Health Insurance Commission Regulations (Amendment) 1997 No. 332
EXPLANATORY STATEMENT
STATUTORY RULES 1997 No. 332
Issued by the Authority of the Minister for Health and Family Services
Health Insurance Commission Act 1973
Health Insurance Commission Regulations (Amendment)
The Health Insurance Commission Act 1973 ("the Act") provides for the functions of the Health Insurance Commission (HIC).
Subsection 8AA(2) of the Act provides that the HIC shall perform such functions as are prescribed.
Section 44 of the Act provides for the Governor-General to make regulations for the purposes of the Act.
The Health Insurance Commission Regulations were amended by the Governor-General in 1993 to give effect to certain administrative functions being carried out by the HIC, on behalf of Australian Hearing Services (AHS).
The Hearing Services Administration Act 1997 and the Hearing Services and AGHS Reform Act 1997 make a number of reforms to the delivery of government-funded hearing services including the creation of a voucher system. Those eligible to participate in the voucher system will be able to choose to receive their hearing services from AHS or from an accredited private sector provider. Previously. AHS had exclusive rights to provide government-funded services. A new Office of Hearing Services has been established to administer the new arrangements.
Previous regulation 3H, which prescribed functions of the HIC in relation to hearing services, is now being omitted.
New regulation 3H will enable the HIC to:
1 . accept claims by and make payments to hearing services providers;
2. release certain information (e.g. date on which the claim was given to the HIC) about claims and payments to the Office of Hearing Services; and
3. recover and offset service provider debts.
Details of the Regulations are set out in the Attachment.
The Regulations commenced on gazettal.
ATTACHMENT
Details of Amendments to Regulation 3
The primary purpose of the amendment to regulation 3H of the Health Insurance Commission Regulations is to enable the Health Insurance Commission (HIC) to administer part of the new hearing services scheme.
Specifically..
* subregulation 1.1 - provides for the amendment of the Health Insurance Commission Regulations (the Regulations), as set out below.
* subregulation 2.1 - provides for the substitution of new regulation 3H. The subregulation inserts:
- subregulation 3H(1) - which will allow the HIC to perform the function of claims acceptance and claims payment body as prescribed under the Hearing Services Administration Act 1997.
- subregulation 3H(2) - which provides that subregulation 3H(1) is only effective when the HIC has been declared a claims acceptance or claims payment body.
- subregulation 3H(3) - which enables the HIC to disclose information to the
Department about claims accepted and paid.
- paragraph 3H(3)(a) to paragraph 3h(3)(s) - enables the HIC to disclose to the Department the following information:
(a) client number;
(b) voucher number;
(c) date on which the claim was given to the HIC;
(d) date on which the HIC processed the claim;
(e) date of the service the claims relates to;
(f) provider number;
(g) practitioner number;
(h) site identification;
(i) item number;
(j) hearing loss details for both ears;
(k) details of the device fitted to the client;
(1) date on which the device was fitted;
(m) details of top-up devices;
(n) contracted service provider's certification details;
(o) client certification details;
(p) cost to the client;
(q) payment details;
(r) a code indicating why a claim was rejected; and
(s) any other details about the protesting of the claim.
- subregulation 3H(4) - allows the HIC to recover service provider debts on behalf of the Commonwealth.
- subregulation 3H(5) - allows the HIC to offset a service provider debt against a future payment to a service provider.
- subregulation 3H(6) - provides for the interpretation of a number of expressions:
"client" - this is a term used to mean a person who has received a hearing services which is the subject of a claim.
"contracted service provider" - this defines "contracted. services provider" by cross-reference to section 4 of the Hearing Services Administration Act 1997.
"hearing service" - this defines "hearing service" by cross-reference to section 4 of the Hearing Services Administration Act 1997.
"service provider debt" - this defines "service provider debt" by crossreference to subsection 24(1) of the Hearing Services Administration Act 1997.
"voucher" - this defines "voucher" by cross-reference to section 4 of the Hearing Services Administration Act 1997.