The Department of Health, Disability and Ageing says it is still actively working on more assignment of benefit solutions.
Patients could eventually sign one enduring assignment of benefit agreement for all doctors working at a particular practice, Department of Health, Disability and Ageing director of telehealth at medical benefits and digital health division Roland Balodis says.
Speaking at a webinar on modernised AoB bulk billing arrangements earlier this week, Mr Balodis reiterated several times that the department was still exploring “regulatory and legislative options to further reduce administrative burden”.
DoHDA had received several queries as to whether patients could sign an enduring AoB agreement – which basically records their consent to be bulk billed for future appointments – with an entire practice, rather than with a single GP.
“We do appreciate that it could be administratively simpler to have one signature for all of the professionals [at one practice] for a common set of services,” Mr Balodis said.
Of course – like all good things – it would not be simple.
“The current wording of legislation and regulations is that patients or assignors make an agreement with an individual … that cuts across not just health law, but contract law,” he said.
“It is a complex issue which we hope to investigate … we also don’t want to have a situation where … the practice roster changes and invalidates 2000 agreements overnight in an individual practice or something.”
Part of the complexity is related to the differences between employees, independent contractors, and tenant doctors.
Legal advice on whether AoB provisions could be further streamlined will be provided to the government before the end of the year, Mr Balodis said.
Another common question, according to the telehealth director, had been whether enduring AoB agreements needed to list every Medicare item which the patient was consenting to be bulk billed for.
The short answer is no.
“What the regulations require is that the agreement essentially identifies or specifies the items such that they would be identifiable in the … General Medical Services Table,” Mr Balodis said.
“That’s the structure for the Medical Benefits Schedule. So, [MBS] categories, groups, subgroups, items or a combination of them are all fine to use.
“To that end … there certainly is provision, as there has been intended to be, to pick and choose which services you want to offer in an enduring assignment agreement. It is up to practitioners and their practices to establish policies about what they would like to offer their patients who would like to make an agreement, noting that essentially it is like a contract.”
Any services which are specifically included in the enduring AoB, though, will have to be bulk billed to that patient going forward, unless the agreement ends.
There are three broad types of enduring AoB agreements – ones where the patient and physician have an enrolled relationship via MyMedicare, ones where the patient attends an Aboriginal Medical Service or Aboriginal Community Controlled Health Organisation, and ones where the patient is in a residential aged care facility.
“There are some slightly different criteria and interactions between the different types of agreements,” Mr Balodis said.
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“There are broad reasons why an enduring agreement would end, but there might be some nuance in certain circumstances.
“For example, the MyMedicare type of agreement would cease if a patient’s MyMedicare registration ceased, because their eligibility for the agreement is based on their registration.
“Similarly for Aboriginal Community Controlled Health Organisations and Aboriginal Medical Services, if the patient is considered no longer to be a patient of that ACCHO or AMS, then their agreement would cease.
“In residential aged care, their eligibility is based on their residential status. So, if the patient no longer resides in the residential care home, then the agreement would become invalid. That might mean that the patient has passed away, obviously, but it’s also important to understand that residential enduring agreements can also work for patients who are in residential care homes for the purposes of respite. If they move back to the community, that specific agreement made in the course of their residential care home stay would cease.”
Ultimately, Mr Balodis stressed, the decision on whether to create an enduring AoB or not was still a choice for the provider.
