EXPLANTORY STATEMENT
Health Insurance Act 1973
Health Insurance (Relevant Professional Bodies) Declaration 2021
Authority
Subsection 129AAD(13) of the Health Insurance Act 1973 (the Act) provides that the Minister may, by legislative instrument, declare a body to be a relevant professional body for the purposes of section 129AAD of that Act.
This instrument declares the bodies that are a relevant professional body for the purposes of subsection 129AAD(13) of the Act.
Purpose and operation of the instrument
This instrument replaces the Declaration of Relevant Professional Bodies under subsection 129AAD(13) (RPB 1 of 2011) (2011 instrument), which sunsets on 1 October 2021.
Section 129AAD of the Act enables the Chief Executive Medicare (the CEM) to give a notice to a person, in respect of a professional service, requiring the person to produce one or more documents relevant to ascertaining whether amounts paid as benefits or payments under the Act should have been paid in respect of the professional service.
Before a notice to produce can be given, the requirements in subsection 129AAD(1) must be met. The first requirement is that the CEM must have a reasonable concern that an amount paid, by way of benefit or payment under the Act, in respect of one or more professional services, may exceed the amount (if any) that should have been paid (paragraph 129AAD(1)(a)). The second requirement is that the CEM must have taken into account advice provided by a medical practitioner employed by the Department about the types of documents that would substantiate the professional services.
The third requirement is that the CEM must take reasonable steps to consult with a relevant professional body about the types of documents that contain information relevant to ascertaining whether amounts paid in respect of professional services of the same kind or kinds as the service (or services) that is the subject of the CEM’s reasonable concern in paragraph 129AAD(1)(a) should have been paid (paragraph 129AAD(1)(c)). The CEM must also request documents before issuing a notice requiring the production of those documents.
Subsection 129AAD(12) defines a relevant professional body to mean a body declared by the Minister under subsection 129AAD(13) to be a relevant professional body. This instrument prescribes the list of relevant professional bodies for the purposes of subsection 129AAD(13).
In order to satisfy the requirements in paragraph 129AAD(1)(c), the prescribed list of relevant professional bodies in this instrument will be relied upon for the purposes of identifying the body that may be consulted with respect to the types of documents that contain information relevant to ascertaining whether a benefit or payment under the Act should have been paid in respect of the professional service rendered by a health professional.
The list of relevant professional bodies in this instrument has been updated from the 2011 instrument. Professional bodies declared in the instrument include the Australian Medical Association, Allied Health Professions Australia, as well as Colleges, Societies and Associations representing a wide variety of health professionals that may be the subject of compliance audits.
Consultation
As part of the sunsetting of legislative instruments review process, the Department of Health (the Department) reviewed the 99 bodies declared in the 2011 instrument.
Bodies that are no longer operational have been removed from this instrument, which has resulted in a reduction in the number of bodies from 99 to 93. The Department consulted with the 93 bodies before the making of this instrument.
Commencement
This instrument commences 1 October 2021.
A provision-by-provision description of the instrument is contained in the Attachment.
Attachment
Details of the Health Insurance (Relevant Professional Bodies) Declaration 2021
Section 1 – Name
This section provides that the name of the instrument is the Health Insurance (Relevant Professional Bodies) Declaration 2021.
Section 2 – Commencement
This section provides that this instrument commences on 1 October 2021.
Section 3 – Authority
This section provides this instrument is made under subsection 129AAD(13) of the Health Insurance Act 1973.
Section 4 – Repeals
This section provides that the Declaration of Relevant Professional Bodies under subsection 129AAD(13) (RPB 1 of 2011) is repealed.
Section 5 – Definitions
This section provides that the definition of the Act means the Health Insurance Act 1973.
Section 6 – Relevant Professional Bodies
This section provides that for the purposes of subsection 129AAD(13) of the Act, a relevant professional body means a body listed in Schedule 1.
Schedule 1 – List of Relevant Professional Bodies
This schedule lists the bodies that are a relevant professional body under subsection 129AAD(13) of the Act.
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Health Insurance (Relevant Professional Bodies) Declaration 2021
This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Legislative Instrument
Section 129AAD of the Act enables the Chief Executive Medicare (the CEM) to give a notice in respect of a professional service to a person, requiring the person to produce one or more documents relevant to ascertaining whether amounts paid as benefits or payments under the Act should have been paid in respect of the professional service.
Before a notice to produce can be given, the requirements in subsection 129AAD(1) must be met. Relevantly, before giving a person a notice to produce, the CEM must take reasonable steps to consult with a relevant professional body about the types of documents that contain information relevant to ascertaining whether amounts paid in respect of professional services of the same kind or kinds as the service (or services) that would be the subject of the notice should have been paid (paragraphs 129AAD(1)(a) and (c)).
Subsection 129AAD(12) defines a relevant professional body to mean a body declared by the Minister under subsection 129AAD(13) to be a relevant professional body. This instrument prescribes the list of relevant professional bodies for the purposes of subsection 129AAD(13).
In order to satisfy the requirements in paragraph 129AAD(1)(c), the prescribed list of relevant professional bodies in this instrument will be relied upon for the purposes of identifying the body that may be consulted with respect to the types of documents that contain information relevant to ascertaining whether a benefit or payment under the Act should have been paid in respect of the professional service rendered by a health professional.
Professional bodies declared in the instrument include the Australian Medical Association, Allied Health Professions Australia, as well as Colleges, Societies and Associations representing a wide variety of health professionals that may be the subject of compliance audits.
Human rights implications
This Legislative Instrument does not engage any of the applicable rights or freedoms.
Conclusion
This Legislative Instrument is compatible with human rights as it does not raise human rights issues.
Daniel McCabe
First Assistant Secretary
Benefits Integrity and Digital Health Division
Department of Health