National Health Reform

National Health Reform Agreement

Schedule B – Establishment of National Bodies

Independent Hospital Pricing Authority

B1. The IHPA will be established as soon as possible as an independent Commonwealth statutory authority under the Financial Management and Accountability Act 1997 (FMA Act) with:

1. a Chairperson appointed by the Commonwealth;


2. a Deputy Chairperson appointed by the States; and


3. five members to be agreed by COAG, with at least one member having regional and rural expertise.

B2. The costs associated with the establishment and ongoing functioning of the IHPA will be borne by the Commonwealth.

B3. The IHPA has the following determinative functions:

1. developing and specifying the national classifications to be used to classify activity in public hospitals for the purposes of ABF;


2. subject to clause B86, determining the supporting data requirements and data standards to apply to data to be provided by States, including:
   
   1. data and coding standards to support uniform provision of data; and
   
   
   2. patient demographic characteristics and other information that is relevant to classifying, costing and paying for public hospital functions;
3. subject to clause B86, specifying costing data, methods and standards to be used in studies of the costs of delivering public hospital services, and to collect such data from Local Hospital Networks, through the States, to enable it to calculate the national efficient price and loadings;


4. determining the national efficient price for services provided on an activity basis in public hospitals through empirical analysis of data on actual activity and costs in public hospitals, taking account of any time lag and the cost weights to be applied to specific types of services;


5. determining the national efficient cost of services provided on a block funded basis in public hospitals through empirical analysis of data on actual activity and costs in Australian public hospitals, taking account of any time lag;


6. developing, refining and maintaining such systems as are necessary to calculate the national efficient price, including determining classifications, costing, data elements and data collections;


7. determining adjustments (‘loadings’) to the national efficient price required to take account of legitimate and unavoidable variations in the costs of service delivery, including those driven by hospital size, type and location;


8. developing projections of the national efficient price for a four year period, updated on an annual basis and providing confidential reports on these projections to the Commonwealth and States;


9. determining what other services provided by public hospitals are eligible for a Commonwealth funding contribution (clause A10-A26 refers);


10. determining the Block Funded Criteria to be applied to agreed hospitals, functions and services that would be better funded in that way, in 2012-13 (for application in 2013-14) and every three years thereafter. Before this determination can be made the Block Funding Criteria must have been endorsed by COAG (clause A27 refers);


11. resolving disputes on cross-border issues, where parties are unable to reach bilateral agreement and either party seeks a determination from the IHPA; and


12. determining the national efficient price that will apply to eligible private patients receiving public hospital services:
    
    1. the IHPA’s determination will be informed by advice from Heads of Treasuries, produced in cooperation with health departments, regarding current funding arrangements and incentives for private patients in public hospitals. Heads of Treasuries will provide this advice by the end of calendar year 2011.

B4. The Standing Council on Health may direct the IHPA to refine the determination of public hospital services eligible for a Commonwealth funding contribution (clause B3(i) refers).

B5. The IHPA has the following advisory functions:

1. advising COAG on a nationally consistent definition and typology of public hospitals eligible for:
   
   1. block funding only (including small rural and regional hospitals better funded in that way); and
      
   2. mixed ABF and block funding;
2. making recommendations to the Treasurer to adjust Commonwealth contributions to implement cross-border recommendations under clause A97;


3. advising the Standing Council on Health on the feasibility of transitioning funding for teaching, training and research to ABF or other appropriate arrangements (clause A49 refers) by no later than 30 June 2018; and


4. making an assessment in relation to cost-shifting in line with clauses A99-A101.

B6. The IHPA will improve transparency by publicly reporting on:

1. ABF, including release of nationally consistent classifications, costing methods and data and efficient prices;


2. its advice in respect of block funding and the basis of that advice; and


3. its findings and supporting analysis on cost-shifting and cross-border issues raised by parties to the Agreement, following consultation with the relevant jurisdictions.

B7. The IHPA will provide all governments with draft copies of its reports before they are released publicly. All governments will have 45 calendar days in which to comment on the reports.

B8. The IHPA may undertake data collection and research, including by commissioning others to undertake specified studies and research.

B9. In carrying out its functions, the IHPA will:

1. publicly call for submissions from interested parties annually;


2. have regard to any submissions from governments regardless of when they are made; and


3. draw on relevant expertise and best practice within Australia and internationally.

B10. Should the IHPA, in carrying out its functions, identify significant anomalies in service provision or pricing which potentially suggest activity contrary to the intent of this Agreement, the IHPA may consult with the relevant jurisdiction. If the matter is unresolved following consultation with the relevant jurisdiction, the IHPA may confidentially provide information to all jurisdictions about the matter. Should a jurisdiction consider this information evidence of cost-shifting, they can make a submission to the IHPA as set out in clause A99.

Principles for Determining the National Efficient Price

B11. The role of the national efficient price is to:

1. form the basis for the calculation of the Commonwealth funding contribution; and


2. provide a relevant price signal to States and Local Hospital Networks.

B12. In determining the national efficient price, the IHPA must:

1. have regard to ensuring reasonable access to public hospital services, clinical safety and quality, efficiency and effectiveness and financial sustainability of the public hospital system;


2. consider the actual cost of delivery of public hospital services in as wide a range of hospitals as practicable;


3. consider the expected changes in costs from year to year when making projections;


4. have regard to the need for continuity and predictability in prices;


5. have regard to any input costs funded through other Commonwealth programs, such as pharmaceuticals supplied under arrangements pursuant to section 100 of the National Health Act 1953 and magnetic resonance imaging services funded through MBS bulk-billing arrangements; and


6. develop methods which allow consideration of reasonable and likely growth in cost inputs, so that the national efficient price can be projected into the future in a predictable and transparent manner.

B13. In determining adjustments to the national efficient price, the IHPA must have regard to legitimate and unavoidable variations in wage costs and other inputs which affect the costs of service delivery, including:

1. hospital type and size;


2. hospital location, including regional and remote status; and


3. patient complexity, including Indigenous status.

B14. While these adjustments to the national efficient price should provide a relevant price signal to States and Local Hospital Networks, the IHPA should not seek to duplicate the work of the Commonwealth Grants Commission in determining relativities.

Establishment of an Interim Independent Hospital Pricing Authority

B15. Prior to the statutory establishment of the IHPA, the Commonwealth will establish an interim IHPA as an executive agency, separate from any Commonwealth government department.

B16. The arrangements for the interim IHPA will be consistent with all relevant clauses of this Agreement (except clause B1). The Commonwealth will not direct the interim IHPA in a way that is inconsistent with this Agreement while it has capacity to do so, ensuring its independence during the interim arrangements.

B17. If the permanent IHPA has not been established by 31 December 2011, COAG will review the arrangements in place for the interim IHPA.

National Health Funding Pool and National Health Funding Body

National Health Funding Pool

B18. A single National Health Funding Pool will be established, comprising a Reserve Bank of Australia account for each State, for the purposes of receiving all Commonwealth and activity-based State public hospital funding.

B19. The existence and operation of the Pool in relation to a particular State owes its authority to the enabling legislation passed by both the Commonwealth Parliament and the Parliament of that State.

B20. Pool accounts will be audited, have complete transparency in reporting and accounting, and will meet all other transparency requirements established by COAG and relevant legislation.

B21. There will be complete transparency and line-of-sight of respective contributions into and out of Pool accounts to Local Hospital Networks, discrete State managed funds, or to State health departments in relation to public health funding and any top-up funding, and of the basis on which the contributions are calculated. There will also be complete transparency and line-of-sight of respective contributions out of State managed funds to Local Hospital Networks.

B22. Additional streams of funding may be incorporated into the National Health Funding Pool, once agreed by COAG, with the aim of optimising transparency and efficiency of all public hospital funding flows.

Governance

B23. To give effect to this COAG agreement, the Administrator will be an independent statutory office holder, distinct from Commonwealth and State departments, to be jointly established by the legislation of the Commonwealth and all States by 1 July 2012.

B24. The Chair of the Standing Council on Health will seek nominations from all Health Ministers for the position of Administrator. The Chair will then seek agreement of all Health Ministers to the proposed appointment. The Administrator will be appointed by written instrument by all Health Ministers in accordance with the advice provided by the Chair of the Standing Council on Health. The same individual will be appointed the Administrator by all jurisdictions.

B25. The Commonwealth and State legislation will detail the collaborative process between all jurisdictions to select the Administrator, will establish the position of the Administrator, and will provide for his or her appointment.

B26. Commonwealth legislation will provide for the Administrator to perform the following functions:

1. calculating and advising the Commonwealth Treasurer of the Commonwealth contribution to the National Health Funding Pool under this Agreement;


2. overseeing payment of Commonwealth funding determined under this Agreement into State accounts established at the Reserve Bank of Australia under State legislation;


3. reconciling estimated and actual volume of service delivery, informed by the results of data checking activities conducted by other bodies on behalf of the Administrator, and incorporating the result of this reconciliation into the calculation of the Commonwealth contribution to the National Health Funding Pool;


4. publicly reporting on:
   
   1. funding received into the National Health Funding Pool from the Commonwealth;
   
   
   2. payments made from the National Health Funding Pool to Local Hospital Networks and State managed funds, and the basis on which these payments are made;
   
   
   3. payments made, and the basis on which these payments are made, from the State managed funds to Local Hospital Networks and other providers, based on information provided by States;
   
   
   4. payments made by the Commonwealth through the National Health Funding Pool to the States for the provision of public health services;
   
   
   5. top-up payments made by the Commonwealth through the National Health Funding Pool to the States;
   
   
   6. the volume of public hospital services provided by Local Hospital Networks; and
   
   
   7. the delivery of other public hospital functions funded by the National Health Funding Pool; and
5. other functions conferred by State legislation in accordance with this Agreement.

B27. States will pass legislation that will provide for the Administrator to perform the following functions:

1. maintaining accounts (established by each State) with the Reserve Bank of Australia in the name of each State, collectively known as the National Health Funding Pool;


2. overseeing payments into Pool accounts of State funding provided under this Agreement;


3. paying State funding from Pool accounts to Local Hospital Networks and other recipients in accordance with the direction of the relevant State Health Minister; and


4. publicly reporting on:
   
   1. funding received into the National Health Funding Pool from the States;
   
   
   2. payments made from the National Health Funding Pool to Local Hospital Networks and State managed funds, and the basis on which these payments are made;
   
   
   3. payments made from the State managed funds to Local Hospital Networks and other providers, and the basis on which these payments are made;
   
   
   4. the volume of public hospital services provided by Local Hospital Networks; and
   
   
   5. the delivery of other public hospital functions funded by the National Health Funding Pool and State managed funds.

B28. States will also pass legislation:

1. establishing an account at the Reserve Bank of Australia in the name of each State for the purpose of receiving relevant funds under this Agreement from the Commonwealth and States;


2. establishing discrete State managed funds for the purposes of receiving funding for block grants, teaching, training and research;


3. ensuring State funding is paid into Pool accounts and State managed funds in accordance with this Agreement;


4. recognising any funds contained in the State Pool account as being part of the State revenue fund;


5. providing that funds held within Pool accounts may only be used to fund public hospital functions or public health activities, and only in accordance with this Agreement;


6. providing that the Commonwealth funding contribution to a Pool account will be distributed in accordance with the distribution provided by the Administrator to the Commonwealth Treasurer;


7. disapplying all relevant and applicable State law, including financial management and accountability legislation, from applying to the functions of the Administrator;


8. adjusting any provision of State privacy legislation required to give effect to the flows of data necessary under this Agreement, subject to suitable safeguards being established to protect personal information and rights; and


9. providing for a copy of all financial statements and audit reports issued by the States to be made available to the Commonwealth Health Minister.

B29. Commonwealth legislation will contain a provision that disapplies the requirements of the FMA Act 1997 (FMA Act) (Commonwealth) from applying to the functions of the Administrator.

B30. The legislation of the Commonwealth and all States will contain a set of provisions, to be agreed by all jurisdictions, detailing the financial management and accountability arrangements pertaining to the functions of the Administrator. These provisions will specify that the Administrator is to comply with a request by any Health Minister to provide such reports, documents and information in relation to the performance of the functions of the Administrator as the Health Minister requires.

B31. Subject to clause B36 and any necessary modifications required to enact this Agreement, the Commonwealth’s administrative law arrangements will apply to the Administrator and the National Health Funding Body. All relevant and applicable Commonwealth administrative legislation, such as the Administrative Appeals Tribunal Act 1975, the Administrative Decisions (Judicial Review) Act 1977, the Legislative Instruments Act 2003, the Ombudsman Act 1976, the Freedom of Information Act 1982, the Australian Information Commissioner Act 2010, and the Privacy Act 1988, will therefore apply to the functions of the Administrator detailed in the legislation of the Commonwealth and the States.

B32. Commonwealth legislation will not allow any Commonwealth Minister to direct the Administrator in the performance of any function detailed in this Agreement.

B33. The Standing Council on Health will agree a list of persons who may act in the role of the Administrator from time to time as required.

B34. The Chair of the Standing Council on Health is to advise all Health Ministers if:

1. any State Health Minister, with the support of two or more additional State Health Ministers, has requested the suspension of the Administrator; or


2. the Commonwealth Health Minister has requested the suspension of the Administrator.

All Health Ministers will then suspend the Administrator, agree the same individual to be the acting Administrator and then appoint the acting Administrator.

B35. All Health Ministers are to terminate the appointment of the Administrator if such an action is agreed by a simple majority of members of the Standing Council on Health.

B36. State legislation may provide for the Administrator to be subject to state-specific anti-corruption legislation.

B37. Any delay in the passage of State legislation establishing the State account in the National Health Funding Pool or the position of the Administrator for a specific State will not, in any way, affect the operation of the Pool in relation to the other States once the Commonwealth legislation has been enacted.

B38. For avoidance of doubt, any jurisdiction that enacts or amends legislation that is inconsistent with the provisions of this Agreement relating to the new National Health Reform funding arrangements, including the establishment, appointment, powers and functions of the Administrator, will be in breach of this Agreement.

B39. The Commonwealth and States will seek COAG agreement to any proposed amendments to legislation establishing the position and functions of the Administrator and the operation of the National Health Funding Pool.

B40. A single annual report and accompanying financial statement on the operation of the National Health Funding Pool will be provided to the Commonwealth parliament and each State parliament. The Commonwealth will formally request the Commonwealth Auditor-General and the States will formally request the Auditor-General of each State to consider how best to achieve this outcome.

B41. The Commonwealth will formally request the Commonwealth Auditor-General and the States will formally request the Auditor-General of each State to consider the appropriate arrangements in relation to financial audits of the National Health Funding Pool and performance audits of the administration of the National Health Funding Pool.

B42. Commonwealth legislation will also establish a prescribed agency, to be known as the National Health Funding Body. The sole function of the National Health Funding Body is to assist the Administrator in carrying out his or her functions under Commonwealth and State legislation.

B43. The Commonwealth will prescribe the National Health Funding Body as ‘inter-jurisdictional’ under part 6A of the FMA Act to ensure State Health Ministers will be given access to information available to the Commonwealth Health Minister.

B44. The National Health Funding Body will be staffed under the Public Service Act 1999 (Commonwealth) and may include staff seconded from the States. The staff of the National Health Funding Body would not be subject to direction from any Commonwealth Minister while undertaking duties as directed by the Administrator.

B45. The Commonwealth Auditor-General will undertake financial audits and may undertake performance audits of the operations of the National Heath Funding Body.

Payments into the National Health Funding Pool and State Managed Funds

B46. Commonwealth payments into the pool will be made monthly, calculated as 1/12th of the estimated annual payment. Commonwealth payments will be made into the National Health Funding Pool in accordance with Schedule D of the IGA FFR.

B47. States will determine when State payments are made into the Pool and State managed funds.

Payments from the National Health Funding Pool and State Managed Funds

B48. Payments will be made from the Pool accounts to Local Hospital Networks and State managed funds in accordance with Service Agreements to be agreed between the States and Local Hospital Networks.

B49. Payments may be made out of the Pool accounts directly to other parties on the behalf of Local Hospital Networks for the provision of shared services, as detailed in a Service Agreement between a Local Hospital Network and a State. Any subsequent reference to payments made to Local Hospital Networks in this Agreement includes a reference to payments made to other parties for the provision of shared services.

B50. States and Local Hospital Networks can agree amendments to Service Agreements in order to adjust service volumes or pricing to take account of such matters as changing health needs, variations in actual service delivery and hospital performance.

B51. States, as the system manager of public hospitals, can determine the frequency of alterations to Service Agreements. States will notify the Administrator, within 28 calendar days, of agreed variations to a Service Agreement.

B52. The payment arrangements for Commonwealth funding are as follows:

1. ABF will flow directly to Local Hospital Networks through Pool accounts;


2. funding for block grants will flow through Pool accounts to State managed funds and from there to Local Hospital Networks;


3. funding for teaching, training and research will flow through Pool accounts to State managed funds and from there to Local Hospital Networks or other organisations (such as universities and training providers) depending upon the specific funding arrangements established in each State for the provision of those services; and


4. public health funding and any top-up funding will flow through Pool accounts to State health departments.

B53. The payment arrangements for States’ funding are as follows:

1. ABF will flow directly through Pool accounts to Local Hospital Networks;


2. funding for block grants will flow through State managed funds to Local Hospital Networks; and


3. funding for teaching, training and research will flow through State managed funds to Local Hospital Networks or other organisations (such as universities and training providers) depending upon the specific funding arrangements established in each State for the provision of those services.

B54. States will direct the disbursement of State funding from Pool accounts and State managed funds to Local Hospital Networks. The frequency of State payments to Local Hospital Networks will be in accordance with Service Agreements, agreed between the State and Local Hospital Network.

B55. States are able to make exceptional payments through a Pool account or a State managed fund to Local Hospital Networks at any time.

B56. States will direct the timing of Commonwealth payments from Pool accounts and State managed funds to Local Hospital Networks. However, States will not redirect Commonwealth payments:

1. between Local Hospital Networks;


2. between funding streams (for example from ABF to block funding); or


3. to adjust the payment calculations underpinning the Commonwealth’s funding.

B57. States can cause Commonwealth payments to be modified by changing the relevant Service Agreements, if they wish, and by notifying the Administrator of an agreed variation, in accordance with clause B51. These changes to Commonwealth funding will take effect in the next payment period.

B58. To ensure that payments flowing out of the National Health Funding Pool are correct, no payment will flow from the Pool until the respective State has validated the schedule of payment and instructed the Administrator to make payment on the State’s behalf.

Adjustments to the Commonwealth’s Contribution to Local Hospital Networks Funding

B59. There will be two levels of adjustments to the Commonwealth’s funding contribution to Local Hospital Networks:

1. a six-monthly adjustment, and


2. an annual adjustment.

B60. The six-monthly adjustment will be conducted in arrears and will arise from the reconciliation conducted to determine the actual volume for services provided by the Local Hospital Networks for Commonwealth payment purposes. Any State may request that the Commonwealth conduct this reconciliation more frequently. Having regard to technological and operational improvements, States will consider moving to more frequent reconciliation and adjustment arrangements.

B61. The annual adjustment will be conducted in arrears once actual volumes have been validated by the service volume reconciliations to ensure the Commonwealth meets its agreed contribution to the funding of efficient growth and to effect any payment arising from the funding guarantee, as detailed in clauses A67-A79.

B62. Any variation to Commonwealth payments arising from the adjustments will be spread equally across payments for a subsequent quarter.

B63. States will provide to the Administrator, within at least three months (with a preference to reducing the period over time) of the end of each reconciliation period, gross volume and patient identified data regarding actual services delivered for those public hospital functions funded by the Commonwealth on an activity basis to enable reconciliations to be undertaken in accordance with clause B60. Variations for the service volume reconciliation will include, but not be limited to, the reconciliation of general transcription errors, including the incorrect coding of services provided and duplicate entries, and the exclusion of services paid for by the Commonwealth via other funding streams, the exclusion of services for which data has not been provided, and the exclusion of services with incomplete data.

B64. In order to attract a Commonwealth funding contribution for each public hospital service provided on an activity basis, States must ensure that all data relevant to the funding of that service has been provided. In order to attract a Commonwealth funding contribution for each public hospital service funded on a block grant basis or function, States must ensure that all data relevant to that service or function has been provided.

Reporting by the Administrator

B65. The Administrator will provide a monthly report to the Commonwealth and States detailing the following at the Local Hospital Network level:

1. the basis for the amount of Commonwealth funding flowing into Pool accounts;


2. the basis for the amount of State funding flowing into Pool accounts and State managed funds;


3. the number of public hospital services funded and provided as a running yearly total, in accordance with the national system of ABF; and


4. the delivery of other public hospital functions funded by the National Health Funding Pool and State managed funds as a running yearly total.

B66. The same transparency arrangements that apply to the National Health Funding Pool will also apply to the State managed funds. States will provide data to the Administrator in accordance with the timeframe and format specified in the Administrator’s data plan on the:

1. flow of Commonwealth and State funds into and out of State managed funds; and


2. provision of public hospital services by Local Hospital Networks.

B67. All reports produced by the Administrator will be publicly available.

B68. Reporting undertaken by the Administrator will be structured to avoid duplication and overlap with the reporting undertaken by other bodies detailed in this Agreement.

Auditing

B69. Financial audits will be undertaken at least annually, at the completion of each financial year. Performance audits may be undertaken at any time.

Establishment and Recurrent Costs of the Administrator and the National Health Funding Body

B70. The costs associated with the establishment and ongoing functioning of the Administrator and the National Health Funding Body will be borne by the Commonwealth.

Notification of the Data Requirements of the Administrator

B71. By January 2012, or as soon as possible thereafter, in advance of the data plans detailed in clause B85, the Administrator will determine the minimum level of data required to calculate the Commonwealth’s contribution of the national efficient price, conduct reconciliation activities and ensure national comparability. From 2013-14 onwards, the data plan developed by the Administrator will determine the minimum level of data required.

B72. The minimum level of data required in the data plans, as detailed in clause B71, may be included in Service Agreements or provided as an attachment to the Service Agreement. This attachment will be made publicly available by the State. Where a reference is made to a Service Agreement elsewhere in this Agreement, the reference also includes this attachment.

Provision of Service Level Data and Service Agreements to the Administrator

B73. States will provide the Administrator with a confidential estimate of weighted service volumes for a financial year, as an aggregated total, by the end of March in the preceding financial year.

B74. States will provide the Administrator with confirmed aggregate weighted service volumes for a financial year, and estimated service volumes for each Local Hospital Network, by the end of May in the preceding financial year. The estimated weighted service volumes provided are to incorporate the level of disaggregation required by the Administrator in order to calculate the Commonwealth’s funding contribution, in accordance with clause B26a.

B75. States will provide the Administrator with a copy of the Service Agreement for each Local Hospital Network once agreed between the State and the Local Hospital Network.

National Health Performance Authority

B76. The NHPA will be established as soon as possible as an independent Commonwealth statutory authority under the FMA Act, with the following governance structure:

1. a Chairperson appointed by the Commonwealth;


2. a Deputy Chairperson appointed by the States; and


3. five members to be agreed by COAG, with at least one member having regional and rural expertise.

B77. The costs associated with the establishment and ongoing functioning of the NHPA will be borne by the Commonwealth.

B78. The NHPA, in accordance with the Performance and Accountability Framework, will:

1. provide clear and transparent quarterly public reporting of the performance of every Local Hospital Network, the hospitals within it, every private hospital and every Medicare Local, through the new Hospital Performance Reports and Healthy Communities Reports, as outlined in clauses C2(c) and C6-C9;


2. monitor the performance of Local Hospital Networks, Medicare Locals and hospitals against these performance measures and standards in order to identify:
   
   1. high-performing Local Hospital Networks, Medicare Locals and hospitals and facilitate sharing of innovative and effective practices; and
   
   
   2. poorly performing Local Hospital Networks and Medicare Locals, to assist with performance management activities;
3. develop additional performance indicators as appropriate, when asked by the Commonwealth Health Minister at the request of COAG; and


4. maintain the MyHospitals website (clause C11 refers).

B79. In undertaking its work, the NHPA will provide comparative analysis across Local Hospital Networks and Medicare Locals and identify best practice.

Australian Commission on Safety and Quality in Health Care

B80. The role of the ACSQHC is to:

1. lead and coordinate improvements in safety and quality in health care in Australia by identifying issues and policy directions, and recommending priorities for action;


2. disseminate knowledge and advocate for safety and quality;


3. report publicly on the state of safety and quality including performance against national standards;


4. recommend national data sets for safety and quality, working within current multilateral governmental arrangements for data development, standards, collection and reporting;


5. provide strategic advice to the Standing Council on Health on best practice thinking to drive quality improvement, including implementation strategies; and


6. recommend nationally agreed standards for safety and quality improvement.

B81. The ACSQHC will expand its role of developing national clinical standards and strengthened clinical governance. These arrangements will be further developed in consultation with States.

B82. The ACSQHC will:

1. formulate and monitor safety and quality standards and work with clinicians to identify best practice clinical care, to ensure the appropriateness of services being delivered in a particular health care setting; and


2. provide advice to the Standing Council on Health about which of the standards are suitable for implementation as national clinical standards.

B83. The ACSQHC does not have regulatory functions.

Governance arrangements

B84. The Commonwealth has established the ACSQHC as a permanent, independent statutory authority under the Commonwealth Authorities and Companies Act 1997.

Data Provision

B85. The national bodies outlined at clauses B1-B79 will develop rolling three year data plans indicating their future data needs.

B86. In determining data requirements, each body must:

1. seek to meet its data requirements through existing national data collections, where practical;


2. conform with national data development principles and wherever practical use existing data development governance processes and structures, except where to do so would compromise the performance of its statutory functions;


3. allow for a reasonable, clearly defined, timeframe to incorporate standardised data collection methods across all jurisdictions;


4. support the concept of ‘single provision, multiple use’ of information to maximise efficiency of data provision and validation where practical, in accordance with privacy requirements;


5. balance the national benefits of access to the requested data against the impact on jurisdictions providing that data; and


6. consult with the Commonwealth and States when determining its requirements.

B87. Privacy of individual healthcare users is paramount and will be protected at all times. The agencies referred to in clause B97 will collect, secure and use information in accordance with relevant legislation and National Privacy Principles, ethical guidelines and practices in order to protect the privacy of individuals. To give effect to this commitment, the Commonwealth will consult with relevant privacy stakeholders on Commonwealth-related data aspects of this Agreement.

B88. The national bodies will develop rolling three year data plans each year, in line with the following process:

1. each national body will develop a data plan that takes into account the objectives of this Agreement and the requirements in clause B86; and


2. each national body will provide its data plan to the Standing Council on Health. The plan will be considered final and complete 30 calendar days after release, unless the process referred to in clause B91 is invoked.

B89. The first data plans will be provided to the Standing Council on Health in early 2012, covering the 2013-14 to 2015-16 financial years.

B90. The national bodies will advise jurisdictions of their data requirements for the period between the commencement of this Agreement and 1 July 2012 (the interim period), following the requirements set out in clause B86.

B91. The Standing Council on Health may direct the national bodies in respect of specific elements of their data plans or interim data plans:

1. if it determines that a plan does not meet the requirements set out at clause B86; and


2. provided that such a direction would not diminish the achievement of transparency, comparability or other objectives of this Agreement or materially delay implementation.

B92. If a jurisdiction intends to request the Standing Council on Health to consider issuing a direction under clause B91, the following procedure will be used:

1. within 45 calendar days of the release of the plan, the jurisdiction must lodge a submission with the Standing Council on Health, setting out its reasons for seeking the direction;


2. the jurisdiction must provide the body that developed the data plan with a copy of the submission; and


3. within 21 calendar days of receiving the submission, the Standing Council on Health will consider the matter out of session and agree its response.

B93. Subject to clauses B86 and B87, the Commonwealth and States will provide the national bodies outlined above with the data the national bodies determine is required to carry out their functions in accordance with their data plans. This data will be provided to each body as required, with the exception of patient identified data which will be provided to the Commonwealth Department of Human Services for the purpose of de-identifying the data (as set out in clause B94). This de-identified data will then be used by the IHPA in the calculation of the national efficient price and ensure appropriate Commonwealth payments for public hospital services.

B94. Where patient identified data is required, States will provide that data with patients identified by a Medicare Card Number to the Commonwealth Department of Human Services. The Department of Human Services will then de-identify that data and provide it to the relevant national body. Where patient identified data is required it will be subject to existing Commonwealth statutory protections of individuals’ privacy.

B95. The Commonwealth and the States will take responsibility for the data integrity within their systems and agree to establish appropriate independent oversight mechanisms for data integrity, to provide certainty to the Australian public about the actual performance of hospitals and other parts of the health system.

B96. The parties agree that over time data should be streamlined and rationalised to reduce administrative overheads and facilitate data sharing. As part of this, the Standing Council on Health will investigate the feasibility, benefits and costs of moving towards a single national data repository.

B97. As set out in clause B86(d), data provided to the national bodies may be shared between agencies as set out by the following principles:

1. agencies created by this Agreement will be able to access data to allow them to meet their functions as set out by this Agreement;


2. the Australian Bureau of Statistics will be able to access relevant data required to meet its legislative and contractual reporting requirements;


3. the Australian Institute of Health and Welfare (AIHW) will be able to access relevant data to allow the AIHW to meet its statutory and contractual reporting requirements;


4. the COAG Reform Council will be able to access relevant data required to meet its obligations as agreed through the IGA FFR;


5. the Commonwealth Department of Human Services will be able to access data to perform its role of de-identifying patient level data to allow the NHPA and the Administrator to perform their functions; and


6. the Commonwealth Department of Health and Ageing, the Commonwealth Department of Veterans’ Affairs, the Commonwealth Treasury, State health departments and State treasuries will be able to access all de-identified data for the purposes of policy analysis and planning.

B98. To ensure that States are able to effectively fulfil their responsibilities in public hospital management and health planning, the Commonwealth will provide reasonable access to Local Hospital Network level and Medicare Local level health and ageing data about Commonwealth programs. The Standing Council on Health will agree appropriate protocols and procedures to govern the operation of this arrangement, including compliance with Commonwealth legislative obligations.

B99. The Standing Council on Health will make provision in the National Health Information Agreement for bona fide researchers to access de-identified data for the purposes of research and analysis.

B100. With regard to clause B97(f), those agencies will not publish, or use in any way publicly, received data without the express approval of the originating body, except where this data has been provided for the purposes of publication and is being used in that manner.

B101. In using the data available, agencies listed in clause B97 will have regard to the caveats and limitations of the collected data.

B102. Each body will publish details of Commonwealth and State compliance with the data requirements of the national bodies on a quarterly basis.

B103. The Commonwealth and the States agree to enter into a National Health Information Agreement by January 2012 that reflects the objectives of this Agreement, and other matters.

B104. The data standards and data development processes set out in the National Health Information Agreement must be consistent with the objectives and provisions of this Agreement. Where there is any inconsistency, the provisions of this Agreement shall have precedence over the National Health Information Agreement.