Health Legislation Amendment Act 1983 (Cth)
PART I—PRELIMINARY
Section
1. Short title
2. Commencement
PART II—AMENDMENTS OF THE HEALTH INSURANCE ACT 1973
3. Principal Act
4. Interpretation
5. Repeal of sections 3a and 3b and substitution of new section-
3b. Certification of in-patient as needing acute care
6. Minister may vary Part 7 of table
7. Disadvantaged persons, being immigrants or refugees
8. Insertion of new section after section 5j—
6. Certain persons in Australia to be treated as eligible persons, &c.
9. Heading to Part II
10. Interpretation
11. Medicare benefits calculated by reference to fees
12. Repeal of section 10 and substitution of new section—
10. Entitlement to medicare benefit
13. Increased fee in complex cases
14. Appeal from decision on increased fee
15. Medicare benefit not to exceed medical expenses incurred
16. Medicare benefit in respect of 2 or more operations
17. Forms of undertaking for approved pathology practitioners
TABLE
OF PROVISIONS—
Section
18. Medicare benefit not payable in respect of certain medical expenses
19. Medicare benefit not payable where compensation, &c., payable
20. Medicare benefit not payable in respect of certain professional services
21. Regulations may provide that medicare benefit be not payable in respect of prescribed class of professional services
22. Medicare benefit not payable in respect of professional services rendered by or on behalf of disqualified practitioners
23. Particulars of disqualifications under section 19b to be published, & c.
24. Persons entitled to medicare benefits
25. Repeal of section 20a and substitution of new section—
20a. Assignment of medicare benefit
26. Claims for medicare benefit
27. Repeal of sections 20c to 20f (inclusive)
28. Medical services outside Australia
29. Undertakings with respect to pensioners
30. Common form of undertaking
31. Repeal of section 23e and substitition of new sections—
23e. Interpretation
23f. Agreement with States for provision of hospital and other health services
23g. Payments in respect of recognized hospitals in the Australian Capital Territory
23h. Minister may formulate principles for certain purposes
32. Repeal of section 24 and substitution of new sections—
23j. Approval in principle of private hospital
24. Approval of premises as a private hospital
33. Repeal of section 25 and substitution of new section—
25. Issue of certificates relating to approval and categorization
34. Display of certificates relating to approval and categorization
35. Repeal of section 27 and substitution of new section—
27. Inspection of, and of records of, private hospitals
36. Notice to person ceasing to be proprietor of hospital
37. Repeal of section 29 and substitution of new sections—
29. Revocation of approval of premises as hospital
29a. Variation of categorization of particular private hospitals
29b. Variation of conditions to which an approval is subject
38. Agreements with States and Northern Territory for provision of hospital services
39. Insertion of new section after section 30—
31. Categorization of private hospitals
40. Repeal of section 33 and substitution of new section—
33. Daily bed payments
41. Claims to proprietors of private hospitals
42. Certain daily bed payments not payable where compensation, & c, is payable to patient
43. Repeal of section 36 and substitution of new section—
36. Power to obtain information
44. Access to premises
45. Insertion of new sections after section 37—
38. Review of decisions
38a. Statements to accompany notification of decision
46. Recognition of consultant physician, &c.
47. Heading to Division 2 of Part V
48. Interpretation
49. Medicare Benefits Advisory Committee
50. Functions of Committee
51. Interpretation
52. Recommendation by Committee
53. Determination by Minister
54. Interpretation
55. Recommendation by Committee
56. Determination by Minister
57. Insertion of new sections before section 128—
126. Prohibition of certain medical insurance
127. Assignor of medicare benefit to be given copy of assignment, &c.
TABLE
OF PROVISIONS—
Section
58. Bribery, &c.
59. Officers to observe secrecy
60. Repeal of section 130c and 130d
61. Delegation
62. Regulations
63. Consequential amendments
64. Insertion of new Schedule 2
PART III—AMENDMENTS OF THE HEALTH INSURANCE COMMISSION ACT 1973
65. Principal Act
66. Interpretation
67. Insertion of new section after section 4—
5. Medicare functions of Commission
68. Medibank private functions
69. Application of National Health Act and Health Insurance Act
70. Additional functions relating to health matters
71. Prescribed functions
72. Delegation
73. Insertion of new section after section 8h—
8j. Directions by Minister
74. Constitution of Commission
75. Repeal of section 15 and substitution of new section—
15. Disclosure of interests
76. Termination of appointment of part-time Commissioner
77. Termination of appointment of General Manager
78. Moneys to be paid to the Commission for purposes of Part II or 11b
79. Insertion of new section after section 33—
34. Estimates
80. Financial policy concerning medibank private functions
81. Insertion of new sections after section 34a—
34b. Apportionment of assets of Commission
34c. Apportionment of expenditure of Commission
82. Repeal of section 35 and substitution of new section—
35. Bank accounts
83. Borrowing and investment by Commission
84. Advances by the Commonwealth
85. Insertion of new sections before section 42—
41a. Delegation of powers by Minister
41b. Modification of provisions to accommodate additional functions
41c. Protection of the ‘medicare’ name and symbol
41d Forfeiture of articles, &c.
41e. Sections 41c and 41d not to limit other laws
86. Annual report of Commission
87. Certain functions performed before Royal Assent
PART IV—AMENDMENTS OF THE NATIONAL HEALTH ACT 1953
88. Principal Act
89. Interpretation
90. Waiting period
91. Interpretation
92. Travel allowance
93. Heading to Part VI
94. Interpretation
95. Application by organizations for registration as hospital benefits organizations
96. Applications by organizations for registration as health benefits organizations
97. Insertion of new section after section 68—
68a. Special procedures for dealing with certain applications under section 68
98. Registration
TABLE
OF PROVISIONS—
Section
99. Insertion of new section 73aa—
73aa. Effect of a grant of registration under sub-section 73 (2).
100. Conditions of registration
101. Insertion of new sections after section 73ba—
73baa. Registered organization not to carry on other business, & c.
73bab. Minimum reserves
73bac. Exemption from section 73baa or 73bab
102. Reinsurance Account in health benefits funds
103. Health Benefits Reinsurance Trust Fund
104. Remuneration and allowances of Trustees of Health Benefits Reinsurance Fund
105. Directions by Minister to registered organizations
106. Minister may give directions to registered organizations concerning management practices
107. Directions subject to Parliamentary disallowance
108. Refusal to admit person as contributor on ground of health
109. Refusal of contributions of patients in institution
110. Directions to reinstate person as contributor to registered organization
111. Minister may require information to be furnished
112. Directions by Minister
113. Exemption of professional services and associated hospital treatment from basic table
114. Determination of certain hospital benefits by Permanent Head
115. Conduct of health benefits funds
116. Registered organization to keep records and furnish information
117. Examination of records, books and accounts of registered organizations
118. Annual report by Permanent Head
119. Changes of rules, &c, by registered organizations
120. Cancellation of registration of organization
121. Offences
122. Interpretation
123. Investigation of organization by inspector
124. Report of inspector
125. Application for judicial management or winding up of a fund
126. Insertion of new section after section 82zg—
82zga. Certain funds conducted by registered organizations to be wound up
127. Order of Court to be binding on all persons, & c.
128. Insertion of new part after Part VIa—
PART VIb—MERGER OF HEALTH BENEFITS FUNDS
82zn. Interpretation
82zp. Merger of funds
129. Applications for review by Tribunal
130. Evidence
131. Schedule
PART V—AMENDMENTS OF OTHER ACTS
132. Amendments of other Acts
PART VI—TRANSITIONAL
133. Interpretation
134. Continued operation of Health Insurance Act and National Health Act
135. Acts Interpretation Act not affected
136. Regulations
TABLE OF
PROVISIONS—
SCHEDULE 1
SCHEDULE 2
SCHEDULE 3
SCHEDULE 4
[
BE IT ENACTED by the Queen, and the Senate and the House of Representatives of the Commonwealth of Australia, as follows:
“‘proprietor’, in relation to premises, means the person, authority or body of persons having effective control of the premises, whether or not he or it is the holder of an estate or interest in the premises;”.
(a) by omitting from the definition of “agreement” in sub-section (1) “section 30” and substituting “section 23f”;
(b) by omitting paragraph (a) of the definition of “approved pathology practitioner” in sub-section (1);
(c) by omitting from sub-section (1) the definitions of “Australian resident” and “Commonwealth medical benefit” and substituting the following definitions:
“‘Australian resident’ means a person who is ordinarily resident in Australia and includes a person domiciled in Australia but does not include a person who is—
(a) the head of a diplomatic mission, or the head of a consular post, established in Australia;
(b) a member of the staff of a diplomatic mission, or a member of the consular staff of a consular post, established in Australia; or
(c) a member of the family of a person referred to in paragraph (a) or (b), being a member who forms part of the household of that person,
being a person who is not an Australian citizen and is not a person domiciled in Australia;
“‘Commission’ means the Health Insurance Commission established under the
Health Insurance Commission Act 1973 ;”;(d) by omitting paragraph (a) of the definition of “dependant” in sub-section (1);
(e) by omitting from sub-section (1) the definition of “eligible pensioner”;
(f) by omitting from sub-section (1) the definitions of “hospital” and “hospital insured person” and substituting the following definition:
“‘hospital’ means a recognized hospital, a private hospital or a hospital that is declared by the Minister, by writing signed by him, to be a hospital for the purposes of this definition;”;
(g) by omitting from sub-section (1) the definition of “medically insured person” and substituting the following definition:
“‘medicare benefit’ means a medicare benefit under Part II;”;
(h) by omitting “60 days commencing on or after 1 July 1979” from the definition of “nursing-home type patient” in sub-section (1) and substituting “35 days”;
(j) by inserting after the definition of “Permanent Head” in sub-section (1) the following definition:
“‘person domiciled in Australia’ means a person whose domicile is in Australia, other than a person in respect of whom the Minister is satisfied that the person’s permanent place of abode is outside Australia;”;
(k) by omitting from sub-section (1) the definition of “private hospital” and substituting the following definition:
“‘private hospital’ means—
(a) a private hospital within the meaning of Part III; or
(b) premises, not being a recognized hospital, included in a class of premises that, under an agreement, are to be taken to be private hospitals for the purposes of the agreement;”;
(m) by omitting from paragraph (c) of the definition of “recognized hospital” in sub-section (1) “an internal Territory” and substituting “the Australian Capital Territory (including the Jervis Bay Territory)”;
(n) by omitting from sub-section (1) the definition of “registered person”;
(o) by omitting from sub-section (7) “who is an eligible pensioner or”;
(p) by omitting from sub-section (7) all the words after “claim lodged before” (first occurring) and substituting the following words and paragraphs:
“1 November 1982 and—
(c) if paragraph 4c (1) (a) applied to the person immediately before the day on which the person became such a disadvantaged person—the pension that was being paid to or in respect of the person was granted pursuant to a claim lodged before 1 November 1982; or
(d) if paragraph 4c (1) (b) applied to the person immediately before the day on which the person became such a disadvantaged person—the pension that would, if the person were not a person to whom paragraph 4c (1) (b) applied, have been payable to or in respect of the person, was granted pursuant to a claim lodged before 1 November 1982.”;
(q) by omitting sub-sections (8) and (9);
(r) by omitting from sub-section (10) “sub-sections (7) and (9)” and substituting “sub-section (7)”;
(s) by omitting from sub-section (11) “60” and substituting “35”; and
(t) by adding at the end thereof the following sub-sections:
“(15) For the purposes of the definition of ‘recognized hospital’ in sub-section (1), ‘State’ includes the Northern Territory.
“(16) In approving a form for the purposes of the definition of ‘approved form’ in sub-section (1), the Minister may specify a disc, tape, film or other medium as the means by which the information to be contained in the form is to be or may be set out.”.
“3b. (1) A medical practitioner may give a certificate in writing in accordance with the approved form stating that, in his opinion, a person who is an in-patient in a hospital is, or will be, in need of acute care for at least the period specified in the certificate, being a period commencing not later than 7 days after the certificate is given and ending not later than 30 days after the commencement of the period.
“(2) A certificate under sub-section (1) comes into force on the commencement of the period specified in the certificate and continues in force until the expiration of that period.
“(3) Where a certificate is given under sub-section (1) by a medical practitioner in respect of a person but is not in force, and the medical practitioner becomes of the opinion that the person will no longer be in need of acute care for at least the period specified in the certificate, he shall revoke the certificate, but nothing in this sub-section precludes him from giving a certificate under sub-section (1) in respect of the person that specifies a period shorter than that first-mentioned period.
“(4) Where a certificate given by a medical practitioner in respect of a person is in force under sub-section (1) and the medical practitioner becomes of the opinion that the person is no longer in need of acute care, he shall revoke the certificate.
“(5) Where a certificate has been given under sub-section (1), the Permanent Head—
(a) may, of his own motion, within 14 days after he became aware of the giving of the certificate; and
(b) shall, within 14 days after an application in writing is made to him by a registered organization, being an application made within 60 days after the certificate was given,
request a Committee to review the certificate.
“(6) After reviewing a certificate given under sub-section (1), the Committee shall, if it is of the opinion that the certificate should be varied or revoked, recommend to the Permanent Head accordingly.
“(7) Upon the receipt of a recommendation for the variation or revocation of a certificate, the Permanent Head may, by writing signed by him, vary or revoke the certificate with effect from the date on which the certificate was given or such later date as he specifies, but nothing in this sub-section requires him to act in accordance with the recommendation.
“(8) The Permanent Head may, in relation to each State and each Territory, establish a Committee or Committees to be known as the Acute Care Advisory Committee, or the Acute Care Advisory Committees, for the State or Territory.
“(9) A Committee shall consist of such persons as, subject to and in accordance with the regulations, the Permanent Head appoints.
“(10) A member of a Committee shall be paid such fees and allowances as are determined by the Remuneration Tribunal and shall hold office on such terms and conditions as the Permanent Head determines.
“(11) In this section, ‘Committee’ means an Acute Care Advisory Committee established under this section.”.
“6. (1) The Minister may, by order in writing, declare that a specified person, or every person included in a specified class of persons, being a person who, but for this sub-section, would not be an eligible person for the purposes of this Act, shall, or shall in specified circumstances (whether circumstances that occurred before or occur after the making of the order) in which he was or is in Australia, be treated as having been or as being an eligible person for the purposes of this Act.
“(2) The Minister may, by order in writing, declare that, notwithstanding anything in this Act, a specified person, or every person included in a specified class of persons, being a person who, but for this sub-section, would be an eligible person for the purposes of this Act, shall, or shall in specified circumstances, be treated as if he were not an eligible person for the purposes of this Act.
“(3) The Minister may, by order in writing, declare that, notwithstanding anything contained in this Act, a specified person, or every person included in a specified class of persons, being a person who, but for this sub-section, would not be an Australian resident for the purposes of section 21, shall, or shall in specified circumstances in which he is outside Australia, be treated as if he were an Australian resident for those purposes.
“(4) Nothing in any other provision of this Act shall be taken, by implication, to limit the generality of this section.
“(5) Where an order is
made under this section specifying a class of persons a copy of the order shall
be published in the
“(6) Sections 48, 49, 49a and 50 of the
“(7) An order made under
this section shall be deemed not to be a statutory rule within the meaning of
the
“(8) For the purposes of
the application of sub-section 5 (3b)
of the
“10. (1) Where, on or after 1 February 1984, medical expenses are incurred in respect of a professional service rendered in Australia to an eligible person, medicare benefit calculated in accordance with sub-section (2) is payable, subject to and in accordance with this Act, in respect of that professional service.
“(2) A medicare benefit under sub-section (1) in respect of a professional service is an amount equal to—
(a) 85% of the fee specified in respect of the service in the table in relation to the State in which the service is rendered; or
(b) if the amount calculated under paragraph (a) is less by more than $10 than the fee from which it is calculated—an amount that is less by $10 than that fee.
“(3) Subject to this Act, where—
(a) a claim (in this sub-section referred to as the ‘threshold claim’) for medicare benefit is made by a claimant in respect of a professional service—
(i) which was rendered to a person, being either the claimant or another person (in this sub-section referred to as the ‘patient’); and
(ii) in respect of which the medical expenses are incurred by the claimant in a year,
and the claim is accepted for payment by the Commission;
(b) the claimant has, or another claimant or other claimants has or have, made other claims (in this sub-section referred to as the ‘prior claims’) for medicare benefit in respect of professional services—
(i) which were rendered to the patient; and
(ii) in respect of which the medical expenses were incurred by the relevant claimant in that year,
and the prior claims were accepted for payment by the Commission before the time when the threshold claim is accepted for payment (in this sub-section referred to as the ‘relevant time’); and
(c) the Commission is satisfied at the relevant time that—
(i) the first-mentioned claimant has paid the medical expenses in respect of the professional service to which the threshold claim relates;
(ii) a claimant has, or claimants have, paid the medical expenses in respect of professional services to which some or all of the prior claims accepted by the Commission for payment before the relevant time relate;
(iii) the sum of the patient contributions in respect of the prior claims referred to in sub-paragraph (ii) is less than the relevant amount for that year; and
(iv) the sum of the patient contribution in respect of the threshold claim and the patient contributions in respect of the prior claims referred to in sub-paragraph (ii) is equal to or exceeds the relevant amount for that year,
the medicare benefit payable—
(d) in respect of the professional service to which the threshold claim relates—shall be increased by the amount of the excess (if any) referred to in sub-paragraph (c) (iv);
(e) in respect of a professional service—
(i) to which a prior claim accepted for payment by the Commission before the relevant time relates; and
(ii) in relation to which the Commission becomes satisfied, after the relevant time, that the claimant has paid the medical expenses,
shall be increased by an amount equal to the patient contribution in respect of that claim; and
(f) in respect of a professional service—
(i) to which a claim for medicare benefit that is accepted for payment by the Commission after the relevant time relates;
(ii) which was rendered to the patient; and
(iii) in respect of which the medical expenses are incurred by the claimant in that year,
shall be increased by an amount equal to the patient contribution in respect of that claim.
“(4) Where an amount calculated in accordance with sub-section (2) is not a multiple of 5 cents, the amount of cents shall be increased to the nearest higher amount that is a multiple of 5 cents.
“(5) For the purposes of sub-sections (3) and (6), but without prejudice to the meaning of an expression in any other provision of this Act—
(a) where a person to whom medicare benefit is payable in respect of a professional service is given or sent a cheque under sub-section 20 (2) for the amount of the medicare benefit, the person shall be taken to
have paid so much of the medical expenses in respect of that service as is represented by the amount of the medicare benefit;
(b) the question when medical expenses are incurred in respect of professional services relating to prescribed items shall, notwithstanding anything in this Act, be determined in accordance with the regulations; and
(c) a reference to a professional service is a reference to a professional service (including a medical service rendered outside Australia)—
(i) in respect of which medicare benefit is payable; and
(ii) the medical expenses in respect of which exceed the amount of medicare benefit that, but for sub-section (3), would be payable in respect of the service.
“(6) In this section—
‘patient contribution’, in relation to a claim for medicare benefit in respect of a professional service, means an amount equal to the difference between—
(a) the fee specified in respect of the service in the table in relation to the State in which the service is rendered or, if the medical expenses in respect of the service are less than that fee, those medical expenses; and
(b) the amount of medicare benefit that, but for sub-section (3), would be payable in respect of the service;
‘relevant amount’ means—
(a) in relation to a year, being the period of 5 months commencing on 1 February 1984—$62.50 or, if a higher amount is prescribed for the purposes of this paragraph, that higher amount; or
(b) in relation to the year commencing on 1 July 1984 or a subsequent year—$150, or if a higher amount is prescribed for the purposes of this paragraph in respect of that year, that higher amount;
‘year’ means—
(a) the period of 5 months commencing on 1 February 1984;
(b) the year commencing on 1 July 1984; or
(c) a subsequent year commencing on a 1 July.”.
(a) by omitting paragraph (1) (a) and substituting the following paragraph:
“(a) a claim for a medicare benefit in respect of a professional service is lodged with the Commission; and”;
(b) by omitting from sub-paragraph (2) (b) “Medical” and substituting “Medicare”; and
(c) by omitting from sub-section (5) all the words after “notice” and substituting “in writing, inform the claimant accordingly”.
(a) by inserting after paragraph (a) the following paragraph:
“(aa) the service related to a prescribed item and was rendered—
(i) to an in-patient of a recognized hospital;
(ii) in a recognized hospital, to an out-patient of the hospital; or
(iii) in a case to which neither sub-paragraph (i) nor (ii) applies, to a patient at a recognized hospital—
(a) in a State that is a party to an agreement under section 23f that declares the State to be a State to which this sub-sub-paragraph applies;
(b) if the Northern Territory is a party to an agreement under section 23f that he declares this sub-sub-paragraph to be applicable to the Northern Territory—in the Northern Territory; or
(C) in the Australian Capital Territory (including the Jervis Bay Territory),
by a medical practitioner—
(iv) in respect of whom there was not in force an approved agreement; or
(v) in respect of whom there was in force an approved agreement but who was acting otherwise than in accordance with the approved agreement;”; and
(b) by adding at the end thereof the following sub-sections:
“(2) Where an amount of medicare benefit is paid to a practitioner, being an amount that, by virtue of paragraph (1) (aa), is not payable, the amount so paid is recoverable in a court of competent jurisdiction as a debt due to the Commonwealth.
“(3) Where a medical practitioner acting in accordance with an approved agreement in force in respect of him renders on his own behalf a professional service that relates to an item prescribed for the purposes of paragraph (1) (aa) in a recognized hospital—
(a) to an in-patient or out-patient of the hospital; or
(b) if sub-paragraph (1) (aa) (iii) applies in relation to the hospital—to a patient at the hospital,
medicare benefit in respect of that service shall not be taken not to be payable by reason only that payment of the medical expenses in respect of that service has been made or is to be made to the hospital but nothing in this sub-section shall be taken to affect the meaning of any expression used in paragraph (1) (a) in circumstances to which this sub-section does not apply.
“(4) A reference in this section to an approved agreement is a reference to an agreement in writing between a medical practitioner and a recognized hospital—
(a) that is entered into on or after 1 February 1984;
(b) that makes provision with respect to the right of the medical practitioner to render professional services that relate to items prescribed for the purposes of paragraph (1) (aa) on his own behalf to in-patients or out-patients of the hospital, and, if sub-paragraph (1) (aa) (iii) applies in relation to the hospital, to other patients at the hospital; and
(c) if the Minister has, by instrument in writing published in the
Gazette, formulated guidelines with which agreements under this section are to comply—that is in accordance with those guidelines.”.
(a) by omitting from sub-section (1) “Commonwealth medical benefits” and substituting “medicare benefits”; and
(b) by omitting from sub-section (2) “Medical” and substituting “Medicare”.
(a) by inserting in sub-section (1) “by the Commission on behalf of the Commonwealth” after “payable”; and
(b) by adding at the end thereof the following sub-section:
“(2) Where a person to whom a medicare benefit is payable under sub-section (1) in respect of a professional service has not paid the medical expenses that he has incurred in respect of that professional service, he shall not be paid the medicare benefit but, if he so requests, there shall, in lieu of that payment, be given to him personally, or sent to him by post at his last-known address, a cheque for the amount of the medicare benefit drawn in favour of the person by whom, or on whose behalf, the professional service was rendered.”.
“20a. (1) Where a medicare benefit is payable to an eligible person in respect of a professional service rendered to the eligible person or to another eligible person, the first-mentioned eligible person and the person by whom, or on whose behalf, the professional service is rendered (in this sub-section referred to as ‘the practitioner’) may enter into an agreement, in accordance with the approved form, under which—
(a) the first-mentioned eligible person assigns his right to the payment of the medicare benefit to the practitioner; and
(b) the practitioner accepts the assignment in full payment of the medical expenses incurred in respect of the professional service by the first-mentioned eligible person.
“(3) Where an assignment under this section takes effect, or an agreement under this section is entered into, with respect to a medicare benefit, the medicare benefit is, subject to section 20b, payable in accordance with the assignment or the agreement, as the case may be.
“(4) A reference in this section to a person by whom a professional service is rendered shall be read as not including a reference to a person (in this sub-section referred to as ‘the agent’) who renders a professional service on behalf of another person or of an organization, but the agent may, if so authorized by that other person or that organization, on behalf of that other person or that organization, enter into an agreement under sub-section (1).
“(5) An assignment of a medicare benefit shall not be made except in accordance with this section.”.
(a) by omitting paragraph (1) (a) and substituting the following paragraph:
“(a) in respect of a professional service other than a professional service referred to in paragraph (b)—shall be made in accordance with the approved form and lodged with the Commission; or”;
(b) by omitting from paragraph (1) (b) “1 September 1981 or such later date as is prescribed—shall be lodged with the relevant medical benefits organization” and substituting “such date (if any) as is prescribed—shall be made in accordance with the approved form and lodged with the Commission”;
(c) by omitting from paragraph (2) (b) “Department” and substituting “Commission”;
(d) by omitting paragraphs (3) (a) and (b);
(e) by omitting from paragraphs (3) (c) and (d) “20a (4)” and substituting”20a (1)”; and
(f) by omitting sub-sections (4) and (5).
(a) by omitting sub-section (1) and substituting the following sub-section:
“(1) Subject to this section, where, on or after 1 February 1984, medical expenses are incurred by an Australian resident in respect of a medical service specified in an item that is rendered outside Australia to the Australian resident or to another Australian resident by, or on behalf of, a prescribed person, medicare benefit is payable in respect of that medical service as if that medical service had been rendered in New South Wales by, or on behalf of, a medical practitioner.”;
(b) by inserting in sub-section (2) “by the Commission on behalf of the Commonwealth” after “payable”;
(c) by adding at the end of paragraph (4) (b) “; and”; and
(d) by omitting paragraphs (4) (d) and (e).
“23e. (1) For the purposes of this Part (including Schedule 2)—
(a) a reference to a State includes a reference to the Northern Territory;
(b) a reference to the Australian Capital Territory includes a reference to the Jervis Bay Territory;
(c) a reference to a category, in relation to a private hospital, is a reference to a category specified in pursuance of sub-section 31 (1);
(d) a reference in a provision of this Part to the Minister for Health of a State is a reference to—
(i) unless sub-paragraph (ii) applies—
(a) in the case of a State other than the Northern Territory—the person who is the Minister of the Crown of the State; or
(b) in the case of the Northern Territory—the person holding ministerial office under section 36 of the
Northern Territory (Self-Government) Act 1978, who is responsible or principally responsible for the administration of matters relating to health in the State; or
(ii) if the person referred to in sub-paragraph (i) authorizes another person to act on his behalf for the purposes of that provision—the person so authorized; and
(e) a State is a non-participating State until, by reason of an election made under an agreement entered into between the Commonwealth and that State under section 23f, the State assumes responsibility for the payment of daily bed payments (however described) in respect of hospitals situated in that State that are private hospitals for the purposes of that agreement.
“(2) Where the Minister is required by a provision of this Part to have regard to the views of a Minister for Health of a State, nothing in this Part shall be taken to preclude him from having regard to any other relevant matters.
“23f. (1) The Commonwealth may enter into an agreement with a State for and in relation to the provision of hospital services and other health services on and after 1 February 1984 to eligible persons.
“(2) An agreement referred to in sub-section (1) shall be in terms that give effect substantially to the Heads of Agreement specified in Schedule 2 but may include provision with respect to other matters, including points of understanding between the parties to the agreement.
“(3) The Commonwealth may, from time to time, enter into agreements varying an agreement under sub-section (1), but so that the agreement as so varied shall comply with sub-section (2).
“(4) An agreement entered into under sub-section (3) may be expressed to have taken effect from a date earlier than the date upon which that agreement was entered into.
“23g. (1) In this section—
‘prescribed hospital authority’ means the Capital Territory Health Commission established under the
Health Commission Ordinance 1975 of the Australian Capital Territory as amended and in force from time to time;‘relevant hospital’ means a recognized hospital that is situated in the Australian Capital Territory;
‘relevant period’ means the period commencing on 1 February 1984 and ending on 30 June 1984 and each succeeding period of one year ending on a 30 June before 1 July 1987.
“(2) There is payable by the Commonwealth, in respect of a relevant period, to the prescribed hospital authority, an amount equal to the sum of—
(a) the amount determined by the Minister to represent revenue foregone by relevant hospitals during that period in respect of the provision of hospital services to eligible persons;
(b) the amount determined by the Minister to represent revenue foregone by relevant hospitals during that period in respect of the provision, without charge, of out-patient services at those hospitals;
(c) the amount determined by the Minister to represent additional expenditure incurred by relevant hospitals during that period in respect of the provision, without charge, of professional services to persons who, being private patients, elect to become hospital patients; and
(d) the amount (if any) determined by the Minister to represent any additional cost to, or revenue foregone by, relevant hospitals during that period, being a cost or revenue of the kind that has been taken into account in determining the amount payable by the Commonwealth to the States in respect of recognized hospitals in the States in pursuance of the agreements entered into under section 23f.
“(3) There is payable by the Commonwealth, in respect of a relevant period, to the prescribed hospital authority an amount determined by the Minister to be appropriate for expenditure during that period upon health services other than hospital services in the Australian Capital Territory.
“(4) A payment under sub-section (2) or (3) is subject to such terms and conditions as the Minister determines having regard to the terms and conditions specified in relation to the States in the Heads of Agreement set out in Schedule 2, and to the terms and conditions of the agreements with the States made under section 23f, in relation to payments of a similar nature that are made to the States.
“(5) Payments under sub-sections (2) and (3) shall be made in such amounts, and at such times, as the Minister determines.
“23h. (1) The Minister may formulate principles to be
complied with by him in the exercise of any of his powers under sub-sections 23j (1), (2) and (3) and 24 (2) and (5)
and sections 29a and 29b of this Act and sub-section 32 (4)
of the
“(2) The Minister shall not formulate principles under sub-section (1) unless he has, at the time of so formulating those principles, consulted with the Minister for Health for each State that is at that time a non-participating State and has had regard to any views of that other Minister expressed in the course of that consultation.
“(3) Sections 48, 49, 49a and 50 of the
“(4) Principles
formulated under sub-section (1) shall be deemed not to be statutory rules
within the meaning of the
“(5) For the purposes of
the application of sub-section (3b)
of section 5 of the
“(6) Section 5 of the
(
“(3) In this Part—
‘private hospital’ means premises in relation to which an approval as a private hospital under section 24 is in effect;
‘proprietor’, in relation to a private hospital, means a proprietor, as defined by sub-section 3 (1), of the premises that are approved under section 24 as a private hospital.”.
“23j. (1) Upon application made in accordance with the approved form by a person who is, or intends to become, the proprietor of premises and who proposes to apply for the approval of those premises under section 24 as a
private hospital, the Minister may, in his discretion, grant to the applicant a certificate in writing—
(a) stating that, if, at any time within the period of 12 months after the grant of the certificate, the applicant applies under sub-section 24 (1) for the approval of the premises as a private hospital, that last-mentioned application will not be refused unless the Minister is not satisfied that the premises comply, at that time, with specifications set out in the certificate;
(b) stating that, if that approval is granted, the category of private hospital to which the premises will be determined to belong will be the category of private hospital specified in the certificate; and
(c) stating that, if that approval is granted, the number of beds that will be determined in relation to the premises for the purposes of paragraph 24 (5) (a) will not be less than the number of beds specified in the certificate.
“(2) Upon application made in accordance with the approved form by the proprietor of a private hospital who proposes to cause an alteration of, or addition to, the premises occupied by the private hospital, being an alteration or addition the purpose of which is, or the effect of which will be, to enable the number of beds available in the private hospital to be increased, the Minister may, in his discretion, grant to the applicant a certificate in writing—
(a) approving that alteration or addition; and
(b) stating that if, at any time within the period of 12 months after the grant of the certificate, the alteration or addition has been completed and the applicant applies under sub-section 29b (1) for the Minister to vary the conditions applicable to the private hospital by substituting for the number of approved beds determined in relation to the private hospital for the purposes of paragraph 24 (5) (a) a number of approved beds not exceeding such other number as is specified in the certificate, that last-mentioned application will not be refused.
“(3) Upon application made in accordance with the approved form by the holder of a certificate in force under sub-section (1) or (2), the Minister may, in his discretion,-vary the certificate—
(a) by deleting the period specified in the certificate (including a period substituted by virtue of a previous application or applications of this sub-section) and substituting such longer period as he determines;
(b) by deleting the number of approved beds specified in the certificate (including a number substituted by virtue of a previous application or applications of this sub-section) and substituting such other number as he determines; or
(c) in the case of a certificate granted under sub-section (1)—by deleting the category of private hospital specified in the certificate and substituting such other category of private hospital as he determines.
“(4) The Minister, in exercising his powers under sub-section (1), (2) or (3) to grant or vary a certificate, shall comply with any relevant principles in force under section 23h.
“(5) The Minister shall not exercise his powers under sub-section (1), (2) or (3) in relation to premises that are situated in a State unless that State is a non-participating State and he has consulted with the Minister for Health of that State and has had regard to any views of that other Minister expressed in the course of that consultation.
“(6) A certificate under this section comes into force on the day on which it is granted and subject to sub-section (7), remains in force—
(a) in the case of a certificate in respect of premises that are situated in the Australian Capital Territory—until the expiration of the period specified in the certificate; or
(b) in the case of a certificate in respect of premises that are situated in a State—until the expiration of the period specified in the certificate or the time when the State ceases to be a non-participating State, whichever first occurs.
“(7) Where premises to which a certificate under sub-section (1) relates are approved as a private hospital under sub-section 24 (1), the certificate ceases to be in force.
“(8) Upon application in writing by the holder of a certificate in force under this section, the Minister shall revoke the certificate.
“(9) Where the Minister makes a decision under sub-section (1), (2) or (3) refusing to grant or vary a certificate, he shall cause to be served, either personally or by post, on the applicant for the certificate or the variation, a notice in writing setting out that decision.
“24. (1) Subject to this section, upon application in accordance with the approved form by the proprietor of premises who holds a certificate in force under sub-section 23j (1) in relation to those premises, the Minister shall, if he is satisfied that the premises comply with the specifications set out in the certificate—
(a) approve the premises to which the certificate relates as a private hospital;
(b) determine, in accordance with the certificate, the category of private hospital to which the premises belong; and
(c) determine, in accordance with the certificate, the number of approved beds in relation to the premises for the purposes of paragraph (5) (a),
but, if he is not so satisfied, he shall refuse the application.
“(2) Subject to this section, upon application in accordance with the approved form by the proprietor of premises not being a proprietor who holds a
certificate in force under sub-section 23j (1) in relation to those premises, the Minister may, in his discretion—
(a) approve the premises as a private hospital;
(b) determine the category of private hospital to which the premises belong; and
(c) determine the number of approved beds in relation to the premises for the purposes of paragraph (5) (a).
“(3) The Minister, in exercising his powers under sub-section (2) or (5), shall comply with any relevant principles in force under section 23h.
“(4) The Minister shall not exercise a power under sub-section (2) in relation to premises that are situated in a State unless that State is a non-participating State and he has consulted with the Minister for Health of that State and has had regard to any views of that other Minister expressed in the course of that consultation.
“(5) The approval of premises as a private hospital under this section is subject to the following conditions:
(a) a condition that the number of beds available in the hospital will not at any time exceed such number as is determined by the Minister to be the number of approved beds in relation to the hospital;
(b) that no alteration of, or addition to, the premises the purpose of which is, or the effect of which will be, to enable the number of beds in the private hospital to be increased will be commenced unless the proprietor of the premises is the holder of a certificate in force under sub-section 23j (2) approving that alteration or addition; and
(c) such other conditions as the Minister determines.
“(6) The approval of premises that are situated in a State as a private hospital ceases to have effect for the purposes of this Act, when the State ceases to be a non-participating State.
“(7) Where the Minister makes a decision under this section refusing to approve an application for approval of premises as a private hospital, he shall cause to be served, either personally or by post, on the applicant for that approval a notice in writing setting out that decision.”.
(a) for the purposes of the application of the condition set out in paragraph (5) (a) of that section to that approval—determined under
that paragraph the number of approved beds in relation to those premises to be the number of beds to which the approval of those premises as in force immediately before that date related; and
(b) if the approval of premises to which this sub-section applies was subject to any conditions under sub-section 24 (4) of the Principal Act immediately before that date—determined those conditions under paragraph (5) (c) of that section,
and any failure before 1 February 1984 to comply with any condition to which the approval of the premises was subject under sub-section 24 (4) of the Principal Act shall be deemed to be a failure to comply with the corresponding condition to which the approval of the premises is subject by virtue of this sub-section.
“25. (1) Upon approval of premises as a private hospital, the Minister shall cause to be issued to the proprietor of the hospital a certificate of approval in accordance with the approved form, specifying the category of private hospital to which the premises belong and setting out the conditions to which the approval of the premises is subject.
“(2) Where the approval of premises as a private hospital has been revoked under section 29, the determination of the category of private hospital
to which premises belong has been varied under section 29a or a condition to which the approval of premises as a private hospital is subject has been varied under section 29B, the Minister shall cause to be issued to the proprietor of the hospital a new certificate of approval, in accordance with the approved form.”.
(a) by omitting from sub-section (1) “hospital” (first occurring) and substituting “private hospital”; and
(b) by omitting from sub-section (2) “as a hospital is revoked or varied” and substituting “as a private hospital ceases to have effect under section 24 or is revoked or suspended under section 29, the determination of the category of private hospital to which the premises belong is varied under section 29a or a condition to which the approval of the premises is subject is varied under section 29B,”.
“27. (1) A person authorized in writing by the Minister to act under this section may, at any reasonable time—
(a) enter and inspect premises in respect of which an approval under section 24 is in effect or an application for such an approval has been made; and
(b) in relation to any premises in respect of which an approval under section 24 is in effect—inspect any books, documents or other records on these premises that relate to the operation of those premises as a private hospital.
“(2) The occupier of premises referred to in sub-section (1) shall provide the authorized person with all reasonable facilities and assistance for the effective exercise of his powers under this section.
Penalty: $1,000.”.
(a) by inserting in sub-sections (1) and (2) “private” before “hospital” (wherever occurring); and
(b) by adding at the end of sub-section (2) “and state whether it is intended to continue to operate the premises as a private hospital”.
(a) prescribing all matters required or permitted by this Act to be prescribed; or
(b) making provision for and in relation to any matter arising from, consequential upon or otherwise connected with the operation of this Act.
—————
SCHEDULE 1 Section 63
CONSEQUENTIAL AMENDMENTS OF THE HEALTH INSURANCE ACT 1973
1. The
following provisions of the
Sections 11, 13, 16, 16a, 17, 19d, 20, 20b, 21 and 42b.
2. The
following provisions of the
Sections 11, 12, 20b and 67.
————
SCHEDULE 2 Section 64
“SCHEDULE 2 Section 23f
HEADS OF AGREEMENT
1. The agreement is to relate to a specified period but may provide for the extension of that period.
2. The agreement is to list the hospitals in the State that are to be recognized hospitals for the purposes of the agreement but may provide for the making of alterations to the list.
3. The agreement is to provide for the payment by the Commonwealth to the State of amounts for the purposes of reimbursing the State for—
(a) revenue losses and additional costs resulting from the removal of in-patient and out-patient fees for eligible persons who elect to be treated free as hospital patients in recognized hospitals;
(b) revenue losses resulting from a reduction in fees for private patients in recognized hospitals; and
(c) certain expenditure for health purposes other than hospital services.
4. The agreement is to provide for the Commonwealth to vary the amount of its payments to take account of movements in costs and utilization of hospital and other health services.
5. The agreement is to provide for the State to ensure that care and treatment of a kind specified in the agreement will be available to all eligible persons without charge as public patients in recognized hospitals.
6. The agreement is to provide for the State to ensure that medical practitioners will not render on their own behalf in recognized hospitals in the State professional services in respect of which medicare benefit would not be payable by reason of paragraph 17 (1) (aa) of this Act.
7. The agreement is to specify certain charges to apply in recognized hospitals.
8. The agreement is to make provision in relation to assumption by the State of the responsibility for making daily bed payments to hospitals that are private hospitals for the purposes of the agreement.
9. The agreement is to provide for the creation of consultative bodies to consider matters relating to the agreement.
10. The agreement is to make provision in relation to the provision by the State to the Commonwealth of statistical and other information.”.
SCHEDULE 3 Section 131
“SCHEDULE Section 73ba
CONDITIONS OF REGISTRATION OF AN ORGANIZATION
(a) The organization will not carry on business in Australia as a registered health benefits organization except in a State or Territory in respect of which it is registered as a registered health benefits organization.
(b) The organization will permit any contributor to a health benefits fund conducted by it to contribute for benefits in respect of himself and his dependants (if any) in accordance with the basic table.
(c) The organization will not offer to the contributors to a health benefits fund conducted by it, whether on its own behalf or on behalf of another person or organization, health insurance in respect of nursing home care.
(d) The amount of fund benefits payable to a contributor by the organization in respect of hospital treatment or other service will not exceed the fees or charges incurred in respect of that hospital treatment or other service.
(e) The amount of fund benefit payable by the organization to a contributor in respect of hospital treatment for a nursing home type patient will not exceed an amount equal to the fees or charges incurred in respect of that hospital treatment (excluding any amount of daily bed payment payable to the hospital in respect of the patient in accordance with section 33 of the
Health Insurance Act 1973 )less the amount of the patient contribution in relation to the patient for each day on which the patient was an in-patient in the hospital.(f) The organization will not permit a person to contribute for benefits in accordance with a supplementary hospital table unless the person also contributes for benefits in accordance with a basic table.
(g) Where a contributor to a health benefits fund conducted by the organization, being a contributor for benefits in accordance with a basic table has ceased to pay contributions, the organization will —
(i) permit the contributor, at any time before the expiration of a period of 2 months after the expiration of the period in respect of which he has paid contributions, to pay contributions due in respect of the period (in this paragraph referred to as ‘the period in arrears’) commencing on the expiration of the period in respect of which he has paid contributions and ending not later than the date on which he makes the payment; and
(ii) if a contributor makes the payment referred to in sub-paragraph (i), permit the contributor to continue to be eligible for benefits in accordance with the basic table in respect of the period in arrears.
(h) The organization will institute, and maintain, in a form and manner satisfactory to the Minister, a record of the contributors, and of the dependants of the contributors, to each health benefits fund conducted by it.
(j) Where the rules of the organization provide for a waiting period with respect to contributors for benefits in accordance with a basic table, that waiting period will not exceed—
(i) in respect of hospital treatment or other service related to an obstetric condition— 9 months; or
(ii) in respect of any other hospital treatment or other service—2 months.
(k) Where the rules of the organization provide for a waiting period in relation to contributors for benefits in accordance with a basic table or a supplementary hospital table in respect of pre-existing ailments, being ailments of a kind that are determined by the Minister by writing signed by him, to be ailments to which this condition applies—
(i) the waiting period in relation to a contributor for benefits in accordance with a basic table shall not exceed the period of 24 months commencing on the date on which the contributor commenced to contribute for benefits in accordance with that basic table; and
(ii) the waiting period in relation to a contributor for benefits in accordance with a supplementary hospital table shall not exceed the period of 24 months commencing on the date on which the contributor commenced to contribute for benefits in accordance with that supplementary hospital table.
(1) The organization will not provide for a waiting period for contributors for benefits in accordance with a basic table who have transferred to a health benefits fund conducted by the organization from—
(i) another health benefits fund conducted by the organization;
(ii) a hospital benefits fund or a medical benefits fund the assets of which have, by force of section 73aa, become the initial assets of that health benefits fund; or
(iii) a health benefits fund, a hospital benefits fund or a medical benefits fund conducted by another organization whose registration under Part VI has been cancelled or is under consideration by the Minister with a view to cancellation.
(m) The organization will not, in determining, in relation to any contributor to a basic table or to any contributor included in a class or kind of contributors to a basic table—
(i) whether or not benefits are payable in accordance with the table;
(ii) if benefits are payable in accordance with the table—the amount of the benefits so payable; or
(iii) the amount of the contributions payable in respect of the table,
have regard to any of the following matters:
(iv) the suffering by the contributor , or a dependant of the contributor, from a chronic disease, illness or other medical condition or from a disease, illness or medical condition of a particular kind;
(v) the age of the contributor or of a dependant of a contributor;
(vi) the frequency of the rendering of professional services to the contributor or to a dependant of a contributor;
(vii) the amount, or extent, of the benefits to which the contributor becomes, or has become, entitled during a period;
(viii) any matter prescribed for the purpose of this sub-paragraph.
(n) Where a claim for a benefit payable by the organization out of a health benefits fund conducted by it is, or has been, lodged with the organization, the organization will pay that claim within 2 months, or such longer period as the Permanent Head approves in a particular case, after—
(i) the date of commencement of this condition; or
(ii) the date of lodgment of the claim with the organization,
whichever is the later date.
(o) Where an exemption has been granted under section 73f in relation to a basic table of a health benefits fund conducted by the organization, the organization will, within a period of one month after the granting of the exemption—
(i) furnish to all contributors to a health benefits fund conducted by the organization; and
(ii) publish in a manner satisfactory to the Minister, for the information of persons who may wish to become contributors to a health benefits fund conducted by the organization,
the particulars of the exemption, including the date upon which the exemption takes effect and the description of the hospital treatment affected by the exemption, and a statement setting out the effect of the exemption on the rights of contributors.
(p) Where—
(i) an exemption is in force under section 73F in relation to the organization;
(ii) at any time during the period of 3 months from the granting of that exemption, a contributor, in accordance with a basic table, to a health benefits fund conducted by the organization, being a person who became, or last became, such a contributor before the granting of the exemption, transfers to another registered organization and becomes a contributor, in accordance with a basic table, to a health benefits fund conducted by the other organization; and
(iii) that person, as such a contributor in relation to the other organization, is subject to a waiting period commencing from the date of that transfer,
the first-mentioned organization will continue to treat that person, during that waiting period, as a contributor, in accordance with a basic table, to the relevant health benefits fund conducted by that first-mentioned organization and, for that purpose, will disregard the exemption.
(q) The organization will comply with any direction of the Minister under this Act served on it.”.
SCHEDULE 4 Section 132
CONSEQUENTIAL AMENDMENTS OF OTHER ACTS
Act | Amendment |
Sub-paragraph 23 (eb) (i)—
| |
Sub-section 121c (1a)—
| |
Paragraph 159r (1a) (a)—
| |
Sub-section 3 (1) (paragraph (k) of the definition of “insurance business”)—
|
1. No. 42, 1974, as amended. For previous amendments, see No. 58, 1975; Nos. 59, 91, 101 and 109, 1976; No. 75, 1977; Nos. 89 and 133, 1978; Nos. 53 and 123, 1979; No. 132, 1980; No. 118, 1981; and Nos. 49 and 112, 1982.
2. No. 41, 1974, as amended. For previous amendments, see Nos. 61, 91 and 100, 1979; Nos. 36 and 134, 1978; and No. 53, 1979.
3. No. 95, 1953, as amended. For previous amendments, see No. 68, 1955; Nos. 55 and 95, 1956; No. 92, 1957; No. 68, 1958; No. 72, 1959; No. 16, 1961; No. 82, 1962; No. 77, 1963; No. 37, 1964; Nos. 100 and 146, 1965; No. 44, 1966; Nos. 14 and 100, 1967; No. 100, 1968; No. 102, 1969; No. 41, 1970; No. 85, 1971; No. 114, 1972; Nos. 49 and 202, 1973; No. 37, 1974; Nos. 1, 13 and 93, 1975; Nos. 1, 60, 91, 99, 108, 157 and 177, 1976; Nos. 98 and 100, 1977; Nos. 36, 88, 132 and 189, 1978; Nos. 54, 91 and 122, 1979; Nos. 117 and 131, 1980; Nos. 40, 74, 118 and 176, 1981; Nos. 49 and 112, 1982; and No. 35, 1983.
0
0
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