Bulk-billing consent fix on the way, but not this year

It will be another 18 months before a permanent fix is fully done, but the ball has officially started rolling in parliament.

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The government has finally unveiled amendments that will drag the Health Insurance Act into this century, but GPs face a wait for a clarified bulk-billing consent protocol.

Should the Health Insurance Legislation Amendment (Assignment of Medicare Benefits) Bill 2024 pass parliament, it will remove the need for GPs to fill out and co-sign an “approved form” when bulk billing and enable the assignment of benefits to be agreed on before or after a consult.

Crucially, this will allow patients to agree to an “enduring” assignment of benefits, where their consent to be bulk billed at one consult can be reapplied to future services.

Residential aged care patients with dementia, for example, may be able to pre-consent to ongoing bulk billing.

The changes will allow for more flexibility under Medicare and signal a shift away from paper-based processes.

Tabled in the House of Representatives on Wednesday, the bill addresses the outrage that arose among GPs following the Services Australia decision to axe verbal consent for telehealth bulk billing.

Services Australia and the Department of Health and Aged Care were under pressure to axe the temporary provision at the time; the Australian National Audit Office lambasted the call to allow verbal consent in a January 2023 report.

After the verbal consent provisions were retracted, GPs were expected to either email patients asking them to reply explicitly consenting to be bulk billed or fill out an additional form to send to the patient prior to claiming any rebates.

GPs promptly pointed out the absurdity of this process in no uncertain terms.

Health Minister Mark Butler came out within the week to announce that a more suitable solution was in the pipeline and that DoHAC would not be pursuing any broad compliance campaigns in the interim.

While this is essentially a handshake promise, both the AMA and RACGP said they were not aware of any practices that had been pulled up by the department on bulk-billing consent in recent times.

These events went down in the first week of October 2023; it’s taken more than six months for the legislation to be tabled and will take longer than that to pass.

It’s expected to be another 18 months until the legislation actually comes into effect, to allow time for new processes to be developed and integrated into practice software.

“I think our members will be a little bit frustrated that it’s going to take that long, but I think that just goes to show that this is actually quite an embedded issue,” RACGP vice president Dr Michael Clements told The Medical Republic.

“This isn’t something that a minister can just sign off on.”

The Queensland GP urged members to consider the fact this issue goes right to the heart of the way DoHAC hands out money.

“We have to accept that, when government money is being spent, we as voters expect the government to apply due diligence to everything that it spends money on, from defence to new roads,” Dr Clements said.

“As GPs, it is important that we understand our place in this when using the Medicare as the insurance for the patient.”

Despite the extended wait period, Dr Clements said GPs have reason to be excited by the changes laid out in the bill.

“Not having to print a piece of paper and have two people sign it is an amazingly modern step for a Department of Health that is still so trapped in many of its old ways,” he said.

AMA vice president Dr Danielle McMullen told TMR the bill, as tabled, was a “significant improvement” on early proposals from the department.

The biggest win, she said, was the removal of the prescribed form requirement.

“Obviously the government wants to make sure that Medicare dollars are spent where patients intend them to be,” said Dr McMullen.

“It is the patient’s Medicare rebates, and so patients need to have some oversight as to where their Medicare money is going.

“[The goal with this legislation is] that we are more flexible with how that happens.”

The bill is now before the House of Representatives.