Anne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) Share this | Link to this | Hansard source

The Health Insurance Amendment (Prescribed Dental Patients and Other Measures) Bill 2023 seeks to amend the Health Insurance Act 1973 with three administrative changes, which are all supported by the coalition. From the outset, can I put on the record our thanks to the cleft palate community for their engagement on this extraordinarily important piece of legislation for them and the people they look after, and can I reiterate my commitment and the commitment of the coalition to working closely with them to ensure better outcomes for young Australians impacted by cleft palate and craniofacial conditions.

Importantly, this bill will improve access to the Medicare Benefits Schedule for eligible persons requiring treatment for cleft and craniofacial conditions by removing the age restrictions, which currently are at 22 years of age. Schedule 2 also enables Services Australia to use computerised systems to action decisions made by a specified body to place doctors on or remove doctors from the Register of Approved Placements. Schedule 3 includes some technical changes to the bonded medical program, including rectifying inconsistencies between the act and the rule about the length of a bonded participant's return of service obligation.

This legislation has arisen following the findings of the Medicare Benefits Schedule Review Taskforce report on the cleft palate dental services MBS item in 2020. The report suggested that the current age limit of 22 years for eligible persons requiring treatment for cleft and craniofacial conditions be lifted. Age limits for access to the scheme were initially established on the basis that patients with cleft and craniofacial conditions would generally have completed most specialist dental work associated with their condition once facial growth was complete—on average 22 years of age. However, there continue to be a small number of patients who are denied treatment on the basis of the age limit in circumstances where that treatment would be clinically beneficial to the patient's condition and their general health. This bill will also serve an important purpose of enabling patients who have had their surgeries deferred beyond the age of 22 due to the COVID-19 pandemic to access Medicare benefits for the treatment that they still require.

Cleft lip or palate conditions affect one in every 800 babies born in Australia. The bill will not significantly alter average patient numbers, but it will nevertheless serve the important purpose of supporting improvements to patients' treatment plans. This will ensure that support is available for all Australians affected by these conditions and make it fairer and more equitable for young people needing cleft palate and craniofacial procedures to access those procedures, regardless of their age.

The coalition absolutely supports the intention of this bill to improve access to affordable and life-changing procedures for those Australians impacted by these conditions, and we absolutely support increased access to critical health care through Medicare. However, we are concerned by the lack of action this government has taken to date to address the challenges currently facing Australians in their access to medical support and treatments more generally. Despite all their rhetoric on Medicare, Labor has slashed Medicare-subsidised health supports in half, cutting 70 telehealth items from Medicare and overseeing plummeting bulk-billing rates since coming to government.

At a time when Australians are struggling with skyrocketing energy bills, mortgage repayments and grocery bills, we are seeing the cost of going to the doctor putting significant pressure on households as well. The government must start taking real and urgent action to ensure that all Australians have affordable access to health care, particularly during this cost-of-living crisis, and to ensure that all Australians have equitable access to essential health care, no matter what their postcode. Because we know rural, regional and remote Australians face unique and disproportionate challenges in accessing health care, particularly during this serious workforce crisis, the coalition remains absolutely committed to ensuring the sustainability of Medicare and to ensuring that all Australians have access to Australia's world-class health system.

In government we increased Medicare funding every year. In fact, total annual funding for Medicare increased under the coalition from $19 billion to $36 billion a year, an increase of over $1 billion annually. In addition, the introduction of universal telehealth under the coalition was the most significant reform to Medicare since its creation. This saw more than 100 million telehealth services delivered under our government, ensuring greater and more flexible access to healthcare support for over 17 million Australians, including, importantly, patients in rural, regional and remote Australia. We know how important it is to address the tyranny of distance faced by rural patients and to ensure all patients have access to the supports they need when they need them, where they need them. That's why this bill is so important. All patients requiring life-changing treatment should have affordable and equitable access to that treatment, where that is possible. That is absolutely undeniable, and it is essential to the lives of patients.

I wish to acknowledge the cleft palate community and their engagement with this legislation. We thank them for their ongoing engagement and for sharing their personal stories, and we appreciate the important advocacy that they provide on this very important health matter. The coalition understand their concerns and the issues raised around the inadequacy of current support offered through speech pathology sessions and we will work with them and the government to address this. We remain committed to solving their plight. We also appreciate the government's engagement on this issue and their commitment to working with us towards meaningful change and to finalising a program that fully addresses the wishes of the cleft palate community. The coalition looks forward to continuing to work collaboratively in the best interests of all Australians living with cleft palate conditions. Once again, we support this bill, in recognition of the important access to life-changing procedures that this legislation will provide to young Australians impacted by cleft palate and craniofacial conditions.

Janet Rice (Victoria, Australian Greens) Share this | Link to this | Hansard source

I'm speaking today in place of Senator Steele-John, the Greens health spokesperson, who is unable to be with us in the Senate today. Every year in Australia around 400 babies are born with a cleft. So the Australian Greens welcome this bill, the Health Insurance Amendment (Prescribed Dental Patients and Other Measures) Bill 2023, today. It will enable those with a cleft lip or palate to have access to the surgery they require at any age. Under current legislation, Medicare eligibility for treatment under the Cleft Lip and Cleft Palate Scheme for prescribed dental patients requires a person to meet complex and problematic access restrictions, with some people being denied treatment on the basis of age alone rather than on the basis of clinical need. This bill will allow a small cohort of patients who are currently denied Medicare reimbursement for treatment based on age alone to access Medicare benefits for the treatment they need, so the Greens join with the community in support of this bill.

However, when this bill came before the parliament, Senator Steele-John was disappointed and frustrated to hear that the key community stakeholder in this space, CleftPALS, had not been consulted on this bill despite it amending a scheme which entirely affects them and their children. When Senator Steele-John first met with CleftPALS, the primary need was clear. For over a decade, these parents of children with a cleft lip and palate have been asking for speech pathology services to be covered under the Medicare cleft lip and palate scheme. These children are currently forced to go without vital speech pathology services because of a lack of government funding. Minister Butler would have had an opportunity to make sure this call was heard if his office had consulted with the community prior to the introduction of this bill.

Speech pathology services should have been included in this bill. To illustrate why this is so important, I want to share the story of Josh, whose father, Tim Devlin, is one of the parents in CleftPALS and has been driving this message of a need for speech pathology, alongside parents all over Australia. Tim joins us here in the Senate today. For two years, Tim and his wife have been fighting to get NDIS funding for speech pathology sessions for Josh. During that time, Tim estimates that his son's private speech pathology costs have added up to around $6,400. A specialist can cost over $190 per hour. Tim says there's an obvious need for speech pathology sessions to be subsidised for children with cleft lip and palate, which is not adequately met by either Medicare or the NDIS. Josh is now in preschool and has had two years of intense speech therapy, but his speech is still not understood by kids in the playground and he requires further speech pathology services.

The amendment that I'll be moving later, during the committee stage, at the request of Senator Steele-John, gives the government the opportunity to rectify their lack of consultation and to amend the cleft lip and palate scheme to include speech pathology services. The advocacy by parents like Tim on behalf of their children has been so important, but it should not have been necessary. It's a government responsibility to ensure that the public health system leaves nobody behind. It has taken far too long to get this right. The time to rectify this and to amend this scheme is now. I call on the government and the opposition to support this amendment and to ensure that all cleft-affected children and adults can receive the speech pathology services they need.

I hope the Senate will also support the Greens' second reading amendment, which summarises the need for speech pathology services and acknowledges and thanks CleftPALS. I think it's worth reading out some of the second reading amendment, which states that we note: 'the continued work of CleftPALS and Speech Pathology Australia in advocating for the services which will improve patient outcomes for those with cleft lip and palate; the Medicare Benefits Scheme's cleft lip and palate scheme does not currently extend to speech pathology services; that many children with cleft lip and palate would greatly benefit from speech pathology services which are not currently accessible under the cleft lip and palate scheme and are expensive for parents and cleft-affected adults; CleftPALS, the peak community body for people with cleft lip and palate, was not consulted in the writing of this bill; that children with clefts, requiring intensive speech therapy, can often attend weekly therapy sessions for blocks of six to 10 weeks, multiple times per year; that due to the surgery schedule that children with cleft lip and palate can experience, which can be 10 to 20 surgeries over 25 years, 20 speech pathology services in a patient's lifetime is often inadequate; and, in response to pressure from the community, the Medical Services Advisory Executive Committee is now reviewing relevant evidence on 18 August 2023 and will subsequently make recommendations'. It further states that we agree: 'to thank CleftPALS organisations across Australia and Speech Pathology Australia for their advocacy and support for the cleft-affected community; and funding for speech pathology services under the MBS cleft lip and palate scheme must be included in the next federal budget'.

At the request of Senator Steele-John, I move:

At the end of the motion, add ", but the Senate:

(a) notes:

(i) the continued work of CleftPals and Speech Pathology Australia in advocating for the services which will improve patient outcomes for those with cleft lip and palate,

(ii) the Medicare Benefits Scheme's Cleft Lip and Palate Scheme does not currently extend to speech pathology services,

(iii) that many children with cleft lip and palate would greatly benefit from speech pathology services which are not currently accessible under the Cleft Lip and Palate Scheme and are expensive for parents and cleft-affected adults,

(iv) CleftPals, the peak community body for people with cleft lip and palate, was not consulted in the writing of this bill,

(v) that children with clefts, requiring intensive speech therapy, can often attend weekly therapy sessions for blocks of 6 to 10 weeks, multiple times per year,

(vi) that due to the surgery schedule that children with cleft lip and palate can experience, which can be 10 to 20 surgeries over 25 years, 20 speech pathology services in a patient's lifetime is often inadequate, and

(vii) in response to pressure from the community, the Medical Services Advisory Executive Committee is now reviewing relevant evidence on 18 August 2023 and will subsequently make recommendations; and

(b) agrees:

(i) to thank CleftPals organisations across Australia and Speech Pathology Australia for their advocacy and support for the cleft-affected community, and

(ii) that funding for speech pathology services under the Medicare Benefits Scheme's Cleft Lip and Palate Scheme must be included in the next federal budget".

I look forward to the support, I hope, of the government and the opposition.

Anthony Chisholm (Queensland, Australian Labor Party, Assistant Minister for Education) Share this | Link to this | Hansard source

I thank the senators who've made a contribution on this bill. The Health Insurance Amendment (Prescribed Dental Patients and Other Measures) Bill 2023 amends the Health Insurance Act 1973 to improve health care for all Australians. The amendments will remove age restrictions for accessing cleft and craniofacial services on the Medicare Benefits Schedule; enable Services Australia to automate management of the register of approved placements; and rectify inconsistencies between the act and the Health Insurance (Bonded Medical Program) Rule 2020 to make amendments enhance administration of the bonded medical program.

Patients with eligible cleft and craniofacial conditions will benefit from the removal of age restrictions, allowing time for their conditions to be appropriately planned and treated. Under the current legislative arrangements, Medicare eligibility for treatment under the Cleft Lip and Cleft Palate Scheme requires a patient to meet complex and problematic access restrictions, with some patients being denied Medicare reimbursement for treatment based on age alone. Age limits for some patients were previously amended under the health insurance amendment bill 2022; however, there continues to be a small number of patients who are denied treatment based on age. These changes will provide equity of access for treatment to those patients who suffer from certain cleft and craniofacial conditions, relying upon a clinical requirement rather than age.

In addition, the bill provides the facility for Services Australia to develop a system to place a doctor on or remove a doctor from the register of approved placements under section 3GA of the act. Specified bodies such as the Department of Health and Aged Care and general practice colleges are responsible for determining if a doctor is eligible to be placed on the register of approved placements. Services Australia places doctors on the register of approved placements based on notifications from specified bodies. The specified bodies will notify Services Australia on the decision, and Services Australia will manually place doctors on and remove doctors from the register of approved placements accordingly. The act does not currently allow this to occur via computer system. This change will reduce the time frames for doctors to start providing Medicare rebated services to their patients at a time critical with workforce shortages in primary care.

The bill also corrects inconsistencies between references to three years and one year in part VD of the act and the definitions of how a participant accrues a week of their return of services obligation under the Health Insurance (Bonded Medical Program) Rule 2020. With this bill, the Australian government will make it fair and equitable for young people needing cleft palate and craniofacial procedures, ensuring access to essential health care.

I note the amendment of Senator Steele-John, moved by Senator Rice, and I thank all parties for their engagement on this bill. The government appreciates the advocacy of CleftPALS and Speech Pathology Australia in raising the separate issue of access to speech therapy for those with cleft conditions. The government notes that there are separate MBS services available for some speech pathology services under the chronic disease management plans which may be applicable to cleft patients. The government also notes the advice of CleftPALS that they do not consider these sufficient for cleft patients. The government will consider the proposals from CleftPALS in conjunction with existing work being undertaken in relation to potential expansion of access to MBS services for those with severe speech and language disorders under the MBS for those with eligible disabilities following a recommendation from the MBS Review Taskforce.

The Medical Services Advisory Committee is an independent and expert committee comprising experienced clinicians and health economists. MSAC provides advice to government on whether a new medical service should be publicly funded and, if so, circumstance on and assessment of its comparative safety, clinical effectiveness, cost-effectiveness and total costs using the best available evidence. Any changes to the MBS funding for allied health services, including speech pathology for cleft patients, needs to be informed by a clinical evidence base and advice from the MSAC. For these reasons the government will not be supporting the amendments put forward by the Australian Greens. Options and pathways for further government consideration of the CleftPALS proposal will be determined by the MSAC executive. This could include consideration of further changes to the disability items in the MBS and may involve consideration of changes to the cleft scheme, as proposed by CleftPALS. The department will continue to consult with CleftPALS, Speech Pathology Australia and other stakeholders in progressing this work. The Australian government is committed to strengthening Medicare and putting the health of Australians first. I thank senators for their contribution to the debate on this bill.

Question agreed to.

Original question, as amended, agreed to.

Bill read a second time.