Hospital Benefits (Private Hospitals) Regulations (Cth)

STATUTORY RULES.

1946. No. 2.

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REGULATIONS UNDER THE HOSPITAL BENEFITS ACT 1945.*

I, THE GOVERNOR-GENERAL in and over the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulations under the Hospital Benefits Act 1945.

Dated this eleventh day of January, 1946.

HENRY

Governor-General.

By His Royal Highness’s Command,

R. V. KEANE

acting Minister of State for Health.

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Hospital Benefits (Private Hospitals) Regulations.

Citation.

1. These Regulations may be cited as the Hospital Benefits (Private Hospitals) Regulations.

Commencement.

2.—(1.) Subject to this regulation, these Regulations shall come into operation on a date to be fixed by the Minister by notice in the Gazette.

(2.) Regulations 3, 4 to 9 (inclusive), sub-regulation (1.) of regulation 11, and regulations 17, 18 and 19 of these Regulations shall come into operation on the day on which these Regulations are notified in the Gazette.

Definitions.

3.—(1.) In these Regulations, unless the contrary intention appears—

“approval” includes renewal of approval;

“approved private hospital” means a private hospital approved by the Minister in pursuance of these Regulations;

“authorized” means authorized by the Director-General;

“benefit” means Commonwealth Hospital Benefit for Private Hospitals paid or payable under these Regulations;

“gross fees” means the amount shown on any account rendered in respect of hospital treatment of a qualified patient in an approved private hospital as being the amount which would be payable apart from any deduction in respect of benefit;

“hospital treatment” means accommodation and nursing care for the purposes of medical, surgical or obstetric treatment

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* Notified in the Commonwealth Gazette on 17th January, 1946.

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by or under the supervision of a legally qualified medical practitioner, or of obstetric treatment by or under the supervision of a registered obstetric nurse;

“private hospital” means any premises, registered under the law of any State or of the Australian Capital Territory or the Northern Territory as a private hospital, in which patients are received and lodged for hospital treatment for which a charge is made; or any part of any such premises, but does not include any mental hospital or home, or any convalescent home, benevolent home, infirmary, home for the aged or orphanage not giving hospital treatment, or any part of any such premises;

“proprietor”, in relation to any private hospital, means the owner of the business or undertaking carried on, at that hospital, and includes any person having the management of that business or undertaking;

“qualified patient”, in relation to an approved private hospital, means a person who was ordinarily resident in Australia at the time of admission to the hospital and who is occupying a bed in the hospital for the purpose of hospital treatment, and includes, where two or more children are born at one birth, any child born at that birth in excess of one, and also any newly born child except during the time the mother of that child is occupying a bed, but does not include a member of the staff of the hospital receiving treatment in his own quarters or a person whose hospital fees are, apart from these Regulations, borne by the Commonwealth or who has received or is entitled to receive those fees under any law in force in any State or Territory of the Commonwealth;

“the Director-General” means the Director-General of Health;

“the Senior Commonwealth Medical Officer”, in relation to a private hospital situated in a State, means the Senior Commonwealth Medical Officer in that State and, in relation to a private hospital situated in a Territory of the Commonwealth, means the Director-General.

(2.) The decision of the Minister that any accommodation and care afforded in a private hospital is or is not hospital treatment for the purposes of these Regulations shall be final and conclusive.

Applications for approval of private hospitals.

4.—(1.) The proprietor of any private hospital may apply for approval of the hospital for the purposes of these Regulations.

(2.) The application shall be in accordance withthe authorized form and shall be lodged with the Senior Commonwealth Medical Officer.

Private Hospitals Benefits Committees.

5.—(1.) The Minister may appoint in any State or Territory a Private Hospitals Benefits Committee consisting of the Senior Commonwealth Medical Officer, who shall be Chairman of the Committee, and such other members, not exceeding four in number, as the Minister thinks fit.

(2.) A member of a Committee, other than the Senior Commonwealth Medical Officer, shall be appointed for such period as the Minister determines, and any such appointment may be terminated by the Minister at any time.

(3.) The proceedings of a Committee shall not be invalidated by reason only of any vacancy in the membership of the Committee.

(4.) The Chairman of a Committee may convene meetings of the Committee.

(5.) The Chairman and one other member of a Committee shall constitute a quorum.

(6.) All matters arising, at a meeting of a Committee shall be decided by a majority of the votes of the members present.

(7.) The Chairman shall have a deliberative vote and, in the case of an equality of votes, shall also have a casting vote.

(8.) A member of a Committee may be paid an allowance for expenses at such rate (if any) as the Minister determines.

(9) Where a Private Hospitals Benefits Committee has not been appointed in any State or Territory, or where the Committee in any State or Territory is, for any reason, unable to function, the Senior Commonwealth Medical Officer in that State or Territory shall have and may exercise the functions of a Private Hospitals Benefits Committee in that State or Territory.

Functions of Committees.

6. A Private Hospitals Benefits Committee shall examine every application for approval of a private hospital referred to it by the Director-General or by a Senior Commonwealth Medical Officer and shall, after causing to be made such inspection or inquiry as it considers necessary, make a recommendation on the application to the Minister through the Director-General.

Approval by Minister.

7.—(1.) The Minister may, after taking into account any recommendation made on the application under these Regulations, grant any application for approval of a private hospital on such terms and conditions (if any) as he sees fit, or refuse the application.

(2.) The approval of a private hospital shall have effect for the period, not being more than one year, for which it is granted.

(3.) The Minister shall cause to be issued to the proprietor of an approved private hospital a certificate of approval of the hospital.

(4.) In the case of a private hospital in a remote or isolated area where there is no resident or visiting legally qualified medical practitioner, the Minister may, if he thinks fit, upon the application of the proprietor, approve the hospital as an approved private hospital for the purposes of these Regulations, and in any such case the accommodation and care provided in the hospital shall be deemed to be hospital treatment for the purposes of those Regulations.

Revocation of approval, &c.

8.—(1.) The Minister may, in his absolute discretion, at any time revoke the approval of a private hospital by notice in writing posted to the person named in the certificate of approval as the proprietor at the address of the hospital.

(2.) The proprietor of an approved private hospital may, at any time, apply in writing to the Minister for the revocation of the approval of the hospital, and the Minister shall, as soon as is practicable, and upon delivery up to the Director-General of the certificate of approval, revoke the approval.

(3.) Where the proprietor of an approved private hospital ceases to be the proprietor, any approval of that hospital previously granted shall cease to have effect.

(4.) Where the approval of a private hospital has been revoked or has otherwise ceased to have effect, except by defluxion of time, the proprietor or former proprietor shall, if he has not already done so, forthwith forward to the Director-General the certificate of approval of the hospital.

Inspection of approved of the hospital.

9. The proprietor and every person concerned in the management of an approved private hospital or of a private hospital in respect of which an application for approval has been made in accordance with regulation 4 of these Regulations shall permit the inspection of the hospital at any reasonable time by a person authorized in writing by the Director-General to make such inspections.

Certificate of approval and table of fees to be displayed.

10. The proprietor of an approved private hospital shall cause to be displayed in a prominent position in the hospital the certificate of approval of the hospital and a statement in an authorized form of the rates of fees chargeable to qualified patients.

Fees in approved private hospitals.

11.—(1.) Where the proprietor of in approved private hospital charges, without the approval of the Minister, fees (before deduction of benefit) in respect of any qualified patient—

(a) where the hospital was in existence on the first day of September, 1945—at a rate higher than the corresponding rate charged in the hospital at that date, or in respect of any service which was not supplied or charged for in the hospital at that date; or

(b)in any other case—at a rate higher than the relevant rate approved by the Minister at the time when the hospital is first approved for the purposes of these Regulations, or in respect of any service which was not supplied or charged for in the hospital at the date of that approval,

benefit shall not be payable to the proprietor in respect of that patient, and the Minister may revoke the approval of the hospital in accordance with, regulation 8 of these Regulations.

(2.) The proprietor of an approved private hospital shall, in the account rendered by him in respect of any period of hospital treatment of a qualified patient, set out the gross fees for that period and show as a deduction therefrom the amount of benefit to which the proprietor is entitled under these Regulations in respect of that patient for that period, and shall, upon receiving the amount remaining after making the deduction and a statement in the authorized form signed by the patient or by some responsible person on his behalf, accept that amount in full discharge of his claim for fees in respect of the hospital treatment of that patient for that period and give a receipt accordingly.

(3.) Where, in respect of any qualified patient, the proprietor of an approved private hospital contravenes or fails to comply with the provisions of either of the two last preceding sub-regulations—

(a.) the proprietor shall be liable to repay to the Commonwealth the amount of any benefit received in respect of that patient, and that amount shall be recoverable in any court of competent jurisdiction as a debt due to the Commonwealth and

(b) the Director-General may, if he thinks fit, direct that an amount not exceeding any amount of benefit paid, or otherwise payable, to the proprietor in respect of that patient shall be paid to the patient or to the person who has paid or is liable to pay the hospital fees of the patient.

Records to be kept.

12. For the purpose of enabling claims for benefit to be verified, the proprietor of every approved private hospital shall keep records in an authorized form in respect of each qualified patient, and shall permit those records to be inspected at any reasonable time by a person authorized in writing by the Director-General to make such inspections.

Benefit payable.

13.—(1.) Subject to, and to compliance with, the provisions of these Regulations, there shall be payable to the proprietor of an approved private hospital in respect of each qualified patient the Commonwealth Hospital Benefit for Private Hospitals of six shillings for every day on which the patient occupies a bed for the purpose of hospital treatment.

(2.) For the purposes of this regulation, “day” means a period of twenty-four hours ending at midnight, and the day of admission to hospital and the day of discharge or death shall together be counted as one day.

Obstetric cases.

14. Benefit shall not be payable in respect of obstetric cases for any waiting period which exceeds two days before the onset of labour or for any period exceeding fifteen days after the birth of a child, unless the claim for benefit is accompanied by a certificate of a legally qualified medical practitioner stating that the patient was in need of the longer period of hospital attention on account of some abnormality, disease of pregnancy or the puerperium, complication or difficult labour, and stating the nature of the abnormality, disease, complication or difficult labour.

Claims for periods exceeding eight weeks.

15. Benefit shall not be payable in respect of any patient for any period exceeding eight weeks, unless the claim for benefit is accompanied by a certificate of a legally qualified medical practitioner stating the nature of the illness and the reason for further hospital treatment, and the Director-General is satisfied that the further hospital treatment was necessary.

Claims for benefit.

16. The proprietor of an approved private hospital who desires to obtain payment of benefit shall, as soon as practicable after the end of every month in respect of which benefit is payable to him, forward a claim in respect of that month in the authorized form, together with a statement in the authorized form signed by each patient in respect of whom benefit is claimed or by some responsible person on his behalf, to

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the person or authority indicated on the form, and shall furnish such further information and evidence relating to the claim as the Director-General requires.

Delegation.

17.—(l.) The Minister or the Director-General may, by writing under his hand, delegate any of his powers under these Regulations (except this power of delegation) so that the delegated powers may be exercised by the delegate with respect to the matter or class of matters, or the State or part of Australia, specified in the instrument of delegation.

(2.). Every delegation by the Minister or the Director-General shall be revocable in writing at will and no delegation shall prevent the exercise of any power by the Minister or the Director-General.

Offences.

18.—(1) A person shall not—

(a) make, either orally or in writing, a false or misleading statement in or in connexion with, or insupport of, any application for approval of a private hospital or claim for benefit;

(b) obtain any benefit which is not payable;

(c) obtain payment of any benefit by means of any false or misleading statement; or

(d) make or present to any person doing duty in relation to these Regulations any statement or document which is false in any particular.

Penalty: Fifty pounds or imprisonment for three months.

(2.) A person shall not refuse or fail to comply with any provision of these Regulations, other than the last preceding sub-regulation, which is applicable to him.

Penalty: Fifty pounds.

Arrangements with States.

19. The Minister may enter into an arrangement with a Minister of State of any State providing for the performance by an authority of the State of any duties or functions, under or for the purposes of these Regulations, and for the re-imbursement of the State or of that authority in respect of payments made, and expenses incurred, in pursuance of the arrangement.

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By Authority: L. F. Johnston, Commonwealth Government Printer, Canberra.