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.
Overview
The Health Insurance Commission Act 1973 was enacted to establish the Health Insurance Commission and outline its functions, particularly concerning health insurance and related health matters. This Act was introduced to address the need for a dedicated body to manage and oversee health insurance schemes in Australia. The Parliament of Australia enacted this legislation to provide a structured framework for the administration and regulation of health insurance within the country. The policy objective of the Act was to ensure efficient and effective management of health insurance functions, which included the administration of the Pharmaceutical Benefits Scheme (PBS). The Health Insurance Commission Regulations (Amendment) issued in 1989 further refined the roles and responsibilities of the Commission, particularly by transferring significant administrative duties of the PBS from the Department of Community Services and Health to the Commission. This transfer aimed to streamline the administration of the PBS and integrate it more cohesively with the broader functions of the Health Insurance Commission.
Scope and Application
The Health Insurance Commission Regulations (Amendment) pertains to the Health Insurance Commission Act 1973 and aims to transfer significant responsibilities for the administration of the Pharmaceutical Benefits Scheme (PBS) from the Department of Community Services & Health to the Health Insurance Commission. This shift is achieved through the prescription of various functions relating to the PBS as functions of the Commission, including the approval of pharmacists, participating dental practitioners, medical practitioners, and hospital authorities, the processing and payment of claims for benefits payable under the PBS, and the investigation and enforcement of compliance with relevant provisions of the National Health Act 1953. The amendments also extend the financial provisions in Part V of the Act to cover these newly prescribed functions, thereby integrating the financial management of the PBS with the existing Medicare and Medibank Private functions. These Regulations came into effect on 17 July 1989, marking a significant change in the administration and oversight of the PBS in Australia.
Key Provisions
The main operative sections of the Health Insurance Commission Regulations (Amendment) are sections 44, 8E(1), and 41B of the Health Insurance Commission Act 1973. These sections provide the legislative framework for the amendment of regulations under the Act to transfer significant administrative responsibilities from the Department of Community Services and Health to the Health Insurance Commission. Specifically, section 44 allows the Governor-General to make Regulations that are not inconsistent with the Act, and which prescribe all matters necessary to carry out the Act. Section 8E(1) assigns the specific functions to be performed by the Commission, while section 41B allows for the modification of existing provisions in the Act to accommodate new functions conferred upon the Commission. These provisions facilitate the transfer of the administration of the Pharmaceutical Benefits Scheme (PBS) to the Commission.
The Health Insurance Commission Regulations (Amendment) impose several obligations on the Health Insurance Commission. Primarily, the Commission is tasked with the approval of pharmacists, dental practitioners, medical practitioners, and hospital authorities participating in the PBS. Additionally, it must handle the processing and payment of claims for benefits under the PBS. The Commission is also responsible for investigating potential breaches of the National Health Act 1953 and its regulations, as well as enforcing these provisions. Furthermore, it must manage the approval and issuance of cards and forms essential for the administration and operation of the PBS. The Regulations have also extended the financial provisions in Part V of the Act to cover these new functions, thereby ensuring that the financial management of the PBS aligns with the broader operations of the Commission.
Violations of the provisions set out in the Health Insurance Commission Regulations (Amendment) can lead to various penalties and consequences. While specific offences and penalties are not detailed in the explanatory statement, breaches of the National Health Act 1953 or its regulations can result in civil or criminal liability. For instance, failure to comply with the requirements for the approval and operation of participating entities in the PBS could lead to financial penalties, revocation of approval, or other administrative actions. Additionally, more severe breaches, such as those involving fraudulent claims or deliberate non-compliance with the Act, could result in criminal charges, with penalties including fines and imprisonment. The exact nature and severity of penalties would be determined by the specific breaches and the provisions of the relevant legislation.