Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

by leave—I move governments (1), (5) to (11) and (13), government amendments (3), (12) and (14) to (16) on sheet BU255 together:

(1)    Clause 5, page 2 (before line 19), before the definition of data source, insert:

contracted service provider, of a healthcare provider, means an entity that provides:

             (a)    information technology services relating to the communication of health information; or

             (b)    health information management services;

to the healthcare provider under a contract with the healthcare provider..

(3)    Clause 5, page 4 (after line 29), after the definition of State or Territory authority, insert:

under this Act includes under the regulations.

(5)    Clause 17, page 12 (line 29), omit “section.”, substitute “section; or”.

(6)    Clause 17, page 12 (after line 29), at the end of subclause (1), add:

             (c)    a contracted service provider (the authorised service provider) of an identified healthcare provider, if that identified healthcare provider has, by notice to the service operator, authorised the contracted service provider to act on behalf of that identified healthcare provider under this section.

(7)    Clause 17, page 12 (line 30), omit “or authorised employee”, substitute “, authorised employee or authorised service provider”.

(8)    Clause 17, page 13 (after line 6), at the end of note 1, add:

            The authorisation extends to certain employees and contracted service providers of the healthcare provider: see section 36.

(9)    Clause 17, page 13 (line 9), at the end of note 2, add “The authorisation extends to certain employees and contracted service providers of the healthcare provider: see section 36.”.

(10)  Clause 31, page 21 (line 15), omit “section.”, substitute “section; or”.

(11)  Clause 31, page 21 (after line 15), at the end of subclause (2), add:

             (c)    a contracted service provider of an identified healthcare provider, if that identified healthcare provider has, by notice to the service operator, authorised the contracted service provider to act on behalf of that identified healthcare provider under this section.

(12)  Clause 35, page 23 (line 4), after “this Act”, insert “and the regulations”.

(13)  Clause 36, page 24 (lines 3 to 7), omit the clause, substitute:

                 An authorisation under this Act to an entity (the first entity) for a particular purpose is an authorisation to:

             (a)    an individual who:

                   (i)    is an employee of the first entity; and

                  (ii)    whose duties involve implementing that purpose; or

             (b)    a contracted service provider of the first entity, if:

                   (i)    the first entity is a healthcare provider; and

                  (ii)    the duties of the contracted service provider under a contract with the healthcare provider involve implementing that purpose by providing information technology services relating to the communication of health information, or health information management services, to the healthcare provider; or

             (c)    an individual who:

                   (i)    is an employee of a contracted service provider to which paragraph (b) applies; and

                  (ii)    whose duties involve implementing that purpose as mentioned in that paragraph.

(14)  Clause 37, page 24 (line 18), after “this Act”, insert “or the regulations”.

(15)  Clause 37, page 24 (line 22), after “this Act”, insert “or the regulations”.

(16)  Clause 37, page 24 (line 26), after “this Act”, insert “and the regulations”.

I also move government amendments (1) and (11) and (2) to (10) on sheet BU269 together:

(1)    Clause 5, page 2 (after line 23), after the definition of date of death accuracy indicator, insert:

Defence Department means the Department that:

             (a)    deals with matters arising under section 1 of the Defence Act 1903; and

             (b)    is administered by the Minister who administers that section.

(2)    Clause 5, page 3 (lines 9 to 17), omit the definition of healthcare provider, substitute:

healthcare provider means:

             (a)    an individual healthcare provider; or

             (b)    a healthcare provider organisation.

(3)    Clause 5, page 2 (line 17) to page 5 (line 6), insert:

Healthcare Provider Directory has the meaning given by subsection 31(1).

healthcare provider organisation means an entity, or a part of an entity, that has conducted, conducts, or will conduct, an enterprise that provides healthcare (including healthcare provided free of charge).

Example: A public hospital, or a corporation that runs a medical centre.

individual healthcare provider means an individual who:

             (a)    has provided, provides, or is to provide, healthcare; or

             (b)    is registered by a registration authority as a member of a particular health profession.

network organisation has the meaning given by subsection 9A(6).

organisation maintenance officer:

             (a)    for a seed organisation—has the meaning given by paragraph 9A(3)(c); and

             (b)    for a network organisation—has the meaning given by paragraph 9A(6)(b).

professional association means an organisation that:

             (a)    is a separate legal entity under a law of the Commonwealth or a State or Territory; and

             (b)    has the following characteristics:

                   (i)    its members practise the same healthcare profession;

                  (ii)    it has enough membership to be considered representative of the healthcare profession practised by its members;

                 (iii)    it sets its own admission requirements, including acceptable qualifications;

                 (iv)    it sets and publishes standards of practice and ethical conduct;

                  (v)    it aims to maintain the standing of the healthcare profession practised by its members;

                 (vi)    it has written rules, articles of association, by-laws or codes of conduct for its members;

                (vii)    it has the ability to impose sanctions on members who contravene the association’s written rules, articles of association, by-laws or codes of conduct;

               (viii)    it sets requirements to maintain its members’ professional skills and knowledge by continuing professional development; and

             (c)    has members who:

                   (i)    may take part in decisions affecting their profession; and

                  (ii)    have the right to vote at meetings of the association; and

                 (iii)    have the right to be recognised as being members of the professional association.

responsible officer has the meaning given by paragraph 9A(3)(b).

retirement, for a healthcare provider organisation’s healthcare identifier, means a state imposed by the service operator on the healthcare identifier so that it may no longer be used by the healthcare provider organisation to identify the healthcare provider organisation.

seed organisation has the meaning given by subsections 9A(3) and (4).

sole practitioner means a person who is both an individual healthcare provider and a healthcare provider organisation.

(4)    Clause 9, page 7 (lines 6 and 7), omit “included in a class prescribed by the regulations for the purpose of this paragraph”, substitute “to whom section 9A applies”.

(5)    Clause 9, page 7 (lines 16 to 24), omit paragraphs (3)(a) and (b), substitute:

             (a)    an identifier that is assigned to an individual healthcare provider; and

             (b)    an identifier that is assigned to a healthcare provider organisation; and

(6)    Clause 9, page 7 (lines 26 to 28), omit all the words from and including “A healthcare provider” to and including “(for example, a sole practitioner)”, substitute “A sole practitioner”.

(7)    Clause 9, page 8 (lines 3 to 6), omit subclause (5).

(8)    Page 8 (after line 8), after clause 9, insert:

Individual healthcare providers

        (1)    This section applies to an individual healthcare provider who is registered by a registration authority as a member of a health profession.

     (2)   This section also applies to an individual healthcare provider who is a member of a professional association that:

             (a)    relates to the healthcare that has been, is, or is to be, provided by the member; and

             (b)    has uniform national membership requirements, whether or not in legislation.

Healthcare provider organisations

        (3)    This section also applies to a healthcare provider organisation (a seed organisation ) that has:

             (a)    an employee who:

                   (i)    is an identified healthcare provider; and

                  (ii)    provides healthcare as part of his or her duties; and

             (b)    only one employee (the responsible officer) to act on behalf of the seed organisation in its dealings with the service operator in relation to the following:

                   (i)    nominating to the service operator at least one employee to be an organisation maintenance officer for the seed organisation;

                  (ii)    nominating to the service operator any network organisation of the seed organisation for which the nominated organisation maintenance officer is to be responsible;

                 (iii)    requesting the assignment or retirement of a healthcare identifier for the seed organisation;

                 (iv)    requesting the merger or reconfiguration of a healthcare identifier for the seed organisation if the seed organisation was part of a merger or acquisition; and

Example: A request after merger activity between 2 healthcare provider organisations if one is a seed organisation, or the acquisition of one healthcare provider organisation by another if one is a seed organisation.

             (c)    an employee (an organisation maintenance officer) to act on behalf of the seed organisation in its dealings with the service operator, including:

                   (i)    nominating to the service operator, if required, at least one additional employee to be an organisation maintenance officer for the seed organisation or any network organisation of the seed organisation; and

                  (ii)    nominating to the service operator any network organisation of the seed organisation for which an additional organisation maintenance officer is to be responsible; and

                 (iii)    requesting the assignment or retirement of a healthcare identifier for any network organisation of the seed organisation; and

                 (iv)    maintaining information that is held by the service operator about the seed organisation, and about any network organisation of the seed organisation for which the organisation maintenance officer is responsible; and

                  (v)    for the seed organisation, or for any network organisation of the seed organisation for which the organisation maintenance officer is responsible, that has consented to its details being included in the Healthcare Provider Directory—providing current details to the service operator about the organisation for inclusion in the Directory; and

                 (vi)    providing any further information requested by the service operator about the seed organisation, or about any network organisation of the seed organisation for which the organisation maintenance officer is responsible; and

                (vii)    requesting the merger or reconfiguration of a healthcare identifier for any network organisation of the seed organisation, if the network organisation was part of a merger or acquisition.

Note:       More than one employee may be an organisation maintenance officer. An employee may be any or all of the following: the responsible officer, an organisation maintenance officer and an authorised employee (see section 17).

        (4)    A sole practitioner is taken to be a healthcare provider organisation to which subsection (3) applies if he or she provides healthcare and performs the roles of responsible officer and organisation maintenance officer.

        (5)    For the purposes of paragraph (3)(b), a delegate of the responsible officer, who is another employee of the seed organisation, is taken to be the responsible officer.

        (6)    This section also applies to a healthcare provider organisation (a network organisation) that:

             (a)    is part of, or subordinate to, a seed organisation that:

                   (i)    has been assigned a healthcare identifier that has not been retired; and

                  (ii)    does not object to the network organisation being a network organisation of the seed organisation; and

             (b)    has a person (an organisation maintenance officer) who complies with subsection (7) to act on behalf of the network organisation in its dealings with the service operator, including:

                   (i)    nominating to the service operator, if required, at least one additional employee to be an organisation maintenance officer for any network organisation of the seed organisation; and

                  (ii)    nominating to the service operator any network organisation of the seed organisation for which an additional organisation maintenance officer is to be responsible; and

                 (iii)    requesting the assignment or retirement of a healthcare identifier for any network organisation of the seed organisation; and

                 (iv)    maintaining information that is held by the service operator about any network organisation of the seed organisation for which the organisation maintenance officer is responsible; and

                  (v)    for any network organisation that the organisation maintenance officer is responsible for and that has consented to its details being included in the Healthcare Provider Directory—providing current details to the service operator about the organisation for inclusion in the Directory; and

                 (vi)    providing any further information requested by the service operator about any network organisation of the seed organisation for which the organisation maintenance officer is responsible; and

                (vii)    requesting the merger or reconfiguration of a healthcare identifier for any network organisation of the seed organisation, if the network organisation is part of a merger or acquisition.

Example: A request after merger activity between the network organisation and another healthcare provider organisation, or the acquisition of one healthcare provider organisation by another if one is the network organisation.

        (7)    For the purposes of paragraph (6)(b), the person must be an employee of:

             (a)    the network organisation (the first network organisation); or

             (b)    the seed organisation of the first network organisation; or

             (c)    another network organisation that is:

                   (i)    linked to the seed organisation of the first network organisation; and

                  (ii)    hierarchically superior to the first network organisation.

(9)    Page 8, after proposed clause 9A, insert:

        (1)    The service operator may request an individual healthcare provider to provide the following information before assigning the healthcare provider a healthcare identifier:

             (a)    identifying information of the healthcare provider;

Note:       Identifying information is defined in section 7.

             (b)    information that shows that section 9A applies to the healthcare provider.

        (2)    The service operator may request a healthcare provider organisation to provide the following information before assigning the healthcare provider a healthcare identifier:

             (a)    identifying information of the healthcare provider;

Note:       Identifying information is defined in section 7.

             (b)    information that shows that section 9A applies to the healthcare provider;

             (c)    information identifying the healthcare provider’s responsible officer and organisation maintenance officer, including the person’s name, work address, work email address, work telephone number or work fax number.

        (3)    The healthcare provider must give the information in any form requested by the service operator.

Example:               A healthcare provider may be asked for original documentation, or for the information to be given in writing or in a statutory declaration.

        (4)    If the service operator is not satisfied by the information given, it does not have to assign a healthcare identifier to the healthcare provider.

(10)  Page 8, after proposed clause 9B, insert:

        (1)    This section applies to a decision by the service operator not to assign a healthcare identifier to a healthcare provider under paragraph 9(1)(a).

Note:   This section does not apply to a decision to assign a healthcare identifier to a healthcare recipient under paragraph 9(1)(b), or a decision by a national registration authority not to assign a healthcare identifier to an individual healthcare provider under subsection 9(2).

        (2)    The service operator must give written notice of the decision to a person whose interests are affected by the decision, including a statement:

             (a)    that the person may apply to the service operator to reconsider the decision; and

             (b)    of the person’s rights to seek review under subsection (8) of a reconsidered decision.

        (3)    A failure of the service operator to comply with subsection (2) does not affect the validity of the decision.

        (4)    A person whose interests are affected by the decision may, by written notice to the service operator within 28 days after receiving notice of the decision, ask the service operator to reconsider the decision.

        (5)    A request under subsection (4) must mention the reasons for making the request.

        (6)    The service operator must:

             (a)    reconsider the decision within 28 days after receiving the request; and

             (b)    give to the person who requested the reconsideration written notice of the result of the reconsideration and of the grounds for the result.

        (7)    The notice must include a statement that the person may apply to the Administrative Appeals Tribunal for review of the reconsideration.

        (8)    A person may apply to the Administrative Appeals Tribunal for a review of a decision of the service operator made under subsection (6).

(11)  Clause 12, page 9 (lines 23 and 24), omit paragraph (2)(c), substitute:

             (c)    the Defence Department.

Brett Mason (Queensland, Liberal Party, Shadow Parliamentary Secretary for Education and School Curriculum Standards) Share this | Link to this | Hansard source

I have just one question. Can the government confirm that the withholding of an individual health identifier will not preclude someone from accessing health services? I understand that the answer is yes.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

Absolutely.

Question agreed to.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I will ask a question before I move my amendments. Minister Ludwig, you confirmed Senator Mason’s point that you can still receive services without using the number?

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

Yes.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I wanted to confirm that because that is an issue that has been raised repeatedly with me—whether you would be able to access services while not using your number. I seek leave to move Greens amendments (1) and (2) on sheet 6156 together.

Leave granted.

I move:

(1)    Clause 9, page 7 (line 4), omit “The”, substitute “Subject to section 9A, the”.

(2)    Page 8 (after line 8), after clause 9, insert:

        (1)    A person may apply to the service operator to opt out of the Healthcare Identifier scheme.

        (2)    If a person applies to the service operator in the form prescribed for the purposes of subsection (1):

             (a)    the service operator is not authorised under section 9 to assign a number (a healthcare identifier) to identify the person as a healthcare recipient or for any other purpose connected with this Act or any other Act; and

             (b)    the service operator must ensure that any healthcare identifier previously assigned to identify the person under section 9:

                   (i)    no longer be assigned to identify the person; and

                  (ii)    no longer be used to identify the person as a healthcare recipient or for any other purpose connected with this Act or any other Act.

I will try to keep this brief. These are our opt-out amendments that I talked about in my speech on the second reading. As we understand it, everybody is allocated a number and people feel concerned that even if they choose not to use their number it is still a number in the system against their name, which they then link to the arguments about it being used later as some sort of overall identity number.

There are concerns around that and the preferred approach that has been put to us is that people get the ability to opt out. This does work in the UK. It has a much bigger population than we have and the approach seems to work okay. We thought it would be appropriate to make a similar provision in our legislation and this amendment is about enabling people to opt  out. I understand that the opt-out provision is not used very often in the UK, so it is not as if we are going to get a massive number of people opting out, but it does provide that provision for people who do choose not to be part of that system.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I am advised that it would increase the administrative burden to agree to the Australian Greens amendment for healthcare providers because they would need to maintain parallel systems depending on whether or not patients have individual health identifiers. Again, it would reduce the benefits of replacing the existing multiple and overlapping identity systems with a unified system which would reduce administrative costs and the potential for mistakes.

I understand where the Australian Greens are coming from. They are seeking to have a system which is workable but provides for an opt-out model. But it is important to remember that, while the bill provides health care for all Australians, it in no way compels Australians to use or have an electronic health record. If the unique healthcare identifier system is to be workable, it is essential that Australians can be assured that their identity cannot be confused with someone else’s. On that basis, although I do understand the Greens’ interest in this, we do not support the amendment. But I thought it was important to put that on the record for the Greens.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I would like to follow this up. I will try to be brief. I do not actually understand the logic of the argument. We have just affirmed that people can choose not to use the identifier. So, particularly with regard to the last argument, that people need this for their identity and to stop mistakes—which is what I took from the minister’s last comments—I do not see why, if you can choose not to use your identifier, providers are not going to need to have a separate system anyway. I am not trying to prolong this, but I do actually want to understand how the system will be different if you choose not to use your identifier, because you can do that, and why—

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I can answer that.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

Okay. Thanks.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

The difficulty is that you would create two classes. There would be one class which would have numbers and one class which would not have numbers, so there would be absent numbers. But you could then have circumstances where people could ask for numbers twice. Confusion could then happen. I know it seems perhaps a little odd at this hour, but what it means is that if everybody has a number then it is unique, but they do not have to, as a consequence, use the electronic health record. That is where the circumstance is like everyone currently having a Medicare number, but in this instance we will have a much clearer identity of each individual through the health identifier system.

One of the things that has been driving this, I am sure, are the privacy implications. They take that very seriously and that is why they have ensured that the unique health identifier number is there, the privacy is protected, but in addition you do not have to pick up the record as a consequence.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

There are two things there I want to follow up. One is that not everybody does have a Medicare number. I thought the point of having this system was because not everyone has a Medicare number—there are a number of people on the card. So it is a bit different, and that is one reason why I understood we needed to have this.

The point about the double number system—and, again, I am trying really hard not to be obtuse and to understand this—I do not get. I do not get why it is going to cause a problem if people absolutely do not have a number and if they choose not to use their number.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I will go back to the two subsets. If you do not have a number then the provider will have to provide some other way to provide the service by providing their own number, a new number or some other number but not a health identifier number, which is separate from the record—which, I am advised, is what happens now. What that would then create is a subset of unique health identifiers, individuals without numbers and then individuals who have accessed health systems with a plethora of numbers. You would then not have a unique health identifier system in place. In terms of having the record, you would then, if you chose, not have an electronic health record. You have to separate the number from the record.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I do understand the separation between the electronic records, but if I go to a clinic and choose not to use my health identifier number how am I going to be identified?

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

What happens now is that when you go to a provider and choose to have a service provided to you, they will allocate a number to you as part of their own record-keeping system. What they will do in future, when this is passed, is allocate you the unique health identifier number as part of the service. You can then choose not to use the health electronic record, but the service provider has still allocated that unique health number.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

What you are saying is that if I go into a clinic and I choose not to use my number, it will still get allocated against me for their purposes but not used beyond that—is that correct?

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

That is right. So if you went to a provider and you said, ‘I don’t want you to access and use my unique health identifier,’ they do not have to.

Question negatived.

Russell Trood (Queensland, Liberal Party) Share this | Link to this | Hansard source

Minister, we have to return to government amendments on sheet BU255, because I am not sure that two items were actually done properly. It is block 2 on the running sheet, the amendments relating to clauses 5 and 6.

The Temporary Chairman:

I move government amendment (2) on sheet BU255:

(2)    Clause 5, page 4 (line 27), omit the definition of service operator, substitute:

service operator means the Chief Executive Officer of Medicare Australia.

We also oppose clause 6 in the following terms:

(4)    Clause 6, page 5 (lines 7 to 12), to be opposed.

The question is that amendment (2) on sheet BU255 be agreed to.

Question agreed to.

The question now is that clause 6 stand as printed.

Question negatived.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I table a further supplementary explanatory memorandum and a further supplementary explanatory memorandum relating to the government amendments to be moved to these bills. The memorandums were circulated in the chamber on 21 and 24 June 2010.

18:44:34

Bill, as amended, agreed to.

Bill reported with amendments; report adopted.