Health Insurance Amendment (Professional Services Review Scheme) Act 2023

Administered by Department of Health, Disability and Ageing

Legislation au C2023A00082 In force Act

Legislation content

 

 

 

 

 

 

Health Insurance Amendment (Professional Services Review Scheme) Act 2023

 

No. 82, 2023

 

 

 

 

 

An Act to amend the Health Insurance Act 1973, and for related purposes

 

 

Contents

1 Short title

2 Commencement

3 Schedules

Schedule 1—Professional Services Review Scheme

Part 1—Main amendments

Health Insurance Act 1973

Part 2—Other minor amendments

Health Insurance Act 1973

Part 3—Application of amendments

 

 

Health Insurance Amendment (Professional Services Review Scheme) Act 2023

No. 82, 2023

 

 

 

An Act to amend the Health Insurance Act 1973, and for related purposes

[Assented to 28 September 2023]

The Parliament of Australia enacts:

1  Short title

  This Act is the Health Insurance Amendment (Professional Services Review Scheme) Act 2023.

2  Commencement

 (1) Each provision of this Act specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  The whole of this Act

The day after this Act receives the Royal Assent.

29 September 2023

Note: This table relates only to the provisions of this Act as originally enacted. It will not be amended to deal with any later amendments of this Act.

 (2) Any information in column 3 of the table is not part of this Act. Information may be inserted in this column, or information in it may be edited, in any published version of this Act.

3  Schedules

  Legislation that is specified in a Schedule to this Act is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Act has effect according to its terms.

Schedule 1—Professional Services Review Scheme

Part 1—Main amendments

Health Insurance Act 1973

1  Subsection 81(1)

Insert:

Associate Director means an Associate Director of Professional Services Review appointed under section 83A.

Note: In this Part, a reference to the Director includes a reference to an Associate Director, subject to certain exceptions (see subsection 83A(2)).

2  Subsection 81(1) (at the end of the definition of Director)

Add:

Note: In this Part, a reference to the Director includes a reference to an Associate Director, subject to certain exceptions (see subsection 83A(2)).

3  Division 2 of Part VAA (heading)

After “The Director”, insert “and Associate Directors”.

4  Subsection 83(2)

Repeal the subsection.

5  After section 83

Insert:

83A  Associate Directors of Professional Services Review

 (1) The Minister may appoint a medical practitioner to be an Associate Director of Professional Services Review.

 (2) In this Part (other than section 83, paragraph 106ZM(2)(b), sections 106ZPL and 106ZPLA and Subdivision A of Division 6 of this Part) a reference to the Director includes a reference to an Associate Director.

6  Subsection 84(3)

Repeal the subsection.

7  Subsection 84(4)

Omit “other than a medical practitioner”.

8  Subsection 85(3)

Repeal the subsection.

9  Subsection 85(4)

Omit “other than a medical practitioner”.

10  Division 6 of Part VAA (heading)

After “the Director,”, insert “Associate Directors,”.

11  After Subdivision A of Division 6 of Part VAA

Insert:

Subdivision AB—Associate Directors

106ZFA  Term of office

 (1) An Associate Director is to be appointed for the period, not exceeding 3 years, specified in the instrument of appointment.

 (2) An Associate Director is eligible for re‑appointment.

106ZFB  Associate Director’s terms and conditions of appointment

 (1) An Associate Director holds office on a full‑time or a part‑time basis as specified in the instrument of appointment.

 (2) An Associate Director holds office on such other terms and conditions (in respect of matters not provided for by this Act) as are determined in the instrument of appointment.

106ZFC  Outside employment

 (1) A person who holds the office of an Associate Director on a full‑time basis must not engage in any paid employment outside the duties of that office without the Minister’s written approval.

 (2) A person who holds the office of an Associate Director on a part‑time basis must not engage in any paid employment that, in the Minister’s opinion, conflicts with the proper performance of the Associate Director’s functions.

106ZFD  Leave of absence

 (1) If an Associate Director holds office on a full‑time basis, the Associate Director has such recreational leave entitlements as are determined by the Remuneration Tribunal.

 (2) The Minister may grant an Associate Director leave of absence, other than recreational leave, on such terms and conditions as to remuneration or otherwise as the Minister determines in writing.

106ZFE  Resignation

  An Associate Director may resign by writing signed and delivered to the Minister.

106ZFF  Termination of an Associate Director’s appointment

 (1) The Minister may terminate the appointment of an Associate Director:

 (a) for misbehaviour; or

 (b) if the Associate Director is unable to perform the duties of the Associate Director’s office because of physical or mental incapacity.

 (2) The Minister may terminate an Associate Director’s appointment if the Associate Director:

 (a) becomes bankrupt, applies to take the benefit of any law for the relief of bankrupt or insolvent debtors, compounds with creditors or makes an assignment of remuneration for their benefit; or

 (b) is appointed on a full‑time basis and is absent from duty, except on leave of absence, for 14 consecutive days or for 28 days in any 12 months; or

 (c) is appointed on a full‑time basis and engages, except with the Minister’s approval, in paid employment outside the duties of the Associate Director’s office; or

 (d) is appointed on a part‑time basis and engages in paid employment that, in the Minister’s opinion, conflicts with the proper performance of the Associate Director’s duties.

106ZFG  Acting appointments

  The Minister may appoint a person to act as an Associate Director:

 (a) during a vacancy in the office of that Associate Director (whether or not an appointment has previously been made to the office); or

 (b) during any period or during all periods when that Associate Director is absent from duty or from Australia or is, for any other reason, unable to perform the duties of the office.

Note: For rules that apply to acting appointments, see section 33A of the Acts Interpretation Act 1901.

106ZFH  Remuneration and allowances

 (1) An Associate Director is to be paid such remuneration as is determined by the Remuneration Tribunal.

 (2) If no determination of that remuneration is in operation, an Associate Director is to be paid such remuneration as is specified in the regulations.

 (3) An Associate Director is to be paid such allowances as are specified in the regulations.

 (4) This section has effect subject to the Remuneration Tribunal Act 1973.

12  Subsection 106ZPB(2)

Repeal the subsection.

13  Subsection 106ZPB(3)

Omit “(other than a medical practitioner)”.

14  Subsection 106ZPH(4)

Omit “Subsections 106ZPB(2) and (3) apply”, substitute “Subsection 106ZPB(3) applies”.

15  Subsection 106ZPH(4)

Omit “they apply”, substitute “it applies”.

16  After subparagraph 106ZPLA(a)(i)

Insert:

 (ia) the Associate Directors;

17  Paragraph 129AAD(1)(b)

Omit “paid; and”, substitute “paid.”.

18  Paragraph 129AAD(1)(c)

Repeal the paragraph.

19  Subsections 129AAD(12) and (13)

Repeal the subsections.

20  After paragraph 130(5E)(a)

Insert:

 (aa) an Associate Director of Professional Services Review appointed under section 83A; or

21  Subsection 130(5E)

After “help the Director,”, insert “Associate Director,”.

Part 2—Other minor amendments

Health Insurance Act 1973

22  Subsection 106ZD(1)

Repeal the subsection, substitute:

 (1) The Minister may terminate the appointment of the Director:

 (a) for misbehaviour; or

 (b) if the Director is unable to perform the duties of the Director’s office because of physical or mental incapacity.

23  Subsection 106ZK(1)

Repeal the subsection, substitute:

 (1) The Minister may terminate the appointment of a Panel member:

 (a) for misbehaviour; or

 (b) if the Panel member is unable to perform the duties of the Panel member’s office because of physical or mental incapacity.

24  Subsection 106ZPG(1)

Repeal the subsection, substitute:

 (1) The Minister may terminate the appointment of a member of the Authority:

 (a) for misbehaviour; or

 (b) if the member of the Authority is unable to perform the duties of the member’s office because of physical or mental incapacity.

Part 3—Application of amendments

25  Application of amendments

(1) The amendments of sections 83, 84 and 85 of the Health Insurance Act 1973 made by Part 1 of this Schedule apply in relation to appointments made after the commencement of this Schedule.

(2) The amendments of section 129AAD of the Health Insurance Act 1973 made by Part 1 of this Schedule apply in relation to notices given after the commencement of this Schedule (whether the amount to which the notice relates is paid before or after that commencement).

(3) The amendments of subsections 106ZD(1), 106ZK(1) and 106ZPG(1) of the Health Insurance Act 1973 made by Part 2 of this Schedule apply in relation to appointments terminated after the commencement of this Schedule (whether the appointment is made before or after that commencement).

 

 

 

 

[Minister’s second reading speech made in—

House of Representatives on 24 May 2023

Senate on 14 June 2023]

 

(51/23)

 

Overview

The Health Insurance Amendment (Professional Services Review Scheme) Act 2023 was enacted by the Parliament of Australia to amend the Health Insurance Act 1973 and address gaps in the existing regulatory framework for the Health Insurance Commission. The primary objective of this Act is to introduce the Professional Services Review Scheme, which includes the appointment of Associate Directors of Professional Services Review, in addition to the existing Director, to enhance the oversight and review of professional services within the health insurance sector. This legislative amendment aims to improve the efficiency and effectiveness of the review process by broadening the scope of expertise and the number of individuals responsible for overseeing professional services, thereby ensuring that the Health Insurance Commission can better manage claims and related activities. The Act came into force on 29 September 2023, the day after receiving Royal Assent. The amendments introduced by the Act apply to appointments made after the commencement date, ensuring that the new provisions are implemented in a timely and structured manner. By refining the appointment, tenure, and termination conditions for the Director and Associate Directors, the Act seeks to provide a more robust and responsive mechanism for addressing issues related to professional services in the health insurance sector.

Scope and Application

The Health Insurance Amendment (Professional Services Review Scheme) Act 2023 amends the Health Insurance Act 1973 to introduce the Professional Services Review Scheme, which includes the establishment of Associate Directors of Professional Services Review. These Associate Directors, who can be appointed by the Minister, are medical practitioners who will work alongside the Director in reviewing professional services within the health insurance framework. This Act applies to all appointments made after its commencement on 29 September 2023, with specific provisions governing the appointment, terms, conditions, remuneration, and termination of Associate Directors. The Act also modifies the termination provisions for the Director, Panel members, and members of the Authority, allowing for the termination of their appointments for misbehaviour or incapacity to perform their duties. The changes are designed to enhance the efficiency and effectiveness of the review processes within the health insurance system. The Act applies nationwide across Australia and does not specify any exclusions or exemptions, but its provisions are subject to further regulation through subordinate instruments.

Key Provisions

The Health Insurance Amendment (Professional Services Review Scheme) Act 2023 introduces significant amendments to the Health Insurance Act 1973, most notably through the establishment of the Professional Services Review Scheme. Section 81 of the Health Insurance Act 1973 is amended to define "Associate Director" as an Associate Director of Professional Services Review appointed under section 83A (section 1 of the amending Act). This definition and its implications are further elaborated in section 83A, which outlines the appointment process for Associate Directors, their terms of office, conditions of appointment, and remuneration (sections 5 to 11 of the amending Act). The Act also makes it clear that references to the Director in certain sections include Associate Directors, subject to specified exceptions (sections 2, 3, 7, 8, 10, and 16 of the amending Act). Under the new scheme, the Minister is empowered to appoint Associate Directors, who may be medical practitioners, to assist in reviewing health insurance-related professional services (section 5 of the amending Act). The appointment of Associate Directors is governed by specific terms and conditions, including their eligibility for reappointment, restrictions on outside employment, and provisions for leave and resignation (sections 6 to 11 of the amending Act). The Minister retains the authority to terminate an Associate Director's appointment for reasons such as misbehaviour, incapacity, or failure to adhere to the terms of their appointment (section 11 of the amending Act). The Act imposes several obligations on Associate Directors, including compliance with the terms of their appointment, adherence to the prohibition on certain outside employment, and the requirement to seek approval for leave of absence (sections 6, 7, and 10 of the amending Act). It also outlines the process for the termination of appointments and the conditions under which such terminations may occur (section 11 of the amending Act). The Act does not explicitly detail specific offences or penalties for breaches of its provisions. However, given the context of the Health Insurance Act 1973 and the nature of the amendments introduced by the Health Insurance Amendment (Professional Services Review Scheme) Act 2023, breaches of the new provisions could potentially be subject to the penalties and enforcement mechanisms provided under the existing Health Insurance Act 1973. This may include civil or criminal penalties, depending on the nature and severity of the breach.

Legal classification tags

Area of Law
Health Law
Instrument
Act
Concepts
Commencement Provisions
Reporting & Disclosure Obligations
Regulatory Standards

Interactions

Authorises

All Versions

Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.