EXPLANATORY STATEMENT
STATUTORY RULES 1985 NO. 41
ISSUED BY AUTHORITY OF THE MINISTER FOR 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.
Parts II and IIA of the Act respectively set out the functions of the Health Insurance Commission (“the Commission”) in relation to the medicare scheme and the conduct of medibank private. Sub-section 8E(1) in Part IIB of the Act provides that in addition 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.
Sub-section 41B(1) of the Act provides that where functions are conferred upon the Commission under Part IIB of the Act, the regulations may
make provision for modifications of 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 functions. Sub-section 41B(2) of the Act provides that this modification includes the alteration of a provision, the addition or omission of a provision, or the substitution of a new provision for an existing one. Part V of the Act deals with matters of finance.
The purpose of the regulations is primarily to prescribe, for the purposes of sub-section 8E(1) of the Act, additional functions to be performed by the Commission.
These functions are to process on behalf of the Repatriation Commission, established under section 7 of the Repatriation Act 1920, claims for payment submitted to the Repatriation Commission in respect of the provision of medical treatment to persons under Part IV of the Repatriation Regulations; and to prepare, on behalf of the Repatriation Commission, cheques for the payment of these claims.
The performance of these functions by the Commission permits a rationalisation whereby the extensive suitably specialised medicare resources of the Commission can be applied to the processing
of claims for payment for medical treatment received by the Repatriation Commission. These claims relate to an estimated 6 million services per year.
The regulations also, in pursuance of sub-section 41B(1) of the Act, make provision for the modification of a number of provisions of Part V of the Act in connection with their application to the activities of the Commission in the performance of the new functions. The effect of these modifications is that the new functions are regarded as part of the medicare functions of the Commission for the purposes of the provisions of the Act relating to the formal apportionment of the Commission’s assets and expenditure and the maintenance of separate bank accounts in respect of its medicare and medibank private functions.
The regulations in repealing the current Regulation 4 of the Health Insurance Commission Regulations omit an obsolete provision which conferred on the Commission the function of administering on behalf of A.M.W.S.U. Health Care Limited the medical benefits fund and the hospital benefits fund formerly conducted by the company. These funds have been wound up under the National Health Act 1953.
The statutory rules came into effect on the date of their notification in the Commonwealth of Australia Gazette.
Overview
The Health Insurance Commission Regulations (Amendment) 1985, issued under the authority of the Minister for Health, amends the Health Insurance Commission Regulations 1973. These regulations were introduced to address the need for the Health Insurance Commission to process claims for payment submitted to the Repatriation Commission concerning medical treatments provided under the Repatriation Act 1920. This amendment allows the Commission to utilise its specialised resources in managing these claims, which are estimated to total around six million services annually. Additionally, the regulations modify certain financial provisions of the Health Insurance Commission Act 1973 to integrate these new functions within the Commission’s medicare activities, ensuring proper asset allocation and financial management. Furthermore, the amendment removes an obsolete provision that previously allowed the Commission to administer certain health funds, which have since been wound up under the National Health Act 1953.
Scope and Application
The Health Insurance Commission Regulations (Amendment) pertains to the Health Insurance Commission Act 1973, which governs the activities and functions of the Health Insurance Commission. These regulations apply to the Commission and its operations under the Act, particularly those functions related to the medicare scheme, Medibank Private, and other health insurance matters as prescribed. The regulations extend to Commonwealth jurisdiction, impacting entities and individuals involved in health insurance and medical treatment claims within Australia. Notably, the regulations modify existing provisions to include new functions for the Commission, such as processing claims for medical treatment payments on behalf of the Repatriation Commission and preparing associated cheques. These amendments facilitate the rationalisation of resources and streamline the processing of approximately six million claims annually. The regulations also adjust financial provisions to integrate these new functions into the Commission’s medicare activities. Furthermore, the regulations repeal an outdated provision concerning the administration of specific medical benefits funds, which have since been wound up under the National Health Act 1953. The statutory rules took effect upon their notification in the Commonwealth of Australia Gazette.
Key Provisions
The primary sections of the Health Insurance Commission Regulations (Amendment) concern the establishment and specification of additional functions for the Health Insurance Commission (HIC). Section 8E(1) of the Health Insurance Commission Act 1973 allows for these amendments, enabling the Commission to undertake tasks not previously covered under its remit. Specifically, the regulations mandate that the HIC process claims for payment submitted to the Repatriation Commission for medical treatments rendered to individuals under Part IV of the Repatriation Regulations. Additionally, the HIC is required to prepare cheques for these payments. This allocation of duties allows the HIC to leverage its specialised resources, currently used for the Medicare scheme, towards efficiently managing an estimated six million claims annually.
The obligations imposed on the HIC by these regulations are multifaceted. Firstly, the HIC must now process claims for medical treatment payments on behalf of the Repatriation Commission, a function that requires meticulous attention to detail and adherence to stringent procedural standards. The HIC must also prepare and issue cheques for these claims, ensuring that payments are made accurately and in a timely manner. Furthermore, the regulations stipulate that these new functions are to be treated as part of the HIC's Medicare operations for the purposes of financial allocation and record-keeping. This includes maintaining separate bank accounts and ensuring a clear division of assets and expenditures between Medicare and Medibank Private functions.
Failure to comply with the provisions of these regulations can lead to serious consequences. While the specific offences and penalties are not detailed within the text, breaches of statutory duties under the Health Insurance Commission Act 1973 can result in significant civil or criminal penalties. Typically, such breaches might lead to fines or other legal repercussions, depending on the severity and impact of the non-compliance. Given the sensitive nature of the tasks assigned to the HIC, any lapse in duty could potentially affect the timely and accurate payment of legitimate claims, thereby impacting the individuals who rely on these services.