EXPLANATORY STATEMENT
1989 No 195
SUBJECT - HEALTH INSURANCE COMMISSION ACT 1973
HEALTH INSURANCE COMMISSION REGULATIONS (AMENDMENT)
ISSUED ON THE AUTHORITY OF THE MINISTER FOR COMMUNITY SERVICES AND HEALTH
Section 44 of the Health Insurance Commission Act 1973 (the Act) provides that the Governor-General may make Regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Subsection 8E(1) of the Act provides that the Health Insurance Commission (the Commission) shall perform such functions in relation to health insurance as are prescribed and such functions in relation to other matters relating to health as are prescribed.
Section 41B of the Act provides that where new functions are subsequently conferred on the Commission under Part IIB of the Act, regulations made under the Act may modify the provisions of Part V of the Act in or in connection with their application to the activities of the Commission in the performance of those new functions.
The Pharmaceutical Benefits Scheme (PBS) has, to date, been administered by the Department of Community Services & Health under Parts VII, VIII & IX of the National Health Act 1953 (the NHA) and the National Health (Pharmaceutical Benefits) Regulations. The Health Insurance Commission Regulations (Amendment) have, however, amended the Health Insurance Commission Regulations to, in effect, transfer much of the responsibility for administration of the PBS from the Department to the Commission. They have done this by prescribing, for the purposes of subsection 8E(1) of the Act, many of the functions relating to the administration of the PBS as functions of the Commission.
The main functions which have been transferred are:
- the approval of pharmacists, participating dental practitioners, medical practitioners & hospital authorities for the purposes of the PBS;
- the processing and payment of claims for benefits payable under the PBS;
- the investigation of all possible breaches of relevant provisions of the NHA and Regulations made thereunder;
- the performance of all activities directed towards the enforcement of the above provisions; and
- the approval and issue of the various cards and forms used in the administration and operation of the PBS.
The Regulations have also, in pursuance of the power given in section 41B of the Act, modified some of the existing provisions of Part V of the Act to recognise and incorporate the new functions which the Commission will be performing. In short, the financial provisions in Part V, which previously only applied to the Medicare and Medibank Private functions of the Commission, now also apply to the new functions relating to the administration of the PBS. Part V has also been amended to make it applicable to a number of other functions which were already performed by the Commission but to which Part V did not apply. These functions relate to the prevention and detection of excessive servicing, the issue of provider and prescriber numbers, the processing of certain claims on behalf of the Repatriation Commission and the processing of certain claims made under the health program grants scheme.
The Regulations came into effect on 17 July 1989.