Health Insurance Commission Regulations (Amendment) (Cth)

Statutory Rules 1989 No. 1951

 

Health Insurance Commission Regulations2

(Amendment)

I, THE GOVERNOR-GENERAL of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulations under the Health Insurance Commission Act 1973.

Dated 14 July 1989.

BILL HAYDEN

Governor-General

By His Excellency’s Command,

Neal Blewett

Minister of State for Community Services and Health

 

Commencement

1. These Regulations are to be taken to have commenced on 17 July 1989.

Principal Regulations

2. In these Regulations, “Principal Regulations” means the Health Insurance Commission Regulations.

Interpretation

3. Regulation 2a of the Principal Regulations is amended:

(a) by inserting the following definition:

“ ‘National Health Act’ means the National Health Act 1953;”;

(b) by omitting “National Health Act 1953” from the definition of “registered organization” and substituting “National Health Act”.

 

(S.R. 229/89)—Cat. No. 3/12.7.1989

 

Additional functions of the Commission: allocation of numbers

4. Regulation 3c of the Principal Regulations is amended by omitting from paragraph (a) “National Health Act 1958”and substituting “National Health Act”.

5. After regulation 3c of the Principal Regulations, the following regulations are inserted:

Additional functions of the Commission: provision of certain appliances

“3d. For the purposes of subsection 8e (1) of the Act, the following functions are prescribed, namely, on behalf of the Minister, to process claims for payment relating to stoma appliances the supply of which is arranged under paragraph 9a (1) (a) of the National Health Act, and to make payments of those claims.

Additional functions of the Commission: provision of pharmaceutical benefits

“3e. For the purposes of subsection 8e (1) of the Act, the following functions are prescribed:

(a) on behalf of the Secretary to the Department, to perform the functions conferred on the Secretary by Part VII of the National Health Act, other than:

(i) to make appointments under paragraph 101 (1) (a) of that Act; and

(ii) to make arrangements for the testing or analysis of pharmaceutical benefits or drugs that may be used as pharmaceutical benefits under section 102 of that Act;

(b) on behalf of the Minister, to perform the following functions conferred on the Minister by Part VII of the National Health Act:

(i) to approve hospital authorities and hospitals under section 94 of that Act;

(ii) to vary, suspend or revoke approvals under subsection 94 (5a) of that Act;

(iii) to determine periods of suspension under subsection 94 (5b) of that Act;

(iv) to cancel approvals under subsection 98aa (1) of that Act;

(v) to make special arrangements for the availability of pharmaceutical services under subsection 100 (1) of that Act;

(c) on behalf of the Minister, to perform the functions conferred on the Minister by Part VIII or IX of the National Health Act in relation to the provision of pharmaceutical benefits;

(d) on behalf of the Secretary to the Department, to perform the functions conferred on the Secretary by Part VIII or IX of the National Health Act in relation to the provision of pharmaceutical benefits;

 

(e) on behalf of the Secretary to the Department, to perform the functions conferred on the Secretary by the National Health (Pharmaceutical Benefits) Regulations;

(f) on behalf of the Minister, to perform the functions conferred on the Minister by the National Health (Pharmaceutical Benefits) Regulations, other than the function of determining the rate at which, and the conditions subject to which, payments of pharmaceutical benefits are to be made under regulation 18 of those Regulations;

(g) for the purposes of Part VII of the National Health Act, to process claims for payment relating to the provision of pharmaceutical benefits and to make payments of those claims;

(h) to process, on behalf of the Repatriation Commission, claims for payment relating to the provision of pharmaceutical benefits under section 91 of the Veterans’ Entitlements Act 1986 and to make payments of those claims;

(i) to devise and implement measures intended to prevent, or facilitate the detection of, contraventions of Part VII of the National Health Act or the National Health (Pharmaceutical Benefits) Regulations;

(j) to investigate cases where there are reasonable grounds to suspect that an act done by a person in relation to the provision of a pharmaceutical benefit may constitute an offence under the National Health Act, the Crimes Act 1914 or the National Health (Pharmaceutical Benefits) Regulations and, where an investigation discloses that there is sufficient evidence to warrant a prosecution, to refer the case investigated and the information obtained in the course of the investigation to the Australian Federal Police or the Director of Public Prosecutions;

(k) to undertake, on behalf of the Commonwealth, action (including the institution of legal proceedings) to recover from a person an amount in respect of a pharmaceutical benefit that is recoverable by the Commonwealth from that person under the National Health Act, the National Health (Pharmaceutical Benefits) Regulations or otherwise;

(l) on behalf of the Secretary to the Department, to certify in accordance with section 139a of the National Health Act in relation to medical practitioners, dental practitioners, pharmacists and hospital authorities.”.

6. Regulation 4a of the Principal Regulations is repealed and the following regulation substituted:

Modification of Part V of the Act

“4a. Part V of the Act is modified, in connection with its application to the activities of the Commission in the performance of the functions referred to in regulations 3, 3a, 3b, 3c, 3d, 3e and 4:

 

(a) by inserting in that Part before section 33 the following sections:

What medicare functions and expenditure includes

‘32a. (1) In this Part, other than section 33, a reference:

(a) to the performance by the Commission of its medicare functions; or

(b) to medicare expenditure;

includes a reference:

(c) to the performance by the Commission of the functions referred to in regulations 3, 3a, 3b and 3c of the Health Insurance Commission Regulations; or

(d) to expenditure for the purposes of the performance of those functions.

‘(2) In this Part, other than sections 33 and 34, a reference to the performance by the Commission of its medicare functions includes a reference to the performance of the functions referred to in regulation 4 of the Health Insurance Commission Regulations.’;

(b) by inserting after section 34 the following section:

Estimates—pharmaceutical benefits

‘34aa. (1) The Commission must prepare estimates, in such form as the Minister directs, of receipts and expenditure of the Commission related to the performance of the functions referred to in regulations 3d and 3e of the Health Insurance Commission Regulations for each financial year and, if the Minister so directs, any other period specified by the Minister, and the Commissioner must submit the estimates to the Minister on a date not later than the date the Minister directs.

‘(2) Moneys of the Commission are not to be expended for the purposes of the performance of a function referred to in subsection (1) other than in accordance with estimates of expenditure approved by the Minister.’;

(c) by amending section 34b:

(i) by adding at the end of subsection (1) the following word and paragraph:

‘; and (c) identify assets of or in the custody of, the Commission as assets held by the Commission primarily for the performance of the functions referred to in regulations 3d and 3e of the Health Insurance Commission Regulations’;

(ii) by inserting after subsection (2) the following subsection:

‘(2a) The Minister is to determine in writing principles for fixing a rental in relation to the use of

 

any asset of the Commission that is or might be used by the Commission in the performance of the functions referred to in regulations 3d and 3e of the Health Insurance Commission Regulations and its medicare functions or its medibank private functions.’;

(iii) by adding at the end the following subsections:

‘(5) Where the Commission, in the performance of its medicare functions or its medibank private functions, uses during a period an asset that has been identified under subsection (1) as an asset held by the Commission primarily for the performance of the functions referred to in regulations 3d and 3e of the Health Insurance Commission Regulations, the Commission must cause to be withdrawn from an account maintained by it under subsection 35 (1) or (2) and paid into an account maintained by it under subsection 35 (2a) such amounts as are from time to time determined by the Commission, in accordance with the principles determined by the Minister under subsection (2a), to represent the rental in relation to that use of that asset during that period.

‘(6) Where the Commission, in the performance of the functions referred to in regulations 3d and 3e of the Health Insurance Commission Regulations, uses during any period an asset that has been identified under subsection (1) as an asset held by the Commission primarily for the performance of its medicare functions or medibank private functions, the Commission must cause to be withdrawn from an account maintained by it under subsection 35 (2a) and paid into an account maintained by it under subsection 35 (1) or (2) such amounts as are from time to time determined by the Commission in accordance with the principles determined by the Minister under subsection (2), to represent the rental in relation to that use of that asset during that period.’;

(d) by amending section 34c:

(i) by inserting after subsection (1) the following subsection:

‘(1a) The Minister is to determine, in writing signed by him or her, principles in accordance with which there may be ascertained, in respect of expenditure of the Commission related to the performance of:

(a) its medicare functions; or

(b) its medibank private functions;

and a function referred to in regulation 3d or 3e of the Health Insurance Commission Regulations, the amount of that expenditure that is to be treated, for the purposes of this Act, as expenditure wholly and exclusively related to the performance of each of those functions.’;

(ii) by omitting from subsection (2) ‘both its medicare functions and its medibank private functions—’ and substituting ‘its medicare functions, its medibank private functions and the functions referred to in regulations 3d and 3e of the Health Insurance Commission Regulations:’;

(iii) by adding at the end of subsection (2) the following word and paragraph:

‘; and (c) ascertain, in accordance with principles applicable under subsection (1a), the amount of that expenditure that is to be treated as expenditure wholly and exclusively related to the performance of the functions referred to in regulations 3d and 3e of the Health Insurance Commission Regulations and treat the amount so ascertained as expenditure of that kind for the purposes of this Act’;

(e) by amending section 35:

(i) by inserting after subsection (2) the following subsection:

‘(2a) The Commission may open and maintain with an approved bank or approved banks an account or accounts for the purposes of the functions referred to in regulations 3d and 3e of the Health Insurance Commission Regulations.’;

(ii) by inserting after subsection (4) the following subsection:

‘(4a) The Commission must pay into an account or accounts maintained by it under subsection (2a) all moneys paid to the Commission in connection with the performance of the functions referred to in that subsection and, subject to subsection (5), must not withdraw from that account any moneys other than amounts required to be expended in connection with those functions.’;

(iii) by omitting from subsection (5) ‘both its medicare functions and its medibank private functions—’ and substituting ‘its medicare functions, its medibank

 

private functions and the functions referred to in regulations 3d and 3e of the Health Insurance Commission Regulations:’;

(iv) by adding at the end of subsection (5) the following word and paragraphs:

‘; or (c) the Commission may withdraw those moneys from an account maintained by it under subsection (1) or (2) but, if it does so, must as soon as practicable thereafter make such withdrawals from, and such payments to, an account maintained under subsection (2a) in relation to those functions as are necessary to ensure that expenditure that is to be treated, for the purposes of this Act, as expenditure wholly and exclusively related to the performance of a function referred to in subsection (2a) is debited to the appropriate account or accounts; or

(d) the Commission may withdraw those moneys from an account maintained by it under subsection (2a) but, if it does so, must as soon as practicable thereafter make such withdrawals from, and such payments to, an account maintained under subsection (1) or (2) in relation to those functions as are necessary to ensure that expenditure that is to be treated, for the purposes of this Act, as expenditure wholly and exclusively related to the performance of a function referred to in either of those subsections is debited to the appropriate account or accounts’;

(f) by amending section 36 by inserting after subsection (6a) the following subsection:

‘(6aa) Moneys held by the Commission for the performance of a function referred to in regulation 3d or 3e of the Health Insurance Commission Regulations that are not immediately required by the Commission for the performance of that function may be invested by the Commission:

(a) on deposit with an approved bank within the meaning of subsection 63e (2) of the Audit Act 1901; or

(b) in Commonwealth securities; or

(c) in any other manner approved by the Treasurer;

 

and any income derived from investments so made is to be paid to the Commonwealth.’.”.

 

NOTES

1. Notified in the Commonwealth of Australia Gazette on 17 July 1989.

2. Statutory Rules 1975 No. 27 as amended to date. For previous amendments see Note 2 to Statutory Rules 1989 No. 55 and see also Statutory Rules 1989 Nos. 55 and 96.

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