Improved Models of Care Working Group of the Private Health Ministerial Advisory Committee -Terms of Reference

This page contains the Terms of Reference for the Private Health Ministerial Advisory Committee Improved Models of Care Working Group

Page last updated: 16 April 2018

PDF version: Terms of Reference – Improved Models of Care Working Group of the Private Health Ministerial Advisory Committee (PDF 33 KB)

Purpose

The Government has established the Improved Models of Care Working Group (the Working Group) to consider improved models of care and to provide advice to the Private Health Ministerial Advisory Committee (the Committee) on potential changes to private health insurance regulation to best support consumers’ access to clinically effective and efficient care that best meets the needs of consumers with private health insurance.

The Government recognises that existing regulation may encourage models of care which may be less efficient than alternate mechanisms and provide less desirable care pathways for consumers. This is not in the interests of patients, carers or practitioners.

The Working Group brings together key individuals with expertise in the delivery and financing of mental health and rehabilitation services funded by private health insurance. The Working Group will focus on options to improve the delivery of private health insurance funded mental health and rehabilitation services with the aim of supporting private health insurance members’ access to efficient and clinically appropriate services to best meet patient needs, acknowledging the importance of clinical independence in decision-making.

The issues and options examined by the Working Group may extend beyond mental health and rehabilitation to other clinical areas where there are opportunities to improve models of care and funding arrangements.

The Working Group has a key role in advising the Committee on possible reforms to service delivery and funding arrangements.

Functions

The role of the Working Group is to provide advice to the Committee on possible reforms to the funding of mental health and rehabilitation services with the aim of better supporting private health insurance members. This includes consideration of:

  • the positive and negative aspects of the current regulatory regime, models of care and funding arrangements for admitted mental health and rehabilitation services funded by private health insurance;
  • options for possible change, including but not limited to:
    • adjustments to current regulatory settings to support the delivery of most efficient and clinically appropriate mental health and rehabilitation services;
    • identification of the most clinically appropriate and efficient settings for the delivery of these services, including consideration of:
      • home based care;
      • community based care; and
      • other non-admitted day programs.
  • implementation issues for any proposed changes, including industry disruption, transition issues and timing;
  • suitability of the new models of care applying to other clinical areas; and
  • other related issues as directed by the Committee.
  • The Working Group will give consideration to the evidence base when considering these issues.

    The Working Group will cooperate with the Medicare Benefits Schedule Review, where appropriate.

    Noting that the Working Group may not come to agreement on all issues, members of the Working Group commit to:

    • acting in a collegiate and collaborative manner when discussing and resolving issues; and
    • respecting the confidentiality of Working Group and Committee procedures.

    The Working Group will report to the Committee.

    External Support

    The Working Group may be supported through the commissioning of external advice (through the Department of Health) if required. The Working Group Chair must first seek agreement from the Committee Chair.

    Membership

    The Chair of the Working Group is Dr Jeffrey Harmer AO. The Working Group will comprise: experts in the delivery of mental health care; experts in the delivery of rehabilitation care; consumer representatives; and other members with expertise in service delivery and private health insurance.

    With the Working Group Chair’s prior approval, individuals and organisations who are not members may be invited to participate in the Working Group discussions where they have particular knowledge, expertise or experience.

    A quorum for a meeting is the Chair and half the Working Group membership plus one. A quorum of members must be present before a meeting can proceed. A member who is unable to attend a meeting should advise the Chair and the Secretariat as soon as possible. Attendance by proxies will not be permitted.

    Working Groups

    There are two main streams of work to be considered by the Working Group: improving models of care for mental health; and improving models of care for rehabilitation services. To provide for the most efficient consideration of these issues, the Working Group may establish a mental health sub-group and a rehabilitation sub-group to examine each of these work streams separately.

    Each sub-group may comprise members with expertise in that work stream or overarching expertise in service delivery and private health insurance. Members of the sub-groups may be members of the Working Group or may be separately appointed.

    The full Working Group will consider advice or analysis prepared by each sub-group.

    Confidentiality

    Members are required to sign confidentiality agreements and declare any real or potential conflicts of interests at the commencement of each meeting. All Working Group members have an obligation to maintain confidence of all matters arising within the Working Group and to maintain this confidence even after their membership of the Working Group has expired. Working Group members are specifically obligated to refrain from making any comment or statement concerning any working group matter to any member of the media. The Chair of the Committee or the Secretariat will coordinate all media contact.

    Timing

    The Working Group and sub-groups will meet in person or via teleconference. The Working Group is expected to hold its first meeting in March 2018, meeting up to 10 times until November 2018. Each sub-group is expected to meet approximately six times from April 2018 to October 2018. The Working Group and sub-groups can meet more or less frequently as required, and will report to the Committee.

    Decisions and consideration of issues can be made out of session by the Working Group including by teleconference or videoconference.

    Secretariat

    The Department of Health will provide the required level of secretariat support for the Chair and the Working Group. Papers will be distributed to the Working Group members at least five working days before a Working Group meeting, except with the Chair’s agreement. The agenda for meetings will be agreed between the Chair of the Working Group and the Secretariat. The Chair of the Working Group and/or the Secretariat may consult with the Chair of the Committee in developing any papers.

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