Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Mental Health) Share this | Link to this | Hansard source

I rise to speak to the Dental Benefits Legislation Amendment Bill 2014 and indicate that the opposition will be supporting this legislation. This is legislation that would have been adopted by Labor if we had been in government, so we indicate that we will support it. The purpose of the Dental Benefits Legislation Amendment Bill 2014 is to amend the Health Insurance Act 1973 and the Dental Benefits Act 2008 to specify that Professional Services Review Scheme, which enforces compliance with appropriate practices, applies to services provided under the Child Dental Benefits Schedule. It is also to waive debts incurred by dentists under the superseded Chronic Disease Dental Scheme before 1 April 2010 due to noncompliance with administrative requirements. It waives debts incurred after this date if a dentist can demonstrate an intent to comply with the scheme. The bill also will ensure compliance with the legislative requirements for the payment of dental benefits and it allows the minister to delegate powers to insert a definition of a dental provider and allow for protected information to be shared between agencies.

The Child Dental Benefits Schedule—CDBS—was closed on 1 December 2012. It operated under Health Insurance (Dental Services) Determination 2007, as made under section 3C of the Health Insurance Act 1973. The scheme provided for up to $4,250 over two calendar years in Medicare benefits for private dental services for people with chronic medical conditions and complex care needs. The Department of Human Services conducted audits on the CDBS and found that there was a high rate of noncompliance with the provider reporting requirements set out in section 10(2) of the determination. Debts were raised against dentists found to be noncompliant through the audit process.

Further, more than 20 per cent of recipients were not pensioners or concession card holders and more than 20 per cent of spending was on high-cost restorative services. Section 10(2) of the determination required a dentist to provide a treatment plan to the referring medical practitioner and the patient and a quote to the patient before starting treatment. Audits for claims of benefits under the CDBS found that many dentists did not comply with these requirements. As a result, benefits were incorrectly paid and under section 129AC of the Health Insurance Act. These amounts are due to the Commonwealth from the dentists concerned.

Representations from the Australian Dental Association and other groups outlined that dentists had not been aware of their obligation under the Chronic Disease Dental Scheme until April 2010 and the government has decided that debts due to the Commonwealth solely as a result of noncompliance with section 10(2) before April 2010 should be waived. The government has further decided that debts solely due to noncompliance after April 2010 should be waived as long as the dentist can demonstrate an intention to comply with the CDBS obligations.

At present, the debt waivers are proceeding under section 34 of the Financial Management and Accountability Act. However, the government thinks this is a slow and unwieldy process that requires unnecessary administration and processing in both the Department of Human Services and the Department of Finance. This has resulted in the government's decision to include a special debt waiver provision in the Health Insurance Act. Powers to assist the chief executive of Medicare in determining and enforcing compliance with legislative requirements for the payments of benefits are inserted under part 3—compliance. Equivalent powers were inserted into the Health Insurance Act through an amendment in 2011 and the provisions in this part are modelled on those Health Insurance Act provisions.

Part 4 of the bill provides for a delegation of ministerial powers, which is currently not included. Part 5 amends the definition of the dental provider to align with the definition under the national law dealing with the registration of health professionals. Part 6, the provision of information, allows for information obtained under the act to be disclosed to the minister and the department administrating the Veterans' Entitlements Act 1986 if the disclosure is for the purpose of administering the Dental Benefits Act, as people may be eligible for dental benefits if they are receiving certain allowances paid by the Department of Veterans' Affairs. Part 7 is a minor technical amendment.

The Child Dental Benefits Schedule commenced on 1 January 2014 and provides two- to 17-year-olds who meet a means test with access of up to $1,000 of benefits over two calendar years for basic dental treatment. The Child Dental Benefits Schedule replaces the Medicare Teen Dental Plan and provides more comprehensive coverage through a greater range of services to a larger group of children. The CDBS formed part of Labor's $4.1 billion dental reform package announced on 29 August 2012. The dental reform package comprised $2.7 billion for around 3.4 million Australian children, who will be eligible for subsidised dental care through the CDBS. It provided $1.3 billion for around 1.4 million additional services for adults on low incomes, who will have better access to dental care in the public system, and $225 million for capital works and workforce in the dental area to support expanded services for people living in outer metropolitan, regional, rural and remote areas.

There are potential risks to the Child Dental Benefits Schedule. Minister Dutton flagged concerns with the way he thinks the CDBS has been structured in the second reading speech to this bill in the other place. He said he was going to keep a watching brief on the outlays and the initial usage rates, as well as practices across states and territories in relation to their operation of this scheme. I am concerned, and I put this on the record, that this could be the government's commencement of undoing this very successful scheme. It is extraordinary that in our country it is only in recent years that we have included dental services in our federally funded health system. Unfortunately, when Medibank was first being negotiated, dental services were not included. It was seen that having a big conversation, if I can put it that way, with both the medical profession and the dental profession at the same time would be a hard thing to achieve, so a decision was made not to include dental services.

That has been a concern to Labor for a long period of time. That is why when we were in government we put a lot of effort into ensuring that we improved our effort from the federal perspective to provide support, particularly for low-income earners, to receive proper dental care. We do not have a good dental record in this country, and it is time that we make sure that children particularly are attending the dentist as regularly as they should and that they get into the habit, frankly, of going to the dentist. Unfortunately, not many of us like doing that, but that is why we established the Child Dental Benefits Schedule when we did, to basically get into place the habit of going to the dentist on a regular basis. Prevention is better than cure, no more so than when it comes to dental services.

This also gives me an opportunity to apprise the Senate of work that the Senate Select Committee on Health has been doing to inquire into changes to the health system that the budget proposes. I want to go to the question of GP co-payments. I listened to AM this week, and Mr Hockey was asked about why the GP co-payment proposal was not considered prior to the election and whether that wasn't a broken promise, because no-one was told during the election campaign that the government was going to require a co-payment to be paid but, come the budget, we find that there is a tax on going to the doctor. Mr Hockey said, 'But we promised that we would fix the budget bottom line', or words to that effect. I was surprised that the interviewer did not pick him up on that, because the budget papers show quite clearly that the funds raised by the GP tax will go to the Medical Research Future Fund.

That will not fix the budget bottom line, and that is an issue that has been canvassed by the Senate Select Committee on Health in a number of places. Not every witness to the committee, but almost all, is extremely critical of the measures in this budget that say that we will tax those who are sick and those who are poor, particularly to go to the doctor but also to get their pharmaceuticals filled and to use diagnostic imaging. We had evidence in the committee from people saying that the people who will be most disadvantaged by this, as I said, will be the sick and the poor but particularly homeless people, people who are living in rural and remote areas and people who use the services of Aboriginal medical services. There is a lot of work being done to try to ascertain the real cost that will be incurred in our Aboriginal and Torres Strait Islander community from people who defer receiving primary healthcare services. So, the GP tax, the GP co-payment, has been broadly and widely criticised for being poorly targeted and because it will add to the health burden of the country. Once again, to go back to Mr Hockey's comment about fixing the budget bottom line: it does not, and he should know that; he is the Treasurer.

Finally, I want to go to some commentary around the disbanding of Medicare Locals. Mr Abbott said, prior to the election, that there would be no change to Medicare Locals—that the 61 Medicare Locals as they existed would be there into the future. Now we find that Medicare Locals have all been abolished; they will cease to operate at the end of June next year. We also know that the potential cost of disbanding and winding up those Medicare Locals is $120 million. Some of that money may be saved if some of those Medicare Locals transition into Primary Health Networks, but the costs are huge, and for what benefit? I say that the reason this government does not like Medicare Locals is that they have the word 'Medicare' in there. Liberals do not like Medicare. We know that. We saw that back in the 1970s when the Liberal Party got rid of Medibank. We had to reinstate it as a Labor government when we came into power. I suggest that the reason this government is disbanding the Medicare Locals system is that they do not like the name, because the Primary Health Networks essentially do a similar job, but they will now do it over a much larger geographic area.

As a person representing particularly a regional area in the country, I express real concerns about this. The geographical area that the North Queensland Medicare Local will now cover will go from the Torres Strait Islands, from the border with Papua New Guinea, to south of Mackay and over the Great Dividing Range. It is a massive area and the health needs of those different communities are enormous. That we could have a local health service connected to local health needs over such a vast area is a fundamental design mistake, in my view. Our committee will continue to investigate the development of the primary health networks. We will continue to do the work to uncover these design mistakes that we believe—certainly Labor members believe—are inherent in the design of the primary health networks. In continuing that work, hopefully we will be able to provide some advice to the parliament about some of those issues in the short term.

To come back to the bill, I reiterate that Labor will be supporting the passage of the Dental Benefits Legislation Amendment Bill. I commend the bill to the chamber.

Catryna Bilyk (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

The Dental Benefits Legislation Amendment Bill 2014 will create a waiver provision for the Medicare Chronic Disease Dental Scheme and make a number of amendments to the operation of the Child Dental Benefits Schedule. At present, the debt waivers are proceeding under section 34 of the Financial Management and Accountability Act 1997. I am aware that the government thinks this is a slow and unwieldy process that requires unnecessary administration and processing, in both the Department of Human Services and the Department of Finance, which has resulted in the government's decision to include a specific debt waiver provision in the Health Insurance Act. This bill will make amendments to the Dental Benefits Act and the Health Insurance Act to align compliance powers and to make these powers applicable to the CDBS. It also amends both acts so that the Professional Services Review scheme can be applied to dental services provided under the CDBS.

On this side, we take very, very seriously the issue of inappropriate professional behaviour and we support the application of compliance powers as well as the operation of the Professional Services Review scheme. The previous scheme was closed from 1 December 2012 and we know that the audit activity of the CDDS detected a high rate of noncompliance with the recording requirements of dentists. As a result of this, audit activity debts were raised against dentists found to be noncompliant. Indeed, I had a dentist in my local area come to me with a number of concerns, which I progressed up the chain of command, so to speak. We are aware on this side of how important that is. As I said, we take very seriously the issue of inappropriate professional behaviour and we support the application of compliance powers as well as the operation of the Professional Services Review scheme.

The bill will amend the Health Insurance Act to create a provision that will require the Chief Executive Medicare, CEM, to waive debts raised against dentists for services provided before 1 April 2010 that had satisfied all legal requirements but had breached section 10(2) of the Health Insurance (Dental Services) Determination 2007. As I said, it will also require the CEM to waive debts for services provided after 1 April 2010 if the dentist can provide evidence that there was an intent to comply with section 10(2) of the determination. Some dentists have already paid CDDS debts to the Commonwealth that fall under this waiver, and this bill provides for those amounts to be repaid to the dentists concerned.

The bill will also make amendments to the Dental Benefits Act 2008 and the Health Insurance Act to support the operation of the child dental benefits scheme, which is obviously a really important scheme. The child dental benefits scheme commenced on 1 January 2014 and provides two- to 17-year-olds who meet a means test with access to up to $1,000 in benefits over two calendar years for basic dental treatment. In my socioeconomic areas, we see a lot of bad dentistry in young people and these measures are needed to ensure the health of their teeth and that they are able to live a decent life. If you have bad teeth, it can lead to all sorts of other health issues and concerns. I have even known of people who have not been able to get jobs because their teeth have been in such bad condition that people did not want to employ them.

The Child Dental Benefits Schedule replaced the Medicare Teen Dental Plan and provides more comprehensive coverage through a greater range of services to a larger group of children. As I said, it is means tested, but, of course, those children really need that sort of help. The child dental benefits scheme formed part of Labor's $4.1 billion dental reform package, which was announced on 29 August 2012. The Child Dental Benefits Schedule replaced the Medicare Teen Dental Plan from 1 January 2014. This program is a really important investment in prevention. We know that oral health in children is the best predictor of our oral health as adults, and this can be of grave concern.

In addition to dental for kids, the dental reform package provides extra funding for 1.4 million additional services for adults on low incomes, including pensioners and concession card holders and those with special needs, to have better access to dental health care in the public system. Just as bad oral health in children can lead to other illnesses and health issues, so it can with adults. It is important that we do what we can to help in that area. There will be more services and more dentists in areas of most need, which are obviously outside the capital cities. Coming from Tasmania, where there is a large rural population and regional population, it is great to hear that. This package was on top of the $515 million announced in the 2012-13 budget, which included a blitz on public dental waiting lists.

I was talking earlier about the oral health of our children, and we know that it has been declining since the mid-1990s. Almost 20,000 kids under the age of 10 are hospitalised each year due to avoidable dental issues. By the age of 15, six out of 10 kids have had tooth decay, which is probably not a good sign of what our nation is doing with regard to dental health and oral hygiene. Further, 45.1 per cent of 12-year-olds had decay in their permanent teeth, and, in 2007, 46 per cent—just under half—of children aged six attending school dental services had a history of decay in their baby teeth. The issue of oral hygiene and dental health is not one that should be taken at all lightly; it is one that we obviously should be supporting and putting money into. Dental providers carry out a range of services for all people, and those services are most important. As I have said, I think this is overlooked quite a lot of the time.

This bill amends the definition of a 'dental provider' to align with the definition under the national law dealing with the registration of health professionals. Part 6, 'Provision of information', allows for information obtained under the act to be disclosed to the minister and department administering the Veterans’ Entitlement Act 1986 if the disclosure is for the purpose of administering the Dental Benefits Act. That is because people may be eligible for dental benefits if they are receiving certain allowances paid by the Department of Veterans' Affairs.

The machinery amendments to the Dental Benefits Act include clarifying provisions related to the disclosure of protected information, allowing the delegation of ministerial powers to the secretary or SES employee of the Department of Health, amending the definition of dental provider and correcting a minor technical error in section 4. It will be interesting to see what sort of impact this has. A longitudinal survey might need to be done with regard to oral dental health and the impact that people having easier access to dentists will have on our society. I know other people wish to speak on this legislation, so I will conclude my remarks.

Claire Moore (Queensland, Australian Labor Party, Shadow Minister for Women) Share this | Link to this | Hansard source

I am not going to take long in this discussion on the Dental Benefits Legislation Amendment Bill 2014, but I want to speak again on this issue around dental services. Mr Acting Deputy President Bernardi, you would remember that in this place we had considerable debate on the issues around the dental services determination bill in 2007. We also had considerable debate—and it is all on record—on concerns about the full understanding of the responsibilities of dentists involved in that program and claims that there was a lack of understanding and a lack of knowledge of the compliance requirements that were brought into place, because this was the first time that there was such a clear use of the government system for dentists. I remember making statements here about the professional needs of organisations to understand their requirements, particularly when government money was involved, and the responsibilities for people in the profession, the dental profession, and also the government departments to work through appropriately their responsibilities. I also talked about the special link that was available in that legislation, which has now passed, between the referral processes of doctors through to the dental profession to make the link that was in that legislation to ensure that the processes under the dental responsibilities met the special needs of people and that there was a genuine understanding of the need for the dental work to fulfil the requirements of the plan, as we then knew.

On our side of the chamber, we celebrated the first steps towards allowing MBS coverage for dental processes. We celebrated the availability of this scheme, because up until then there had been real concerns in the community about how they could access dental services. There was so much evidence, across the board, on dental health; evidence that was pointed out most clearly, from my point of view, in the Senate Community Affairs References Committee Inquiry into Poverty where we were looking at the whole range of issues which had impact on the community. Consistently, when we had private meetings and when we had public meetings in the community, the issues around dental health came up so strongly.

That led to a range of consultations, negotiations and the development of policy on our side but also from the government, who did listen to the concerns about appropriate dental health and the impact of dental health on people's wellbeing at all ages. Indeed, the issues that were raised through that process of consultation did not limit the needs around dental health to one particular group. It talked about the particular processes for young people, which was then picked up by the Labor scheme that came later about adolescent dental health. It looked at the particular needs of developing dental processes so that people would have timely intervention early in their lives so that they would not have the horrors of exacerbated decay and also malfunction in dental processes, which lead to inordinate pain and inconvenience, which are lifelong.

Another particular group of people that came to see us were age pensioners and people who had had no ability in their own youth to have that intervention, and who, as they grew older, were suffering quite seriously from poor dental hygiene and poor dental health.

There was a welcoming but then, when there was an audit of the scheme at the time, we found that the simple process of making the scheme operate, the compliance issues, were not effectively being fulfilled. When the Department of Human Services did their audit—and I think Senator McLucas mentioned this—there was a high rate of noncompliance with provider reporting requirements which were clearly set out in the act. I know that there is a range of opinion but, if you reflect on what I said in this chamber at the time when we were looking at the changes in the dental scheme, I seriously believe that there is a personal responsibility for professional people and organisations to understand the rules and to work within them. Nonetheless, it was put forward by the then government that there was concern, there was a lack of knowledge and there could well have been an 'inadvertent' misuse of the program. People were unaware of their responsibilities and therefore were paid considerable money by the government for providing services under the legislation and then were found out, in effect, to have had an overpayment.

The bill before us talks about the importance of having a clearly understood waiver so that, when the overpayments are identified, there is the opportunity to put it to the people involved. There was great lobbying and advocating by the Australian Dental Association, as well as by individual dentists who visited most parliamentarians in this place to put forward their cases. There was an agreement that there would be a procedure put in place where many debts would be waived, but there were a distinct number of dental operators who did have overpayments identified and then appropriate repayment plans were put in place.

One of the issues that has come out through this bill, which is for all intents and purposes a bit of a housekeeping bill, was to change the way that the waivers and repayments would operate from what is a standard government procedure, which is the Financial Management and Accountability Act 1997—which we all know is essential reading for everybody. Nonetheless, that piece of legislation spells out how overpayments are identified and how repayments to the government are done. Minister Dutton has actually seen that and believes that this is complex and may cause undue stress and delay and therefore they are placing the procedures within the health department to ensure that that will happen. We have no intrinsic opposition to that. I think it is important to see that we look at the history of where it came from and the delegations that now operate within the health act.

I certainly hope that the amount of work that will be done developing this legislation will ensure that professionals in all areas, particularly the dental profession, will have a greater awareness of their requirements of access to Medicare payments, and will have established a stronger communication link so that there is the ability for people to check out what they are required to do before they enter into a contract—and it is a contract.

This is a contract between professionals and the government to ensure that they appropriately receive Medicare payments. My hope is that, from the problems we have had in the past, the identification has been that, perhaps, communication was not as strong as it should have been. Also there is the clear link and understanding that you just do not get Medicare benefits because you do a service. There are individual responsibilities around the type of service you are providing and what you are required to do. In the previous scheme, that real link between appropriate referrals and the types of services covered by the act did seem to be of some concern around the lack of clarity.

The other element leading on directly from putting responsibility back into the Department of Health is the extension of the professional services review to cover dental practitioners who are involved in providing these services. It is one of those things that is self-evident. The professional services review that now operates in the medical profession allows professional consideration of the behaviour and practices of anyone within the services and, under those professional bodies, allows them the ability to check out if there are any allegations of malpractice or misuse of Commonwealth money. We know that it operates in all medical areas now if people are receiving Medicare payments. There have been some considerations around that.

The community affairs committee had an inquiry into this area about 18 months ago, actually stimulated to an extent by lobbying around Senator Abetz with concerns about the way the PSR, the Professional Services Review, operated. The core principle that came out of that discussion, which was vindicated and reinforced by the inquiry, was that there must be appropriate review. Should there be allegations of any malpractice or change of behaviour, there should be a process where that is able to be considered. This bill, amongst other things, actually ensures that activation of the professional services review, with dentists providing services under the MBS covered by the PSR, and that it is appropriate that that would be covered by this scheme.

In terms of our past experience and the investigations that we have had through the development of the wider dental scheme, we totally support the two elements of, firstly, ensuring that the waiver responsibility is back with the department so that they understand the profession and are able to work with it and, secondly, the PSR. I am not going to take the time of the chamber by talking about the importance that Labor places on an appropriate dental scheme across our country. We have made that commitment on the basis that, if you are looking at the health and wellbeing of Australians, it is absolutely critical that we acknowledge that there are needs around oral hygiene and oral health. We have a highly skilled and well-trained dental profession in our nation. In fact, it is highly regarded around the world for the training we provide. We are able, then, to ensure that we can best link the needs of the community across our whole country, not just in large capital cities, but across the whole nation, with effective and responsive services. In this area, it is absolutely essential that we look at making sure that the workforce is located where the need occurs. I see Senator O'Sullivan across the chamber and I am sure he can confirm that, when visiting regional areas in Queensland, one of the key issues that is raised all the time is access to dental services.

I will put on the record a visit I made to the central western area. I went to several significant regional towns with fully set up dental chairs and a history of having had dental professionals—dental professionals with immediate links to the local schools, the local aged-care sector and the local community. Because of workforce shortages and a reluctance of people to serve in regional areas, those chairs—that equipment, those practices—had been abandoned. As a result, people have to travel long distances to get the basic dental services we all expect, as a right, to be able to access in our own suburbs and towns.

We support this bill. There are a whole range of other housekeeping matters in the bill, but I will not refer to those.

Scott Ryan (Victoria, Liberal Party, Parliamentary Secretary to the Minister for Education) Share this | Link to this | Hansard source

Of course you won't!

Claire Moore (Queensland, Australian Labor Party, Shadow Minister for Women) Share this | Link to this | Hansard source

No, I will not. I have put the issues that are of principal concern to me. If Senator Ryan were to check the record of debates on this subject, he would find that I have contributed to most of them—and the issues of credibility and professional integrity have always been central to the contributions I have made.

Scott Ryan (Victoria, Liberal Party, Parliamentary Secretary to the Minister for Education) Share this | Link to this | Hansard source

While I note that the opposition has indicated its support for the Dental Benefits Legislation Amendment Bill 2014, we have had a couple of contributions that were a bit unexpected, given that this time on Thursday mornings is set aside for non-controversial legislation. It is tempting to address those contributions, particularly the bits on the history of dental care in Australia and the importance of dental care. I will just note in passing that it was the Howard government, when the current Prime Minister was the Minister for Health, that first put dental care on the MBS.

However, this bill is about administrative arrangements. It is finely targeted at administrative arrangements. It is not about dental care more generally. I note again that the opposition has indicated its support for this bill and I commend it to the Senate.

Question agreed to.

Bill read a second time.