Medicare Australia (Functions of Chief Executive Officer) Direction 2005 (Cth)

Medicare Australia (Functions of Chief Executive Officer) Direction 2005

as amended

made under section 5 (1) (d) of the

Medicare Australia Act 1973

This compilation was prepared on 17 August 2007
taking into account amendments up to Medicare Australia (Functions of Chief Executive Officer) Amendment Direction 2007 (No. 2)

Prepared by the Office of Legislative Drafting and Publishing,
Attorney‑General’s Department, Canberra

Contents

1Name of Direction [see Note 1]   3
2Commencement   3
3Definitions   3
4Functions in relation to inappropriate practices   3
5Functions in relation to medicare benefits   5
6Functions in relation to undertakings by optometrists   5
7Functions in relation to pathology services etc   6
8Functions in relation to pathology laboratories and specimen collection centres            8
9Functions in relation to remote area exemptions   9
10Functions in relation to diagnostic imaging services   9
11Functions in relation to radiation oncology services   9
12Functions in relation to health program grants   9
13Functions in relation to the Medicare Benefits Advisory Committee          9
14Functions in relation to certain committees   10
15Functions in relation to the General Practice Recognition Eligibility Committee and the General Practice Recognition Appeal Committee   12
16Miscellaneous functions in relation to the Health Insurance Act              12
17Functions in relation to accredited orthodontists   13
18Functions in relation to the allocation of identification numbers               13
19Functions in relation to the provision of certain appliances   13
20Functions in relation to the provision of pharmaceutical benefits             13
21Miscellaneous functions in relation to the National Health Act                15
22Functions in relation to claims by, and payments to, hearing services providers            16
23Functions in relation to claims for compensation under the Military Rehabilitation and Compensation Act 2004   17
24Functions in relation to claims for treatment provided under certain Acts 17
25Functions in relation to the Income Tax Assessment Act 1936              18
27Functions in relation to the registration of sonographers   18
28Functions in relation to mental health care   18
29Functions in relation to the Bowel Cancer Screening Pilot   18
30Functions in relation to the Prescription Shopping Project   19
31Functions in relation to planning and preparation of legislative proposals 22
32Functions in relation to consultancy, management and information technology services 23
33Functions in relation to the provision of special assistance                    23
34Functions in relation to payments   24
35Functions in relation to the unique healthcare identifier program             25

Notes 27

Name of Direction [see Note 1]

This Direction is the Medicare Australia (Functions of Chief Executive Officer) Direction 2005.

Commencement

This Direction commences on 1 October 2005.

Definitions

In this Direction:

Act means the Medicare Australia Act 1973.

Note Before 1 October 2005, the Medicare Australia Act 1973 was known as the Health Insurance Commission Act 1973.

Health Insurance Act means the Health Insurance Act 1973.

Health Minister means the Minister administering the Health Insurance Act and the National Health Act.

Human Services Minister means the Minister administering the Medicare Australia Act 1973.

Military Rehabilitation and Compensation Commission means the Commission established by section 361 of the Military Rehabilitation and Compensation Act 2004.

National Health Act means the National Health Act 1953.

Repatriation Commission means the Repatriation Commission continued in existence by section 179 of the Veterans’ Entitlements Act 1986.

Note Unless otherwise stated, a term used in this Direction and in the Act has the same meaning in this Direction as it has in the Act. The following terms are defined in section 3 of the Act:

· Chief Executive Officer

· Commonwealth service

· medicare benefit

· pharmaceutical benefit.

Functions in relation to inappropriate practices

(1) In this section, the following expressions have the same meaning as in Part VAA of the Health Insurance Act:

(a) inappropriate practice;

(b) practitioner;

(c) service.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) to devise and implement measures intended:

(i) to prevent practitioners and other persons from engaging in inappropriate practice; and

(ii) to facilitate the detection of cases where practitioners or other persons have engaged in inappropriate practice in connection with rendering or initiation of services and to enable the identification of those services; and

(iii) to prevent, or facilitate the detection of, activities related to claims for payment, or the receipt, of medicare benefits that may constitute an offence under the Health Insurance Act, the Crimes Act 1914 or the Criminal Code;

(b) if there are reasonable grounds to suspect that a practitioner or other person has engaged in inappropriate practice, to investigate the conduct of that practitioner or other person for the purpose of deciding whether to request the Director of Professional Services Review, appointed under section 83 of the Health Insurance Act, to review the provision of services by the practitioner or other person;

(c) to investigate cases where there are reasonable grounds to suspect that:

(i) an act done by a person in relation to a claim for payment, or the receipt, of medicare benefits may constitute an offence under the Health Insurance Act, the Crimes Act 1914 or the Criminal Code; or

(ii) a person may have committed an offence against section 23DP, 106D or 106EA, or subsection 19D (2), 19D (7), 106E (1) or 106E (2), of the Health Insurance Act;

and, where an investigation discloses that there is sufficient evidence to warrant a prosecution, to refer the case investigated and the information obtained in the course of the investigation to the Australian Federal Police or the Director of Public Prosecutions;

(d) on behalf of the Health Minister:

(i) to give directions under subsections 19C (3) and (4) of the Health Insurance Act and undertake such action as is required under that Act in relation to those directions; and

(ii) to undertake, unless otherwise directed by the Health Minister, such action as is required of the Health Minister under subsections 19CA (2), (4) and (5) of that Act in relation to the review of a decision; and

(iii) to give a direction under subsection 19CB (1) of that Act;

(e) to give advice to the Health Minister in relation to directions that are to be given personally by the Health Minister under section 19D of the Health Insurance Act;

(ea) for directions under subsection 19D (1), (1A), (3) or (5) of the Health Insurance Act that are not directions to be given personally by the Health Minister — to give directions on behalf of the Health Minister under any of those subsections;

(eb) to undertake, on behalf of the Health Minister, such action as is required under the Health Insurance Act in relation to the directions mentioned in paragraph (e) or (ea);

(f) to provide such clerical and administrative services as are necessary to enable the Health Minister to exercise his or her powers under Divisions 3, 4 and 5 of Part VA of the Health Insurance Act, as in force on 31 July 1999;

(g) to undertake action (including the institution of legal proceedings) to recover from a person an amount of medicare benefit that is recoverable by the Commonwealth from that person under the Health Insurance Act or otherwise.

Functions in relation to medicare benefits

(1) In this section, the following expressions have the same meaning as in section 3 of the Health Insurance Act:

(a) medical expenses;

(b) practitioner;

(c) professional service.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions on behalf of the Health Minister:

(a) to approve, under subsection 16 (1) of the Health Insurance Act, the payment of a medicare benefit;

(b) to make a determination under subsection 18 (1) of that Act;

(c) under the definition of approved form in subsection 3 (1) of that Act, and subject to subsection 3 (16) of that Act, to approve forms for the purposes of sections 20A and 20B of that Act;

(d) to allow, under subsection 20B (3A) of that Act, a longer period for lodging a claim for a medicare benefit;

(e) to approve, for the purposes of subsection 20BA (6) of that Act, a medium for storing referrals and other information.

Functions in relation to undertakings by optometrists

(1) In this section:

optometrist has the same meaning as in section 23A of the Health Insurance Act.

undertaking means an undertaking in accordance with the common form of undertaking as drawn up or varied from time to time under section 23A of the Health Insurance Act.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) to process undertakings by optometrists that are given to the Health Minister for the purposes of section 23B of the Health Insurance Act;

(b) on behalf of the Health Minister:

(i) to accept, or refuse to accept, an undertaking in accordance with section 23B of the Health Insurance Act; or

(ii) to refer to an Optometrical Services Committee of Inquiry for inquiry and report the question whether the Health Minister would be justified in refusing to accept an undertaking;

(c) to serve on an optometrist, in accordance with subsection 23B (3) of the Health Insurance Act, notification of acceptance or refusal of acceptance of the optometrist’s undertaking.

Functions in relation to pathology services etc

(1) In this section, the following expressions have the same meaning as in section 3 of the Health Insurance Act:

(a) approved pathology authority;

(b) approved pathology practitioner.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) on behalf of the Health Minister:

(i) to give a direction under subsection 4B (3) of the Health Insurance Act; and

(ii) to approve the form of a request or confirmation for the purposes of subsection 16A (12) of that Act; and

(iii) under the definition of approved form in subsection 3 (1) of that Act, and subject to subsection 3 (16) of that Act, to approve forms of application for the purposes of paragraphs 23DC (2) (b) and 23DF (2) (b) of that Act; and

(iv) to carry out the functions conferred on the Health Minister by sections 23DDA and 23DGA of that Act; and

(v) to approve, for the purposes of paragraphs 23DK (7) (a) and (b) of that Act, mediums for recording a request or confirmation; and

(vi) under subsection 23DK (8) of that Act, to set out in an approval any conditions to which the approval is subject; and

(vii) under the definition of approved form in subsection 3 (1) of that Act, and subject to subsection 3 (16) of that Act, to approve a form of application for the purposes of subsection 23DN (1) of that Act; and

(viii) to carry out the functions conferred on the Health Minister by section 23DN of that Act; and

(ix) under the definition of approved form in subsection 3 (1) of that Act, and subject to subsection 3 (16) of that Act, to approve a form for the purposes of subsection 23DP (3) of that Act;

(b) on behalf of the Health Minister under sections 23DC and 23DF of the Health Insurance Act:

(i) to determine, under paragraph 23DC (2) (c) or 23DF (2) (c), the particulars to be contained in an application; and

(ii) to process applications for acceptance of undertakings given by persons who wish to become approved pathology practitioners or approved pathology authorities, respectively; and

(iii) to undertake any investigations and inquiries that are necessary or expedient in relation to applications for acceptance of undertakings; and

(iv) to accept or refuse to accept an undertaking; and

(v) to give a notice under subsection 23DC (10) or 23DF (11) of that Act, including (in accordance with section 23DDA or 23DGA of that Act) a notice specifying as the day on which an undertaking is taken to have come into force, a day earlier than the day on which the undertaking was accepted; and

(vi) to undertake any other action as is required under section 23DC or 23DF in relation to the acceptance or refusal of an undertaking;

(c) to process notices of termination of undertaking given under section 23DE or 23DH of the Health Insurance Act;

(d) unless otherwise directed by the Health Minister:

(i) to carry out the functions conferred on the Health Minister by section 23DL of the Health Insurance Act; and

(ii) to review, under subsection 23DO (2) or (2D) of that Act, a decision of the Health Minister; and

(iii) to give a notice under subsection 23DO (3) of that Act;

(e) to undertake, for the purpose of enabling the Health Minister to perform his or her functions under sections 23DL and 23DO of the Health Insurance Act, any investigations and inquiries that are necessary or expedient in relation to:

(i) the compliance with, or the breach of, an undertaking given by a person who is or was an approved pathology practitioner or an approved pathology authority; and

(ii) the review of a decision of the Health Minister to refuse to accept an undertaking given under subsection 23DC (1) or 23DF (1) of the Health Insurance Act; and

(iii) the detection of offences in relation to requests of the kind referred to in section 16A of that Act;

and to refer to the Health Minister:

(iv) any information obtained in the course of the investigations or inquiries, being information relevant to the matters in relation to which the investigations or inquiries were undertaken; and

(v) any comments and recommendations arising from the investigations or inquiries that the Chief Executive Officer considers appropriate;

(f) to provide such clerical and administrative services in relation to a matter specified in paragraph (b) or (e) as the Health Minister may require.

Functions in relation to pathology laboratories and specimen collection centres

(1) In this section, a word or expression that is defined for the purposes of:

(a) the Health Insurance Act; or

(b) Part IIA of that Act; or

(c) Division 4A, or a section of Division 4A, of that Part;

has the meaning given to it by that definition.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions on behalf of the Health Minister:

(a) under Division 4 or 4A of Part IIA of the Health Insurance Act or under any applicable principles determined under a provision of either of those Divisions:

(i) to approve in principle, and approve, premises as an accredited pathology laboratory; and

(ii) to refuse to approve premises as an accredited pathology laboratory; and

(iii) to vary or revoke an approval of a kind mentioned in subparagraph (i); and

(iv) to determine a qualification to be equivalent, or not to be equivalent, to a qualification referred to in:

(A) paragraph (a) or (b) of the definition of scientist in subsection 23DNA (4) of the Health Insurance Act; or

(B) paragraph (a) or (b) of the definition of senior scientist in that subsection; and

(v) to give a notice under subsection 23DNA (5) of that Act; and

(vi) to grant an approval for an eligible collection centre under section 23DNBA of the Health Insurance Act; and

(vii) to allocate an identification number to an approved collection centre under section 23DNBB of that Act; and

(viii) to revoke an approval under section 23DNG of that Act; and

(ix) to cancel an approval under section 23DNH of that Act; and

(x) if an approval granted under section 23DNBA of that Act is cancelled — to pay a partial refund of the tax paid on the grant of the approval; and

(xi) to give authorisation to a person for the purposes of section 23DNJ of that Act;

(b) under subsection 23DO (2B) of the Health Insurance Act, to review a decision, made under the definition of scientist, or senior scientist, in subsection 23DNA (4) of that Act, that a qualification is not equivalent to a qualification referred to in paragraph (a) or (b) of the definition;

(c) under subsection 23DO (2DB) of the Health Insurance Act, to review a decision not to grant an approval for an eligible collection centre under section 23DNBA of that Act;

(d) under subsection 23DO (2H) of the Health Insurance Act, to review a decision to revoke an approval under section 23DNG of that Act.

Functions in relation to remote area exemptions

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform, on behalf of the Health Minister, the functions conferred on the Health Minister by Division 2 of Part IIB of the Health Insurance Act in relation to remote area exemptions, other than the function of making a determination under subsection 23DU (1) of that Act.

Functions in relation to diagnostic imaging services

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions on behalf of the Health Minister:

(a) to give a direction under subsection 16D (1) of the Health Insurance Act;

(b) to carry out the functions conferred on the Health Minister by sections 23DZH and 23DZJ of that Act;

(c) to carry out the functions conferred on the Health Minister by Division 4 of Part IIB of that Act in relation to the Diagnostic Imaging Register.

Functions in relation to radiation oncology services

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions on behalf of the Health Minister:

(a) to give a direction under subsection 16F (1) of the Health Insurance Act;

(b) to carry out the functions conferred on the Health Minister by Part IIC of that Act in relation to the Radiation Oncology Register.

Functions in relation to health program grants

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions on behalf of the Health Minister:

(a) to process claims for payment under Part IV of the Health Insurance Act in relation to costs of the provision of radiation oncology services submitted to the Department of Health and Ageing under subsection 45 (1) of that Act;

(b) to make payments of those claims.

Functions in relation to the Medicare Benefits Advisory Committee

(1) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the function of providing to the Medicare Benefits Advisory Committee established under subsection 66 (1) of the Health Insurance Act all clerical or administrative support services that are necessary or convenient for the performance of the Committee’s functions under section 67 of that Act.

(2) This function includes:

(a) preparing and distributing briefing material for consideration by the Committee; and

(b) drafting reports of the Committee; and

(c) arranging travel, and payment of sitting fees and expenses, for members (including acting members) of the Committee; and

(d) preparing notices by delegates of the Health Minister to appellants regarding the results of appeals; and

(e) distributing circulars setting out, by way of precedents, decisions arising out of recommendations of the Committee.

Functions in relation to certain committees

(1) This section applies to the following committees:

(a) a Specialist Recognition Advisory Committee, established under section 48 of the Health Insurance Act;

(b) the Specialist Recognition Appeal Committee, established under section 49 of that Act;

(c) a Medicare Participation Review Committee, established under section 124E of that Act;

(d) a Medical Benefits (Dental Practitioners) Committee, established under section 136 of the National Health Act;

(e) the General Practice Recognition Eligibility Committee, established under regulation 9 of the Health Insurance (Vocational Registration of General Practitioners) Regulations 1989;

(f) the General Practice Recognition Appeal Committee, established under regulation 10 of those Regulations.

(2) In this section, the following expressions have the same meaning as in section 3 of the Health Insurance Act:

(a) dental practitioner;

(b) medical practitioner.

(3) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) to prepare material for meetings of a committee;

(b) to draft minutes of those meetings;

(c) to prepare notices from:

(i) the chairperson of a committee regarding decisions of the committee; or

(ii) the Health Minister regarding decisions of a committee;

(d) to prepare, on behalf of a committee, statements of reasons and responses to persons who have applied to the committee for recognition;

(e) to arrange appointments of members (including acting members) of a committee and of consultants to a committee;

(f) to prepare instruments of referral of matters to a committee;

(g) to prepare determinations for the Health Minister in relation to matters on which a committee has advised the Health Minister;

(h) to arrange travel, and payment of sitting fees and expenses, for members (including acting members) of a committee;

(i) in relation to a Medical Benefits (Dental Practitioners) Committee — for the purposes of administering the scheme known as the Cleft Lip and Cleft Palate Scheme:

(i) to make a declaration on behalf of the Health Minister for the purposes of paragraph 3BA (2A) (d) of the Health Insurance Act; and

(ii) to make a determination on behalf of the Health Minister for the purposes of paragraph 3BA (3) (a) of that Act; and

(iii) to approve, on behalf of the Health Minister, medical practitioners and dental practitioners for the purposes of subsection 3BA (4) of that Act; and

(iv) to maintain a register of medical practitioners or dental practitioners, or medical practitioners and dental practitioners, who are approved for the purposes of the Scheme; and

(v) to approve, on behalf of the Health Minister under subsection 3BA (5) of that Act, the form of certificate that may be issued for the purposes of paragraphs 3BA (1) (a), (2) (a) and (3) (a) of that Act; and

(vi) to register applications by patients for admission to the Scheme; and

(vii) to issue a numbered card to each patient under the Scheme for facilitating payment to the patient of medicare rebates related to the Scheme;

(j) in relation to a Medicare Participation Review Committee:

(i) on behalf of the Health Minister:

(A) to give a notice to a Chairperson of a Committee under section 124D or subsection 124E (5) of the Health Insurance Act; and

(B) to carry out the functions conferred on the Health Minister by section 124EA of that Act; and

(C) to revoke an undertaking under subsection 124S (3) of that Act; and

(D) to carry out the functions conferred on the Health Minister by subsection 124S (4) of that Act; and

(ii) to undertake on behalf of a Committee any investigations and inquiries that are necessary or expedient in relation to a matter in respect of which the Committee was established; and

(iii) to refer to the Committee any information obtained in the course of the investigations or inquiries, being information relevant to the matter in respect of which the Committee was established; and

(iv) to refer to the Committee any comments and recommendations arising from the investigation or inquiries that the Chief Executive Officer considers appropriate; and

(v) to provide such clerical and administrative services as the Committee may require;

(k) in relation to a Specialist Recognition Advisory Committee and the Specialist Recognition Appeal Committee — on behalf of the Health Minister, to carry out the functions conferred on the Health Minister by subsections 52 (1), (2) and (6) and sections 53, 61, 62 and 64 of that Act.

Functions in relation to the General Practice Recognition Eligibility Committee and the General Practice Recognition Appeal Committee

(1) In this section, the following expressions have the same meaning as in the Health Insurance (Vocational Registration of General Practitioners) Regulations 1989:

(a) Committee;

(b) member.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions on behalf of the Health Minister under the Health Insurance (Vocational Registration of General Practitioners) Regulations 1989:

(a) to call a meeting of a Committee under regulation 12 of those Regulations;

(b) to appoint, under regulation 13 of those Regulations, a person to act in the office of a member of a Committee;

(c) to ask for nominations under regulation 16 of those Regulations;

(d) to approve the engaging of a consultant under regulation 20 of those Regulations.

Miscellaneous functions in relation to the Health Insurance Act

(1) In this section, the following expressions have the same meaning as in section 3 of the Health Insurance Act:

(a) dental practitioner;

(b) medical practitioner;

(c) professional service;

(d) vocationally registered general practitioner.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions on behalf of the Health Minister:

(a) to accredit a dental practitioner for the purposes of the definition of accredited dental practitioner in section 3 of the Health Insurance Act;

(b) to give a direction under subsection 3 (5) of that Act;

(c) to carry out the functions conferred on the Health Minister by sections 3DB and 3DC of that Act;

(d) to make, and revoke, a determination under section 3E of that Act;

(e) to approve, under subsection 3F (5) of that Act, the manner in which a medical practitioner may apply for registration as a vocationally registered general practitioner;

(f) to provide certification for the purposes of paragraph 130 (3) (a), subsection 130 (7) and paragraph 130 (8) (b) of that Act;

(g) to decide, for the purposes of paragraph 130 (3) (c) of that Act, if express or implied authorisation to divulge information has been given.

Functions in relation to accredited orthodontists

(1) In this section:

dental practitioner has the same meaning as in the Health Insurance Act.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the function of accrediting, on behalf of the Health Minister, a dental practitioner for the purposes of the definition of accredited orthodontist in the regulations made under the Health Insurance Act that prescribe a table of medical services for the purposes of subsection 4 (1) of that Act.

Functions in relation to the allocation of identification numbers

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) the allocation of identification numbers, for the purposes of the National Health Act, to medical practitioners within the meaning of that Act and participating dental practitioners within the meaning of Part VII of that Act;

(b) the allocation of identification numbers, for the purposes of the Health Insurance Act, to persons who are practitioners, approved pathology practitioners or participating optometrists within the meaning of that Act, in respect of the particular places of practice of those persons.

Functions in relation to the provision of certain appliances

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions on behalf of the Health Minister:

(a) to process claims for payment relating to stoma appliances the supply of which is arranged under paragraph 9A (1) (a) of the National Health Act;

(b) to make payments of those claims.

Functions in relation to the provision of pharmaceutical benefits

(1) In this section:

National Health (Pharmaceutical Benefits) Regulations means the National Health (Pharmaceutical Benefits) Regulations 1960.

Secretary means the Secretary to the Department of Health and Ageing.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) on behalf of the Secretary, to perform the functions conferred on the Secretary by Part VII of the National Health Act, other than:

(i) to make appointments under subsection 99N (2), and terminate appointments under subsection 99N (4), of that Act; and

(ii) to make arrangements for the testing or analysis of pharmaceutical benefits or drugs that may be used as pharmaceutical benefits under section 102 of that Act;

(b) on behalf of the Health Minister, to perform the functions conferred on the Health Minister by sections 94 and 98AA of the National Health Act;

(c) on behalf of the Health Minister, to perform the functions conferred on the Health Minister by Part VIII or IX of the National Health Act in relation to the provision of pharmaceutical benefits, other than:

(i) to establish, and appoint members of, a Pharmaceutical Services Federal Committee of Inquiry under subsection 113 (1) of that Act; and

(ii) to establish, and appoint members of, a Pharmaceutical Services Committee of Inquiry for a State under section 115 of that Act; and

(iii) to establish, and appoint members of, a Nursing Home Fees Review Committee of Inquiry for a State under section 117A of that Act; and

(iv) to terminate the appointment of a member of a Committee under subsection 119 (1) of that Act; and

(v) to appoint a person to act in the stead of a member of a Committee under section 119A of that Act; and

(vi) any functions conferred on the Health Minister by sections 114, 116, 117B and subsection 125 (2) of that Act; and

(vii) to establish a Committee under subsection 136 (1) of that Act; and

(viii) to appoint a member of a Committee under section 136A of that Act; and

(ix) to give directions to the Secretary, or a delegate of the Secretary, under sections 138 and 138A of that Act;

(d) on behalf of the Secretary, to perform the functions conferred on the Secretary by Part VIII or IX of the National Health Act in relation to the provision of pharmaceutical benefits, other than:

(i) to appoint a person to act in the Secretary’s stead as a member of a Pharmaceutical Services Federal Committee of Inquiry under subsection 113 (2) of that Act; and

(ii) to revoke the appointment of such a person; and

(iii) any functions conferred on the Secretary by sections 114 and 116 and subsection 125 (2) of that Act;

(e) on behalf of the Secretary, to perform the functions conferred on the Secretary by the National Health (Pharmaceutical Benefits) Regulations;

(f) on behalf of the Health Minister, to perform the functions conferred on the Health Minister by the National Health (Pharmaceutical Benefits) Regulations, other than:

(i) to determine the rate at which, and the conditions subject to which, payments of pharmaceutical benefits are to be made under regulation 18 of those Regulations; and

(ii) to appoint the Chairperson of the Pharmaceutical Benefits Advisory Committee under regulation 39 of those Regulations; and

(iii) any functions conferred on the Health Minister by regulations 40, 45 and 47 of those Regulations;

(g) for the purposes of Part VII of the National Health Act, to process claims for payment relating to the provision of pharmaceutical benefits and to make payments of those claims;

(h) to process, on behalf of the Repatriation Commission and the Military Rehabilitation and Compensation Commission, claims for payment relating to the provision of pharmaceutical benefits under the Veterans’ Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004, and to make payments of those claims;

(i) to devise and implement measures intended to prevent, or facilitate the detection of, contraventions of Part VII of the National Health Act or the National Health (Pharmaceutical Benefits) Regulations;

(j) to investigate cases where there are reasonable grounds to suspect that an act done by a person in relation to the provision of a pharmaceutical benefit may constitute an offence under the National Health Act, the Crimes Act 1914, the Criminal Code or the National Health (Pharmaceutical Benefits) Regulations and, where an investigation discloses that there is sufficient evidence to warrant a prosecution, to refer the case investigated and the information obtained in the course of the investigation to the Australian Federal Police or the Director of Public Prosecutions;

(k) to undertake action (including the institution of legal proceedings) to recover from a person an amount in respect of a pharmaceutical benefit that is recoverable by the Commonwealth from that person under the National Health Act, the National Health (Pharmaceutical Benefits) Regulations or otherwise;

(l) on behalf of the Secretary, to provide a certification under section 139A of the National Health Act in relation to medical practitioners, dental practitioners, pharmacists and hospital authorities.

Miscellaneous functions in relation to the National Health Act

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) on behalf of the Health Minister:

(i) to carry out the functions conferred on the Health Minister by section 134A of the National Health Act; and

(ii) to provide certification for the purposes of paragraph 135A (3) (a), subsection 135A (7) and paragraph 135A (8) (b) of that Act; and

(iii) to decide, for the purposes of paragraph 135A (3) (c) of that Act, if express or implied authorisation to divulge information has been given;

(b) on behalf of the Secretary to the Department of Health and Ageing, to divulge information under subsections 135A (3), (6) and (7) of the National Health Act.

Functions in relation to claims by, and payments to, hearing services providers

(1) In this section:

client means a person who received a hearing service for which a claim has been made.

(2) In this section the following expressions have the same meaning as in the provision of the Hearing Services Administration Act 1997 mentioned:

(a) contracted service provider — section 4;

(b) hearing services — section 4;

(c) service provider debt — subsection 24 (1);

(d) voucher — section 4.

(3) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

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

(b) the function of a claims payment body for that section.

(4)This function includes:

(a) recovering, under section 24 of the Hearing Services Administration Act 1997, a service provider debt the existence of which:

(i) is apparent from the records of the Chief Executive Officer; or

(ii) is made known to the Chief Executive Officer by the Department of Health and Ageing; and

(b) disclosing the following information to the Department of Health and Ageing about a claim accepted or paid by the Chief Executive Officer:

(i) client number;

(ii) voucher number;

(iii) date on which the claim was given to the Chief Executive Officer;

(iv) date on which the claim was processed by the Chief Executive Officer;

(v) date of the service to which the claim relates;

(vi) provider number;

(vii) practitioner number;

(viii) site identification;

(ix) item number;

(x) hearing loss details for right and left ears;

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

(xii) date on which the device was fitted;

(xiii) details of top‑up devices;

(xiv) contracted service provider’s certification details;

(xv) client certification details;

(xvi) cost to the client;

(xvii) payment details;

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

(xix) any other details about the processing of the claim.

(5) Subsection (3) has effect only when a declaration that the Chief Executive Officer is a claims acceptance body, or a claims payment body, for the purposes of section 21 of the Hearing Services Administration Act 1997 is in force.

Functions in relation to claims for compensation under the Military Rehabilitation and Compensation Act 2004

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) to process, on behalf of the Military Rehabilitation and Compensation Commission, claims for compensation under Chapter 6 of the Military Rehabilitation and Compensation Act 2004;

(b) to make payments in respect of those claims.

Functions in relation to claims for treatment provided under certain Acts

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) to process, on behalf of the Repatriation Commission and the Military Rehabilitation and Compensation Commission, claims for payment in respect of:

(i) the provision of medical treatment under Division 2 of Part IV of the Seamen’s War Pensions and Allowances Regulations, as in force on 30 June 1994; and

(ii) the provision of treatment under the Veterans’ Entitlements Act 1986, the Safety, Rehabilitation and Compensation Act 1988 and the Military Rehabilitation and Compensation Act 2004;

(b) to make payments of those claims.

Functions in relation to the Income Tax Assessment Act 1936

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the function of providing, on behalf of the Health Minister, certification for the purposes of paragraph 251U (1) (f) of the Income Tax Assessment Act 1936.

Functions in relation to the registration of sonographers

For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the function of establishing and maintaining a Register of Sonographers.

Functions in relation to mental health care

(1) In this section:

general practitioner means a medical practitioner (other than a specialist or consultant physician) who practices in general practice.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the functions of establishing and maintaining a register of general practitioners who may provide Focussed Psychological Strategies under the Better Outcomes in Mental Health Care Initiative administered by the Department of Health and Ageing.

Functions in relation to the Bowel Cancer Screening Pilot

(1) In this section:

Bowel Cancer Screening Pilot, or Pilot, means the national pilot for the early detection of bowel cancer as announced in the 2000–2001 Commonwealth Budget, conducted by, or on behalf of, the Commonwealth.

health professional means a person or body involved in the provision of health care, including but not limited to medical practitioners, pathologists and allied health professionals.

participant means a person who is within the target population for the Pilot, as determined by the Department of Health and Ageing from time to time.

Register means the register of information about participants for the purposes of the Pilot including, but not limited to, names, addresses and clinical information.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the function of administering, or assisting with the administration of, aspects of the Bowel Cancer Screening Pilot conducted by, or on behalf of, the Commonwealth.

(3) This function includes:

(a) the establishment and maintenance of the Register known as the National Bowel Cancer Screening Pilot Register; and

(b) the service function, described in subsection (4); and

(c) the epidemiological and monitoring function, described in subsection (5); and

(d) the doing of anything incidental or conducive to the performance of the above functions.

(4) The service function is to:

(a) invite participants for screening and re‑screening at appropriate intervals; and

(b) provide a system of communication with participants and health professionals to allow for appropriate and timely follow up of participants; and

(c) record participants’ screening and detection histories in the Register; and

(d) provide information on a participant’s screening and detection history recorded in the Register to health professionals to assist them in advising participants about options for their clinical management; and

(e) make payments to health professionals, or another person authorised by the health professional to receive the payment, for services provided to participants and for the transfer of information about participants to the Register.

(5) The epidemiological and monitoring function is to:

(a) monitor participation rates for participants; and

(b) monitor the response rate of participants and their health professionals to reminders for screening, re‑screening and follow up; and

(c) assist in evaluating the response of participants to public education campaigns designed to promote screening activity; and

(d) provide identified information about consenting participants to the Australian Institute of Health and Welfare to assist in assessing the accuracy of screening tests by comparing screening register data with cancer and other disease registry data; and

(e) provide de‑identified information about the Pilot to the Department of Health and Ageing to assist in:

(i) monitoring screening and disease trends; and

(ii) studying the efficacy of the management and treatment of abnormal screening and follow up results; and

(iii) monitoring and evaluating the quality, effectiveness and cost‑effectiveness of the Pilot; and

(iv) increasing public awareness of bowel cancer and screening.

Functions in relation to the Prescription Shopping Project

(1) In this section:

approved supplier has the same meaning as in Part VII of the National Health Act.

health care providers includes:

(a) medical practitioners; and

(b) prescribers; and

(c) pharmacists; and

(d) approved suppliers; and

(e) dentists; and

(f) State and Territory health departments; and

(g) State and Territory mental health authorities; and

(h) private and public pain management clinics; and

(i) private and public alcohol or drug detoxification centres; and

(j) private and public hospitals.

nominated prescriber, in relation to a prescription shopper, means a prescriber nominated by the prescription shopper from time to time to be that person’s primary prescriber.

PBS information means any information collected by the Chief Executive Officer, whether before, on or after 1 October 2005, in performing functions conferred on the Chief Executive Officer to administer the Pharmaceutical Benefits Scheme established under Part VII of the National Health Act.

pharmacist means a person registered as a pharmacist or pharmaceutical chemist under a law of a State or Territory providing for the registration of pharmacists or pharmaceutical chemists.

prescriber means a person who prescribes a pharmaceutical benefit and is, at the time of prescribing the pharmaceutical benefit, a medical practitioner authorised by Part VII of the National Health Act to do so, or purports to be so authorised.

prescription shopper has the meaning given by subsection (2).

Prescription Shopping Project, or Project, means the project provided for in the 2002–2003 Commonwealth Budget under the measure entitled ‘Sustaining the PBS ‑ Restrictions on Doctor Shopping’.

target pharmaceutical benefits means pharmaceutical benefits in any of the following categories:

(a) Nordic stem code N02 (Analgesics);

(b) Nordic stem code N03 (Antiepileptics);

(c) Nordic stem code N04 (Anti‑Parkinson Drugs);

(d) Nordic stem code N05 (Psycholeptics);

(e) Nordic stem code N06 (Psychoanaleptics);

(f) Nordic stem code N07 (Other central nervous system drugs);

(g) Nordic stem code R03 (Drugs for obstructive airway diseases);

(h) Nordic stem code C10A (Serum Lipid Reducing Agents);

(i) Nordic stem code A02B (Drugs for peptic ulcer and gastro‑oesophageal reflux diseases);

(j) Nordic stem code J01 (Antibacterials for Systemic Use);

(k) Nordic stem code M01 (Antiinflammatory and Antirheumatic products);

(l) Nordic stem code A10A (Insulin and analogues);

(m) Nordic stem code C02 (Antihypertensives).

(2) In this section, prescription shopper means a person who, within any 3 month period (being the 3 month period ending on 31 December 2002, or a later period):

(a) has had supplied to him or her pharmaceutical benefits prescribed by 6 or more different prescribers; or

(b) has had supplied to him or her a total of 25 or more target pharmaceutical benefits; or

(c) has had supplied to him or her a total of 50 or more pharmaceutical benefits.

(3) For paragraph (2) (a), prescriber does not include a prescriber who is a specialist for the purposes of subsection 3 (1) of the Health Insurance Act and who has prescribed pharmaceutical benefits to a person in that capacity.

(4) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the function of administering the Prescription Shopping Project.

(5) This function includes:

(a) the education and prevention function, described in subsection (6); and

(b) the identification and detection function, described in subsection (7); and

(c) the disclosure function, described in subsection (8); and

(d) the evaluation and reporting function, described in subsection (10); and

(e) the doing of anything incidental or conducive to the performance of the above functions, including using PBS information.

(6) The education and prevention function is to:

(a) promote awareness of the Project to health care providers, prescription shoppers and members of the Australian public; and

(b) promote measures to assist health care providers to manage prescription shoppers or people who may be at risk of prescription shopping; and

(c) educate health care providers and prescription shoppers about the legislative framework and requirements within which the Project operates; and

(d) encourage prescription shoppers to have a nominated prescriber; and

(e) encourage prescribers to become nominated prescribers; and

(f) encourage communication links between prescribers, approved suppliers and pharmacists; and

(g) discourage inefficient and improper use of pharmaceutical benefits.

(7) The identification and detection function is to:

(a) identify prescription shoppers, prescribers prescribing pharmaceutical benefits to prescription shoppers and approved suppliers supplying pharmaceutical benefits to prescription shoppers; and

(b) establish and maintain databases of some or all prescription shoppers and information about those prescription shoppers; and

(c) detect and identify prescription shoppers who may be improperly using, stockpiling, swapping, diverting or illegally dealing with pharmaceutical benefits; and

(d) enable the Chief Executive Officer to identify when disclosure of PBS information is appropriate.

(8) Subject to subsection (9), the disclosure function is to:

(a) disclose PBS information about whether a person is or is not a prescription shopper; and

(b) disclose PBS information about a prescription shopper to:

(i) the prescription shopper; and

(ii) a prescriber, to assist the prescriber to make decisions about prescribing to the prescription shopper, if that prescription shopper has visited or is visiting that prescriber or is a patient of that prescriber; and

(iii) an approved supplier who is proposing to supply, or has supplied, pharmaceutical benefits to the prescription shopper, to assist the approved supplier (or a pharmacist within their employment) to make decisions about supplying pharmaceutical benefits to that prescription shopper.

(9) The Chief Executive Officer may undertake the disclosure function for the following purposes:

(a) administering and enforcing functions under the National Health Act conferred upon the Chief Executive Officer; and

(b) protecting public revenue; and

(c) discouraging inefficient and improper use of pharmaceutical benefits.

(10) The evaluation and reporting function is to use PBS information and information collected by the Chief Executive Officer under the National Health Act to:

(a) evaluate the Project; and

(b) report (using de‑identified PBS information) to the Department of Health and Ageing and other bodies on the administration and outcomes of the Project.

Functions in relation to planning and preparation of legislative proposals

(1) In this section, legislative proposal means:

(a) a Bill that has been introduced into the Parliament; or

(b) a proposal for a Bill; or

(c) a draft legislative instrument.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the function of undertaking preparatory work in relation to a legislative proposal referred to the Chief Executive Officer by the Health Minister or the Human Services Minister.

Functions in relation to consultancy, management and information technology services

(1) For paragraph 5 (1) (d) of the Act, and subject to subsection (2), the Chief Executive Officer is to perform the following functions:

(a) to enter into agreements with other persons (including the Governments of other countries) for the provision by Medicare Australia of consultancy and management services relating to any of the expertise that Medicare Australia has acquired in performing its functions;

(b) to provide, to the Commonwealth or a body established by a law of the Commonwealth:

(i) services relating to any of the expertise that Medicare Australia has, in performing its functions, acquired in a field of information technology; or

(ii) equipment for use in the provision of information technology services.

(2) The Chief Executive Officer is to undertake a function to the extent only that the function is not in excess of functions that may be conferred on the Chief Executive Officer under a legislative power of the Parliament.

(3) In particular, the Chief Executive Officer may undertake a function:

(a) for purposes related to money appropriated for the purposes of the Commonwealth; or

(b) for purposes related to the executive power of the Commonwealth; or

(c) for purposes related to insurance (other than State insurance) not extending beyond the limits of the State concerned; or

(d) for purposes related to pharmaceutical, sickness and hospital benefits and medical and dental services; or

(e) for purposes related to external affairs; or

(f) for purposes related to matters incidental to the execution of any of the legislative powers of the Commonwealth or the executive power of the Commonwealth.

Functions in relation to the provision of special assistance

(1) In this section:

special assistance circumstance includes any circumstance in relation to which the Australian Government has decided that a special assistance program involving the provision of a Commonwealth service is to be implemented.

Note Natural disasters, terrorist acts and other emergency situations are examples of circumstances in relation to which the Australian Government may decide that a special assistance program is to be implemented.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) to provide Commonwealth services to assist persons adversely affected, whether directly or indirectly, by a special assistance circumstance;

(b) to participate in disaster policy and planning activities, including activities undertaken by relevant disaster policy and planning committees.

(3) The function described in paragraph (2) (a) includes:

(a) establishing and maintaining a register of persons adversely affected by the special assistance circumstance; and

(b) receiving, processing, investigating, deciding and paying claims for assistance; and

(c) operating a telephone enquiry line or providing call centre assistance; and

(d) making arrangements for health assessments and other assistance in relation to health care; and

(e) referring a person to another organisation if the person requires assistance provided by that organisation; and

(f) working with other government and non‑government bodies in relation to the provision of assistance; and

(g) undertaking action (including the institution of legal proceedings) to recover payments inappropriately made; and

(h) disclosing statistical information (including de‑identified information from the Register) about assistance provided.

Functions in relation to payments

(1) In this section:

eligible nursing home has the same meaning as in section 58 of the National Health Act.

eligible premises has the same meaning as in section 52 of the National Health Act.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) to make payments, as directed by the Department of Health and Ageing, in relation to the program for Day Therapy Centres administered by that Department;

(b) to make payments, as directed by the Department of Health and Ageing, in accordance with:

(i) an approval of a grant of a Commonwealth benefit, in relation to eligible premises, made by the Health Minister under section 55 of the National Health Act and payable under section 56 of that Act; and

(ii) an approval of a grant of a Commonwealth benefit, in relation to an eligible nursing home, made by the Health Minister under section 58CE of the National Health Act and payable under section 58CF of that Act;

(c) to make payments, as directed by the Department of Health and Ageing, in relation to the program for Capital Transition Payments administered by that Department;

(d) to make payments, under section 60 of the Aged Care (Consequential Provisions) Act 1997, of additional amounts payable in respect of residential care services for which residential care subsidy is payable under section 43‑1 of the Aged Care Act 1997;

(e) to undertake action (including the institution of legal proceedings) to recover from a person, to whom an amount has been paid under paragraph (a), (b), (c) or (d), any amount paid to the person that is an overpayment.

Functions in relation to the unique healthcare identifier program

(1) In this section:

health care means care, treatment, advice or service provided for the physical or mental health of an individual.

healthcare provider means:

(a) an individual who provides health care, including the following:

(i) a medical practitioner;

(ii) an individual who:

(A) practises a health care related vocation; and

(B) must be registered, enrolled or certified under a State or Territory law to practise that vocation;

(iii) an individual who provides a professional service; or

(b) an organisation that provides health care.

medical practitioner has the meaning given by subsection 3 (1) of the Health Insurance Act.

NEHTA means National E‑Health Transition Authority Ltd, ABN 18 114 638 336.

organisation means a body corporate, a partnership, an unincorporated association or a trust.

personal information has the meaning given by subsection 6 (1) of the Privacy Act 1988.

professional service has the meaning given by subsection 3 (1) of the Health Insurance Act.

unique healthcare identifier, or UHI, means a unique number assigned to an individual or a healthcare provider.

UHI program means the program for the development, implementation and operation of systems for:

(a) the assignment of UHIs to individuals and healthcare providers; and

(b) the exchange of information for health care purposes using UHIs to:

(i) identify individuals and healthcare providers; and

(ii) link individuals and healthcare providers with information.

(2) For paragraph 5 (1) (d) of the Act, the Chief Executive Officer is to perform the following functions:

(a) to enter into a contract with NEHTA for Medicare Australia to provide services for carrying out the UHI program;

(b) to scope, develop, build and test UHI program systems in accordance with the contract mentioned in paragraph (a);

(c) in performing the function mentioned in paragraph (b):

(i) to copy personal information from the following databases kept by Medicare Australia:

(A) the Consumer Directory Maintenance System;

(B) the Provider Directory System; and

(ii) to apply a process to the personal information to create new data that cannot be used to identify the individuals to whom it relates; and

(iii) to use the created data.

(3) Performance by Medicare Australia of the contract mentioned in paragraph (2) (a) is limited to the activities mentioned in paragraph (2) (b).

Notes to the Medicare Australia (Functions of Chief Executive Officer) Direction 2005

Note 1

The Medicare Australia (Functions of Chief Executive Officer) Direction 2005 (in force under section 5 (1) (d) of the Medicare Australia Act 1973) as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Title	Date of FRLI registration	Date of commencement	Application, saving or transitional provisions
Medicare Australia (Functions of Chief Executive Officer) Direction 2005	30 Sept 2005 (see F2005L02968)	1 Oct 2005
Medicare Australia (Functions of Chief Executive Officer) Amendment Direction 2005 (No. 1)	21 Oct 2005 (see F2005L03254)	21 Oct 2005	—
Medicare Australia (Functions of Chief Executive Officer) Amendment Direction 2007 (No. 1)	8 June 2007 (see F2007L01674)	9 June 2007	—
Medicare Australia (Functions of Chief Executive Officer) Amendment Direction 2007 (No. 2)	16 Aug 2007 (see F2007L02583)	17 Aug 2007	—

Table of Amendments

ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted
Provision affected	How affected
S. 4.........................................	am. 2005 No. 1
S. 14.......................................	am. 2005 No. 1
S. 26.......................................	rep. 2005 No. 1
S. 28.......................................	am. 2007 No. 1
S. 34.......................................	ad. 2005 No. 1
S. 35.......................................	ad. 2007 No. 2

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Medicare Australia (Functions of Chief Executive Officer) Direction 2005 (Cth)

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