Medical Benefits Reviews Task Group

The Medicare Benefits Schedule (MBS) is the cornerstone of the Australian health care system as it facilitates universal access to allied health, general practice and specialist medical services. The Australian Government announced in the 2009-10 Budget that it would provide $9.3 million over two years to develop and implement a new evidence-based framework for managing the MBS into the future – the MBS Quality Framework.

What is the MBS Quality Framework?

At its core, the MBS Quality Framework will strengthen the listing, pricing and review processes that underpin the MBS by ensuring that services are aligned with contemporary clinical evidence, represent best value for money and improve health outcomes for patients.

The MBS Quality Framework involves four key elements:

• introducing a time-limited listing for new MBS items that do not undergo an assessment through the Medical Services Advisory Committee (MSAC);
• requiring an evaluation process for all time-limited items at the end of the time-limited period and before items can be approved for long-term MBS listing;
• strengthening arrangements for appropriately pricing and listing new MBS services; and
• establishing systematic MBS monitoring and review processes to inform appropriate amendment or removal of existing MBS items.

The MBS Quality Framework is aligned with several other reform processes that will also generate change over the short and longer-term to modernise the MBS. These include:

• the Review of Health Technology Assessment (HTA Review), which will report in late 2009. This review is examining the several Commonwealth HTA processes and will make recommendations about options for improving process efficiency and reducing the regulatory burden; and
• Reviews of Diagnostic Imaging and Pathology, which were also announced as part of the 2009-10 Budget and are being conducted in parallel with the development of the MBS Quality Framework.

What is the new MBS time-limited listing process?

In facilitating a more transparent approach to the MBS listing process, the Department will replace the informal internal assessment of new MBS item applications with a more formal process that determines eligibility for MBS listing and the appropriate assessment pathway. Initial MBS applications assessed as eligible for MBS listing will then be referred to either MSAC or the new time-limited listing process. Applications for MBS time-limited listings can potentially be made by anyone with an interest in seeking government funding for a medical service.

New Item Submissions

Applications for new MBS time-limited items will require a range of information including the description of the service, patient target group, indications, therapeutic claim, clinical need, current evidence, and information to inform the establishment of an appropriate MBS fee.

The initial application form and guidelines is available to download.

If you are planning to lodge an application for a new MBS listing in the first quarter of 2010 then please contact Adrienne Hallam on (02) 6289 8810 to discuss the matter before proceeding further.

Initial Assessment

The Department will undertake an initial assessment of the proposal for listing a new MBS item to ensure it meets up-front requirements for its eligibility for funding based on strict criteria. These criteria will be revised over time through consultation with stakeholders. Based on this assessment, the appropriate pathway for potential listing will be determined.

MSAC currently assesses new medical technologies and procedures and this role will continue, with MSAC maintaining the capacity to recommend interim funding for new items to facilitate the collection of evidence for later review. The time-limited process will be the default approach for all other applications where there is sufficient cause to proceed with an MBS item.

Time-Limited Listings

Time-limited items will require an approved evaluation plan before being funded. The Department will work with applicants/clinical sponsors in developing the evaluation plan and identifying and collecting data to be used in an evaluation.

Evaluation Following Time-Limited Listing

The outcomes of the evaluation will be assessed to determine whether the MBS service has met its stated objectives. Where indicated by that evaluation, the service will be placed on the MBS on a long term basis. If the stated objectives are not met then the new MBS item will either be amended prior to listing or lapse and be removed from the MBS.

Pricing of New Items

Under the MBS Quality Framework the price of new services will be evidence-based. The process for establishing a price for a particular service is under development and will be further informed by consultation with stakeholders.

Reviews of Existing MBS Items

The MBS Quality Framework will develop in close consultation with stakeholders a robust process to systematically review MBS items on an ongoing basis. See the Review of existing MBS Items page for more information.

Proposed Governance Arrangements

Formal advisory mechanisms will be an important part of ensuring that stakeholder input is facilitated and utilized during the implementation phase. Over the next 18 months it is anticipated three Departmental advisory committees will be established to provide advice and guidance.

Each committee will be made up of an appropriate range of stakeholders and will help develop and refine the various components of the MBS Quality Framework so that a comprehensive proposal for the long term operation of the Quality Framework can be considered by the Government in the 2011-12 Budget.

Consultation With Stakeholders

The Department would like to engage and collaborate effectively with a broad range of stakeholders and over the next three months consultations will be undertaken with interested parties. These initial meetings will outline the broader Quality Framework initiative and seek feedback on the proposed approach over the next twelve to eighteen months.

A consultation paper is available to inform stakeholders and interested parties. If you have an interest in discussing the implementation of the MBS Quality Framework then please contact Craig Rayner on (02) 6289 9034 or you can provide input on the consultation paper or any other matters at mbrtg@health.gov.au.