Hospital Benefits Regulations (Cth)

STATUTORY RULES.

1952. No. 72.

—————

REGULATIONS UNDER THE HOSPITAL BENEFITS ACT 1951.*

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 1951.

Dated this twentieth day of August, 1952.

Governor-General.

By His Excellency’s Command,

SGD. EARLE PAGE

Minister of State for Health.

———

HOSPITAL BENEFITS REGULATIONS.

PART I.—PRELIMINARY.

Citation.

1. These Regulations may be cited as the Hospital Benefits Regulations.

Repeal.

2.—(1.) The Hospital Benefits (Private Hospitals) Regulations (comprising Statutory Rules 1946, No. 2; Statutory Rules 1946, No. 52; Statutory Rules 1947, No. 56; Statutory Rules 1948, No. 151; Statutory Rules 1949, No. 12; Statutory Rules 1950, No. 77; Statutory Rules 1951, No. 119; and Statutory Rules 1952, No. 11) are repealed.

(2.) The Hospital Benefits (Temporary Absence from Australia) Regulations (comprising Statutory Rules 1948, No. 70; Statutory Rules 1948, No. 150; and Statutory Rules 1949, No. 31) are repealed.

Parts.

3. These Regulations are divided into Parts, as follows:—

Part I.—Preliminary (Regulations 1-4).

Part II.—Approval of Hospitals.

Division 1.—Approval of Private Hospitals (Regulations 5-15).

Division 2.—Approval of Public Hospitals (Regulations 16-19).

 

* Notified in the Commonwealth Gazette on , 1952.

3075.—Price 1S. 15/13.8.1952.

Part III.—Payment of Hospital Benefits in respect of Patients in Private Hospitals (Regulations 20-25).

Part IV.—Payment of Hospital Benefits in respect of Patients in Public Hospitals (Regulations 26-30).

Part V.—Payment of Additional Benefit (Regulations 31-49).

Part VI.—Hospital Benefits payable in respect of Persons Temporarily Absent from Australia (Regulations 50-57).

Part VII.—Miscellaneous (Regulations 58-59).

Interpretation.

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

“additional benefit” means the amount payable in respect of a contributing patient under Part V.;

“approval” includes renewal of an approval;

“approved private hospital” means a private hospital or premises approved in pursuance of Division 1 of Part II.;

“approved public hospital” means a public hospital approved in pursuance of Division 2 of Part II.;

“authorized” means authorized by the Director-General;

“contributing patient” means a qualified patient who is a contributor;

“contributor” means—

(a) a person who, by reason of payments made by him to the funds of a registered organization, is entitled to receive from those funds an amount at a rate of not less than Six shillings per day for each day on which that person receives hospital treatment; and

(b) the spouse or a dependant of such a person;

“gross fees” means the amount of fees for hospital treatment which would be payable in respect of a qualified patient without the deduction of hospital benefit;

“hospital benefit” means the hospital benefit payable under Part III. or Part IV., as the case requires;

“hospital treatment”, in relation to an approved private or public hospital, means accommodation and nursing care for the purposes of—

(a) medical or surgical treatment by or under the supervision of a legally qualified medical practitioner;

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

(c) dental treatment by or under the supervision of a legally qualified dentist or dental practitioner;

“organization” means an organization or body—

(a) which, in accordance with its rules, makes payment of amounts at a rate of not less than Six shillings per day to, or in respect of, some or all of the contributors to its funds for hospital treatment provided at a public or private hospital for a contributor or the spouse or a dependant of a contributor, to its funds; and

• (a) 

  (b)the rules of which authorize the payment of moneys received by it as contributions for hospital benefits only for the payment of hospital benefits and administrative expenses and disbursements incurred in, or in connexion with, the receipt by it of those contributions and the payment of hospital benefits;

“private hospital” means—

(a) a private hospital which was, immediately before the commencement of these Regulations, an approved private hospital as defined by the repealed regulations (not being an approved private hospital which consisted of the non-public wards of a public hospital owned or maintained by a State); or

(b)premises or part of premises, not being a public hospital, in which patients are received and lodged for hospital treatment;

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

“public hospital” means—

(a)a public hospital in a State in respect of the patients of which financial assistance is payable to the State under sub-section (2.) of section 3 of the Act in accordance with the terms of the agreement with that State referred to in that sub-section; or

(b)the premises or part of premises (other than a mental institution, as defined by an agreement the execution of which is authorized by the Mental Institution Benefits Act 1948 or premises or part of premises the maintenance expenditure of which is provided for under an arrangement entered into under the Tuberculosis Act 1948) which is, in accordance with the law of a State, recognized as a public hospital and in which patients are received and lodged for hospital treatment,

and includes, in relation to the State of South Australia, a hospital to which Part IV. of the Hospitals Act, 1934-1951, of that State applies;

“qualified patient” means a person, ordinarily resident in Australia at the time of admission to an approved private or public hospital, who occupies a bed in the hospital for the purpose of hospital treatment and includes—

(a) where two or more children are born at one birth, a child born at that birth in excess of one; and

(b) a newly born child whose mother does not occupy a bed in the hospital;

“registered organization” means an organization registered under Part V.;

“the Act” means the Hospital Benefits Act 1951;

“the Committee” means the Registration Advisory Committee established for the purposes of Part V.;

“the Deputy Director” means—

(a) in relation to a hospital in a State other than the State of Tasmania—the Commonwealth Deputy Director of Health for that State;

(b) in relation to a hospital in the State of Tasmania—the Senior Commonwealth Medical Officer in that State; and

(c) in relation to a hospital in a Territory of the Commonwealth—the Director-General;

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

“the repealed Regulations” means the Hospital Benefits (Private Hospitals) Regulations repealed by sub-regulation (1.) of regulation 2 of these Regulations.

(2.) For the purposes of these Regulations—

(a) a convalescent home, benevolent home, home for the aged or orphanage or a part of such a home or of an orphanage which does not provide hospital treatment shall be deemed not to be a public hospital or a private hospital;

(b) a person who is—

• (i)

   a member of the staff of a public hospital or private hospital receiving treatment in his own quarters;

(ii) a person the whole of whose fees for hospital treatment are paid or payable, whether directly or indirectly, by the Commonwealth;

(iii) a person who has received, may receive or is entitled to receive, whether by way of damages, compensation or otherwise, the whole of his fees for hospital treatment under the law in force in a State or Territory of the Commonwealth or in settlement of a claim under that law; or

(iv) a person (not being a dependant of a person) the whole of whose fees for hospital treatment are payable by another person in pursuance of a liability imposed on that other person by or under a law of a State or Territory of the Commonwealth,

shall be deemed not to be a qualified patient;

(c) an approved private hospital or approved public hospital which, by reason of payments made by a person, provides hospital treatment for that person or for the spouse or a dependant of that person without charge or at a reduced charge shall be deemed to be an organization under the rules of which an amount of not less than Six shillings per day is payable to such a person for each day on which he is a qualified patient;

(d) a person shall be deemed to be a dependant of a contributor if, in accordance with the rules of the organization to the funds of which that contributor makes payments, a payment may be made from the funds of the organization for hospital treatment provided at an approved private hospital or approved public hospital for that person or, in the case of any approved private hospital or approved public hospital that is deemed to be an organization by

the last preceding paragraph, hospital treatment is provided for that person at that approved private hospital or approved public hospital without charge or at a reduced charge; and

(e) the day of admission and the day of discharge or death of a qualified patient shall be counted together as one day.

(3.) Where—

(a) portion of a person’s fees for hospital treatment are paid or payable, whether directly or indirectly by the Commonwealth;

(b) a person has received, may receive or is entitled to receive, whether by way of damages, compensation or otherwise, portion of his fees for hospital treatment under the law in force in a State or Territory of the Commonwealth or in settlement of a claim under that law; or

(c) portion of the fees of a person (not being a dependant of a person) for hospital treatment are payable by another person in pursuance of a liability imposed on that other person by or under a law of a State or Territory of the Commonwealth,

that person shall, for the purposes of the provisions of these Regulations (other than the provisions of Part VI.) be deemed to be a qualified patient for a number of days which is calculated by dividing an amount ascertained by subtracting that portion of that person’s hospital fees from the total amount of hospital fees payable in respect of that person by the rate per day of those hospital fees.

PART II.—APPROVAL OF HOSPITALS.

Division 1.—Approval of Private Hospitals.

Approval of private hospitals as defined by repealed regulations to be approved.

5.—(1.) A private hospital which was, immediately before the commencement of these Regulations, an approved private hospital as defined by the repealed Regulations (not being an approved private hospital which consisted of the non-public wards of a public hospital owned or maintained by a State) shall, without an application being made by the proprietor of the private hospital, be approved by the Director-General as an approved private hospital for the purposes of these Regulations.

(2.) Where the approval of a private hospital under the repealed Regulations was granted on terms and conditions, the approval of the private hospital under the last preceding sub-regulation shall be deemed to have been granted on the same terms and conditions.

Hospital Benefits Committees.

6.—(1.) For the purposes of this Division, the Minister may establish a Hospital Benefits Committee in each State or Territory of the Commonwealth.

(2.) A Hospital Benefits Committee shall consist of—

(a) the Deputy Director who shall be Chairman of the Committee; and

(b) two other members.

(3.) A member of a Hospital Benefits Committee, other than the Deputy Director—

(a) shall be appointed by the Minister; and

(b) shall hold office, during the pleasure of the Minister, on such terms and conditions as the Minister determines.

(4.) The exercise or performance of the powers or functions of a Hospital Benefits Committee is not affected by reason only of there being a vacancy in the office of a member of that Committee.

Meetings of Committee.

7.—(1.) A Hospital Benefits Committee shall meet at such times and at such places as the Chairman from time to time determines.

(2.) At a meeting of a Hospital Benefits Committee, the Chairman and one other member form a quorum.

(3.) All questions arising at a meeting of a Hospital Benefits Committee shall be decided by a majority of the votes of the members present.

(4.) The Chairman is entitled to exercise a deliberative vote and, in the event of an equality of votes, is also entitled to exercise a casting vote.

Functions and powers of committees.

8. A Hospital Benefits Committee shall—

(a) examine each application for approval as a private hospital made under this Division which is referred to it by a Deputy-Director;

(b) cause such inspections and inquiries to be made in relation to the application as it thinks fit; and

(c) make such recommendation to the Director-General on the application as it thinks fit.

Application for approval of private hospitals.

9.—(1.) The proprietor of a private hospital may apply for approval of the private hospital as an approved private hospital.

(2.) An application under the last preceding sub-regulation—

(a) shall be made in accordance with the form and manner authorized for the purposes of this regulation; and

(b) shall be lodged with the Deputy Director in the State or Territory of the Commonwealth in which the private hospital is situated.

(3.) The Deputy Director may refer an application made under this regulation to the Hospital Benefits Committee in the State or Territory in which the private hospital is situated.

(4.) Where—

(a) a Hospital Benefits Committee is not established in a State or Territory of the Commonwealth; or

(b) a Hospital Benefits Committee established in a State or Territory of the Commonwealth is, for any reason, unable to function,

the Deputy Director in that State or Territory shall have and may exercise the powers and functions of a Hospital Benefits Committee.

Approval of applications.

10.—(1.) The Director-General may, after examining the application made under the last preceding regulation and taking into account the recommendation of a Hospital Benefits Committee or a Deputy Director, as the case requires, on the application—

(a) approve the private hospital in respect of which the application is made as an approved private hospital for the purposes of these Regulations upon such terms and conditions (if any) as he thinks fit; or

(b) refuse the application.

(2.) The proprietor of a private hospital whose application has been refused by the Director-General may apply to the Minister for a review of the Director-General’s decision.

(3.) The Minister shall, upon an application to review under the last preceding sub-regulation, review the decision of the Director-General and may vary the decision as he thinks fit.

(4.) The decision of the Minister on a review under this regulation shall be final and conclusive.

Approval of premises in remote areas.

11.—(1.) The proprietor of premises in a remote or isolated area where there is no resident or visiting medical practitioner may, in the form and manner authorized for the purposes of this regulation, apply to the Director-General for approval of the premises as an approved private hospital.

(2.) The Director-General may, in his discretion, approve the premises as an approved private hospital or refuse the application.

(3.) Accommodation and nursing care provided in premises which are approved under this regulation shall be deemed to be hospital treatment for the purposes of these Regulations.

Certificate of approval.

12.—(1.) The Director-General shall cause to be issued to the proprietor of an approved private hospital a certificate of approval of the private hospital or premises.

(2.) The proprietor of an approved private hospital shall display the certificate of approval in a prominent position in the private hospital or premises.

Period of approval.

13. The approval of a private hospital under this Division has effect for such period, not exceeding twelve months, as is specified in the certificate of approval or until the revocation of the approval of that private hospital in accordance with the next succeeding regulation.

Revocation of approval.

14.—(1.) The approval of a private hospital or premises as a private hospital may be revoked—

(a) by the Minister at any time, in his discretion, by notice in writing posted to the person named in the certificate of approval as the proprietor of the private hospital or premises; or

(b) by the Director-General, upon the receipt of—

(i) an application in writing to revoke the approval from the proprietor of the approved private hospital;

(ii) notice in writing from the person named in the certificate of approval as the proprietor of the approved private hospital that that person has ceased to be the proprietor of that hospital; or

(iii) a notice of the death of the proprietor of the approved private hospital from the legal personal representative of the proprietor.

(2.) A person who makes an application or gives a notice to the Director-General under paragraph (b)of the last preceding sub-regulation shall forward the certificate of approval of the hospital with his application or notice.

 

(3.) Where the Minister revokes the approval of a private hospital, the person named in the certificate of approval as the proprietor of the hospital shall forthwith forward the certificate to the Director-General.

Inspection of hospitals.

15.—(1.) The Director-General may, by writing under his hand, authorize a person to inspect an approved private hospital or a private hospital or premises in respect of which an application for approval has been made under regulation 9 or regulation 11 of these Regulations.

(2.) The proprietor of the approved private hospital or the private hospital or premises shall permit the person so authorized to inspect the hospital at all reasonable times.

Division 2.—Approval of Public Hospitals.

Approval of public hospitals in respect of the patients of which hospital benefits were paid immediately before the commencement of these Regulations.

16. Where, at the commencement of these Regulations, financial assistance is payable to a State under sub-section (2.) of section three of the Act in accordance with the terms of the agreement with that State referred to in that sub-section, each public hospital in respect of the patients of which financial assistance is so payable shall, without an application being made under this Division, be approved by the Minister as an approved public hospital for the purposes of these Regulations.

Applications for approval of public hospitals.

17.—(1.) The Minister for Health of a State or a person authorized by the Minister for Health of a State for the purposes of this Division may apply to the Minister for a public hospital in that State to be approved as an approved public hospital.

(2.) An application under this regulation—

(a) shall be made in accordance with a form authorized for the purposes of this regulation; and

(b) shall be lodged with the Director-General.

Approval of applications by Minister.

18. The Minister may grant an application made under the last preceding regulation for such period and on such terms and conditions as he determines or may refuse the application.

Revocation of approval.

19.—(1.) The Minister may, in his discretion, at any time revoke the approval of a public hospital by notice in writing to the Minister for Health of the State in which the approved public hospital is situated.

(2.) The Minister shall, upon application by the Minister for Health of a State, revoke the approval of an approved public hospital specified in the application.

(3.) Upon the revocation of the approval of a public hospital, that public hospital ceases to be an approved public hospital.

PART III.—PAYMENTS OF HOSPITAL BENEFITS IN RESPECT OF PATIENTS IN PRIVATE HOSPITALS.

Benefit payable.

20. Subject to, and upon compliance with, the provisions of these Regulations, there is payable to the proprietor of an approved private hospital a hospital benefit of Eight shillings per day for each day on which a person is, or is deemed to be, a qualified patient in that approved private hospital.

 

Period for which benefit is payable in obstetric eases.

21. Hospital benefit under this Part is not payable in respect of obstetric cases for a waiting period which is in excess of two days before the, onset of labour or for a period which is in excess of fifteen days after the birth of a child, unless a medical practitioner certifies, for the purposes of this regulation, that the patient was in need of the longer period of hospital treatment on account of an abnormality, disease of pregnancy or puerperium or a complication or difficult labour, specified in the certificate.

Claims for periods exceeding eight weeks.

22.—(1.) Subject to the next succeeding sub-regulation, hospital benefit is not payable in respect of a qualified patient for a period in excess of eight weeks, unless a medical practitioner certifies, for the purposes of this regulation, as to the nature of the illness and the necessity for hospital treatment in excess of eight weeks, and the Director-General is satisfied that the hospital treatment was necessary for a period exceeding eight weeks.

(2.) Unless the Director-General otherwise directs, the last preceding sub-regulation does not apply to the payment of hospital benefit in respect of a patient in a private, mental hospital or home or a house for the reception of the insane.

Conditions to be complied with by proprietor of private hospital.

23.—(1.) Payment of the hospital benefit under this Part shall not be payable to the proprietor of an approved private hospital in respect of a qualified patient unless—

(a) the proprietor has rendered in respect of a period for which that qualified patient has received hospital treatment an account specifying—

• (i)

   the gross fees payable in respect of that qualified patient for that period; and

(ii) the amount of hospital benefit which the proprietor is entitled to receive under this Part in respect of that qualified patient for that period,

and requiring payment of an amount ascertained by deducting the amount of the hospital benefit from the amount of the gross fees;

(b) the proprietor has received a statement, in the form authorized for the purpose of this paragraph, signed by the qualified patient in respect of whom the hospital benefit is claimed or by a responsible person on behalf of the, patient; and

(c) upon receiving payment of the amount ascertained in accordance with paragraph (a) of this sub-regulation, the proprietor gives a receipt in full discharge of his claim for fees in respect of the hospital treatment provided for that qualified patient for that period.

(2.) Where, in respect of a qualified patient, the proprietor of an approved private hospital fails to comply with a condition specified in the last preceding sub-regulation—

(a) the Director-General may, in his discretion, direct that an amount not exceeding the amount of the hospital benefit paid or payable in respect of that qualified patient be paid to the qualified patient or to a person who has paid, or is liable for the payment of, the hospital fees of that qualified patient; and

(b) if the amount of the hospital benefit payable in respect of that qualified patient has been paid to the proprietor of the private, hospital, that amount may be recovered as a debt due and payable to the Commonwealth.

Claims for benefits.

24. For the purposes of obtaining payment of the hospital benefit under this Part, the proprietor of an approved private hospital shall, as soon as practicable after the end of each month—

(a) forward a claim in respect of hospital benefit for that month in the form authorized for the purposes of this regulation to the person or authority specified in that form;

(b)forward with the claim the statements in the form authorized for the purposes of paragraph (b)of sub-regulation (1.) of regulation 23 of these Regulations received by him in respect of each qualified patient;

(c) where necessary, forward with the claim the certificates given by medical practitioners for the purposes of regulations 21 and 22 of these Regulations; and

(d) forward with the claim such further information and evidence relating to the claim as the Director-General requires.

Records to be kept.

25.For the purpose of enabling claims for hospital benefit to be verified, the proprietor of an approved private hospital shall keep records in the form authorized for the purposes of this regulation in respect of each qualified patient, and shall permit those records to be inspected at all reasonable times by a person authorized to make those inspections.

PART IV.—PAYMENT OF HOSPITAL BENEFITS IN RESPECT OF PATIENTS IN PUBLIC HOSPITALS.

Definition.

26. In this Part, “State” means a State other than a State—

(a) to which financial assistance continues to be payable under sub-section (2.) of section 3 of the Act; or

(b) with which there is for the time being in force an agreement with the Commonwealth under section 5 of the Act.

Benefit payable.

27. Subject to these Regulations, there is payable to a State a hospital benefit of Eight shillings per day for each day on which, a person is, or is deemed to be, a qualified patient in a non-public ward of an approved public hospital in that State, being a ward which was, immediately before the commencement of these Regulations, part of an approved private hospital under the repealed Regulations.

Benefit to be deducted from accounts payable to public hospitals.

28.—(1.) The hospital benefit under this Part shall not be payable in respect of a qualified patient unless—

(a) where the rate of gross fees payable in respect of the qualified patient exceeds Eight shillings per day, the amount chargeable by the approved public hospital in respect of that qualified patient is reduced by the amount of the hospital benefit payable in respect of that qualified patient; or

(b)in any other case, an amount is not charged by the approved public hospital in respect of that qualified patient.

(2.) Where, in respect of a qualified patient, an approved public hospital fails to comply with a condition specified in the last preceding sub-regulation—

(a) the State shall not claim hospital benefit in respect of that qualified patient;

(b) if the State has claimed hospital benefit in respect of that qualified patient, the Commonwealth shall make such adjustments in the claim as are necessary; and

(c) the Director-General may, in his discretion, direct that the amount of hospital benefit payable in respect of that qualified patient be paid to that qualified patient or to a person who has paid, or is liable for the payment of, the hospital fees of that qualified patient.

Determination of qualified patients.

29.Where a question arises as to whether a patient who is receiving, or has received, hospital treatment in an approved public hospital in a State is or is not a qualified patient, that question shall be determined by a person appointed by the Minister for Health of that State to determine that question.

(2.) Where the person so appointed is not satisfied that the patient is or was a qualified patient, the person so appointed may, by writing under his hand, direct that, for such period as is specified in the writing, the patient shall be deemed not to be, or shall be deemed not to have been, a qualified patient.

(3.) Hospital benefit shall not be payable in respect of a patient during the period specified in a direction referred to in the last preceding sub-regulation.

Payment of benefits.

30.—(1.) Payment of the hospital benefit under this Part shall be made quarterly to each State.

(2.) A State shall, as soon as practicable after the end of each quarter, furnish to the Director-General a statement showing the number of beds occupied by qualified patients for a full day in each approved public hospital in that State during that quarter.

(3.) Payment of hospital benefit under this Part is subject to the condition that the State will, as soon as practicable after the thirtieth day of June in each year, furnish to the Minister a detailed statement, which shall be in accordance with a form approved by the Minister and shall be certified by the Auditor-General of that State, of the working operations of the approved public hospitals in that State during the period of twelve months which ended on that thirtieth day of June.

PART V.—PAYMENT OF ADDITIONAL BENEFITS.

Registration of organizations registered under Part V. of the repealed Regulations.

31.—(1.) The Minister shall grant registration under this Part to an organization which was, immediately before the date of commencement of these Regulations, an organization registered under Part V. of the repealed Regulations without an application being made by the organization.

(2.) Where the registration of an organization under Part V. of the repealed Regulations was granted on terms and conditions, the registration of the organization under the last preceding sub-regulation shall be deemed to have been granted on the same terms and conditions.

Applications for registration.

32.—(1.) An organization may apply for registration under this Part.

(2.) The application shall be in accordance with the form authorized for the purposes of this regulation and shall be lodged with the Director-General.

(3.) An organization shall furnish to the Director-General with its application—

(a) a copy of the instrument constituting the organization;

(b) a copy of the articles of association or rules of the organization;

(c) a copy of the revenue account and balance-sheet of the organization for the last completed accounting year prior to the date of the application for registration;

(d) a copy of the last report made by the organization to its members prior to the date of the application for registration;

(e) a statement showing, in respect of the last completed accounting year of the organization prior to the date of the application for registration—

(i) the number of persons who were contributors to the funds of the organization at the end of that year, sub-divided according to the class of benefit for which contributions were made; and

(ii) the respective number of persons who commenced, and ceased, to contribute to the funds of the organization in that year, sub-divided according to the class of benefit for which contributions were made; and

(f) a statement showing particulars of the tables or classes of benefit provided by the organization and the contributions for, and the amount of, those benefits.

(4.) The application shall be signed on behalf of the organization by a person authorized by the organization for that purpose.

(5.) The person who signs the application on behalf of the organization shall certify that the copies of the documents furnished with the application are true and correct copies of what they purport to be and that the information contained in the statements so furnished is true and correct.

Director-General may require additional information to be furnished.

33.—(1.) The Director-General may, by notice in writing, require an organization, or an officer of an organization, that has applied for registration under this Part to furnish him with such additional information relating to any of the matters specified in sub-regulation (3.) of the last preceding regulation, or to the affairs or finances of the organization, as is required by the notice.

(2.) Where an organization fails to comply with a requirement of a notice given under this regulation, the Minister may refuse to entertain the application for registration.

Registration Advisory Committee.

34.—(1.) For the purposes of this Part, there shall be a Registration Advisory Committee which shall consist of—

(a)the Commonwealth Actuary or a person appointed by the Commonwealth Actuary; and

(b) an officer of the Department of Health appointed by the Director-General.

Application to be referred for report to Registration Advisory Committee.

35. The Director-General shall refer an application for registration, the documents furnished with the application and any information furnished under regulations 32 and 33 of these Regulations to the Committee for examination and report to the Minister.

Recommendation of the Committee.

36. The Committee shall, in its report, recommend to the Minister that the application by the organization be granted or refused and in making the recommendation the Committee shall take into account—

(a) the number of contributors to the funds of the organization;

(b) the rate, of contributions made by each contributor to the funds of the organization;

(c) the amount of the payments made by the organization to, or in respect of, a contributor for hospital treatment;

(d) the rules of the organization relating to payments out of the funds of the organization; and

(e) the, ratio which amounts paid as management and administration expenses bear to the amount of payments made by contributors to the funds of the organization.

Registration.

37.—(1.) The Minister may, after taking into consideration the report of the Committee, grant the application for registration on such terms and conditions (if any) as he thinks fit, or refuse the application.

(2.) The Director-General shall notify the organization in writing of the granting of the application for registration and the terms and conditions (if any) on which the Minister has granted the application or of the refusal of the application, as the case requires.

Public officers of registered organizations.

38.—(1.) A registered organization shall, within fourteen days after the receipt by it of the notification of the granting of, the application for registration, appoint a person to be the public officer of the organization for the purposes of these Regulations and shall, within seven days after the, making of the appointment, furnish to the Director-General a notification of the appointment in accordance with the form authorized for the purposes of this sub-regulation.

(2.) The public officer shall perform, on behalf of the registered organization, all acts which are required or permitted to be performed by or under these Regulations and everything done by the public officer in his capacity as public officer shall be deemed to have been done by the registered organization.

(3.) Where a registered organization contravenes, or fails to comply with, a provision of these Regulations applicable to the registered organization, the contravention of, or failure to comply with, that provision shall, without limiting in any way the liability of the organization, be deemed to be a contravention or failure by the public officer, and the public officer shall be punishable accordingly.

 

(4.) A registered organization—

(a) may, at any time, revoke the appointment of a person as its public officer and appoint another person to be its public officer in the place of that first-mentioned person; and

(b) shall, where a person ceases to be its public officer, by death or otherwise or is, for any reason, unable to act as its public officer, forthwith appoint another person to be its public officer in the place of that first-mentioned person.

(5.) The registered organization shall, within seven days after the making of an appointment under the last preceding sub-regulation, furnish to the Director-General a notification of the appointment in accordance with the form authorized for the purposes of this sub-regulation.

Amount of additional benefit.

39.—(1.) Where there is payable, under the rules of a registered organization, an amount of not less than Six shillings per day in respect of a contributing patient for each day on which he is a qualified patient, there is, subject to this Part, payable in respect of that contributing patient an additional benefit of Four shillings per day for each day on which the contributing patient is a qualified patient.

(2.) Where—

(a) by reason of the period for which a contributing patient has made contributions to, or has received payments from, a registered organization; or

(b)by reason of circumstances specified in the rules of the registered organization or notified to a contributing patient in accordance with those rules,

a contributor is not entitled to receive payment of the amount per day which would, but for the existence of one or more of those reasons, be payable or is entitled to receive payment of an amount which is less than Six shillings per day, the amount which would otherwise be payable but for the existence of one or more of those reasons shall, for the purposes of these Regulations, be deemed to be payable unless one of the grounds on which payment is not made or the payment of the amount which is less than Six shillings per day is made is that the contributing patient has not paid all amounts due and owing by him to the registered organization.

Additional benefit to be paid to registered organization.

40.—(1.) The additional benefit payable, under this Part in respect of a contributing patient is, subject to this Part, payable to the registered organization to which contributions are paid by the patient or by the spouse of the patient or the person on whom the, patient is dependent.

(2.) The additional benefit shall not be payable to the organization unless it satisfies the Director-General that the amount (if any) payable under the rules of the organization and an amount equal to the amount of the additional benefit payable under this Part have been paid by the organization—

(a) to the approved private, hospital or an approved public hospital for or in respect of the contributing patient; or

(b) where an account rendered in respect of hospital treatment of a contributing patient has been paid by the contributing patient or by another person on the contributing patient’s behalf, to the person who paid the account.

Additional benefit not payable or may be reduced in certain cases.

41.—(1.) Where, in accordance with the terms of an agreement made with a State under section 5 of the Act, the rate of benefit payable to that State in respect of contributing patients and persons who are qualified patients exceeds Eight shillings per day, the additional benefit under this Part is not payable.

(2.) Where the gross fees per day for hospital treatment payable in respect of a contributing patient do not exceed Fourteen shillings per day, the additional benefit under this Part is not payable.

(3.) Where the gross fees per day in respect of a contributing patient exceed Fourteen shillings per day but do not exceed Eighteen shillings per day, there is payable, in lieu of the additional benefit specified in regulation 39 of these Regulations, an additional benefit per day ascertained by deducting an amount of Fourteen shillings from the amount of those gross fees per day.

Regulations 40 (2.), 41 (2.) and 41 (3.) do not apply in certain cases.

42. Sub-regulation (2.) of regulation 40 of these Regulations and sub-regulations (2.) and (3.) of the last preceding sub-regulation do not apply in relation to contributing patients who are qualified patients in approved private hospitals or approved public hospitals which are deemed to be organizations under paragraph (c) of sub-regulation (2.) of regulation 4 of these Regulations.

Claims for payment to be made monthly.

43. Payment of the additional benefit under this Part shall not be made unless the registered organization furnishes to the Director-General, as soon as practicable after the end of each month, a claim, in respect of that month, in the form authorized for the purposes of this regulation, together with such further information and evidence relating to the claim as is indicated in the form to be required to be furnished or as the Director-General requires.

Advances on account of claims.

44.—(1.) The Director-General may, in his absolute discretion, make an advance to a registered organization on such terms and conditions as he thinks fit for the purpose of enabling the organization to make payment of the additional benefit payable under this Part.

(2.) Where an advance has been made in pursuance of the last preceding sub-regulation and the amount payable to the organization in respect of any month is less than the amount of the advance, the amount of the difference shall be recoverable as a debt due and payable to the Commonwealth.

Notification of change of particulars.

45. If, subsequent to the registration of an organization under this Part, a change takes place in the particulars specified in the application of the organization for registration, in the tables or classes of benefits provided by the organization, in the contributions for, or the amount of, those benefits, in the instrument constituting the organization or in the articles of association or rules of the organization, the registered organization shall, within fourteen days after the change takes place, notify the Director-General in writing of the change.

Annual accounts and statements to be furnished.

46.—(1.) A registered organization shall, within three months after the expiration of the organization’s accounting year, or within such further time as the Director-General, on the application of the organization, allows, furnish to the Director-General—

(a)a copy of the balance-sheet and revenue account of the organization for that year;

 

(b) a statement setting out details of the management and administrative expenses and other disbursements incurred or made in that year in respect of both payments for hospital treatment and other payments; and

(c) a statement showing, in respect of that year—

• (i)

   the number of persons who were contributors to the funds of the organization at the end of that year, sub-divided according to the, class of benefit for which they made contributions; and

(ii) the respective numbers of persons who commenced to contribute, and who ceased to contribute, to the funds of the organization in that year, subdivided according to the class of benefit for which they made contributions.

(2.) The organization shall certify that the copies of the documents furnished under the last preceding sub-regulation are true and correct copies of what they purport to be and that the information contained in the statements so furnished is true and correct.

Inspection of books and accounts and power to require information.

47.—(1.) Where, in the opinion of the Director-General, it is desirable that the books and accounts of a registered organization be examined, the Director-General may, by writing under his hand, authorize an officer of the Department of Health to examine and report cm those books and accounts.

(2.) An officer authorized under this regulation shall, at all reasonable times, have full and free access to any premises in which those books and accounts are kept and may make extracts from, or copies of, the books and documents.

(3.) The Director-General may, by notice in writing, require a person who is or has been an officer, servant or agent of a registered organization—

(a) to furnish, within the time specified in the notice, to him or to an officer specified in the notice such information relating to the affairs of the registered organization as is required by the notice;

(b) to attend, at a time and place specified in the notice, before him or an officer specified in the notice and give evidence relating to the affairs of the registered organization; or

(c) to produce, at a time and place specified in the notice, all books, documents and accounts in his custody or under his control relating to the affairs of the registered organization.

(4.) The Director-General may require the information to be furnished or the evidence to be given on oath and either orally or in writing and, for that purpose, he or the officer specified in the notice may administer an oath.

(5.) A person shall not—

(a) refuse or fail to comply with a requirement contained in a notice given to him under sub-regulation (3.) of this regulation; or

(b) refuse to be sworn.

Additional functions of the Committee.

48.—(1.) The Director-General may refer to the Committee for examination—

(a)the documents furnished by a registered organization in accordance with regulation 46 of these Regulations;

(b)any reports and extracts from, and copies of, books and documents made by an officer under the last preceding regulation; and

(c) any information furnished or evidence given under that regulation.

(2.) The Committee may make such recommendations to the Minister as it thinks fit.

Concellation or suspension of registration.

49.—(1.) The Minister may, by notice in writing, suspend, for such period as is specified in the notice, the registration of an organization or may cancel the registration of an organization where—

(a) the Committee has recommended the suspension or cancellation of the registration of the organization;

(b) the organization fails to comply with the terms and conditions on which the registration of the organization was granted; or

(c) the organization fails to furnish the documents referred to in regulation 46 of these Regulations.

(2.) The additional benefit under this Part is not payable in respect of any period for which the registration of the organization is suspended.

(3.) Where the registration of an organization is cancelled, that organization ceases to be a registered organization.

.

PART VI.—HOSPITAL BENEFITS PAYABLE IN RESPECT OF PERSONS TEMPORARILY ABSENT FROM AUSTRALIA

Interpretation.

50.—(1.) In this Part, unless the contrary intention appears—

“dependant” means a person wholly dependent for support on a resident of Australia;

“hospital” means premises or part of premises in a place outside Australia, ordinarily recognized as a public or private hospital in that place, in which patients are received and lodged for hospital treatment for which a charge is made, but does not include premises or part of premises which consist of a mental hospital or home, a convalescent home, benevolent home, infirmary, home for the aged or an orphanage not giving hospital treatment;

“hospital treatment” means accommodation and nursing care for the purposes of—

(a) medical, surgical or obstetric treatment by or under the supervision of a medical practitioner legally qualified to practice as such in the place in which the treatment is provided; or

(b) obstetric treatment by or under the supervision of an obstetric nurse lawfully practising as such in that place;

“qualified patient” means a person who is a resident of Australia, or the spouse, child or dependant of a resident of Australia, and who occupies a bed in a hospital for the purposes of hospital treatment for which a charge is made, and includes, where two or more children are born at one birth to a qualified patient, any child born at that birth in excess of one, and also any newly born child born to a qualified patient except during the time the mother of that child is occupying a bed, but does not include a member of the staff of a hospital receiving treatment in his own quarters;

“resident of Australia” means a person who ordinarily resides in Australia, and includes a person who is a resident of Australia within the meaning of the Income Tax and Social Services Contribution Assessment Act 1936-1952 other than a person who is a resident of Norfolk Island, the Territory of Papua or the Territory of New Guinea or a person deemed to be a resident of Australia by section 7 of that Act.

(2.) The Director-General may decide whether accommodation and care afforded in a hospital is or is not hospital treatment, or whether an institution is or is not a hospital, for the purposes of this Part, and the decision of the Director-General is final and conclusive.

Benefit payable.

51.—(1.) Subject to the provisions of this Part, there is payable in respect of a qualified patient a hospital benefit of Eight shillings per day for every day on which the qualified patient occupies a bed in a hospital for the purpose of hospital treatment.

(2.) The hospital benefit payable in respect of a qualified patient in respect of any period shall not exceed—

(a) the hospital fees and expenses payable in respect of the patient for that period; or

(b) where part of the hospital fees and expenses in respect of the qualified patient for that period are paid or payable, apart from these Regulations, by the Commonwealth or where any other law (whether in force in Australia or elsewhere) provides for payment on behalf of, or reimbursement to, the qualified patient of part of those fees and expenses—the amount (if any) remaining after deducting the amount so paid or payable by the Commonwealth or the amount payable under that law, from the full amount of the fees and expenses.

(3.) The hospital benefit under this Part is not payable where the whole of the hospital fees and expenses in respect of a qualified patient are paid or payable by the Commonwealth or where any other law (whether in force in Australia or elsewhere) provides for payment on behalf of, or reimbursement to, the qualified patient of those fees and expenses.

Obstetric cases.

52.The hospital benefit under this Part is not payable in respect of obstetric cases for any waiting period which is in excess of two days before the onset of labour or for any period which is in excess of fifteen days after the birth of a child, unless a medical practitioner, legally qualified to practice as such in the place in which the hospital is

situated, certifies that the patient was in need of the longer period of hospital attention on account of an abnormality, disease of pregnancy or the puerperium or a complication or difficult labour, specified in the certificate.

Claims for periods exceeding eight weeks.

53. The hospital benefit under this Part is not payable in respect of a qualified patient for a period in excess of eight weeks, unless a medical practitioner, legally qualified to practice as such in the place in which the hospital is situated, certifies as to the nature of the illness and the reason which rendered hospital treatment for a period in excess of eight weeks necessary, and the Director-General is satisfied that the hospital treatment was necessary for a period exceeding eight weeks.

Additional benefit payable.

54. The additional benefit payable under Part V. of these Regulations is payable, in accordance with that Part, in respect of a qualified patient to whom the hospital benefit under this Part is payable and who was a contributing patient during the period for which the hospital benefit payable under this Part was payable in the same manner, and subject to the same conditions, as if that qualified patient had received hospital treatment in an approved private hospital or an approved public hospital in Australia.

Manner of making claims.

55. Each claim for hospital benefit and additional hospital benefit under this Part shall be—

(a) in accordance with a form authorized for the purposes of this regulation;

(b) signed by the qualified patient or by some responsible person on behalf of the patient; and

(c) accompanied by—

• (i)

   the receipted hospital account in respect of the period covered by the claim;

(ii) a certificate, in accordance with the authorized form, of the medical practitioner or obstetric nurse by or under whose supervision the medical, surgical or obstetric treatment was received; and

(iii) where necessary, by the certificate referred to in regulation 52 or regulation 53 of these Regulations.

Manner of payment.

56.—(1.) Hospital benefit and additional benefit in respect of a qualified patient shall be paid in such manner and to such person as the Director-General considers to be appropriate.

(2.) The Director-General may make arrangements with representatives of the Commonwealth outside Australia for the payment of the hospital benefit and additional hospital benefit under this Part.

Power to dispense with certain requirements.

57. The Director-General may, in special circumstances, dispense with the production, in support of a claim for hospital benefit or additional hospital benefit under this Part, of a document, certificate or other evidence required to be furnished under this Part, and may direct payment of benefit as if the document, certificate or other evidence had been produced.

PART VII.—MISCELLANEOUS.

Delegation.

58.—(1.) 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 to the State or part of Australia, or place outside Australia, specified in the instrument of delegation.

(2.) Every delegation by the Minister or the Director-General is revocable in writing at will and no delegation prevents the exercise of a power by the Minister or the Director-General.

Offences.

59.—(1.) A person or a registered organization shall not, whether in Australia or elsewhere—

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

(b) obtain payment of hospital benefit or additional benefit which is not payable;

(c) obtain payment of hospital benefit or additional benefit by means of a false or misleading statement;

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

(e) contravene or fail to comply with a provision of these Regulations which is applicable to him or it.

(2.) A person shall not, for any purpose whatsoever, make a representation that an organization, association or body that is not a registered organization is a registered organization.

Penalty: Fifty pounds or imprisonment for three months.

 

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