Federal Register of Legislation - Australian Government

Primary content

A Bill for an Act to amend the Health Insurance Act 1973, and for related purposes
Administered by: Health
For authoritative information on the progress of bills and on amendments proposed to them, please see the House of Representatives Votes and Proceedings, and the Journals of the Senate as available on the Parliament House website.
Registered 08 Jul 2019
Introduced Senate 04 Jul 2019

 

 

 

 

 

2019

 

 

 

THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA

 

 

 

 

SENATE

 

 

 

 

 

 

 

 

 

 

 

HEALTH INSURANCE AMENDMENT (BONDED MEDICAL PROGRAMS REFORM) BILL 2019

 

 

 

 

 

EXPLANATORY MEMORANDUM

 

 

 

 

 

 

 

 

 

 

 

 

 

(Circulated by authority of the Minister for Health, the Hon Greg Hunt MP)


HEALTH INSURANCE AMENDMENT (BONDED MEDICAL PROGRAMS REFORM) BILL 2019

 

OUTLINE

 

This Bill introduces a statutory scheme to administer the Bonded Medical Program and includes the existing Bonded Medical Places (BMP) and the Medical Rural Bonded Scholarship (MRBS) schemes (current schemes). The statutory scheme provides a legislative basis for the Bonded Medical Program. This program requires participants to complete a return of service obligation (i.e. to work in regional, rural and remote areas and areas of workforce shortage, as would be defined in the Bonded Medical Program rules) in return for a bonded Commonwealth supported place in a course of study in medicine at an Australian university.

 

The Bill amends the Health Insurance Act 1973 (the Act) and the legislative amendments are intended to streamline and modernise the Bonded Medical Program.

The purpose of the Bill is to implement a new statutory scheme that brings the current schemes together under a single legislative framework to progress Government’s long term objective to move towards a single bonded medical scheme in future years.

The new statutory scheme will, over time, replace the need for individual contracts or deeds of agreement with each participant of the Bonded Medical Program, which is the existing administrative arrangement.

 

The new statutory scheme aims to reduce the administrative burden of administering contracts/deeds of agreement with each participant by reducing and standardising the number of conditions and sanctions, better targeting the bonded medical workforce to changing workforce distribution requirements and requiring the use of a web-portal to improve administrative management of the program.

 

Under the new statutory scheme, internal review will be available in relation to certain decisions, as well as review of certain administrative decisions by the Administrative Appeals Tribunal.

 

The Minister will have the power to make Bonded Medical Program rules to ensure the Bonded Medical Program remains up-to-date and responds to workforce distribution requirements into the future.

 

Overview of the Bonded Medical Program

The Bonded Medical Program is an Australian Government initiative designed to address the doctor shortage across regional, rural and remote areas. Participants receive a Commonwealth supported place in a medical course at an Australian university in return for completion of a return of service commitment to work in regional, rural and remote areas and areas of workforce shortage (referred to as the return of service obligation or RoSO).

 

Persons who are not offered a place to study medicine under another arrangement, such as a full fee paying or Commonwealth supported place, may be offered one of the 850 bonded Commonwealth supported places currently offered annually through the Bonded Medical Program. Without the offer of a bonded Commonwealth supported place in a medical course at an Australian university through the Bonded Medical Program, the person would not have the opportunity to study medicine.

 

The current schemes - Medical Rural Bonded Scholarship (MRBS) Scheme

The MRBS Scheme commenced in 2001. It provided up to 100 Commonwealth supported places each year in a medical course at an Australian university, with an attached scholarship. Participants signed a contract requiring them to work as a doctor in a rural or remote area for six years once they attained fellowship.

 

The MRBS Scheme was closed to new entrants after the 2015 academic year. The 100 places reserved for the MRBS Scheme each year were added to the yearly cohort of the BMP Scheme from 2016 (without the accompanying scholarship). 

 

The current schemes - Bonded Medical Places (BMP) Scheme

The BMP Scheme commenced in 2004. It provides a Commonwealth supported place in a medical course at an Australian university to a participant in exchange for agreement to work in an underserviced area for a length of time equivalent to the length of the medical degree, i.e. between four (4) and six (6) years. For participants who joined the BMP Scheme in the years from 1 January 2016 to 31 December 2019, the return of service is reduced from the previous 4-6 years to 12 months full time.

 

Administration of the current schemes

Currently, the Bonded Medical Program is delivered through contracts and deeds of agreement. These arrangements have been in place for up to 18 years, depending upon when a participant entered the program and, over time, have become increasingly outdated. Due to policy developments and not all participants taking up offers to update their arrangements, significant differences in contractual arrangements have developed both within and across schemes.

 

The out-dated nature of the current arrangements has greatest impact on participants who entered into the program in the earlier years. The majority of participants in the early cohorts of each scheme will commence their return of service obligations over the next five (5) to seven (7) years.

 

Existing individual deeds of agreement (under the BMP Scheme) or contracts (under the MRBS Scheme) are complex to administer and to comply with. There are over 20 different contractual and deed of agreement arrangements currently in place. Any change to participant obligations, including those that would be beneficial, require individual amendment to each contract or deed. The purpose of the new statutory scheme is to modernise and consolidate the current schemes to ensure the program consistently responds to current and future workforce needs and offers more modern and flexible arrangements to support the future rural medical workforce.

It can take a participant about 22 years to complete their obligations under the current schemes. This is due to the extensive time required to complete a medical degree, carry out internship, attain specialist training (fellowship) and complete their return of service obligation, which is currently up to six (6) years.

Key stakeholder groups, representing previous and current participants of the program, and key professional agencies and support groups, have over a number of years raised their concerns that existing arrangements including compliance and reporting requirements are outdated and obstruct, rather than facilitate, support for bonded students and doctors and the delivery of acceptable program outcomes.

 

Existing participants of the current schemes who do not choose to opt in to the new statutory scheme will retain their existing contract or deed of agreement arrangements under the current schemes.

 

The new statutory scheme – The Bonded Medical Program

Under the new statutory framework, existing participants of the BMP and MRBS schemes can voluntarily opt in to the statutory scheme.

 

If the Secretary agrees to an existing participant opting in to the statutory scheme, the person is then subject to the provisions of the statutory scheme. Notably, however, a participant of the MRBS scheme may not opt in if section 19ABA of the Act applies to the person; that is, where a medical practitioner has breached a contract with the Commonwealth under which the practitioner agreed to work in a rural or remote area.

 

From 1 January 2020, new participants will be able to voluntarily agree to participate in the Bonded Medical Program. New participants will enter the new statutory scheme as a first year student in a course of study in medicine at an Australian university.

 

To be eligible to participate, a person must have accepted a bonded Commonwealth funded place in a course of study in medicine at an Australian university, be an Australian citizen or permanent visa holder and agree to participate in the program using a web-portal maintained by the Department

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Under the new statutory scheme, participants will be required to work as a medical practitioner in eligible locations for a total period of three (3) years. The three (3) year return of service obligation is half the six (6) years required under the MRBS scheme and a reduction of between one (1) and three (3) years for BMP scheme participants who entered the scheme in 2015 or earlier. Participants of the BMP scheme who entered the scheme in the years 2016-2019 (inclusive) agreed to a 12 month return of service obligation. These participants will retain their 12 month return of service obligation under the new statutory scheme should they voluntarily opt in.

 

Under the new statutory scheme, the return of service obligation must be completed within 18 years from when the participant completes their course of study in medicine at an Australian university but may be completed by a series of periods. The period of 18 years to complete the return of service obligation may be extended in limited circumstances only where a participant or a family member has a medical condition that prevents the participant from completing their return of service obligation within the 18 years provided.

 

A participant will be subject to a number of conditions including that they must complete their course of study in medicine at an Australian university; the return of service obligation must be completed in accordance with the rules and the participant must give information or documents to the Department in particular circumstances.

Where a participant withdraws from their course of study in medicine after the census date for the second year of study, the participant will be liable to pay the Commonwealth the cost of the participant’s course of study for the years or part year (semester) of study undertaken, plus interest.

 

Where a participant does not complete their return of service within 18 years from completion of their course of study (or an extended period), the person will be liable to pay the Commonwealth the cost of the person’s course of study that was funded by the Commonwealth, less a pro-rata proportion of the return of service obligation completed, plus interest; or, the cost of the Commonwealth funded scholarship plus interest, as applicable.

 

Under the new statutory scheme, Medicare benefits will not be payable to a MRBS participant who becomes a participant under the new statutory scheme and does not complete their return of service within 18 years. Medicare benefits will not be payable for six (6) years from the day the breach occurs.

 

Further, under the new statutory scheme, a participant may be liable for an administrative penalty of $10,000 if the person fails to comply with a condition to provide the Department with information or documents. The administrative penalty is considered a debt due to the Commonwealth and may be recovered by the Commonwealth. 

 

A participant will be able to withdraw from the Bonded Medical Program at any time by notifying the Department using the web portal maintained by the Department. If a person withdraws after the census date for their second year of study, the person will be liable to pay the Commonwealth either, as applicable, the cost of the person’s course of study in medicine that was funded by the Commonwealth, less a pro-rata proportion based on any return of service obligation completed, plus interest, or the amount of the Commonwealth funded scholarship plus interest. This repayment will be recoverable as a debt due to the Commonwealth.

 

In addition to this, for participants who are MRBS participants and who withdraw from the Bonded Medical Program after the census date for the second year of the person’s course of study, a Medicare benefit will not be payable in respect of professional services rendered by that medical practitioner for six (6) years from the day the person withdraws from the Bonded Medical Program.

 

Under the new statutory scheme, a decision under new Part VD may be reviewed by the Secretary and certain specified decisions may be reviewed Administrative Appeals Tribunal.

 

The Minister will have authority to make rules prescribing a number of matters. In particular, the rules may prescribe a regional, rural or remote area of Australia or an area of workforce shortage for the purpose of the definition of an eligible location.

 

Financial Impact Statement

The 2018-19 Federal Budget, under the Stronger Rural Health Strategy, supported $20.2 million over four (4) years to June 2022 to implement legislative and administrative reforms.


Statement of Compatibility with Human Rights

 

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

 

HEALTH INSURANCE AMENDMENT (BONDED MEDICAL PROGRAMS REFORM) BILL 2019

 

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

This Bill introduces a statutory scheme to administer the Bonded Medical Program which includes the existing Bonded Medical Places (BMP) and the Medical Rural Bonded Scholarship (MRBS) schemes (current schemes) – to move towards a single bonded medical scheme in future years. The new statutory scheme provide a legislative basis for the Bonded Medical Program. This program requires participants to complete a return of service obligation (that is, to work in regional, rural and remote areas) in return for a bonded Commonwealth supported place in a course of study in medicine at an Australian university.

 

The purpose of the Bill is to implement a new statutory scheme which bring the current schemes together under a single legislative framework to progress Government’s long term objective to move towards a single bonded medical scheme in future years.

 

The new statutory scheme aims to reduce the administrative burden of administering contracts/deeds of agreement with each participant by reducing and standardising conditions and sanctions for breaches of those conditions, better targeting the bonded medical workforce to changing workforce distribution requirements and requiring the use of a web portal to improve administrative management of the program.

 

The Minister will have the power to make, by legislative instrument, Bonded Medical Program rules to ensure the Bonded Medical Program remains up-to-date, implement the objectives of the program and respond to workforce distribution requirements into the future.

 

The new statutory scheme will come into effect from 1 January 2020 for new entrants to the Bonded Medical Program and existing participants who choose to opt in to the new statutory scheme.


 

Human rights implications

The Bill engages Articles 6 and 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the right to work and the right to health.

 

The Right to Work

The right to enjoy economic, social and cultural rights as well as civil and political rights is contained in Part III, Article 6 (1 and 2) of the ICESCR. There is an obligation under the Charter of the United Nations to promote universal respect for, and observance of, human rights and freedoms.

 

In accordance with the Universal Declaration of Human Rights, the idea of free human beings enjoying freedom from fear and want can only be achieved if conditions are created whereby everyone may enjoy economic, social and cultural rights, as well as civil and political rights.

 

Analysis

In this context, it is considered that the provisions to be made under the legislative amendments provide participants of the Bonded Medical Program with flexibility to work with limited restriction. The legislative amendments will provide full opportunity for entrants to voluntarily apply to register in the program or for participants to opt in.  

 

New participants to the program agree to participate voluntarily and receive a Commonwealth funded place at university in return for fulfilment of a commitment to complete their return of service obligation, that is, to work in regional, rural or remote locations or areas of workforce shortage. The new statutory scheme will allow participants to complete their three (3) years return of service obligation over a total of 18 years.

 

Within the 18-year timeframe, participants will be allowed to complete the 3 year return of service obligation by a series of periods. Whilst the provisions would not restrict where a participant may work when not completing their return of service obligation, the provisions would require the return of service obligation be completed in particular geographic locations.

 

To meet the objectives of the program, participants will be required to complete their return of service obligation in certain geographic areas which include all regional, rural and remote areas and districts of workforce shortage for medical specialities.

 

Participants will not be prohibited from working in areas which do not count towards their return of service obligation during the 18 year period in which the return of service obligation must be undertaken. Should a participant delay completion of their return of service until the final three years of the 18 year timeframe, they will continue to retain the right to work elsewhere whilst they undertake their return of service obligation.    

 

The only exception to the 3 year return of service obligation is the 2016-2019 cohorts of the BMP Scheme who retain their full-time 12 month return of service obligation. These participants have access to all other flexible work options granted under the new statutory scheme regarding the timeframe (within 18 years), where (in terms of which eligible location) and how (if completed by a series of periods) the return of service obligation is completed.

 

The full-time requirement placed on participants with a 12 month return of service obligation is considered reasonable given the considerably reduced length of return of service (reduced to 12 months from four (4) to six (6) years), the substantial commitment of Government to fund a Commonwealth supported place enabling the participant to gain a medical career and the objective of the program to deliver more medical services to areas of shortage.

 

The rules to be made will ensure some stability in relation to the eligible locations, requirements for completing the return of service and other requirements that are to be detailed in the rules, by allowing the rules to limit variation or future changes to these requirements in relation to a particular class of participant (refer to new paragraph 124ZT(2)(b) and new subsection 124ZT(4). 

 

For example, a participant may have already commenced their return of service obligation in a particular district of workforce shortage, but updated geographic classifications may prescribe areas of workforce shortage excluding that location. The rules will allow for varying the application of the new eligible locations to specified participants only, excluding from its operation in this particular example, that particular participant who has already commenced their return of service in the particular location. Thereby allowing that participant to continue their return of service in the particular location which was a previous eligible location.

 

It is considered that due to the options that will be available to participants to choose which eligible location and when to work across a broad timeframe of 18 years, there would be very limited restriction on the participant’s right to work. The limited restriction that will exist is in keeping with the benefit provided to participants of a Commonwealth supported place in a course of study in medicine at an Australian university and a medical career.

 

The Right to Health

The right to the enjoyment of the highest attainable standard of physical and mental health is contained in Article 12(1) of the ICESCR. The UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not a right for each individual to be healthy, but is a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.

 

The Committee reports that the ‘highest attainable standard of health’ takes into account the country’s available resources. This right may be understood as a right of access to a variety of public health and health care facilities, goods, services, programs, and conditions necessary for the realisation of the highest attainable standard of health.


Analysis

The Bill will promote equity of access to health services and, as such, supports the right to health by facilitating more access to essential medical services in geographic areas in Australia identified as having less than adequate access to services. 

Participants will be required to complete their return of service obligation in a regional, rural or remote area or an area of workforce shortage which will improve health service delivery in these areas. In turn, this will provide greater opportunity for people in these areas to access health services. The new statutory scheme will, within the available health workforce resources, improve the right of access to a variety of health care services. 

 

The requirement to complete the return of service obligation is a limitation that is considered minimal and well balanced with the benefits to those living in regional, rural or remote areas and the objective of the program to provide more access to medical services in non-metropolitan areas.

 

Conclusion

The legislative amendments are compatible with human rights, noting that the limitations placed on voluntary participants of the program is considered reasonable, necessary and proportionate to the objectives of the program and benefits to the participant and the Australian public.

 

 

The Hon Greg Hunt MP, Minister for Health
HEALTH INSURANCE AMENDMENT (BONDED MEDICAL PROGRAMS REFORM) BILL 2019

 

NOTES ON CLAUSES

 

Clause 1 – Short Title

Clause 1 provides for the Act, once the Bill is enacted, to be cited as the Health Insurance Amendment (Bonded Medical Programs Reform) Act 2019.

 

Clause 2 – Commencement

This clause sets out when the provisions contained in the Bill commence:

·         Sections 1 to 3, and anything in the Bill not elsewhere covered by the commencement table, commence the day that the Bill receives Royal Assent.

·         Schedule 1 commences on 1 January 2020.

 

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. This is a technical provision which gives operational effect to the amendments contained in the Schedule(s). Schedule 1 amends the Health Insurance Act 1973 (Act).

 

SCHEDULE 1 – AMENDMENT OF THE HEALTH INSURANCE ACT 1973

 

Item 1 Subsection 3(1)

This item amends subsection 3(1) of the Act to introduce a number of new definitions. A number of terms are defined by reference to definitions in other legislation (such as Australian university and permanent visa) and a number of terms are defined by reference to another provision in the legislation (such as bonded participant and return of service obligation).

 

Census date

The census date is the final date by which universities accept student entry into a course of medical study. It has historically been used by the Bonded Medical Program as the threshold date to manage bonded student timeframes for entry to or withdrawal from their medical course due to this alignment.

 

Course of study in medicine

Twenty universities participate in the Bonded Medical Program across 22 campuses by offering a bonded Commonwealth funded place to students across undergraduate and postgraduate medical courses. Each university is responsible for selecting medical students to fill their allocated bonded Commonwealth support places. Course length varies from between four (4) to six (6) years.

 

A Commonwealth supported place is a type of enrolment where the total cost of the university course is split into two parts, one part paid for by the Australian Government and the other part paid by the student.  


 

Item 2 After Part VC

This item adds Part VD – Bonded Medical Program after Part VC of the Act. The new Part VD establishes a single legislative framework for the existing Bonded Medical Places (BMP) and the Medical Rural Bonded Scholarship (MRBS) Schemes (current schemes) and future entrants into the Bonded Medical Program to establish a single bonded medical scheme in future years.

 

Division 1 – Bonded Medical Program

This division sets out the statutory scheme for the Bonded Medical Program

 

New Subdivision A – Introduction

This subdivision sets out who may participate in the Bonded Medical Program, how a bonded participant (participant) will enter the program and what the requirements of the program are.

 

Only entrants into the Bonded Medical Program from 1 January 2020 and those existing participants of the Bonded Medical Program under its current schemes, the BMP and MRBS schemes, who voluntarily choose to opt in to the statutory scheme will participate in the new statutory scheme.

 

Deeds of agreement under the current BMP scheme will no longer be offered from 1 January 2020. The existing contracts and deeds of agreement will eventually phase out as bonded medical program participants with these arrangements complete their obligations and exit the program, or choose to voluntarily opt in to the new statutory scheme.

 

New Section 124ZD Bonded Medical Program

New section 124ZD outlines the Bonded Medical Program (program). It is a statutory scheme requiring participants to complete a return of service obligation in return for a Commonwealth funded place in a course of study in medicine at an Australian university, which is provided as a benefit to bonded participants as students.

This new statutory scheme will come into effect from 1 January 2020 when this Schedule to the Bill will commence. The new statutory scheme will be offered to new entrants and existing participants alike from 1 January 2020. Existing participants in the current schemes have an open timeframe to opt in to the statutory scheme should they wish to do so. Existing participants who choose not to opt in will retain their existing contract or deed of agreement until they complete their obligations and exit the program.

 

The term ‘Commonwealth funded place’ means a place in a medical course for which the university receives Commonwealth funding and, in the case of a former participant of the MRBS scheme, the participant received a scholarship under the Bonded Medical Program. 

 

The Bonded Medical Program provides to a bonded participant a Commonwealth funded place in a medical course at an Australian university as a benefit to a student under the student benefits power in section 51(xxiiiA) of the Constitution.

 

New Section 124ZE Bonded participants

New section 124ZE specifies the eligibility requirements for new persons wishing to enter the Bonded Medical Program and those participants of the current schemes who wish to opt in. It describes the eligibility criteria for each category of participant:

  • Bonded Medical Program participants;
  • former participants of the BMP scheme; and,
  • former participants of the MRBS Scheme.

 

New section 124ZE outlines the eligibility requirements by prescribing when a person is and ceases to be a participant.

 

Under new section 124ZE, persons who wish to be a participant will be required to voluntarily agree to participate in the Bonded Medical Program by using a specifically designed web-portal maintained by the Department. The web-portal, which may be accessed through the internet or a specific phone application, has been specifically designed for the program to reduce the administrative burden for both Government and participants. Participants will benefit by being able to check or update their details including milestones, submit evidence, and plan and track their return of service obligation online.  

 

Bonded Medical Program participants

New subsection 124ZE(1) specifies the eligibility requirements of new persons entering the program. The statutory requirements retain the same entry requirements as the current schemes. To be eligible, a person must reside in Australia, be either an Australian citizen or hold a permanent visa (within the meaning of the Migration Act 1958), have enrolled in an offered Commonwealth funded place in a medical course at an Australian university and that offer which the person accepted must be subject to the person participating in the Bonded Medical Program.

 

To be a participant, the person must also voluntarily agree to participate in the Bonded Medical Program using a web portal maintained by the Department. The program is a voluntary program and it is for a prospective participant to choose whether they agree to participate in the program and comply with the requirements of the scheme, including completing the return to service obligation. Agreement to participate in the program is to be notified to the Department through a web portal, which is intended to streamline the administrative arrangements.

 

If a new person entering the program meets the above eligibility criteria, that person will be a ‘bonded participant’ from the day the person agrees to participate in the program (i.e. the day that notice of this agreement is given to the Department through the web portal). The participant continues to be a participant until they cease to be a participant, that is, if any of the provisions in new subsection 124ZE(4) apply.

 

Former Bonded Medical Places (BMP) Scheme

Under new subsection 124ZE(2), a person who was a party to a deed of agreement with the Commonwealth (as represented by the Department of Health) for the funding of a place in the BMP Scheme may become a participant under the new statutory scheme. That person must advise the Department in writing that they wish to opt in to the Bonded Medical Program under new section 124ZU, and the Secretary must agree to their participation in the program. The person is then considered a participant from the day after the Secretary agrees to the person’s participation in the program. The person continues to be a participant until they cease to be a participant, that is, if any of the provisions in new subsection 124ZE(4) apply.

 

A BMP scheme participant will not be required to opt in to the new statutory scheme. This is optional and the participant may choose if they wish to voluntarily opt in or not.

 

Former Medical Rural Bonded Scholarship (MRBS) Scheme

Under new subsection 124ZE(3), a person who was a party to a contract with the Commonwealth (as represented by the Department of Health) for the funding of a place in the MRBS scheme, including a scholarship, may become a participant under the new statutory scheme. That person must advise the Department in writing that they wish to opt in to the Bonded Medical Program under new section 124ZU, and the Secretary must agree to their participation in the program. The person is then considered a participant from the day after the day the Secretary agrees in writing to the person’s participation in the program. The person continues to be a participant until they cease to be a participant, that is, if any of the provisions in new subsection 124ZE(4) apply.

 

A MRBS scheme participant is not required to opt in to new statutory scheme. This is optional and the participant may choose if they wish to voluntarily opt in or not.

However, a participant of the MRBS scheme may not opt in to the Bonded Medical Program if they are subject to the application of a Medicare ban under section 19ABA of the Act (refer to new section 124ZU(3)). Participants of the MRBS Scheme are subject to section 19ABA of the Act and will continue to be subject to that provision. If they are subject to a Medicare ban under section 19ABA of the Act, they will need to remain under their existing arrangements until the end of the Medicare ban.

 

Section 19ABA of the Act provides that Medicare benefits are not payable in respect of services rendered by, or on behalf of, a medical practitioner who has breached a contract with the Commonwealth under which the practitioner agreed to work in a rural or remote area. The period during which Medicare benefits are not payable is a period equal to twice the length of the period that the practitioner agreed, under the contract, to work in the rural or remote area, or such shorter period as determined in, or in accordance with, the contract (refer to subsection 19ABA(2) of the Act).

 

New subsection 124ZE(4) specifies when a person will cease to be a ‘bonded participant’ for the purposes of the Bonded Medical Program under the new statutory scheme. A participant ceases to be a participant on the day any of the following events occur:

  • the participant completes their return of service obligation, that is, they have fulfilled their obligation under the program. To complete the return of service obligation, a participant must complete three (3) years of work in an eligible location in accordance with new section 124ZF and requirements that may be set out in the prescribed rules;
  • the participant withdraws from, or is barred from, their university medical course at an Australian university;
  • the participant fails to comply with the condition that the return of service obligation be completed within a specified time period as outlined in new paragraph 124ZG(1)(c) and new section 124ZJ does not apply to the person, that is the person is not subject to a Medicare benefits payment ban under new section 124ZJ; 
  • new section 124ZJ applies (that is, the person is subject to a Medicare benefits payment ban) and the period that Medicare benefits are not payable ends;
  • the participant withdraws from the Bonded Medical Program after the census date of the second year of study and that participant is not a former MRBS participant who is subject to a Medicare benefits payment ban under new subsection 124ZQ(3);
  • the participant withdraws from the Bonded Medical Program after the census date of the second year of study and that participant is a former MRBS participant who is subject to a Medicare benefits payment ban under subject 124ZQ(3) that has ended.

 

New Subdivision B – Conditions of Bonded Medical Program

 

New Section 124ZF Return of service obligation

New section 124ZF describes the return of service obligation and outlines the requirements that must be met in order to comply with the obligation. The requirements include the location of service and the period of service.

 

The return of service obligation is the period of work to be undertaken by a participant in return for accepting an offer of a bonded Commonwealth funded place in a medical course at an Australian university. A participant’s completion of their return of service obligation is the primary outcome of the Bonded Medical Program to facilitate access to essential medical services by Australians in geographic areas identified as having less than adequate access to services.

 

New subsection 124ZF(1) prescribes what a return of service obligation is. The obligation requires a participant to work as a medical practitioner in an eligible location for a period of three (3) years.

 

Eligible location will be defined in section 3(1) as an area prescribed in the rules as a regional, rural or remote area or an area prescribed by the rules as an area of workforce shortage. Under the program, participants are fully responsible for choosing where they work provided it is in an eligible location in order to undertake their return of service obligation.  

 

The new statutory scheme provides for the Minister to make rules prescribing how workforce distribution mechanisms and their sub-classifications will be applied for the purposes of prescribing regional, rural and remote areas and areas of workforce shortage. The two current workforce mechanisms are the Modified Monash Model (MMM) classifications of 2 -7 and Districts of Workforce Shortage.

 

All participants are required to meet the three (3) year return of service obligation under new subsection 124ZF(1), other than former participants of the BMP scheme who entered the program in the academic years between 2016 and 2019 and who will retain their 12 month return of service obligation upon entry into the new statutory scheme. Provision is made under new paragraph 124ZV(2)(b) to cater for this ‘grandfathered’ arrangement.

The three (3) year return of service obligation is a negotiated position and is one of the key reforms to be introduced by the new statutory scheme. It is supported by key stakeholder groups including the Australian Medical Association and the Australian Medical Students Association and will be introduced from 1 January 2020. The three (3) year requirement reflects an increase from the existing 12 months return of service obligation required of cohorts that entered the BMP scheme over the period 2016 through to 2019 and a reduction from the four (4) to six (6) years return of service obligation for earlier BMP scheme cohorts.

 

Under the new statutory scheme, the standardisation of the duration of the return of service obligation to three (3) years is of most benefit to MRBS scheme participants, who were required to complete six (6) years of continuous return of service as a specialist. Under new subsection 124ZF(1) and new paragraph 124ZF(2)(e), participants of the MRBS scheme who opt in to the new statutory scheme will be able to complete a return of service obligation of three (3) years.

 

Inconsistency in the length of the return of service obligation has attracted substantial criticism from key stakeholders. The 12 month return of service obligation introduced from the 2016 academic year is inadequate to meet the forecasted workforce needs. A three (3) year return of service obligation is considered sufficient to address the identified risk of having an inadequate number of bonded doctors to meet workforce shortage needs from 2030.

 

New subsection 124ZF(2) outlines the requirements of the return of service obligation.

 

New paragraph 124ZF(2)(a) requires participants to complete their three (3) years return of service obligation within 18 years of the day on which the participant completed their medical course. The completion date of a medical course is the date on which the university provides written notice to a participant that they have successfully completed the medical course.

 

New paragraph 124ZF(2)(b) states that the return of service obligation must be completed in accordance with any requirements that are prescribed by the Bonded Medical Program rules.

 

New paragraph 124ZF(2)(c) states that the return of service obligation may be completed by a series of periods. That is, the return of service obligation does not need to be completed within a consecutive three (3) year period and instead may be completed by a series of periods which equal to three (3) years of service completed within 18 years of the date of completion of the medical course.

 

New paragraphs 124ZF(2)(d) and (e) enable participants who were participants of the BMP scheme (2015 or earlier cohorts only) or MRBS scheme, respectively, to reduce the 3 year return of service obligation by the amount of time the participant had worked towards their return of service obligation under their former scheme (refer to new paragraphs 124ZV(2)(a) and 124ZW(2)(a)). Accordingly, prior services towards the return of service obligation under the current schemes will be counted towards the return of service obligation under the new statutory scheme.

New subsection 124ZF(3) enables a participant to apply to the Secretary for an extension of time to complete their return of service obligation if the participant, or a member of the participant’s family, has a medical condition that prevents the participant from completing their return of service obligation within 18 years. The application must be made before the end of the 18 year period required by new paragraph 124ZF(2)(a).

 

A ‘medical condition’ includes a serious medical condition or illness of the participant or a first degree relative of the participant that is:

                                i.            a life threatening illness;

                              ii.            an illness that could become life-threatening if not treated; or

                            iii.            a chronic illness or disabling condition where the treatment or the illness itself creates an insurmountable barrier to working in a regional, rural or remote area.

 

The Department will consider all applications for an extension of time to complete the return of service obligation due to a medical condition. Decisions regarding an extension will be made on the basis of the medical evidence submitted with the application.

 

Under new subsection 124ZF(4), the Secretary may make a decision, in writing, to extend the 18 year timeframe within which the return of service obligation must be completed to enable a participant to complete their return of service obligation. This discretion may only be exercised where the participant makes an application before the end of the 18 year period and the Secretary is satisfied that the participant is unable to complete their return of service obligation during the 18 year period required by new paragraph 124ZF(2)(a).  

 

The circumstances in which an extension of time to complete the return of service obligation may be granted are limited to where a participant or a member of the participant’s family has a medical condition that prevents the participant from completing their return of service obligation. The medical condition would need to be one that is a serious illness causing the participant to be unable to complete their return of service obligation. Not all medical conditions would render the participant unable to complete their return of service obligation.

 

New Section 124ZG Conditions of the Bonded Medical Program

New section 124ZG specifies the conditions applying to a bonded participant receiving a Commonwealth funded place, provided as a benefit to students.

 

New paragraph 124ZG(1)(a) requires participants to complete their medical course of study. They must do so at an Australian university and within the period of time to be prescribed by the Bonded Medical Program rules.

 

New paragraphs 124ZG(1)(b) and (c) require participants to complete their return of service obligation within 18 years from completion of their medical studies (refer to new paragraph 124ZF(2)(a)) and to work as a medical practitioner in eligible locations which will meet their return of service obligation. Eligible locations for meeting return of service obligations are regional, rural or remote areas and areas or workforce shortage as prescribed in the Bonded Medical Program rules. Note that new section 124ZF allows for the reduction of the three year return of service obligation and an extension of the 18 year period within which the return of service obligation must be completed beyond 18 years.

 

New paragraphs 124ZG(1)(d) and (e) require a participant to provide documents and information to the Department in the circumstances, and as prescribed by the Bonded Medical Program rules and in response to a request of the Secretary as soon as practical after a request is made. These conditions to provide information or documents to the Department is for the purpose of determining whether a participant is complying with the conditions and the requirements of the Bonded Medical Program.  

 

The kinds of information that may be required include information about the completion of the medical course, completion of milestones such as internship, entering a specialist training program, attainment of fellowship, and information about the period of return of service that has been completed or the location where it has been completed.

 

Under new paragraph 124ZG(1)(f), the participant must comply with any other condition set out in the Bonded Medical Program rules. Other conditions may be prescribed in the rules which the participant must also comply with.

 

New subsection 124ZG(2) clarifies that any breach of the requirements set out in the Bonded Medical Program rules will be a breach of the condition under paragraph 124ZG(1)(b).

 

New Section 124ZH Breach of conditions of Bonded Medical Program – repayment of education costs

New section 124ZH specifies that a participant is liable to repay of cost of the participant’s course of study undertaken, and pay the applicable interest, where the participant breaches a specified condition of the Bonded Medical Program.

 

New subsection 124ZH(1) specifies the particular breaches of conditions which attract the requirement to repay to the Commonwealth the cost of the participant’s course of study in medicine at an Australian university. This provision applies where:

(a)    the participant withdraws from, or did not complete their course of study, within the period prescribed in the rules, thereby breaching the condition set out in new paragraph 124ZG(1)(a), and the breach occurs, after the person’s census date for the second year of the person’s course of study in medicine at an Australian university; or 

(b)   the person did not complete the required return of service obligation within the time allowed under new section 124ZF, that is the participant breached the condition set out in new paragraph 124ZG(1)(c).

 

In these circumstances, the participant is required to repay to the Commonwealth the cost of the participant’s course of study in medicine, being the cost of the participant’s course of study for each year or part year (semester) of study undertaken.

 

New subsection 124ZH(2) provides that the person must pay specified amounts and interest on the specified amount, worked out and applied in accordance with the Bonded Medical Program rules. 

 

New paragraph 124ZH(2)(a) provides that a new Bonded Medical Program participant or a former participant of the BMP Scheme must pay 100 per cent of the cost of the person’s course of study in medicine, as funded by the Commonwealth as a benefit to the person as a student, less a proportional reduction based on any return of service obligation completed. The person must pay the cost of the course of study that the Commonwealth has funded; being, the cost of the participant’s course of study for the years or part year (semester) of study undertaken. The person must also pay interest on this amount as set out in the Bonded Medical Program rules.

 

New paragraph 124ZH(2)(b) applies only to participants of the former MRBS Scheme who received a Commonwealth funded place in a medical course with an accompanying scholarship as a benefit to the person as a student. Under new paragraph 124ZH(2)(b), former participants of the MRBS scheme may be liable to pay 100 percent of the cost of the Commonwealth funded scholarship provided to the person, less a proportional reduction based on any return of service obligation completed. The person must also pay interest on this amount as set out in the Bonded Medical Program rules.

 

New subsection 124ZH(3) provides for the amounts payable under new subsection 124ZH(2) to be recoverable as a debt due to the Commonwealth from the person or the estate of the person.

 

Under the new statutory scheme, the financial consequence under new subsections 124ZH(1) and (2) will operate by law and will not be dependent upon the Secretary determining that a breach has occurred.

 

New Section 124ZJ Breach of condition of Bonded Medical Program – medicare benefits not payable

New paragraphs 124ZJ(1)(a) and (b) provide that a Medicare benefit is not payable in respect of professional services rendered by, or on behalf of, a medical practitioner who is a bonded participant who also is a former MRBS Scheme participant, and who breaches the condition in new paragraph 124ZG(1)(c) that the participant complete their return of service obligation within the period allowed by section 124ZF.

 

New subsection 124ZJ(2) provides that Medicare benefits will not be payable to a participant for a period of six (6) years from the day the breach occurs, even if this six (6) year period extends beyond the 18 year period for completion of the return of service obligation (refer to new paragraph 124ZF(2)(a)).

 

New subsection 124ZJ(3) provides that the Medicare benefits payment ban under this section applies irrespective of whether the participant was a medical practitioner at the time the breach occurred.

 

New Section 124ZK Breach of condition of Bonded Medical Program – administrative penalty

New section 124ZK requires the payment of an administrative penalty by participants of the Bonded Medical Program when they breach specified conditions. These conditions are to provide certain information or documents necessary for the administration of the program, and incidental to the provision of the student benefits.

 

Under new subsection 124ZK(1) a participant is liable for an administrative penalty if he or she does not comply with the conditions set out under new paragraphs 124ZG(1)(d) or (e). That is, where a participant has not provided documents or information to the Department in accordance with the requirements set out in the Bonded Medical Program rules or as soon as practical after the Secretary has made a request.

 

New subsection 124ZK(2) specifies the amount of administrative penalty to be $10,000 per breach.  

 

The amount of $10,000 is considered insignificant compared to the Commonwealth funding to cover the cost of the participant’s course of study in medicine.

 

New subsection 124ZK(3) requires the Secretary to provide written notice to a participant of their liability to pay an administrative penalty, the breach of condition to which the administrative penalty relates and the total amount of the administrative penalties if there is more one breach of condition and the date on which the penalty becomes due for payment. The penalty is cumulative and is required to be paid by the day it becomes due for payment as specified in the notice, which must be at least 14 days after the notice is given.

 

New subsection 124ZK(4) provides that the administrative penalty payable under new section 124ZK is a debt due to the Commonwealth and may be recovered by the Secretary by action in a court of competent jurisdiction.

 

New Subdivision C - Review of decisions

New Section 124ZL Application for review

New section 124ZL provides for internal review of a decision of an APS employee in the Department made under this Part.

 

Application may be made

New subsection 124ZL(1) provides that a person may apply for a review of an original decision made by an APS employee, to whom the power to make the decision has been delegated by the Secretary, under this Part.

 

New subsection 124ZL(2) requires the application made under new subsection 124ZL(1) to be in writing, set out reasons for the application and be made within 14 days of the making of the original decision or a longer period if the Secretary allows a longer period.

 

New subsection 124ZL(3) requires the internal review of an original decision to be undertaken by the Secretary or a person who has been delegated the power to review the original decision, who was not involved in the original decision and who occupies a position that is at least at the same level as the person who made the original decision.

 

Decision on review

New subsection 124ZL(4) requires the person reviewing the original decision to either affirm, vary or set aside, and substitute a new decision for, the original decision. A participant may make an application to the Administrative Appeals Tribunal for review of a decision made under this subsection (refer to new section 124ZN).

 

Withdrawal of application

New subsection 124ZL(5) allows a person to withdraw their application for review of an original decision. The person must withdraw in writing and withdrawal can occur at any time before the review has been completed.  

 

New subsection 124ZL(6) provides that an application for review which is withdrawn to be considered as never having been made.

 

New Section 124ZM Notice of decision on review

New section 124ZM outlines the requirements for the notice to be provided by the person reviewing an original decision to the person who requested the review.

 

New subsection 124ZM(1) requires the person reviewing the original decision to provide written notice of the decision on review. The notice must include the reasons for the decision, any findings on material questions of fact, including references to evidence or other material on which those findings were based, notice of any right to have the decision on review reviewed by the Administrative Appeals Tribunal.

 

New subsection 124ZM(2) requires that written notice of a decision on review must be provided to the Registrar of the Administrative Appeals Tribunal where a decision on review has been made by the Secretary under new subsection 124ZL(4), and the decision on review varied the original decision or set the original decision aside and substituted a new decision, and the decision on review is made after the person has applied to the Administrative Appeals Tribunal for review of the original decision.

 

New Section 124ZN Review by the Administrative Appeals Tribunal

New section 124ZN prescribes the decisions that are reviewable by the Administrative Appeals Tribunal. These are:

  • under new paragraph 124ZN(a), a decision by the Secretary under new subsection124ZF(4) to refuse to extend the timeframe for a participant to complete their return of service obligation; 
  • under new paragraph 124ZN(b), a decision made by a person reviewing an original decision; and,
  • under new paragraph 124ZN(c), a decision of the Secretary to refuse to agree to a person’s participation in the Bonded Medical Program due to not meeting the requirements to opt in to the new statutory scheme as outlined in new paragraphs 124ZV(1)(c) or 124ZW(1)(c).

New Subdivision D – Withdrawal from Bonded Medical Program

 

New section 124ZP Withdrawal from Bonded Medical Program

New subsections 124ZP(1) and (2) provide that participants may withdraw from the Bonded Medical Program at any time. Participants may withdraw by notifying the Department using the web portal maintained by the Department.

 

New section 124ZQ Consequences of withdrawal

 

Consequences for all participants

New subsection 124ZQ(1) specifies the consequences if a participant withdraws from the Bonded Medical Program after the participant’s census date for the second year of a course of study in medicine at an Australian university.

 

New paragraph 124ZQ(1)(a) requires new participants of the Bonded Medical Program or former participants of the BMP Scheme to pay:

(i)                 100 per cent of the cost of the person’s course of study in medicine, as funded by the Commonwealth as a benefit to the person as a student, less a proportional reduction due to any return of service obligation already completed; and

(ii)               interest on the amount worked out under subparagraph (i) and applied in accordance with the Bonded Medical Program rules.

 

The person must pay the cost of the course of study that the Commonwealth has funded; being, the cost of the participant’s course of study for the years or part year (semester) of study undertaken.

 

New paragraph 124ZQ(1)(b) requires former participants of the MRBS Scheme to pay:

(i)                 100 percent of the cost of the Commonwealth funded scholarship provided to the person, less a proportional reduction due to any return of service obligation completed; and,

(ii)               interest on the amount worked out under subparagraph (i) and applied in accordance with the Bonded Medical Program rules.

 

New subsection 124ZQ(2) provides that the amounts payable under new subsection 124ZQ(1) are recoverable as a debt due to the Commonwealth or the estate of the person.

 

Additional consequences for former Medical Rural Bonded Scholarship (MRBS) participants

New subsection 124ZQ(3) provides that a Medicare benefit is not payable in respect of professional services rendered by, or on behalf of, a medical practitioner who is a former MRBS Scheme participant covered by new subsection 124ZE(3) and who withdrew from the Bonded Medical Program after the participant’s census date for the second year of their course of study in medicine at an Australian university.

 

New subsection 124ZQ(4) provides that the period in which Medicare benefits not payable under subsection 124ZQ(3) is for a period of six (6) years from the day the participant withdraws from the program (even if this six (6) year period extends beyond the 18 year period mentioned in new paragraph 124ZF(2)(a)).

 

New subsection 124ZQ(5) provides that the Medicare benefits payment ban under this section applies irrespective of whether the participant was a medical practitioner at the time they withdrew from the program.

 

New Subdivision E - Information sharing

 

New Section 124ZR Authorised collection, use and disclosure

New section 124ZR allows for the Department to collect, use and disclose information including personal information about participants for the purposes of administering the program in accordance with section 130 of the Constitution.

 

Administration or enforcement of Part

New subsection 124ZR(1) authorises the Secretary or an APS employee (including on-going and non-ongoing employees) to collect, use and disclose information about a participant, including personal information, if the collection, use or disclosure is reasonably necessary for the purpose of administering or enforcing the provisions of this Part.

 

The prescribed rules will specify the type of personal and sensitive information which the Department will collect from participants and hold for the purposes of monitoring and compliance or the consideration and application of an extension to the return of completion date due to a medical condition; reporting to Government and the evaluation of program outcomes.

 

New paragraph 124ZR(2)(a) allows for collection, use and disclosure of information within what is reasonably necessary to confirm a participant compliance with the program’s eligibility requirements relating to citizenship or the holding of a permanent visa within the meaning of the Migration Act 1958. This may include collection advice from universities during the opt in process which confirms that the person meets citizenship requirements under new paragraph 124ZE(1)(b).

 

Under new paragraph 124ZR(2)(b) information may be collected, used and disclosed for the purpose of monitoring compliance with the conditions of the program as under section124ZG. This may include a participant submitting documentary evidence of compliance with prescribed rules; such as, in relation to completion of the required medical course; or, for monitoring purposes or entry into a fellowship training program. It may also include provision of employer documentation or Medicare provider information for assessment and monitoring of completion of return of service obligations.

 

Under new paragraphs 124ZR(2)(c) and (d), collection, use and disclosure of information may include verification of the accuracy of notifications provided by the participant and provision of documents and other information needed in relation to participation in the program and to support that participation.

 

Compiling and reporting statistical information

New subsection 124ZR(3), authorises the Secretary or an APS employee in the Department to collect, use and disclose information relating to a participant for compiling and reporting a purposes relating to the operation of the program. Data would be de-identified for use under new subsection 124ZP(3). Examples of

de-identified data collated and used for this purpose includes periodic reporting to Government and undertaking evaluation of the program outcomes.

 

New Section 124ZS Interaction with the Privacy Act 1988

New section 124ZS provides that the collection, use or disclosure of information about a participant under this Part is also an authorisation to collect, use or disclose information relating to the participant for the purposes of the Privacy Act 1988.

 

New Subdivision F – Bonded Medical Program Rules

 

New Section 124ZT – Bonded Medical Program Rules

 

Content of Rules

New Section 124ZT – The Bill provide for rules to prescribe specified matters in order to give effect to the Bonded Medical Program.

 

New subsection 124ZT(1) authorises the Minister to, by legislative instrument, make rules prescribing matters required or permitted by this Part to be prescribed or necessary or convenient to be prescribed for carrying out or giving effect to Part VD.

 

New subsection 124ZT(2) provides that the rules, for the purposes of the definition of eligible location, must prescribe either or both of the following: a regional, rural or remote area of Australia and an area of workforce shortage. The Modified Monash Model (MMM) classification under the Australian Statistical Geography Standard and published by the Australian Bureau of Statistics at its website has been used in prescribing areas that are regional, rural or remote for the purposes of the return of service obligation under the Program. Definitions of areas of workforce shortage under other instruments made under the Act will be adopted or slightly modified for the purposes of the Program. The rules may prescribe that an area is prescribed as an eligible location only in relation to a particular class of participants, especially since the eligible location may change over time.

 

Eligible locations change with time due to changes in the number of residents (population) in particular areas or the change in health workforce distribution in a particular location. Thus, it is possible that a participant who opted in at a particular period of time would be required to carry out their return of service obligation in eligible locations that are slightly different or significantly different from the eligible locations prescribed when they became a participant in the program. Paragraph 124ZT(2)(b), would allow the Minister to make rules prescribing an eligible location to only apply prospectively, ie in relation to new bonded participants. The previous eligible locations can still apply to participants who entered the program prior to the amendments being made.

 

New subsection 124ZT(3) provides that the rules may provide for any or all of the following matters that are described in paragraphs 124ZT(3)(a) to 124ZT(3)(g).

 

Under new paragraph 124ZT(3)(a) the rules may specify the specific events or milestones that the participant must notify to the Department to evidence compliance with the conditions of the Bonded Medical Program, and the specific evidence of those specific events. The events may include, for example: acceptance into a medical course as a first year medical student and completion of their medical course, commencement and completion of internship, commencement of vocational training and attainment of fellowship.

 

Under new paragraph 124ZT(3)(b) the rules may detail the requirements for completion of a return of service obligation. This may include the number of full-time hours per week that a participant is required to work in an eligible location; the amount of work which meets any full-time and part-time requirements; possible arrangements enabling a participant to work in more than one location whilst also working in a return of service location.

 

This rule may also cover the requirement for participants to complete the approved on-line return of service obligation plan (approved RoSO plan) which maps out the proposed timing, location and place of return of service to inform the Department about a participant’s return of service arrangements.

 

The rules may set out any specific requirement which only relate to former participants of 2016-19 cohorts under the BMP Scheme who have retained their 12 month return of service obligation. These participants are required to work full time during their return of service and are able to complete all return of service obligations prior to becoming a medical specialist.

 

Under new paragraph 124ZT(3)(c), the rules may set out the circumstances in which work which qualifies for completing a return of service obligation may be scaled. The scaling incentive may be available to participants who meet specific criteria. The scaling incentive is designed to maximise the objectives of the program by encouraging participants to work in areas which are more rural or remote, that is in areas which are classified MMM 4-7. A scaling incentive is applied under the current schemes.

 

The criteria, which a participant must meet to benefit from the scaling incentive under the new statutory scheme, may be included in the rules including, for example: whether full-time or part-time work will be counted, the locations of work classified under the Modified Monash Model and for how long work must be undertaken at locations for scaling to be applied.

 

The rules may also include whether completion of specialist training is a requirement and whether a participant must continue to work in MMM 4-7 locations after specialisation for scaling to be applied. The rules may specify the amount of service that will contribute towards a participant’s return of service obligation under the scaling incentive. The scaling incentive may not be available for participants who have a 12 month return of service obligation or participant do not attain specialisation.

 

Under new paragraph 124ZT(3)(d), the Bonded Medical Program rules may set out rules related to the circumstances in which work will qualify for completing the return of service obligation. These rules may: enable a participant to retain an existing return of service work location for a set time period if the location where they are working ceases to be classified as an eligible location due to changes to areas of workforce shortage.

Under new paragraph 124ZT(3)(e), the rules may set out, for the purposes of new section 124ZF, who is considered a member of a participant’s family and the nature of evidence required to be submitted to establish whether a participant or a member of their family has a medical condition.  

 

The rules may include a detailed timeframe and the period when information is to be submitted.

 

Under new paragraph 124ZT(3)(f), the rules may set out the rate of interest and how interest will be applied in relation to the consequences of a breach of the conditions in new paragraphs 124ZG(1)(a) or (c). The rules may cover rate of interest that will be applied, from when and how it will be applied, the timing and the process applied by the Commonwealth.

 

Under new paragraph 124ZR(3)(g), the rules may set out the form and way in which information and documents are to be provided to the Department. The rules may specify these requirements for the provision of evidence related to completion of program conditions, tracking of progress, meeting of return of service requirements or applications to the Department.

 

New subsection 124ZR(4) enables the rules to provide for any matter mentioned in new subsection 124ZR(3) to apply only in relation to a particular class of participants. This provision would allow the Minister to make rules that only apply to, for example, new participants in the program, and other rules continue to apply to existing participants.

 

New subsection 124ZR(5) prohibits the rules from doing the following:

(a)    creating an offence or civil penalty;

(b)   providing powers of arrest or detention; or entry, search or seizures;

(c)    imposing a tax;

(d)   setting an amount to be appropriated from the Consolidated Revenue Fund under an appropriation in this Act;

(e)    directly amending the text of the Act.

 

Incorporation of other instruments

New subsections 124ZT(6) enable the rules to apply, adopt or incorporate, with or without modification, any matter contained in an instrument or other writing as in force at a particular time or from time to time. This would apply, for example, to incorporation of instruments, such as the Modified Monash Model published by the Australian Bureau of Statistics for the purposes of defining an eligible location, that is, what is considered a regional, rural or remote area of Australia or an area of workforce shortage.

 

Section 14(2) of the Legislation Act 2003 prohibits a legislative instrument or notifiable instrument from making provision in relation to a matter by applying, adopting or incorporating any matter contained in an instrument or other writing as in force or existing from time to time. This prohibition applies unless the contrary intention appears in the legislative instrument.

 

New subsection 124ZT(7) expresses a contrary intention and, therefore, overrides section 14(2) of the Legislation Act 2003 as stated in new subsection 124ZR(6).

 

The purpose of enabling the rules to refer to other instruments by incorporation is to enable the rules to be responsive to changing needs in workforce distribution without any delays and to enable eligible locations to be defined using the workforce distribution mechanism which is currently used. It would effectively enable the Secretary to update the workforce distribution mechanism currently applied by the Secretary. The two current workforce mechanisms are the Modified Monash Model (MMM) classifications of 2 -7 and Districts of Workforce Shortage, used to determine regional, rural and remote areas and other areas of workforce shortage for the purposes of defining locations which are eligible for participants to work in for completion of their Return of Service Obligations under the program.

 

The Australian Statistical Geography Standard, July 2011 edition, published by the Australian Bureau of Statistics defines the Modified Monash Model (MMM) classification. The MMM is available free on the Department of Health’s website. The Districts of Workforce Shortage (DWS) are defined in legislative instruments made under the Health Insurance Act 1973 such as the Health Insurance (Section 19AB Exemptions) Guidelines 2017. The current DWS status of every location in Australia for the medical specialty of general practice is available through the locator map at www.doctorconnect.gov.au/.

 

Inconsistency of rules and regulations

New subsection 124ZT(8) provides that rules that are inconsistent with the regulations have no effect to the extent of inconsistency, but the rules are taken to be consistent with the regulations to the extent that the rules are capable of operating concurrently with the regulations.

 


Division 2 – Transitional arrangements

 

New Section 124ZU Opt in process for participating in the Bonded Medical Program

New section 124ZU allows for existing participants of the BMP scheme or MRBS scheme to opt in to the Bonded Medical Program under the new statutory scheme.

 

New subsection 124ZU(1) provides that persons who are a party to either a deed of agreement under the BMP Scheme or party to a contract under the MRBS Scheme are eligible to opt in in the Bonded Medical Program under the new statutory scheme.

 

New subsection 124ZU(2) provides that persons who are a participant of the BMP Scheme or the MRBS Scheme may opt in by advising the Department in writing that they voluntarily wish to opt in to the program and voluntarily agree to participate in the program using a web portal maintained by the Department.

 

New subsection 124ZU(3) provides that a person may not opt in to the Bonded Medical Program in two circumstances:(a) a Medicare ban under section 19ABA of the Act applies in relation to the person, noting that this only applies to participants of the MRBS Scheme; or, in the case of an MRBS participant, the person has not completed their course of study in medicine at an Australian university.

 

New subsection 124ZU(3) does not allow MRBS scheme participants who are still completing their medical course to opt in. This is due to the provision of scholarship payments under the MRBS scheme’s contractual arrangements. MRBS scheme scholarship payments are provided to a participant for each year of study of a medical course and cease towards the end of the final year of study. Once a MRBS scheme participant has completed their medical course, they will be able to approach the Department indicating their wish to opt in. MRBS scheme participants who are still completing their medical studies are not adversely impacted by this delay in opt in arrangements to the program.

 

New Section 124ZV - Effect of opting in to the Bonded Medical Program – BMP participants

 

New subsection 124ZV(1) provides that where a person, who is a party to a deed of agreement with the Commonwealth for funding of a place in the BMP Scheme, advises the Department in writing that the person wishes to opt in to the Bonded Medical Program (refer to new section 124ZU), the person voluntarily agrees to participate using a web portal maintained by the Department, and the Secretary agrees, in writing, to the person’s participation in the program, then the following apply:

(a)    on the day the person becomes a participant, the person’s deed of agreement ceases; and,

(b)   on and after that day, the person is subject to the provisions of Part VD of the Act.

 

 

New subsection 124ZV(2) provides that the following provisions apply in relation the participant once they opt in to the new statutory scheme:

(a)    the three (3) year return of service obligation is to be reduced by any prior service completed in accordance with the provisions of the person’s deed of agreement;

(b)   if the person entered into a deed of agreement during the period beginning on 1 January 2016 and ending on 31 December 2019, then for the purposes of new section 124ZF, a reference to “3 years” is to be read as a reference to “12 months”; and

(c)    new paragraph 124ZG(1)(a) which relates to the completion of a course of study in medicine at an Australian university applies only if the person has not, on the day the person becomes a participant, completed their course of study in medicine at an Australian university.

 

New Section 124ZW - Effect of opting in to the Bonded Medical Program – MRBS participants

 

New subsection 124ZW(1) provides that where a person who is a party to a contract with the Commonwealth for a MRBS advises the Department in writing that the person wishes to opt in to the Bonded Medical Program (refer to new section 124ZU), the person voluntarily agrees to participate using a web portal maintained by the Department, and the Secretary agrees, in writing, to the person’s participation in the program, then the following apply:

(a)    on the day the person becomes a participant, the contract ceases; and,

(b)   on and after that day, the person is subject to the provisions of Part VD of the Act.

 

New subsection 124ZW(2) provides that the following provisions apply in relation the participant once they opt in to the new statutory scheme:

      (a) their three (3) year return of service is to be reduced by any previous return of         service worked under their MRBS contract;

(b) the Commonwealth funded scholarship provided to the participant under the participant’s former MRBS contract is the scholarship amount paid to the person by the Commonwealth under the contract for the purpose of new paragraph 124ZH(2)(b)(i); and,

(c)    new paragraph 124ZG(a), relating to the completion of a medical course at an Australian university, only applies if the person has not, on the day the person becomes a participant, completed their course of study in medicine at an Australian university.

 

New subsection 124ZW(3) provides that nothing in new Part VD of the Act affects the application of section 19ABA of the Act in relation to the person if the person breached their contract before the day the Secretary agreed in writing, to the person’s participation in the Bonded Medical Program, even if the breach of condition which triggers the application of section 19ABA is identified on or after that day.