows sufficient time to undertake the functions required.
79AC Functions of the National Rural Health Commissioner
Subsection 79AC(1) provides that the functions of the National Rural Health
Commissioner are to advise the Minister in relation to rural health, including by
defining what it means to be a rural generalist, developing a National Rural Generalist
Pathway, and as requested by the Minister, advising the Minister on matters relating
to rural health reform. The Minister may request the National Rural Health
Commissioner to consider other aspects of rural health reform.
Subsection 79AC(2) provides that in undertaking the functions in subsection 79AC(1)
the National Rural Health Commissioner must consult with health professionals in
regional, rural and remote areas, consult with the state and territory governments, and
with other rural health stakeholders, as appropriate. The National Rural Health
Commissioner will also give consideration to appropriate remuneration, and ways to
improve access to training for rural generalists.
Subsection 79AC(3) provides that the National Rural Health Commissioner must
prepare and present to the Minister a draft report about the National Rural Health
Commissioner's functions in 79AC(1) that includes draft advice and
recommendations before 1 January 2020. It also provides that the National Rural
Health Commissioner must prepare and present to the Minister a Final report about
the National Rural Health Commissioner's functions in 79AC(1) that includes advice
and recommendations before 1 July 2020.
Subsection 79AC(4) provides that an extension of up to two weeks may be provided
by the Minister for the draft report in 79AC(3)(a). An extension is not applicable for
the Final report in 79AC(3)(d).
79AD Appointment
Subsection 79AD(1) provides that the National Rural Health Commissioner will be
appointed by the Minister by written instrument either on a full-time or part-time
basis.
A note under Subsection 79AD(1) provides that a person may be re-appointed for a
further term, as provided for by the Acts Interpretation Act 1901.
Subsection 79AD(2) provides that the National Rural Health Commissioner will hold
the term of office for the period outlined in the instrument of appointment and that
this period will not exceed two years.
Subsection 79AD(3) provides that a person can only be appointed to the position of
National Rural Health Commissioner if they can demonstrate experience in rural
health. Experience in rural health may include time practising as a health professional
in a rural area and an understanding of the key rural stakeholder issues, extensive
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knowledge/academic research of rural health issues or other relevant experience in
rural health able to be demonstrated.
79AE Acting Appointments
Subsection 79AE provides that the Minister by written instrument may appoint a
person to act as the National Rural Health Commissioner when, there is a vacancy in
the office of the National Rural Health Commissioner (whether or not an appointment
has previously been made to the office) [79AE(a)]; or the National Rural Health
Commissioner is absent from duty, or from Australia, or is unable to perform the
duties of the office [79AE(b)].
A note at the end of the section draws the reader's attention to section 33AB and 33A
of the Acts Interpretation Act 1901 which describes additional rules in relation to
acting appointments.
79AF Terms and Conditions
Subsection 79AF provides that the National Rural Health Commissioner holds office
on the terms and conditions that the Minister provides in addition to those provided
for in the legislation.
79AG Remuneration
Subsection 79AG(1) provides that the National Rural Health Commissioner will be
paid the remuneration amount determined by the Remuneration Tribunal. If no
determination exists, the National Rural Health Commissioner will be paid the
remuneration prescribed by the Minister through a legislative instrument detailed at
79AG(4).
Subsection 79AG(2) provides that the National Rural Health Commissioner is to be
paid allowances prescribed by the legislative instrument under 79AG(4).
Subsection 79AG(3) provides that this section is subject to the Remuneration Tribunal
Act 1973.
Subsection 79AG(4) provides that the Minister may prescribe remuneration 79AG(1)
and allowances 79AG(2) via a legislative instrument if no determination is made by
the Remuneration Tribunal.
79AH Leave of absence
Subsection 79AH(1) provides that if the National Rural Health Commissioner is
appointed on a full time basis, he or she has the recreation leave entitlements
determined by the Remuneration Tribunal.
Subsection 79AH(2) provides that the Minister may grant the National Rural Health
Commissioner leave of absence, other than recreation leave, on the terms and
conditions as to remuneration or otherwise that the Minister determines.
Subsection 79AH(3) provides that if the National Rural Health Commissioner is
appointed on a part time basis, the Minister may grant leave of absence to the
National Rural Health Commissioner on the terms and conditions that the Minister
determines.
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79AI Outside employment
Subsection 79AI(1) provides that if the National Rural Health Commissioner is
appointed on a full time basis, he or she must not engage in paid employment outside
the duties of the National Rural Health Commissioner's office, without the Minister's
approval.
Subsection 79AI(2) provides that if the National Rural Health Commissioner is
appointed on a part time basis, he or she must not engage in any paid employment that
the Minister deems conflicts with, or may conflict with the proper performance of his
or her duties.
Subsection 79AI(3) provides the definition of 'paid work' for the purposes of this Act.
'Paid work' means work for financial gain or reward (whether as an employee, a self-
employed person or otherwise).
79AJ Resignation
Subsection 79AJ provides that the National Rural Health Commissioner may resign
his or her appointment by notifying the Minister in writing. Subsection 79AJ(2)
provides that the resignation takes effect on the day it is received by the Minister or, if
a later day is specified in the resignation, on that later day.
79AK Termination of appointment
Subsection 79AK provides that the Minister may terminate the National Rural Health
Commissioner's appointment for misbehaviour [79AK(1)(a)]; or if the National Rural
Health Commissioner is unable to perform his or her duties because of physical or
mental incapacity [79AK(1)(b)].
Subsection 79AK(2) provides that the Minister may terminate the appointment of the
National Rural Health Commissioner if he or she:
(i) becomes bankrupt; or
(ii) applies to take the benefit of any law for the relief of bankrupt or insolvent
debtors; or
(iii) compounds with his or her creditors; or
(iv) makes an assignment of his or her remuneration for the benefit of his or
her creditors; or
(v) if the Commissioner is appointed on a full-time basis--the Commissioner
is absent, except on leave of absence, for 14 consecutive days or for 28
days in any 12 months; or
(vi) if the Commissioner is appointed on a full-time basis--the Commissioner
engages, except with the Minister's approval, in paid work outside the
duties of his or her office [see subsection 79AI(1)];
(vii) if the Commissioner is appointed on a part-time basis--the Commissioner
engages in paid work that, in the Minister's opinion, conflicts or could
conflict with the proper performance of his or her duties [see subsection
79AI(2)];
(viii) the Commissioner fails, without reasonable excuse, to comply with section
79AL.
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79AL Disclosure of interests
79AL provides that the National Rural Health Commissioner must disclose to the
Minister the details of any direct or indirect financial or monetary interests that the
National Rural Health Commissioner has or acquires that conflict or could conflict
with the proper performance of the National Rural Health Commissioner's functions.
This would include, for example, notification of any interests in, including financial
interests or membership of a rural health professional/peak body. It would include if
the National Rural Health Commissioner provides clinical based health services in a
rural area.
79AM Annual report
Subsection 79AM(1) provides that the National Rural Health Commissioner must,
within 3 months after the end of each calendar year, prepare and give to the Minister,
for presentation to the Parliament, a report on the National Rural Health
Commissioner's activities during the previous calendar year.
A note at the end of 79AM(1) draws the reader's attention to section 34C of the Acts
Interpretation Act 1901 which provides additional rules regarding annual reports.
Subsection 79AM(2) provides that the annual report must contain the details of the
Commissioner's activities during the reporting period [79AM(2)(a)], and any other
matters that the Minister would direct the National Rural Health Commissioner to
include in the report [79AM(2)(b)].
79AN Minister may give directions to the National Rural Health Commissioner
Subsection 79AN(1) provides that the Minister may, by notifiable instrument, give
written directions to the National Rural Health Commissioner about [79AN(1)(a)] the
performance of the National Rural Health Commissioner's functions; and
[79AN(1)(b)] matters to be included in the annual report. These directions are not
considered to be of legislative character as the direction would not determine or alter
the content of the law, but rather give directions to an individual regarding specific
matters.
79AN(2) provides that the National Rural Health Commissioner is obliged to comply
with a direction provided by the Minister under 79AN(1).
79AO Assistance from APS employees
Subsection 79AO(1) provides that the Secretary of the Department of Health may
enter into an arrangement with the Commissioner for the services of APS employees
in the Department to be made available to the Commissioner. This is intended as
assistance for the position whilst the Commissioner undertakes duties as described in
section 79AC.
Subsection 79AO(2) provides that staff made available to the Commissioner under
arrangements made between the Commissioner and the Secretary will be subject to
the directions of the Commissioner.
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SCHEDULE 2 -- Abolition of National Rural Health Commissioner
Item 1 - Part VA
This item repeals Part VA of the HIA and terminates the position of the National
Rural Health Commissioner on 1 July 2020 with completion of functions at that time.
SCHEDULE 3 -- Other Measures
Item 1 - Section 3GC
This item repeals Section 3GC of the HIA, abolishing the Medical Training Review
Panel (MTRP). This will remove the duplication of functions between the MTRP and
the National Medical Training Advisory Network (NMTAN). Members of the MTRP
agreed the Panel could be ceased, and NMTAN members agreed to undertake to
duties of the MTRP.
Item 2 - Section 19AD
This item repeals Section 19AD of the HIA, removing the requirement to conduct
reviews of the Medicare Provider Number legislation. This repeal is intended to
reduce regulatory burden for external stakeholders, such as rural workforce agencies.
By repealing Section 19AD, a resource intensive and ineffective process will be
discontinued.
10