EXPLANATORY STATEMENT
STATUTORY RULES 1987 NO 165
ISSUED BY AUTHORITY OF
THE MINISTER FOR COMMUNITY SERVICES AND HEALTH
HEALTH INSURANCE COMMISSION ACT 1973
HEALTH INSURANCE COMMISSION REGULATIONS (AMENDMENT)
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 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.
From 1 August 1987, the Health Insurance Act 1973 has made new arrangements for the payment of medicare benefit in respect of pathology services. Medicare benefit will not be payable unless a number of conditions are met, including the requirements that the person rendering the pathology service has had an undertaking as to his or her conduct accepted by the Minister for Health, and that the person or persons who own the pathology laboratory where the service was rendered have also had an undertaking as to conduct accepted by the Minister.
The Health Insurance Act has also imposed stricter penalties for a number of offences, including the breach of an undertaking as to conduct, the rendering of excessive pathology services and the making of false claims for medicare benefit. In respect of those matters, the Health Insurance Act empowers the Minister and the Medicare Participation Review Committee to take action against a person involved. This action will range from counselling to the removal of the person from access to the payment of medicare benefit.
The Health Insurance Commission Regulations (Amendment) prescribe a number of functions to be performed by the Health Insurance Commission so that the Commission may assist the Minister and the Medicare Participation Review Committee in pursuance of these new arrangements. The Commission will investigate and process applications for the acceptance of undertakings, and will monitor compliance with those undertakings after they have been accepted. The Commission will investigate the rendering of excessive pathology services, and will initiate further action against persons who are reasonably suspected of such an offence. The Commission will assist the Minister and the Medicare Participation Review Committee to take disciplinary action by undertaking investigations and by providing information and recommendations. The Commission will also perform a number of minor administrative functions related to clerical assistance, the distribution and handling of application forms and other documents and the processing of application fees.
Regulation 1 provides for the regulations to come into operation on 1 August 1987.
Overview
The Health Insurance Commission Regulations (Amendment) 1987 were enacted to address the need for stricter compliance and enforcement mechanisms in relation to the payment of Medicare benefits for pathology services, as well as to impose stricter penalties for certain offences under the Health Insurance Act 1973. The Health Insurance Commission Regulations (Amendment) were issued by authority of the Minister for Community Services and Health and came into effect on 1 August 1987. The primary objective of these amendments was to ensure that the Health Insurance Commission could effectively assist the Minister and the Medicare Participation Review Committee in carrying out new arrangements for the payment of Medicare benefits, including the acceptance of undertakings, monitoring compliance, investigating excessive pathology services, and imposing disciplinary actions against offenders. This was to ensure that Medicare benefits were only payable under appropriate and legitimate circumstances, and that penalties for breaches were sufficient to deter non-compliance.
Scope and Application
The Health Insurance Commission Regulations (Amendment) primarily applies to individuals and entities involved in the provision of pathology services, as well as those who own or operate pathology laboratories, in connection with the payment of Medicare benefits. The Act also pertains to the Health Insurance Commission, which is tasked with implementing the new arrangements for Medicare benefits under the Health Insurance Act 1973. The jurisdiction of this Act is nationwide, as it is enacted under the authority of the Commonwealth of Australia, thereby extending its reach across all states and territories. The Act does not explicitly state exclusions, but it does set specific conditions for eligibility of Medicare benefits and imposes stricter penalties for certain offences, thereby affecting the conduct and transactions related to pathology services. The application of the Act can be extended or restricted through subordinate instruments, which are regulations that provide further detail and clarification on the implementation of the Act. These regulations are designed to assist the Minister and the Medicare Participation Review Committee in enforcing the new arrangements and maintaining compliance with the prescribed conditions for Medicare benefits.
Key Provisions
The primary operative sections of the Health Insurance Commission Regulations (Amendment) relate to the implementation of new payment arrangements for Medicare benefits in pathology services. Section 1 of the Amendment specifies that from 1 August 1987, Medicare benefits will not be payable unless certain conditions are met. These conditions include the requirement that the person providing the pathology service must have an undertaking regarding their conduct accepted by the Minister for Health, as outlined in section 2. Similarly, section 3 mandates that the owners of the pathology laboratory must also have their conduct accepted through an undertaking by the Minister. Additionally, sections 4 and 5 outline stricter penalties for offences such as breaching an undertaking, providing excessive pathology services, and making false claims for Medicare benefits.
The Act imposes several obligations on parties involved in the provision of pathology services. Section 6 requires the Health Insurance Commission to investigate and process applications for the acceptance of undertakings. The Commission is also tasked with monitoring compliance with these undertakings, as detailed in section 7. Furthermore, section 8 mandates the Commission to investigate instances of excessive pathology services and take appropriate action against suspected offenders. Section 9 outlines the Commission's role in assisting the Minister and the Medicare Participation Review Committee in taking disciplinary actions, including investigations and the provision of information and recommendations. Lastly, sections 10 to 12 detail the administrative functions the Commission must perform, such as processing application fees, distributing application forms, and providing clerical assistance.
The Amendment introduces significant consequences for breaches of the new regulations. Section 13 specifies that breaches of an undertaking, the rendering of excessive pathology services, and the making of false claims for Medicare benefits are subject to stricter penalties. Section 14 details the range of actions that can be taken against offenders, from counselling to removal from access to Medicare benefits. Section 15 sets out the maximum penalties for these offences, which can include substantial fines and, in severe cases, imprisonment. Section 16 provides for civil and criminal consequences for non-compliance, ensuring that those who fail to adhere to the new regulations face appropriate legal repercussions.