Health Insurance Commission Regulations (Amendment) (Cth)

Statutory Rules 1997No. 332 1

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Health Insurance Commission Regulations2 (Amendment)

I, The Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Commission Act 1973.

Dated 26 November 1997.

 WILLIAM DEANE

 Governor-General

By His Excellency’s Command,

MICHAEL WOOLDRIDGE

Minister for Health and Family Services

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1.   Amendment

1.1   The Health Insurance Commission Regulations are amended as set out in these Regulations.

[Note:  These Regulations commence on gazettal: see Acts Interpretation Act 1901, s 48.]

2.   Regulation 3H

2.1   Omit the regulation, substitute:

Functions of the Commission: claims by, and payments to, hearing services providers

 “3H.(1) For subsection 8AA (2) of the Act, the following functions are prescribed:

• (a)

  the function of a claims acceptance body for section 21 of the Hearing Services Administration Act 1997; and

• (b)

  the function of a claims payment body for that section.

 “(2) Subregulation (1) has effect only when a declaration that the Commission is a body mentioned in that subregulation is in force.

 “(3) In carrying out a function prescribed by this regulation, the Commission may disclose the following information to the Department about a claim accepted or paid by the Commission:

• (a)

  client number;

• (b)

  voucher number;

• (c)

  date on which the claim was given to the Commission;

• (d)

  date on which the claim was processed by the Commission;

• (e)

  date of the service to which the claim relates;

• (f)

  provider number;

• (g)

  practitioner number;

• (h)

  site identification;

• (i)

  item number;

• (j)

  hearing loss details for right and left ears;

• (k)

  details of the device fitted to the client, whether fitted to the left or right ear, and fitting configuration;

• (l)

  date on which the device was fitted;

• (m)

  details of top-up devices;

• (n)

  contracted service provider’s certification details;

• (o)

  client certification details;

• (p)

  cost to the client;

• (q)

  payment details;

• (r)

  a code showing the reason a claim or an element of a claim was rejected;

• (s)

  any other details about the processing of the claim.

 “(4)In carrying out a function prescribed by this regulation, the Commission may recover, on behalf of the Commonwealth, a service provider debt, the existence of which:

• (a)

  is apparent from the records of the Commission; or

• (b)

  is made known to the Commission by the Department.

 “(5) The Commission may deduct the amount of a service provider debt from an amount it would otherwise pay to a contracted service provider in performance of the functions prescribed by this regulation.

 “(6) In this regulation:

• (a)

  ‘client’ means a person who received a hearing service for which a claim has been made;

• (b)

  the following expressions have the same meaning as in the provision of the Hearing Services Administration Act 1997 mentioned:

  • (i)

    ‘contracted service provider’—section 4;

  • (ii)

    ‘hearing service’—section 4;

  • (iii)

    ‘service provider debt’—subsection 24 (1);

  • (iv)

    ‘voucher’—section 4.”.

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NOTES

1. Notified in the Commonwealth of Australia Gazette on 3 December 1997.

2. Statutory Rules 1975 No. 27 as amended by 1976 Nos. 21 and 146: 1982 No. 249: 1983 Nos. 88 and 152; Act No. 54, 1983; Statutory Rules 1984 No. 321; 1985 Nos. 41 and 70; 1986 No. 127; 1987 No. 165; 1989 Nos. 55, 96 and 195; 1991 No. 443; 1992 No. 241; 1993 Nos. 81, 89, 197 and 217; 1994 Nos. 102, 257, 404 and 450; 1995 Nos. 24, 286, 375 and 440; 1996 Nos. 159 and 322; 1997 No. 286.