Q&A - MBS and PBS changes for professionals

These questions and answers are designed to inform maternity health professionals about important changes to give pregnant women, new mothers and families greater choice in and access to maternity services in Australia.

Page last updated: 26 June 2012

PDF printable version of the Q&A - MBS and PBS changes for Professionals (PDF 590 KB)

General

What is the purpose of these reforms?

The Australian Government has committed $120.5 million over four years to reform maternity services – improving choice and access for pregnant women, new mothers and families.

Of this, $66 million will fund changes to the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS) to make maternity care more affordable.
The reforms respond to the growing pressure on the nation’s maternity services due to the rising number of births and workforce shortages – by making better use of the midwifery workforce working collaboratively with doctors, while maintaining current high standards of safety and quality.

The reforms recognise the important role played by midwives in the birthing experience of many Australian women.

How do the reforms help midwives deliver maternity care?

By being able to access the MBS and PBS, eligible, privately practising midwives are able to provide Medicare-rebateable services to women, and prescribe certain PBS-subsidised medicines. This provides more affordable maternity care to women.

By being covered by Australian Government-supported professional indemnity insurance, midwives can be confident they are protected.
As well, midwives will work collaboratively with obstetricians and medical practitioners who provide obstetric services (i.e. GP obstetricians) – delivering the best possible care for women.

How do these reforms fit in with the National Maternity Services Plan?

These reforms reflect the Government’s commitment to improving maternity services across Australia and represent a significant investment towards the National Maternity Services Plan (the Plan).

The Commonwealth and states and territories are developing the Plan together.

MBS changes

How have the schedule fees and rebates attached to the new MBS items for midwives been determined?

The details of the Medicare item descriptors and fee levels have been finalised in consultation with the profession. Detailed information on the items can be found at the Medicare Benefits Schedule website.

How/when will I access this?

The new arrangements and associated Medicare items will be introduced from 1 November 2010. From this date, qualified and experienced midwives who have obtained a Medicare provider number will be able to provide specified antenatal, birthing and postnatal services to private patients under Medicare.

Women receiving such care will be able to claim a Medicare rebate for these services.

What services are covered by the new MBS changes?

The services covered by Medicare are:
• antenatal services;
• delivery in a hospital setting – including a hospital birth centre; and
• postnatal services.

How do I apply?

To be recognised as an eligible midwife able to access the MBS and PBS, midwives must be trained and be either:
• registered under the National Registration and Accreditation Scheme; or
• registered with a state or territory board.
For more information about registration requirements, go to the Nursing and Midwifery Board of Australia website Nursing and Midwifery Board of Australia website

To be able to provide MBS services and prescribe certain PBS-subsidised medicines, midwives need to meet eligibility requirements and apply for a Medicare provider number and/or a PBS prescriber number. To do so, visit the Medicare website, click on the ‘For health professionals’ page, and then on the ‘Nurse practitioners and midwives’ link.

PBS changes

How do I apply for a PBS prescriber number?

See ‘MBS changes – How do I apply?’

What PBS-subsidised medicines will authorised midwives be able to prescribe?

The PBS medicines available for subsidy for different prescriber groups are approved by the Minister for Health and Ageing on recommendation from the Pharmaceutical Benefits Advisory Committee (PBAC). In determining medicines suitable for prescribing by authorised midwives, the PBAC has considered advice from the PBS midwife technical advisory group. This group was established by the Department of Health and Ageing and included experts from maternity care, health professionals and consumer groups.

The PBS medicines for prescribing by authorised midwives and other information regarding the operation of the PBS will be made available with the publication of the Schedule of Pharmaceutical Benefits on 1 November 2010.

Is it safe to allow midwives to prescribe PBS-subsidised medicines?

The safety of mothers and babies will be paramount.

Only appropriately qualified and experienced midwives who meet the requirements of the proposed amendments to the National Health Act 1953 and are registered with Medicare Australia will be able to prescribe PBS-subsidised medicines.

Prescribing will only be within the scope of their practice, and in accord with the state and territory legislation under which they work.

Medicines required to treat more complicated pregnancies will be prescribed by patients’ medical practitioners.

Activities to ensure safety and quality in PBS prescribing will be implemented, for example through quality use of medicines activities provided by the National Prescribing Service.

If midwives can prescribe, why can’t other health professionals?

Prescribing medicines is regulated by the states and territories.

Any decision to allow health professionals to prescribe PBS-subsidised medicines needs to take account of the safety and quality issues involved.

The Government has been exploring ways to ensure access to necessary health services for the Australian community. This includes making better use of the skills of health professionals in providing health care.

Collaborative arrangements

What is a collaborative arrangement?

A collaborative arrangement is an arrangement between an eligible midwife and a medical practitioner that must provide for:
    • consultation with a specified medical practitioner;
    • referral of a patient to a specified medical practitioner; and
    • transfer of the patient’s care to a specified medical practitioner, as clinically relevant, to ensure safe, high quality health care.

How can an eligible midwife demonstrate a collaborative arrangement?

A collaborative arrangement can be demonstrated by:
    • being employed or engaged by a medical practice or an entity that provides medical services, or
    • receiving patients on written referral from a medical practitioner, or
    • a signed written agreement with a specified medical practitioner/s, or
    • an arrangement in the midwife’s or nurse practitioner’s written records.

Who can I have a collaborative arrangement with?

A collaborative arrangement for a participating midwife can be with the following specified medical practitioners:
• an obstetrician;
• a medical practitioner who provides obstetric services; or
• a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative arrangement.

Where can I find more information about collaborative arrangements?

The legislation regarding collaborative arrangements includes:
• the National Health (Collaborative arrangements for midwives) Determination 2010, the National Health (Collaborative arrangements for nurse practitioners) Determination 2010, and
• the Health Insurance Amendment Regulations 2010 (No.1).
These documents can be found on the Commonwealth of Australia Law website

Why do midwives have to work collaboratively?

Maintaining Australia’s strong record of safety and quality in maternity care for all Australian women, regardless of their health status throughout their pregnancy, is an important consideration of this reform package.

Currently, clinical practice in maternity care requires that midwives and other health professionals collaborate to ensure that women receive access to appropriate expertise and treatment as clinical needs arise. Working flexibly within collaborative teams also encourages and enables the development of new, innovative models of care tailored to local needs.

The new arrangements will see MBS/PBS benefits for antenatal and postnatal services provided by an eligible midwife, but not for the delivery if it is a planned homebirth.

Collaborative practice will be further supported by the development of the National Guidance on Collaborative Maternity Care, through the National Health and Medical Research Council Midwives will also refer their patients to an obstetrician for assessment around 34 weeks gestation, to ensure there are no potential or evident complications.

Australian Government funding for an expanded role for appropriately qualified and experienced midwives, working in collaborative arrangements, represents a significant step forward for maternity care in Australia.

Eligibility

Which midwives will be eligible to access the new arrangements and how is this being determined?

Midwives will have to be registered as a midwife, be privately practising and also meet additional eligibility requirements and have in place suitable collaborative arrangements to ensure that Australia’s record of safety and quality in health care is maintained.

To write PBS prescriptions, an authorised midwife needs to be approved as a PBS prescriber. A midwife needs to be currently registered with the Australian Health Practitioner Regulation Agency, be endorsed to prescribe scheduled medicines, have in place collaborative arrangements, prescribe within their scope of practice, and in accordance with state/territory law and PBS requirements. It is the responsibility of the prescriber to ensure when writing a PBS prescription that they comply with all the requirements for that practice setting.

Why are midwives required to obtain advanced qualifications to practise when they already have qualifications?

The Government wants to ensure that Commonwealth-subsidised midwives will provide maternity services of the highest standard.

As authorised midwifes will independently prescribe PBS-funded medicines and provide MBS-funded services (including referral and ordering of appropriate tests), unlike other midwives who will mostly be working in hospital settings, they will be expected to demonstrate high standards of theoretical and practical knowledge and experience.

Are midwives employed in hospitals affected by the new arrangements?

No. Midwives employed in hospitals, either public or private, are not affected by the new arrangements. Only privately practising midwives are able to access the new MBS and PBS arrangements.

Professional indemnity insurance

How will eligible midwives access the new Government-supported professional indemnity cover and how much will it cost?

Midwives can purchase insurance from Medical Insurance Group Australia (MIGA). To do so, visit the MIGA website and click on the ‘Midwives’ link. This change came into effect from 1 July 2010 and will provide greater protection for midwives and women alike.

This insurance does not cover the planned delivery of babies in the home. Midwives in private practice will still need to have insurance for providing antenatal and postnatal services, regardless of the birth setting.

Research and data collection

Does the Government collect data on pregnancy and related statistics? Where can I access this information?

Maternal and perinatal data is mainly collected by state and territories. This data is then collated and reported by Commonwealth agencies such as the Australian Institute of Health and Welfare and the Australian Bureau of Statistics. Reports containing pregnancy and related statistics are available electronically on these sites.

For more information, visit Maternity Services Reform - www.health.gov.au/maternity or call 1800 678 636.

If you have any difficulty in accessing this information, please contact pacdweb@health.gov.au for an alternate version to be sent to you.

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