Health Insurance Regulations (Amendment) (Cth)
REGULATIONS UNDER THE HEALTH INSURANCE ACT 1973-1975.*
I,
THE GOVERNOR-GENERAL of Australia, acting with the advice of the Executive
Council, hereby make the following Regulations under the
Dated this twenty-sixth day of June, 1975.
JOHN R. KERR
Governor-General.
By His Excellency’s Command,
JOHN M. WHEELDON
Minister of State for Social Security.
Amendments of the Health Insurance Regulation
“ 2aa. For the purposes of the definition of ‘diagnostic service’ in sub-section 3 (1) of the Act, items 794, 797, 803, 806, 809 and 859 are prescribed items.
“ 2ab. A medical service specified in an item, being an item that includes the symbol ‘(D)’, is a prescribed medical service for the purposes of paragraph (b) of the definition of ‘professional service’ in sub-section 3 (1) of the Act.
“ 2ac. For the purposes of paragraph 13 (1) (a) of the Act, each of the following classes of patients is a prescribed class of patients:—
(a) patients with myopia of greater than 4.0 dioptres (spherical equivalent) in the dominant eye;
(b) patients with manifest hyperopia of greater than 5.0 dioptres (spherical equivalent) in the dominant eye;
(c) patients with astigmatism of greater than 4.0 dioptres in the dominant eye;
(d) patients with astigmatism of greater than 3.0 dioptres in the dominant eye, requiring, for distance correction, a lens of plus power plus 3.0 dioptres or greater in one meridian;
*
Notified in the
Statutory Rules 1975, Nos. 80 and 118.
(e) patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed by Keratometric observation, where the maximum visual acuity obtainable with spectacle correction is less than 6/12 and where that corrected acuity would be improved by more than 10 per cent by the use of a contact lens;
(f) patients with anisometropia of greater than 4.0 dioptres (difference between spherical equivalents);
(g) patients with subnormal corrected visual acuity of not greater than 6/30 in either eye, being patients for whom a contact lens is prescribed as part of a telescopic system;
(h) patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by—
(i) pathological mydriasis;
(ii) aniridia;
(iii) coloboma of the iris; or
(iv) pupillary malformation or distortion,
whether congenital, traumatic or surgical in origin; and
(j) patients in respect of whom a registered medical practitioner has prescribed, or recommended the prescription of, contact lenses.
“ 2ad. (1) Where, under paragraph 16 (4) (a) of the Act, one amount only shall be deemed to be reduced, that amount shall be deemed to be reduced by 80 per cent.
“ (2) Where, under paragraph 16 (4) (a) of the Act, 2 or more amounts shall be deemed to be reduced, the greater or greatest of those amounts shall be deemed to be reduced by 80 per cent and each other such amount shall be deemed to be reduced by 90 per cent.
“ (3) For the purposes of sub-regulation (2), where 2 or more of the amounts that shall be deemed to be reduced are equal, one of those amounts shall be treated as being greater than the other amount or the greatest of those amounts.”.
“ 2ca. For the purposes of sub-section 23b (6) of the Act a notice of termination shall be served by being delivered personally or by pre-paid post to—
(a) where the premises to which the notice relates are situated in a State—the Director, Department of Social Security, in that State;
(b) where the premises to which the notice relates are situated in the Australian Capital Territory—the Director, Department of Social Security, in the State of New South Wales; or
(c) where the premises to which the notice relates are situated in the Northern Territory—the Director, Department of Social Security, in the State of South Australia.”.
“ 10. (1) In sub-regulation (2), a reference to a medical practitioner, in relation to a referring of a patient to a specialist, shall be read as including a reference to—
(a) where the specialist to whom the patient is referred is an ophthalmologist—a registered optometrist or a registered optician; and
(b) where the referring arises out of a dental service—a registered dentist.
“ (2) Subject to sub-regulation (4), where an item specifies a medical service that is to be rendered by a consultant physician, or a specialist, in the practice of his specialty to a patient who has been referred to him, the patient shall, for the purposes of the item, be referred by a medical practitioner in the following manner, namely, by the medical practitioner furnishing the prescribed information concerning the referral to the consultant physician or specialist, as the case may be, on a referral form made available to him by the Department of Social Security for the purpose.
“ (3) For the purposes of sub regulation (2) the prescribed information is—
(a) the name and address of the medical practitioner, registered optometrist, registered optician or registered dentist who is referring the patient to a consultant physician or specialist;
(b) the name and address of the patient;
(c) the name of the consultant physician or specialist to whom the patient is being referred;
(d) if the patient is being referred by a medical practitioner—whether the patient is being referred for an opinion, for immediate treatment or for continued management of the patient’s condition at the time the referral form is signed;
(e) if the patient is being referred by a registered optometrist or a registered optician to an ophthalmologist for ophthalmological services—that the patient is being referred for ophthalmological services; and
(f) if the referring arises out of a dental service rendered to the patient by a registered dentist—that the patient is being referred for medical attention arising out of a dental service.
“ (4) A medical practitioner, registered optometrist, registered optician or registered dentist shall be taken not to have referred a patient to a consultant physician or specialist in the manner prescribed by sub-regulation (2)unless he has signed the referral form containing the information referred to in that sub-regulation and has stated on it the date on which he signed it.
“ 11. (1) Subject to and in accordance with this regulation, hospital benefits are payable by Australia to persons who have incurred expense in respect of the care and treatment outside Australia in hospitals of persons who are Australian residents temporarily absent from Australia.
“ (2) Hospital benefits are not payable under sub-regulation (1) in respect of the care and treatment of a person otherwise than as an in-patient in a hospital.
“ (3) Subject to sub-regulation (5), the rate at which hospital benefits are payable under sub-regulation (1) in respect of the care and treatment of a person is $16.00 per day.
“ (4) For the purposes of sub-regulation (3), the day of admission and the day of discharge or death of a person cared for and treated in a hospital shall be counted as one day.
“ (5) Hospital benefits payable under sub-regulation (1) in respect of the care and treatment of a person shall not exceed—
(a) the total amount of expense incurred in respect of that care and treatment; or
(b) where part of the expense incurred in respect of that care and treatment is paid or payable by Australia (otherwise than under the provisions of this regulation or under regulations in force for the time being under the
National Health Act 1953-1975) or where under another law (whether in force in Australia or elsewhere) provision is made for payment of part of that expense on behalf of,or by way of reimbursement of, the person who incurred that expense—the amount remaining after deducting the amount so paid or payable by Australia or the amount so paid or payable under that law from the total amount of the expense.
“ (6) Hospital benefits are not
payable under sub-regulation (1) in respect of the care and treatment of a
person where the total amount of expense incurred is paid or payable by
Australia (otherwise than under the provisions of this regulation or under regulations
in force for the time being under the
“ (7) Hospital benefits are not payable under sub-regulation (1) in respect of the care and treatment of a person for so much of the period of care and treatment as exceeds 8 weeks unless a medical practitioner, legally qualified to practise as such in the place in which the person receives that care and treatment certifies in writing, for the purposes of this regulation, that the nature of the illness of the person necessitates hospital treatment for a period exceeding 8 weeks, and the Minister is satisfied that the hospital treatment is necessary for that period.
“ (8) Subject to sub-regulation (9), hospital benefits shall not be paid under sub-regulation (1) unless a claim signed by the person making the claim or by some responsible person on behalf of that person is furnished to the Minister together with—
(a) the hospital account in respect of the period covered by the claim and the receipt for, or other evidence of, the payment of that account;
(b) a certificate of a medical practitioner or an obstetric nurse who provided, or supervised the provision of, the care and treatment in respect of which the claim is made certifying that the illness of the person who received that care and treatment necessitated hospital treatment; and
(c) where necessary, the certificate referred to in sub-regulation (7).
“ (9) The Minister may, in special circumstances, dispense with the production, in support of a claim for hospital benefits, of a document or certificate required to be furnished under this regulation and may direct payment of hospital benefits under sub-regulation (1) as if the document or certificate had been produced.
“ (10) A claim for the payment of hospital benefits under sub-regulation (1) shall be made to the Minister in accordance with a form approved by the Minister.
“ (11) In this regulation—
‘hospital’ means premises—
(a) in which persons receive hospital treatment; and
(b) that the Minister is satisfied are recognized as a hospital at the place at which the premises are located,
but does not include premises—
(c) used, exclusively or principally, for the care or treatment of mentally ill or mentally defective persons; or
(d) in which patients are received and lodged exclusively for the purposes of nursing home care;
‘in-patient’, in relation to a hospital, means a person who occupies a bed in the hospital for the purposes of hospital treatment but does not include—
(a) a member of the staff of the hospital who is receiving treatment in his or her own quarters;
(b) except as provided in sub-regulation (12), a newly-born child whose mother also occupies a bed in the hospital; or
(c) a person who is not charged for that hospital treatment;
‘nursing home care’ means accommodation and nursing care of a kind ordinarily provided in a nursing home, benevolent home, convalescent home, home for aged persons or rest home.
“ (12) For the purposes of this regulation—
(a) a newly-born child who occupies a bed in a facility in a hospital, being a facility that the Minister is satisfied is an intensive care facility, for the purpose of the provision of special care shall be deemed to be an in-patient of the hospital; and
(b) where there are 2 or more newly-born children of the same mother in a hospital—each such child in excess of one shall be deemed to be an in-patient of the hospital.
“ (13) A certificate that is required by this regulation to be furnished to the Minister shall be in a form approved by the Minister.
“ 12. (1) The Minister may, by writing under his hand, delegate all or any of his powers and functions under regulation 11 to—
(a) a Commissioner appointed under Part III or IV of the
Health Insurance Commission Act 1973;(b) an officer of the Department of Social Security; or
(c) an officer of the Commission.
“ (2) A delegation under sub-regulation (1) is revocable at will and does not prevent the exercise of a power or the performance of a function by the Minister.”.
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