Health Insurance Commission Regulations (Amendment) 1994 No. 404
EXPLANATORY STATEMENT
STATUTORY RULES 1994 No. 404
Issued by the authority of the Minister for Human Services and Health
Health Insurance Commission Act 1973
Health Insurance Commission Regulations (Amendment)
Section 8E of the Health Insurance Commission Act 1973 (the Act) provides that the Health Insurance Commission (the Commission) shall perform such functions in relation to health insurance and other health related matters as are prescribed in the Health Insurance Commission Regulations.
Section 44 of the Act provides that the Governor-General may make regulations for the purposes of the Act.
The new regulation 3P allows the Commission to perform the new prescribed function of administering the Better Practice Program (the Program) and allow certain decisions made in the administration of the program to be reviewed, initially by the Commission and, if required, by the Administrative Appeals Tribunal (AAT). Details of this regulation are attached.
Regulation 4A has been amended to bring regulation 3P within the scope of Part V of the Act for the financial management purposes of the Commission.
The Regulations commenced on gazettal.
The Minute recommends that the Regulations be made in the form proposed.
ATTACHMENT A
Details of Regulation 3P
Subregulation 3P(1) allows the Commission to perform the new prescribed function of administering the Better Practice Program. Specifically, subregulation 3P(1) will allow the Commission to:
• receive and process applications for payments under the Better Practice Program from general medical practices. A nominated person(s) will apply on behalf of the practice as a whole in a form approved by the Commission;
• decide if a general practice is eligible to participate in the Program and if so, to determine the amount payable to that general medical practice;
• make payments to eligible general medical practices once the amount of the payment has been calculated;
• provide feedback to the Minister on the performance of the Program. The protocols for this are those established under section 81 of the Act; and
• review the decisions made regarding the eligibility of a general medical practice to participate in the Program and the amount payable to that practice.
Subregulation 3P(2) will require the Commission to make decisions regarding eligibility of and the amount payable to general medical practices in accordance with the criteria set out in the document "Eligibility Criteria and Payment Arrangements for the Better Practice Program, 1994-95". A copy of this document is attached.
Subregulation 3P(2) will also require the Commission to inform the nominated person in each general practice of the decisions made regarding that practice's eligibility to participate in the Program and the amount payable to that practice. The Commission must also inform the nominated person of their entitlement to obtain a copy of the reasons for those decisions by writing to the Commission and to apply for a review of those decisions.
Subregulations 3P(3) to (5) refer to the internal review of decisions made regarding eligibility and the amount payable. Specifically:
• subregulation 3P(3) allows a general medical practice affected by a decision regarding its eligibility or the amount payable to it to have the decision reviewed by the Commission. The practice must apply to the Commission in writing and within 28 days of receiving notice of the decision. The request must include the name and address of the person lodging the appeal, the name of the general medical practice, the decision being appealed and the grounds for review;
• once the Commission has received an application for review of a decision, subregulation 3P(4) will require the Commission to review that decision in accordance with the criteria used to make the initial decision. The Commission is then required to make a decision that either affirms or replaces the original decision under review. This decision is referred to as a "reconsidered decision"; and
• subregulation 3P(5) will require the Commission to promptly inform the person who lodged the application, of the reconsidered decision. The Commission is also required to advise that a copy of the reasons for that decision can be obtained by writing to the Commission and that an application may be made to have the decision reviewed by the AAT.
Subregulation 3P(6) provides that:
• decisions regarding the eligibility of a practice to participate in the Program and the amount payable to that practice remain valid decisions even if the practice is not notified that a copy of the reasons for the decision can be obtained by writing to the Commission or that it may apply for an internal review of the decision; and
• reconsidered decisions remain valid decisions even if the general medical practice is not notified that a copy of the reasons for the decision can be obtained by writing to the Commission or that it may apply for a review of the decision by the AAT.
Subregulation 3P(7) will allow reconsidered decisions made by the Commission to be reviewed by the AAT. Applications for review of a reconsidered decision would have to be made in accordance with the Administrative Appeals Tribunal Act 1975.
Subregulation 3P(8) will allow the proprietors of a general practice or their authorised representative to lodge the application for either internal review or review by the AAT on behalf of the practice as a whole. The authorised representative need not be a medical practitioner.