Health Legislation Amendment (Miscellaneous Measures No. 1) Act 2025

Health Legislation Amendment (Miscellaneous Measures No. 1) Act 2025

No. 54, 2025

An Act to amend the law relating to health, and for related purposes

Contents

1 Short title

2 Commencement

3 Schedules

Schedule 1—Automation of provider numbers

Part 1—Main amendments

Health Insurance Act 1973

Part 2—Consequential amendments

Australian Immunisation Register Act 2015

Schedule 2—Premiums reduction scheme

Part 1—Amendments

Private Health Insurance Act 2007

Part 2—Application, transitional and validation provisions

Schedule 3—Assignment of medicare benefits

Part 1—Commencement

Health Insurance Legislation Amendment (Assignment of Medicare Benefits) Act 2024

Part 2—Amendment of the Health Insurance Act 1973

Health Insurance Act 1973

Schedule 4—Bonded Medical Program

Part 1—Repayment of education costs

Division 1—Main amendments

Health Insurance Act 1973

Division 2—Other amendments

Health Insurance Act 1973

Part 2—Medicare benefits

Health Insurance Act 1973

Part 3—Bonded Medical Program rules

Health Insurance Act 1973

Health Legislation Amendment (Miscellaneous Measures No. 1) Act 2025

No. 54, 2025

An Act to amend the law relating to health, and for related purposes

[Assented to 4 November 2025]

The Parliament of Australia enacts:

1  Short title

  This Act is the Health Legislation Amendment (Miscellaneous Measures No. 1) Act 2025.

2  Commencement

 (1) Each provision of this Act specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

Note: This table relates only to the provisions of this Act as originally enacted. It will not be amended to deal with any later amendments of this Act.

 (2) Any information in column 3 of the table is not part of this Act. Information may be inserted in this column, or information in it may be edited, in any published version of this Act.

3  Schedules

  Legislation that is specified in a Schedule to this Act is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Act has effect according to its terms.

Schedule 1—Automation of provider numbers

Part 1—Main amendments

Health Insurance Act 1973

1  Subsection 3(1)

Insert:

administrative action has the meaning given by subsection 22R(2).

2  After Part II

Insert:

Part IIAA—Provider numbers

Division 1—Simplified outline of this Part

22C  Simplified outline of this Part

Division 2—Allocation of provider number upon application

22D  Application for a provider number

 (1) A person who is one of the following may apply to the Chief Executive Medicare for the allocation of a provider number to the person for a place of practice:

 (a) a practitioner;

 (b) an approved pathology practitioner;

 (c) a participating midwife;

 (d) a participating nurse practitioner;

 (e) an optometrist;

 (f) a health professional of a kind specified in an instrument under subsection (7).

 (2) An application must be from a single applicant but may cover more than one place of practice.

Note: Section 22E refers to the allocation of a unique provider number for each different place of practice.

 (3) An application may be a digital application or a documentary application.

 (4) A digital application must:

 (a) be given electronically in accordance with the Health Professional Online Services system maintained by Services Australia or another electronic system approved by the Chief Executive Medicare under subsection (8); and

 (b) include the information required by that system to be included in the application; and

 (c) be accompanied by any documents required by that system to accompany the application.

 (5) A documentary application must:

 (a) be in the appropriate form approved by the Chief Executive Medicare under paragraph (9)(a); and

 (b) include the information required by the form; and

 (c) be accompanied by any documents required by the form; and

 (d) be made in the manner (if any) approved by the Chief Executive Medicare under paragraph (9)(b).

 (6) An application is taken to be a documentary application under this section if:

 (a) the application is in the appropriate form approved as mentioned in paragraph (5)(a); and

 (b) the application is uploaded to the Health Professional Online Services system maintained by Services Australia or another electronic system approved as mentioned in paragraph (4)(a).

Legislative instrument

 (7) The Minister may, by legislative instrument, specify a kind of health professional for the purposes of paragraph (1)(f).

Notifiable instruments

 (8) The Chief Executive Medicare may, by notifiable instrument, approve an electronic system for the purposes of paragraph (4)(a).

 (9) The Chief Executive Medicare may, by notifiable instrument, do either or both of the following:

 (a) approve one or more forms for the purposes of paragraph (5)(a);

 (b) approve a manner for the purposes of paragraph (5)(d).

22E  Chief Executive Medicare may allocate provider number

Decision that may be automated by computer program

 (1) If a person makes a digital application under section 22D, the Chief Executive Medicare must, in writing, allocate a unique provider number to the person for a particular place of practice if:

 (a) the application complies with subsection 22D(4); and

 (b) the criteria (if any) specified in an instrument under subsection (6) of this section are met in connection with the application.

Note: A decision under this subsection is able to be automated by a computer program: see section 22R.

Decision that cannot be automated by computer program

 (2) If a person makes a digital application under section 22D and paragraph (1)(a) or (b) of this section is not satisfied in connection with the application, or a person makes a documentary application under section 22D, the Chief Executive Medicare must, in writing:

 (a) allocate a unique provider number to the applicant for a particular place of practice if the Chief Executive Medicare is satisfied that it would be appropriate in all the circumstances to do so; or

 (b) otherwise, refuse to allocate a provider number to the applicant for a particular place of practice.

Note 1: A decision under this subsection is not able to be automated by a computer program.

Note 2: For reconsideration of a refusal decision, see section 22T.

 (3) For the purposes of making a decision under subsection (2), the Chief Executive Medicare may, by notice in writing given to the applicant, require the applicant to give to the Chief Executive Medicare such further information concerning the application as is specified in the notice.

 (4) The applicant must give the further information to the Chief Executive Medicare before the end of the following:

 (a) the period specified in the notice (which must be at least 14 days after the day the notice is given), unless paragraph (b) applies;

 (b) if the Chief Executive Medicare allows a longer period—that longer period.

Provider number

 (5) A provider number allocated under this section must consist of one or more of the following:

  (a) numbers;

 (b) letters;

 (c) symbols.

Criteria for allocating provider number

 (6) The Minister may, by legislative instrument, specify criteria for the purposes of paragraph (1)(b).

 (7) Without limiting subsection (6), the criteria may relate to one or more of the following:

 (a) kinds of applicants under section 22D;

 (b) kinds of places of practice that are the subject of applications under that section;

 (c) kinds of professional services (if any) that are, or are to be, rendered by, or on behalf of, those applicants at those places of practice.

Section applies separately to each place of practice

 (8) This section applies separately in relation to each place of practice covered by an application under section 22D.

22F  Notifying and substituting decisions

Decision under subsection 22E(1)

 (1) For a decision under subsection 22E(1), the Chief Executive Medicare must cause the applicant under section 22D to be notified in writing of the following:

 (a) the decision;

 (b) the provider number and the place of practice;

 (c) the day on which the allocation of the provider number takes effect, which must be:

 (i) the day of the decision, unless subparagraph (ii) applies; or

 (ii) if the applicant, in the application, specified a day on which any allocation of a provider number for that place of practice should take effect and that day is after the day of the decision—that specified day.

Decision under subsection 22E(2)

 (2) Subject to this section, for a decision under subsection 22E(2), the Chief Executive Medicare must cause the applicant under section 22D to be notified in writing of the following:

 (a) the decision;

 (b) for a decision covered by paragraph 22E(2)(a):

 (i) the provider number and the place of practice; and

 (ii) the day on which the allocation of the provider number takes effect, which may be the day of the decision, an earlier day or a later day;

 (c) for a refusal decision covered by paragraph 22E(2)(b)—the reasons for the decision.

Substituting decisions under subsection 22E(2)

 (3) The Chief Executive Medicare may set aside a decision (the original decision) under subsection 22E(2) of a delegate of the Chief Executive Medicare if:

 (a) the applicant under section 22D has not been notified, under subsection (2) of this section, of the original decision; and

 (b) the Chief Executive Medicare is satisfied that the original decision is not correct.

 (4) If the Chief Executive Medicare sets aside the original decision:

 (a) the Chief Executive Medicare must make a new decision under subsection 22E(2) in substitution for the original decision; and

 (b) the Chief Executive Medicare is not required, under subsection (2) of this section, to notify the applicant under section 22D of the original decision.

Note: Subsection (2) of this section will require the applicant under section 22D to be notified of the substituted decision under subsection 22E(2).

22G  Changing day of effect of allocation of provider number

 (1) The person allocated a provider number for a place of practice may, in writing, request the Chief Executive Medicare to change the day of effect of the allocation to a day nominated in the request.

 (2) The day nominated in the request must be a day that is before the day (the current day) on which the allocation has taken effect or is to take effect.

 (3) If the person makes a request in accordance with subsections (1) and (2), the Chief Executive Medicare must, in writing:

 (a) change the day of effect of the allocation of the provider number to another specified day; or

 (b) refuse to change the day of effect of the allocation of the provider number.

Note 1: For reconsideration of a decision to change the day on which the allocation of the provider number takes effect to a day that is different from the day nominated by the person, see section 22T.

Note 2: For reconsideration of a refusal decision, see section 22T.

Notifying decisions

 (4) For a decision under subsection (3), the Chief Executive Medicare must cause the person to be notified in writing of the following:

 (a) the decision;

 (b) for a decision under paragraph (3)(a)—the new day of effect of the allocation of the provider number, which must be a day before the current day;

 (c) for a refusal decision under paragraph (3)(b)—the reasons for the decision.

Substituting decisions under subsection (3)

 (5) The Chief Executive Medicare may set aside a decision (the original decision) under subsection (3) of a delegate of the Chief Executive Medicare if:

 (a) the person has not been notified, under subsection (4), of the original decision; and

 (b) the Chief Executive Medicare is satisfied that the original decision is not correct.

 (6) If the Chief Executive Medicare sets aside the original decision:

 (a) the Chief Executive Medicare must make a new decision under subsection (3) in substitution for the original decision; and

 (b) the Chief Executive Medicare is not required, under subsection (4), to notify the person of the original decision.

Note: Subsection (4) will require the person to be notified of the substituted decision under subsection (3).

22H  Period that allocation of provider number is in effect

  Subject to this Part, the allocation of a provider number under this Part remains in effect indefinitely.

Division 3—Revocation of allocation of provider number

22J  Revocation of allocation of provider number

Mandatory revocation

 (1) The Chief Executive Medicare must, in writing, revoke the allocation of a provider number to a person for a place of practice in the circumstances specified in an instrument under subsection (5).

Note: For reconsideration of a revocation decision, see section 22T.

 (2) The allocation of a provider number to a person for a place of practice is taken to be revoked if the holder of the provider number dies.

Discretionary revocation

 (3) The Chief Executive Medicare may, in writing, revoke the allocation of a provider number to a person for a place of practice if the Chief Executive Medicare is satisfied that it would be appropriate in all the circumstances to do so.

Note: For reconsideration of a revocation decision, see section 22T.

Notifying decisions

 (4) For a decision under subsection (1) or (3), the Chief Executive Medicare must take all reasonable steps to notify the person in writing of the following:

 (a) the decision;

 (b) the reasons for the decision;

 (c) the day that the revocation takes effect, which must not be earlier than the day after the notification is given to the person.

Revocation circumstances

 (5) The Minister may, by legislative instrument, specify circumstances for the purposes of subsection (1).

Setting aside decisions under subsection (1) or (3)

 (6) The Chief Executive Medicare may set aside a decision (the original decision) under subsection (1) or (3) of a delegate of the Chief Executive Medicare if:

 (a) the person has not been notified, under subsection (4), of the original decision; and

 (b) the Chief Executive Medicare is satisfied that the original decision is not correct.

 (7) If the Chief Executive Medicare sets aside the original decision, the Chief Executive Medicare is not required, under subsection (4), to notify the person of the original decision.

Division 4—Suspension of allocation of provider number

Subdivision A—Suspension of allocation of provider number

22K  Suspension of allocation of provider number

Mandatory suspension on request

 (1) The Chief Executive Medicare must, in writing, suspend the allocation of a provider number to a person for a place of practice if:

 (a) the holder of the provider number:

 (i) requests, in writing, the Chief Executive Medicare to suspend the allocation of the provider number; and

 (ii) specifies in the request the day on which the suspension is to take effect, being a day on or after the day the request is made; or

 (b) the applicant under section 22D for the allocation of the provider number:

 (i) requested, in the application, the Chief Executive Medicare to also suspend the allocation of the provider number; and

 (ii) specified in the application the day on which the suspension is to take effect, being a day on or after the day the application is made.

Note: A decision under this subsection is able to be automated by a computer program: see section 22R.

Mandatory suspension in other circumstances

 (2) The Chief Executive Medicare must, in writing, suspend the allocation of a provider number to a person for a place of practice in the circumstances specified in an instrument under subsection (6).

Note: For reconsideration of a suspension decision, see section 22T.

Discretionary suspension

 (3) The Chief Executive Medicare may, in writing, suspend the allocation of a provider number to a person for a place of practice if the Chief Executive Medicare is satisfied that it would be appropriate in all the circumstances to do so.

Note: For reconsideration of a suspension decision, see section 22T.

Notifying decisions

 (4) For a decision under subsection (1), the Chief Executive Medicare must cause the person allocated the provider number to be notified in writing of the following:

 (a) the decision;

 (b) the day on which the suspension takes effect, which must be the day covered by subparagraph (1)(a)(ii) or (b)(ii).

 (5) For a decision under subsection (2) or (3), the Chief Executive Medicare must cause the person allocated the provider number to be notified in writing of the following:

 (a) the decision;

 (b) the reasons for the decision;

 (c) the day on which the suspension takes effect, which must not be earlier than the day after the notification is given to the person allocated the provider number.

Suspension circumstances

 (6) The Minister may, by legislative instrument, specify circumstances for the purposes of subsection (2).

Setting aside decisions under subsection (2) or (3)

 (7) The Chief Executive Medicare may set aside a decision (the original decision) under subsection (2) or (3) of a delegate of the Chief Executive Medicare if:

 (a) the person allocated the provider number has not been notified, under subsection (5), of the original decision; and

 (b) the Chief Executive Medicare is satisfied that the original decision is not correct.

 (8) If the Chief Executive Medicare sets aside the original decision, the Chief Executive Medicare is not required, under subsection (5), to notify the person allocated the provider number of the original decision.

22L  Duration and effect of suspension of allocation of provider number

 (1) The suspension of the allocation of a provider number to a person for a place of practice continues until the suspension is lifted under this Division.

 (2) The allocation of a provider number to a person for a place of practice is taken not to be in effect while the allocation of the provider number is suspended.

 (3) If a person’s allocation of a provider number for a place of practice is suspended under this Division, the person is still the holder of the provider number for the purposes of sections 22J, 22M, 22N, 22P and 22Q.

Note: For example, during the suspension, the Chief Executive Medicare could revoke the allocation of the provider number under section 22J or the holder of the provider number could make an application under subsection 22M(1) or 22P(1).

Subdivision B—Changing day of effect of suspension of allocation of provider number

22M  Application to change day of effect of suspension of allocation of provider number

 (1) The holder of a provider number under this Part for a place of practice may apply to the Chief Executive Medicare for a change to the day on which a suspension of the allocation of the provider number takes effect.

 (2) An application may be a digital application or a documentary application.

 (3) A digital application must:

 (a) be given electronically in accordance with the Health Professional Online Services system maintained by Services Australia or another electronic system approved by the Chief Executive Medicare under subsection (6); and

 (b) not specify a new day for the suspension to take effect that is a day before the day of the application; and

 (c) include the information required by that system to be included in the application; and

 (d) be accompanied by any documents required by that system to accompany the application.

 (4) A documentary application must:

 (a) be in the appropriate form approved by the Chief Executive Medicare under paragraph (7)(a); and

 (b) not specify a new day for the suspension to take effect that is a day before the day of the application; and

 (c) include the information required by the form; and

 (d) be accompanied by any documents required by the form; and

 (e) be made in the manner (if any) approved by the Chief Executive Medicare under paragraph (7)(b).

 (5) An application is taken to be a documentary application under this section if:

 (a) the application is in the appropriate form approved as mentioned in paragraph (4)(a); and

 (b) the application is uploaded to the Health Professional Online Services system maintained by Services Australia or another electronic system approved as mentioned in paragraph (3)(a).

Notifiable instruments

 (6) The Chief Executive Medicare may, by notifiable instrument, approve an electronic system for the purposes of paragraph (3)(a).

 (7) The Chief Executive Medicare may, by notifiable instrument, do either or both of the following:

 (a) approve one or more forms for the purposes of paragraph (4)(a);

 (b) approve a manner for the purposes of paragraph (4)(e).

22N  Chief Executive Medicare may change day of effect of suspension of allocation of provider number

Decision on application that may be automated by computer program

 (1) If the holder of a provider number makes a digital application under section 22M, the Chief Executive Medicare must, in writing, change the day on which the suspension takes effect if:

 (a) the application complies with subsection 22M(3); and

 (b) the criteria (if any) specified in an instrument under subsection (8) of this section are met in connection with the application.

Note: A decision under this subsection is able to be automated by a computer program: see section 22R.

Decision on application that cannot be automated by computer program

 (2) If the holder of a provider number makes a digital application under section 22M and paragraph (1)(a) or (b) of this section is not satisfied in connection with the application, or the holder of a provider number makes a documentary application under section 22M, the Chief Executive Medicare must, in writing:

 (a) change the day on which the suspension takes effect to a specified day if the Chief Executive Medicare is satisfied that it would be appropriate in all the circumstances to do so; or

 (b) otherwise, refuse to change the day on which the suspension takes effect.

Note 1: A decision under this subsection is not able to be automated by a computer program.

Note 2: For reconsideration of a refusal decision, see section 22T.

 (3) For the purposes of making a decision under subsection (2), the Chief Executive Medicare may, by notice in writing given to the holder, require the holder to give to the Chief Executive Medicare such further information concerning the application as is specified in the notice.

 (4) The holder must give the further information to the Chief Executive Medicare before the end of the following:

 (a) the period specified in the notice (which must be at least 14 days after the day the notice is given), unless paragraph (b) applies;

 (b) if the Chief Executive Medicare allows a longer period—that longer period.

Chief Executive Medicare may change day on own initiative

 (5) The Chief Executive Medicare may, in writing and on the Chief Executive Medicare’s own initiative, change the day on which a suspension of the allocation of a provider number to a person for a place of practice takes effect.

Note 1: A decision under this subsection is not able to be automated by a computer program.

Note 2: For reconsideration of a decision under this subsection, see section 22T.

Notifying decisions

 (6) For a decision under subsection (1), the Chief Executive Medicare must cause the holder to be notified in writing of the following:

 (a) the decision;

 (b) the new day on which the suspension takes effect, which must be the day specified by the holder in the application.

 (7) For a decision under subsection (2) or (5), the Chief Executive Medicare must cause the holder to be notified in writing of the following:

 (a) the decision;

 (b) for a decision covered by paragraph (2)(a) or subsection (5)—the new day on which the suspension takes effect, which must not be a day before the day of the decision;

 (c) for a refusal decision covered by paragraph (2)(b)—the reasons for the decision.

Criteria for changing day

 (8) The Minister may, by legislative instrument, specify criteria for the purposes of paragraph (1)(b).

Substituting decisions under subsection (2)

 (9) The Chief Executive Medicare may set aside a decision (the original decision) under subsection (2) of a delegate of the Chief Executive Medicare if:

 (a) the holder has not been notified, under subsection (7), of the original decision; and

 (b) the Chief Executive Medicare is satisfied that the original decision is not correct.

 (10) If the Chief Executive Medicare sets aside the original decision:

 (a) the Chief Executive Medicare must make a new decision under subsection (2) in substitution for the original decision; and

 (b) the Chief Executive Medicare is not required, under subsection (7), to notify the holder of the original decision.

Note: Subsection (7) will require the holder to be notified of the substituted decision under subsection (2).

Subdivision C—Lifting the suspension of allocation of provider number

22P  Application to lift suspension of allocation of provider number

 (1) The holder of a provider number under this Part for a place of practice may apply to the Chief Executive Medicare for a suspension of the allocation of the provider number to be lifted.

 (2) An application may be a digital application or a documentary application.

 (3) A digital application must:

 (a) be given electronically in accordance with the Health Professional Online Services system maintained by Services Australia or another electronic system approved by the Chief Executive Medicare under subsection (6); and

 (b) include the information required by that system to be included in the application; and

 (c) be accompanied by any documents required by that system to accompany the application.

 (4) A documentary application must:

 (a) be in the appropriate form approved by the Chief Executive Medicare under paragraph (7)(a); and

 (b) include the information required by the form; and

 (c) be accompanied by any documents required by the form; and

 (d) be made in the manner (if any) approved by the Chief Executive Medicare under paragraph (7)(b).

 (5) An application is taken to be a documentary application under this section if:

 (a) the application is in the appropriate form approved as mentioned in paragraph (4)(a); and

 (b) the application is uploaded to the Health Professional Online Services system maintained by Services Australia or another electronic system approved as mentioned in paragraph (3)(a).

Notifiable instruments

 (6) The Chief Executive Medicare may, by notifiable instrument, approve an electronic system for the purposes of paragraph (3)(a).

 (7) The Chief Executive Medicare may, by notifiable instrument, do either or both of the following:

 (a) approve one or more forms for the purposes of paragraph (4)(a);

 (b) approve a manner for the purposes of paragraph (4)(d).

22Q  Chief Executive Medicare may lift suspension of allocation of provider number

Decision that may be automated by computer program

 (1) If the holder of a provider number makes a digital application under section 22P, the Chief Executive Medicare must, in writing, lift the suspension if:

 (a) the application complies with subsection 22P(3); and

 (b) the criteria (if any) specified in an instrument under subsection (7) of this section are met in connection with the application.

Note: A decision under this subsection is able to be automated by a computer program: see section 22R.

Decision that cannot be automated by computer program

 (2) If the holder of a provider number makes a digital application under section 22P and paragraph (1)(a) or (b) of this section is not satisfied in connection with the application, or the holder of a provider number makes a documentary application under section 22P, the Chief Executive Medicare must, in writing:

 (a) lift the suspension on a specified day if the Chief Executive Medicare is satisfied that it would be appropriate in all the circumstances to do so; or

 (b) otherwise, refuse to lift the suspension.

Note 1: A decision under this subsection is not able to be automated by a computer program.

Note 2: For reconsideration of a refusal decision, see section 22T.

 (3) For the purposes of making a decision under subsection (2), the Chief Executive Medicare may, by notice in writing given to the holder, require the holder to give to the Chief Executive Medicare such further information concerning the application as is specified in the notice.

 (4) The holder must give the further information to the Chief Executive Medicare before the end of the following:

 (a) the period specified in the notice (which must be at least 14 days after the day the notice is given), unless paragraph (b) applies;

 (b) if the Chief Executive Medicare allows a longer period—that longer period.

Notifying decisions

 (5) For a decision under subsection (1), the Chief Executive Medicare must cause the holder to be notified in writing of the following:

 (a) the decision;

 (b) the day on which the suspension is lifted, which must be:

 (i) the day of the decision, unless subparagraph (ii) applies; or

 (ii) if the holder, in the application, specified a day on which any lifting of the suspension should take effect and that day is after the day of the decision—that specified day.

 (6) For a decision under subsection (2), the Chief Executive Medicare must cause the holder to be notified in writing of the following:

 (a) the decision;

 (b) for a decision to lift the suspension—the day on which the suspension is lifted, which may be the day of the decision, an earlier day or a later day;

 (c) for a refusal decision—the reasons for the decision.

Criteria for lifting suspension

 (7) The Minister may, by legislative instrument, specify criteria for the purposes of paragraph (1)(b).

Substituting decisions under subsection (2)

 (8) The Chief Executive Medicare may set aside a decision (the original decision) under subsection (2) of a delegate of the Chief Executive Medicare if:

 (a) the holder has not been notified, under subsection (6), of the original decision; and

 (b) the Chief Executive Medicare is satisfied that the original decision is not correct.

 (9) If the Chief Executive Medicare sets aside the original decision:

 (a) the Chief Executive Medicare must make a new decision under subsection (2) in substitution for the original decision; and

 (b) the Chief Executive Medicare is not required, under subsection (6), to notify the holder of the original decision.

Note: Subsection (6) will require the holder to be notified of the substituted decision under subsection (2).

Division 5—Use of computer programs

22R  Automation of administrative action

 (1) The Chief Executive Medicare may, in writing, arrange for the use, under the Chief Executive Medicare’s oversight, of computer programs to take administrative action that must be taken by the Chief Executive Medicare under this Part.

 (2) Administrative action is:

 (a) making, or refusing or failing to make, a decision under subsection 22E(1), 22K(1), 22N(1) or 22Q(1); or

 (b) doing, or refusing or failing to do, anything related to making a decision covered by paragraph (a).

Chief Executive Medicare is treated as having taken administrative action

 (3) Administrative action taken by the operation of a computer program under an arrangement under subsection (1) is treated, for all purposes, as administrative action taken by the Chief Executive Medicare.

Substituting administrative action

 (4) The Chief Executive Medicare may take administrative action (the substituted action) in substitution for administrative action the Chief Executive Medicare is treated as having taken under subsection (3) if the Chief Executive Medicare is satisfied that the administrative action taken by the operation of the computer program is not correct.

Note: For reconsideration of a substituted decision, see section 22T.

 (5) The substituted action takes effect on:

 (a) if the Chief Executive Medicare specifies the day on which the substituted action takes effect—that specified day; or

 (b) otherwise—the day of the administrative action taken by the operation of the computer program.

 (6) The day specified under paragraph (5)(a) may be earlier than the day the substituted action is taken but not earlier than the day of the administrative action taken by the operation of the computer program.

Chief Executive Medicare may still take administrative action

 (7) An arrangement under subsection (1) does not prevent the Chief Executive Medicare from taking administrative action under this Part.

Arrangement not a legislative instrument

 (8) An arrangement under subsection (1) is not a legislative instrument.

22S  Oversight and safeguards for automation of administrative action

Chief Executive Medicare to ensure administrative action is action that could be validly taken

 (1) The Chief Executive Medicare must take all reasonable steps to ensure that administrative action taken by the operation of a computer program under an arrangement under subsection 22R(1) is administrative action that the Chief Executive Medicare could validly take under this Part.

 (2) Without limiting subsection (1), the Chief Executive Medicare must do the things (if any) prescribed by the regulations for the purposes of this subsection.

Note: Administrative action may still be invalid even if subsections (1) and (2) are complied with.

 (3) A failure to comply with subsection (1) or (2) does not affect the validity of the administrative action taken by the operation of a computer program under an arrangement under subsection 22R(1).

Notification of decisions made by the operation of computer programs

 (4) If, in accordance with section 22R, a decision is made by the operation of a computer program under an arrangement under subsection 22R(1), the Chief Executive Medicare must, within 14 days of the making of the decision, cause the person who is the subject of the decision to be notified in writing of:

 (a) the decision; and

 (b) the fact that the decision was made by the operation of a computer program.

 (5) The notification under subsection (4) may be part of the notification under subsection 22F(1), 22K(4), 22N(6) or 22Q(5).

 (6) A failure to comply with subsection (4) does not affect the validity of the decision made by the operation of the computer program.

Notification of substituted decisions

 (7) If the Chief Executive Medicare makes a decision under subsection 22R(4) in substitution for a decision the Chief Executive Medicare is treated as having taken under subsection 22R(3), the Chief Executive Medicare must, within 14 days of the making of the substituted decision, cause the person who is the subject of the substituted decision to be notified in writing:

 (a) of the substituted decision and of the fact that the substituted decision was made by the Chief Executive Medicare; and

 (b) of the person’s right to make an application under section 22T for reconsideration of the substituted decision.

 (8) A failure to comply with subsection (7) does not affect the validity of the substituted decision.

Publication

 (9) If the Chief Executive Medicare makes an arrangement under subsection 22R(1) in relation to particular provisions of this Part, the Chief Executive Medicare must cause a statement to be published on Services Australia’s website:

 (a) to the effect that the Chief Executive Medicare has made such an arrangement; and

 (b) setting out those particular provisions.

Details in annual report

 (10) The Chief Executive Officer of Services Australia, when preparing Services Australia’s annual report under section 46 of the Public Governance, Performance and Accountability Act 2013 for a period, must include the following information in that report:

 (a) the total number of substituted actions taken by the Chief Executive Medicare under subsection 22R(4) in that period;

 (b) the kind of substituted actions so taken;

 (c) the kind of administrative action taken by the operation of the computer program that the Chief Executive Medicare was satisfied was not correct.

 (11) The Chief Executive Officer of Services Australia may also include in the report any other information (other than personal information within the meaning of the Privacy Act 1988) about the operation of section 22R and this section in that period that the Chief Executive Officer of Services Australia considers appropriate.

Division 6—Reconsideration and review of decisions

22T  Chief Executive Medicare’s reconsideration of decisions

 (1) The person who is the subject of a decision of the following kind made by the Chief Executive Medicare may request, in writing, the Chief Executive Medicare to reconsider the decision:

 (a) a decision under paragraph 22E(2)(b) to refuse to allocate a provider number for a place of practice;

 (b) a decision under paragraph 22G(3)(a) to change the day of effect of the allocation of a provider number to a day that is different from the day nominated by the person allocated the provider number;

 (c) a decision under paragraph 22G(3)(b) to refuse to change the day of effect of the allocation of a provider number;

 (d) a decision under subsection 22J(1) or (3) to revoke the allocation of a provider number for a place of practice (except if that place of practice was not one covered by the person’s application under section 22D);

 (e) a decision under subsection 22K(2) or (3) to suspend the allocation of a provider number;

 (f) a decision under paragraph 22N(2)(b) to refuse to change the day on which the suspension of the allocation of a provider number takes effect;

 (g) a decision under subsection 22N(5) to change the day on which the suspension of the allocation of a provider number takes effect;

 (h) a decision under paragraph 22Q(2)(b) to refuse to lift the suspension of the allocation of a provider number;

 (i) a decision under subsection 22R(4) in substitution for a decision the Chief Executive Medicare is treated as having taken under subsection 22R(3).

Timing of request

 (2) The person must make the request in writing as follows:

 (a) before the end of the period of 30 days beginning on the day on which the Chief Executive Medicare notifies the person of the decision, unless paragraph (b) applies;

 (b) if the Chief Executive Medicare allows a longer period for making the request—before the end of that longer period.

Reasons for request

 (3) The person must set out in the request the reasons for the request.

Withdrawal of request

 (4) A person’s request for reconsideration of a decision made under paragraph 22E(2)(b) to refuse to allocate a provider number for a place of practice is taken to have been withdrawn if:

 (a) the person makes another application under section 22D for the allocation of a provider number to the person for that place of practice; and

 (b) the person makes the other application before the Chief Executive Medicare makes a decision under subsection (5) of this section on reconsideration of the decision made under paragraph 22E(2)(b).

Decision on reconsideration

 (5) The Chief Executive Medicare, on receiving a person’s request made in accordance with subsections (2) and (3):

 (a) must affirm, vary or set aside the decision covered by subsection (1); and

 (b) if the Chief Executive Medicare sets aside the decision—may make such other decision as the Chief Executive Medicare thinks appropriate.

 (6) The Chief Executive Medicare must make the decision on reconsideration before the end of the following:

 (a) the period of 60 days beginning on the day the Chief Executive Medicare receives the request, unless paragraph (b) applies;

 (b) if the person and the Chief Executive Medicare agree on a longer period—that longer period.

Notice of decision on reconsideration

 (7) The Chief Executive Medicare must give the person written notice of the Chief Executive Medicare’s decision on reconsideration and of the reasons for that decision.

Note: Section 266 of the Administrative Review Tribunal Act 2024 requires the person to be notified of the person’s review rights.

When decision on reconsideration takes effect

 (8) The Chief Executive Medicare’s decision on reconsideration takes effect:

 (a) on the day specified in the notice; or

 (b) if a day is not specified in the notice—on the day on which that decision is made.

Chief Executive Medicare may be taken to have affirmed decision

 (9) The Chief Executive Medicare is taken to have made a decision affirming the decision under reconsideration if the Chief Executive Medicare has not notified the person of the Chief Executive Medicare’s decision on reconsideration before the end of the period applicable under subsection (6).

22U  Administrative Review Tribunal review of decisions

  Applications may be made to the Administrative Review Tribunal for review of a decision under subsection 22T(5) that is made, or a decision under subsection 22T(9) that is taken to have been made, by the Chief Executive Medicare.

Division 7—Other matters

22V  Incorporation of other instruments

  Despite subsection 14(2) of the Legislation Act 2003, an instrument under this Part may make provision in relation to a matter by applying, adopting or incorporating, with or without modification, any matter contained in an instrument or other writing as in force or existing from time to time.

22W  Part does not disentitle person to medicare benefit

  If:

 (a) the Chief Executive Medicare makes a decision under this Part on a day; and

 (b) the effect of the decision is that:

 (i) the allocation of a provider number to a person (the relevant person) for a place of practice comes into effect, or resumes being in effect, on or before that day; or

 (ii) the suspension of the allocation of a provider number to a person (the relevant person) for a place of practice takes effect on or before that day;

that decision does not, of itself, operate to disentitle a person from receiving a medicare benefit that would otherwise be payable to the person in respect of a professional service rendered by, or on behalf of, the relevant person on or before that day.

3  Transitional provisions—old identification numbers

(1) An identification number:

 (a) that, before the commencement of this item:

 (i) for the purposes of the Health Insurance Act 1973, was allocated, or taken to have been allocated, under the Human Services (Medicare) Regulations 2017 to a person in relation to a place of practice; or

 (ii) for the purposes of the Health Insurance Act 1973, was allocated, as mentioned in paragraph 18(b) of the former Medicare Australia (Functions of Chief Executive Officer) Direction 2005, to a person in respect of a place of practice; or

 (iii) for the purposes of the Health Insurance Act 1973, was allocated under the former Health Insurance Commission Regulations, or former Health Insurance Commission Regulations 1975, to a person in respect of a place of practice; and

 (b) that was in effect immediately before the commencement of this item;

has effect on and after that commencement as if it were a provider number allocated under Part IIAA of the Health Insurance Act 1973 to that person for that place of practice.

Note 1: Section 35 of the Human Services (Medicare) Regulations 2017 deals with the allocation of identification numbers.

Note 2: Regulation 31 of the former Human Services (Medicare) Regulations 1975 dealt with the allocation of identification numbers. Section 38 of the Human Services (Medicare) Regulations 2017 has the effect that identification numbers allocated under the former Human Services (Medicare) Regulations 1975 are taken to have been allocated under the Human Services (Medicare) Regulations 2017.

(2) The allocation of that provider number takes effect on the day on which this item commences. Section 22H of the Health Insurance Act 1973 applies in relation to the allocation of that provider number.

Note: That section provides that, subject to Part IIAA of that Act, the allocation of a provider number remains in effect indefinitely.

(3) Section 22F of the Health Insurance Act 1973 does not apply in relation to the allocation of a provider number as mentioned in subitem (1).

Note: That section provides for notification of decisions allocating a provider number to a person for a particular place of practice.

(4) This item has effect subject to rules made under item 7 of this Schedule.

4  Transitional provision—pending requests for old identification numbers

If:

 (a) before the commencement of this item, a person covered by section 35 of the Human Services (Medicare) Regulations 2017 had made a request to the Chief Executive Medicare for the allocation of an identification number in relation to a place of practice; and

 (b) the Chief Executive Medicare had not decided the request before that commencement;

then, on and after that commencement, the request has effect as if it:

 (c) were a documentary application made under section 22D of the Health Insurance Act 1973 for the allocation of a provider number to the person for the place of practice; and

 (d) complied with subsection 22D(5) of that Act.

Note: The Chief Executive Medicare must decide the application under subsection 22E(2) of that Act.

5  Validation of automated allocation of identification numbers

(1) If:

 (a) before the commencement of this item:

 (i) an identification number was allocated, or purportedly allocated, under section 35 of the Human Services (Medicare) Regulations 2017 or paragraph 31(b) of the former Human Services (Medicare) Regulations 1975; or

 (ii) an identification number was allocated, or purportedly allocated, as mentioned in paragraph 18(b) of the former Medicare Australia (Functions of Chief Executive Officer) Direction 2005; and

 (b) the allocation, or purported allocation, was by the use of a computer program;

then the allocation is taken for all purposes to be, and to have always been, as valid and effective as it would have been if, at the time of the allocation:

 (c) the Health Insurance Act 1973 had authorised the responsible person to do the following:

 (i) arrange for the use of computer programs to allocate identification numbers under section 35 of the Human Services (Medicare) Regulations 2017 or paragraph 31(b) of the former Human Services (Medicare) Regulations 1975;

 (ii) arrange for the use of computer programs to allocate identification numbers as mentioned in paragraph 18(b) of the former Medicare Australia (Functions of Chief Executive Officer) Direction 2005; and

 (d) such an arrangement had been in force.

(2) For the purposes of this item, the responsible person is:

 (a) before 1 July 2011—the Chief Executive Officer of Medicare Australia; or

 (b) on or after 1 July 2011—the Chief Executive Medicare.

6  Validation of decisions to refuse to allocate identification numbers

(1) If:

 (a) before the commencement of this item and for the purposes of the Health Insurance Act 1973, the responsible person, or a delegate of the responsible person, made a decision, or purportedly made a decision, to refuse to allocate to a person (the affected person) an identification number referred to:

 (i) in section 35 of the Human Services (Medicare) Regulations 2017 or paragraph 31(b) of the former Human Services (Medicare) Regulations 1975; or

 (ii) in paragraph 18(b) of the former Medicare Australia (Functions of Chief Executive Officer) Direction 2005; and

 (b) the responsible person, or the delegate of the responsible person, took into account either or both of the following considerations:

 (i) whether medicare benefits under the Health Insurance Act 1973 would have been payable in respect of professional services that would have been rendered by, or on behalf of, the affected person if a decision had been made to allocate an identification number to that person in relation to a place of practice requested by that person;

 (ii) the adequacy or completeness of the affected person’s request;

then the refusal decision is taken for all purposes to be, and to have always been, as valid and effective as it would have been if, at the time of the refusal decision, the Health Insurance Act 1973 had authorised those considerations to be taken into account in making decisions about the allocation of those identification numbers.

(2) For the purposes of this item, the responsible person is:

 (a) before 1 July 2011—the Chief Executive Officer of Medicare Australia; or

 (b) on or after 1 July 2011—the Chief Executive Medicare.

7  Transitional rules

(1) The Minister may, by legislative instrument, make rules prescribing matters of a transitional nature (including prescribing any saving or application provisions) relating to:

 (a) the enactment of this Act; or

 (b) the amendments of regulations or any other instruments made under any Act, where those amendments are in connection with the enactment of this Act.

(2) To avoid doubt, the rules may not do the following:

 (a) create an offence or civil penalty;

 (b) provide powers of:

 (i) arrest or detention; or

 (ii) entry, search or seizure;

 (c) impose a tax;

 (d) set an amount to be appropriated from the Consolidated Revenue Fund under an appropriation in this Act;

 (e) directly amend the text of this Act.

(3) Items 3 and 4 of this Schedule do not limit the rules that may be made for the purposes of subitem (1) of this item.

Part 2—Consequential amendments

Australian Immunisation Register Act 2015

8  Paragraph 5A(b)

Omit “if a number known as a provider number”, substitute “if a provider number, under Part IIAA of the Health Insurance Act 1973,”.

9  Subparagraph 9(d)(iv)

Omit “if a number known as a provider number”, substitute “if a provider number, under Part IIAA of the Health Insurance Act 1973,”.

Schedule 2—Premiums reduction scheme

Part 1—Amendments

Private Health Insurance Act 2007

1  Section 23‑15 (heading)

Omit “Registration”, substitute “Application to register”.

2  Subsection 23‑15(2)

Omit “, in the *approved form, no more than 14 days (or any other period determined by the Chief Executive Medicare)”, substitute “no more than 7 business days (or any other period determined by the Chief Executive Medicare under subsection (4))”.

3  Subsections 23‑15(3) and (4)

Repeal the subsections, substitute:

 (3) A notice under subsection (2) must:

 (a) be given electronically in accordance with the electronic system approved by the Chief Executive Medicare under section 333‑16 for the purposes of this paragraph; and

 (b) include the information required by that system to be included in the notice; and

 (c) be accompanied by any documents required by that system to accompany the notice.

 (4) The Chief Executive Medicare may, by legislative instrument, determine a different period for the purposes of subsection (2).

4  After section 23‑15

Insert:

23‑16  Registration of participants

 (1) If a private health insurer notifies the Chief Executive Medicare of an application made under subsection 23‑15(1) in respect of a *complying health insurance policy issued by the insurer, the Chief Executive Medicare must register the applicant as a *participant in respect of the policy if:

 (a) the notice complies with subsection 23‑15(3); and

 (b) the criteria (if any) specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph are met in relation to the application.

Note: A decision under this subsection is able to be automated by a computer program: see section 333‑17.

Notification of proposed refusal

 (2) If the Chief Executive Medicare proposes to refuse to register the applicant as a *participant in respect of the policy, the Chief Executive Medicare must:

 (a) notify the private health insurer of the proposed refusal and the reasons for the proposed refusal; and

 (b) give the private health insurer an opportunity to amend and resubmit the notice given to the Chief Executive Medicare in relation to the application before the end of the period that applies in relation to section 23‑20.

Notification of registration

 (3) If the Chief Executive Medicare registers the applicant as a *participant in the *premiums reduction scheme in respect of the policy, the Chief Executive Medicare must notify the private health insurer of the decision.

5  Subsections 23‑20(1) and (2)

Repeal the subsections, substitute:

  The Chief Executive Medicare is taken to have refused to register an applicant as a *participant in the *premiums reduction scheme in respect of a *complying health insurance policy if the Chief Executive Medicare has not registered the applicant as a participant within:

 (a) the period of 30 days commencing on the day the Chief Executive Medicare is notified of the application under subsection 23‑15(2); or

 (b) if another period is specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph—that specified period.

6  Subsection 23‑30(1)

After “must notify”, insert “(the withdrawal notice)”.

7  Subsection 23‑30(2)

Repeal the subsection, substitute:

 (2) A private health insurer must notify the Chief Executive Medicare of each withdrawal notice that the insurer receives under subsection (1).

 (2A) A notice given by the private health insurer under subsection (2) must:

 (a) be given no more than 7 business days (or any other period determined by the Chief Executive Medicare under subsection (4)) after the withdrawal notice is received by the private health insurer; and

 (b) be given electronically in accordance with the electronic system approved by the Chief Executive Medicare under section 333‑16 for the purposes of this paragraph; and

 (c) include the information required by that system to be included in the notice; and

 (d) be accompanied by any documents required by that system to accompany the notice.

8  At the end of section 23‑30

Add:

Note: A revocation under this subsection is able to be automated by a computer program: see section 333‑17.

 (4) The Chief Executive Medicare may, by legislative instrument, determine a different period for the purposes of paragraph (2A)(a).

9  At the end of section 23‑40

Add:

Note: A variation under this subsection is able to be automated by a computer program: see section 333‑17.

10  Section 279‑1

Repeal the section, substitute:

279‑1  Who can make reimbursement claims

 (1) A private health insurer may claim reimbursement from the Chief Executive Medicare for amounts by which premiums under a *complying health insurance policy issued by the private health insurer are reduced because of the operation of Division 23 if:

 (a) the private health insurer is a *participating insurer when the premium is reduced; and

 (b) the premium is reduced in the 36 month period ending before the month in which the claim for reimbursement is made.

 (2) The claim for reimbursement must be made in accordance with section 279‑10.

11  Section 279‑10

Repeal the section, substitute:

279‑10  Requirements relating to reimbursement claims

 (1) A private health insurer may only make one claim each month for reimbursement from the Chief Executive Medicare of amounts by which premiums under a *complying health insurance policy issued by the private health insurer are reduced.

 (2) The claim must:

 (a) be made within 7 days after the end of a month; and

 (b) be given to the Chief Executive Medicare electronically in accordance with the electronic system approved by the Chief Executive Medicare under section 333‑16 for the purposes of this paragraph; and

 (c) include the information required by that system to be included in the claim; and

 (d) be accompanied by any documents required by that system to accompany the claim.

 (3) Before making a claim, a private health insurer must be satisfied that:

 (a) the claim only includes amounts by which premiums under a *complying health insurance policy issued by the private health insurer have been reduced because of the operation of Division 23; and

 (b) the private health insurer was a *participating insurer when the premiums were reduced; and

 (c) the premiums were reduced in the 36 month period ending before the month in which the claim for reimbursement is made; and

 (d) the amounts have not previously been reimbursed to the private health insurer under this Division.

279‑11  Determination of claim

 (1) If:

 (a) the Chief Executive Medicare receives a claim in accordance with section 279‑10; and

 (b) the criteria specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph have been met in relation to the claim;

the Chief Executive Medicare must pay the insurer, in accordance with section 279‑15, the amount payable under that section.

Note: A decision under this subsection is able to be automated by a computer program: see section 333‑17.

 (2) If the criteria specified for the purposes of paragraph (1)(b) are not met in relation to the claim, or part of the claim, the Chief Executive Medicare must:

 (a) if the criteria are not met in relation to part of the claim—refuse the claim in part and only pay the insurer, in accordance with section 279‑15, the amount payable under that section in respect of such part of the claim that meets the specified criteria; or

 (b) otherwise—refuse the claim.

 (3) The Chief Executive Medicare must notify the private health insurer if the Chief Executive Medicare makes a decision mentioned in subsection (2).

 (4) A notice under subsection (3) must include reasons for the decision.

 (5) The Chief Executive Medicare is taken, for the purposes of this Part, to have accepted a claim in whole if the Chief Executive Medicare does not notify the private health insurer of a decision mentioned in subsection (2) on or before the day under subsection 279‑15(2) by which the claim would have been required to have been paid.

12  Subsections 279‑15(1) and (2)

Repeal the subsections, substitute:

 (1) The amount payable to the private health insurer in respect of a claim is the sum of the amounts that are included in the claim as amounts by which premiums under the *complying health insurance policies issued by the private health insurer have been reduced because of the operation of Division 23.

 (1A) However, if paragraph 279‑11(2)(a) applies in relation to the claim, the amount payable to the private health insurer under subsection (1) of this section must not include any amounts included in the claim that do not meet the criteria specified for the purposes of paragraph 279‑11(1)(b).

 (2) The amount must be paid to the private health insurer on or before the 15th day of the month in which the claim for reimbursement is made.

13  Sections 279‑20 to 279‑40

Repeal the sections.

14  Subsection 279‑45(1)

Omit “279‑20(2) or 279‑40(3)”, substitute “279‑11(3)”.

15  Paragraphs 282‑1(1)(d), (e) and (f)

Omit “or 279‑40”.

16  Paragraph 282‑1(1)(g)

Repeal the paragraph, substitute:

 (g) so much of a payment made under section 279‑15 that is not an amount by which premiums under a complying health insurance policy issued by the private health insurer were reduced because of the operation of Division 23;

 (ga) so much of a payment made under section 279‑15 in relation to a claim for reimbursement as relates to a premium for which a reduction was made before the 36 month period ending before the month in which the claim was made;

 (gb) so much of a payment made under section 279‑15 as:

 (i) relates to a premium for which a reduction was made while the private health insurer was not a *participating insurer; or

 (ii) relates to a premium for which a reduction was made where the amount of the reduction has previously been reimbursed to the private health insurer under Division 279;

17  Subsection 282‑1(1A)

Repeal the subsection, substitute:

 (1A) However, an amount is not recoverable under paragraph (1)(d), (e), (f) or (g) if the situation giving rise to the amount occurred because:

 (a) the private health insurer relied on information provided to the private health insurer by, or on behalf of, a person who is, or was, a *participant in the *premiums reduction scheme; and

 (b) the provided information was incomplete or inaccurate.

18  Paragraph 282‑1(2)(b)

Omit “(f) or (g)”, substitute “(f), (g), (ga) or (gb)”.

19  Subsection 282‑20(1)

Repeal the subsection, substitute:

 (1) The Chief Executive Medicare may, by notice given to a private health insurer, require the insurer, within the period specified in the notice, to provide information specified in the notice about:

 (a) a person who is covered at any time during a financial year specified in the notice by a *complying health insurance policy issued by the insurer; or

 (b) a person who paid premiums under such a policy; or

 (c) a claim made at any time by the insurer under the *premiums reduction scheme for reimbursement of premiums reduced under Division 23.

20  Subsection 333‑10(1) (table item 2, column headed “is the approver of these forms …”)

After “Part 2‑2”, insert “and subsection 282‑20(2)”.

21  After section 333‑15

Insert:

333‑16  Approved electronic system

  The Chief Executive Medicare may, by notifiable instrument, approve one or more electronic systems for the purposes of paragraphs 23‑15(3)(a), 23‑30(2A)(b) and 279‑10(2)(b).

333‑17  Automation of administrative action

 (1) The Chief Executive Medicare may, in writing, arrange for the use, under the Chief Executive Medicare’s oversight, of computer programs to take administrative action that must be taken by the Chief Executive Medicare under this Act.

 (2) Administrative action is:

 (a) making, or refusing or failing to make, a decision under a provision mentioned in subsection (3); or

 (b) exercising, or refusing or failing to exercise, a power under a provision mentioned in subsection (3); or

 (c) performing, or refusing or failing to perform, a function or duty under a provision mentioned in subsection (3); or

 (d) doing, or refusing or failing to do, anything (including giving a notice) related to making a decision, exercising a power or performing a function or duty under a provision mentioned in subsection (3).

 (3) For the purposes of subsection (2), the provisions are the following provisions of the Act:

 (a) subsection 23‑16(1) (which deals with registering a person as a *participant in the *premiums reduction scheme);

 (b) subsection 23‑30(3) (which deals with revoking a person’s registration as a participant in the premiums reduction scheme);

 (c) subsection 23‑40(2) (which deals with variations to registrations);

 (d) subsection 279‑11(1) (which deals with reimbursement claims);

 (e) a provision of this Act prescribed by the Private Health Insurance (Incentives) Rules.

Chief Executive Medicare is treated as having taken administrative action

 (4) Administrative action taken by the operation of a computer program under an arrangement under subsection (1) is treated, for all purposes, as administrative action taken by the Chief Executive Medicare.

Substituting administrative action

 (5) The Chief Executive Medicare may take administrative action (the substituted action) in substitution for administrative action the Chief Executive Medicare is treated as having taken under subsection (4) if the Chief Executive Medicare is satisfied that the administrative action taken by the operation of the computer program is not correct.

 (6) The substituted action takes effect on:

 (a) if the Chief Executive Medicare specifies a day on which the substituted action takes effect—that specified day; or

 (b) otherwise—the day of the administrative action taken by the operation of the computer program.

 (7) The day specified under paragraph (6)(a) may be earlier than the day the substituted action is taken but not earlier than the day of the administrative action taken by the operation of the computer program.

Chief Executive Medicare may still take administrative action

 (8) An arrangement under subsection (1) does not prevent the Chief Executive Medicare from taking administrative action under the provisions referred to in subsection (3).

 (9) Subsection (5) does not limit any other provision of this Act that provides for the review or reconsideration of an administrative action.

Arrangement not a legislative instrument

 (10) An arrangement under subsection (1) is not a legislative instrument.

333‑18  Oversight and safeguards for automation of administrative action

Chief Executive Medicare to ensure administrative action is action that could be validly taken

 (1) The Chief Executive Medicare must take all reasonable steps to ensure that administrative action taken by the operation of a computer program under an arrangement under subsection 333‑17(1) is administrative action that the Chief Executive Medicare could validly take under this Act.

 (2) Without limiting subsection (1), the Chief Executive Medicare must do the things (if any) prescribed by the Private Health Insurance (Incentives) Rules for the purposes of this subsection.

Note: Administrative action may still be invalid even if subsections (1) and (2) are complied with.

 (3) A failure to comply with subsection (1) or (2) does not affect the validity of the administrative action taken by the operation of a computer program under an arrangement under subsection 333‑17(1).

Notification of substituted decisions

 (4) If, under subsection 333‑17(5), the Chief Executive Medicare makes a decision in substitution for a decision the Chief Executive Medicare is treated as having taken under subsection 333‑17(4), the Chief Executive Medicare must, within 14 days of the making of the substituted decision, cause the person who is the subject of the substituted decision to be notified in writing:

 (a) of the substituted decision and of the fact that the substituted decision was made by the Chief Executive Medicare; and

 (b) of the person’s right (if any) to apply for reconsideration of the substituted decision.

 (5) A failure to comply with subsection (4) does not affect the validity of the substituted decision.

Publication

 (6) If the Chief Executive Medicare makes an arrangement under subsection 333‑17(1) in relation to particular provisions of this Act, the Chief Executive Medicare must cause a statement to be published on Services Australia’s website:

 (a) to the effect that the Chief Executive Medicare has made such an arrangement; and

 (b) setting out those particular provisions.

Details in annual report

 (7) The Chief Executive Officer of Services Australia, when preparing Services Australia’s annual report under section 46 of the Public Governance, Performance and Accountability Act 2013 for a period, must include the following information in that report:

 (a) the total number of substituted actions taken by the Chief Executive Medicare under subsection 333‑17(5) in that period;

 (b) the kind of substituted actions so taken;

 (c) the kind of administrative action taken by the operation of the computer program that the Chief Executive Medicare was satisfied was not correct.

 (8) The Chief Executive Officer of Services Australia may also include in the report any other information (other than personal information within the meaning of the Privacy Act 1988) about the operation of section 333‑17 and this section in that period that the Chief Executive Officer of Services Australia considers appropriate.

22  Paragraph 333‑20(1)(b)

Omit “Part or section”, substitute “Part, section or Schedule”.

23  Subsection 333‑20(1) (table item 1, column headed “Chapter/Part/section/Schedule”)

After “Part 6‑4”, insert “, section 333‑17 and section 333‑18”.

24  Clause 1 of Schedule 1 (definition of participant)

Repeal the definition, substitute:

participant, in relation to the *premiums reduction scheme, means a person who is registered as a participant in the scheme under subsection 23‑16(1).

Part 2—Application, transitional and validation provisions

25  Definitions

In this Part:

Act means the Private Health Insurance Act 2007.

amending Part means Part 1 of this Schedule.

commencement time means the commencement of this Schedule.

26  Application of amendments relating to participation in the premiums reduction scheme

(1) Subsections 23‑15(2) and (3) of the Act, as amended by the amending Part, apply in relation to an application under subsection 23‑15(1) of the Act that is received by a private health insurer on or after the commencement time.

(2) Sections 23‑16 and 23‑20 of the Act, as inserted or amended by the amending Part, apply in relation to an application under subsection 23‑15(1) of the Act that is notified to the Chief Executive Medicare before the commencement time if the application has not been dealt with, or taken to have been dealt with, by the Chief Executive Medicare before that time.

(3) Section 23‑30 of the Act, as amended by the amending Part, applies in relation to a notice under subsection 23‑30(1) of the Act that is given to a private health insurer on or after the commencement time.

27  Participants in the premiums reduction scheme

(1) A person who was a participant in the premiums reduction scheme immediately before the commencement time continues to be a participant after that time as if the person had been registered under subsection 23‑16(1) of the Act as inserted by the amending Part.

(2) The person’s registration, after the commencement time, may be dealt with under Division 23 of the Act as amended by the amending Part.

28  Application of amendments relating to claims for reimbursement

(1) Section 279‑10 of the Act, as repealed and substituted by the amending Part, applies in relation to a claim for reimbursement made on or after the commencement time.

(2) Sections 279‑11 and 279‑15 of the Act, as inserted or amended by the amending Part, apply in relation to a claim for reimbursement made before the commencement time if the claim has not been dealt with, or taken to have been dealt with, by the Chief Executive Medicare before that time.

29  Pending applications for additional payments

(1) This item applies in relation to an application made under subsection 279‑25(2) or 279‑30(2) of the Act if the application:

 (a) was made before the commencement time; and

 (b) has not been dealt with, or taken to have been dealt with, by the Chief Executive Medicare before that time.

(2) The application is taken, at the commencement time, to have been a claim made in accordance with section 279‑10 of the Act and may be dealt with under Division 279 of the Act as amended by the amending Part.

30  Reconsideration of decisions

(1) This item applies in relation to a notice of a decision given to a private health insurer in accordance with subsection 279‑20(2) or 279‑40(3) of the Act if:

 (a) the notice was given before the commencement time; and

 (b) the period referred to in section 279‑45 of the Act for making a request to the Chief Executive Medicare to reconsider the notified decision has not expired before the commencement time.

(2) After the commencement time:

 (a) the notice is taken to be a notice given to the private health insurer in accordance with subsection 279‑11(3) of the Act, as inserted by the amending Part; and

 (b) the private health insurer may request the Chief Executive Medicare to reconsider the decision by the end of the same period as the period referred to in paragraph (1)(b) of this item.

31  Recovery of payments

 Section 282‑1 of the Act, as amended by the amending Part, applies in relation to an amount that is paid on or after the commencement time.

32  Validation of registration of persons as participants in the premiums reduction scheme

(1) If:

 (a) before the commencement time a person was registered, or purportedly registered, under section 23‑15 of the Act as a participant in the premiums reduction scheme in respect of a complying health insurance policy issued by an insurer; and

 (b) a computer program was used in relation to the registration, under section 23‑15 of the Act, of the person in the premiums reduction scheme in a way that was not authorised by the Act;

the registration of the person is taken for all purposes to be, and to have always been, valid and effective as it would have been if, at the time the person was registered:

 (c) the Act had authorised the responsible person to arrange for the use of computer programs to approve the registration of a person to become a participant in the premiums reduction scheme in respect of a complying health insurance policy; and

 (d) such arrangements had been in force; and

 (e) the responsible person had been satisfied that paragraphs 23‑15(1)(a), (b) and (c) of the Act (as in force at the time the computer program was used in relation to the registration of the person) applied in relation to the person.

(2) For the purposes of this item, the responsible person is:

 (a) before 1 July 2011—the Chief Executive Officer of Medicare Australia; or

 (b) on or after 1 July 2011—the Chief Executive Medicare.

33  Validation of refusals to register persons as participants in the premiums reduction scheme

(1) If:

 (a) before the commencement time the responsible person refused, or purportedly refused, to register a person as a participant in the premiums reduction scheme in respect of a complying health insurance policy issued by an insurer; and

 (b) a computer program was used in relation to the refusal to register the person in a way that was not authorised by the Act;

the refusal to register the person is taken for all purposes to be, and to have always been, valid and effective as it would have been if, at the time the person was refused registration:

 (c) the Act had authorised the responsible person to arrange for the use of computer programs to refuse the registration of a person to become a participant in the premiums reduction scheme in respect of a complying health insurance policy; and

 (d) such arrangements had been in force; and

 (e) the responsible person had not been satisfied that paragraphs 23‑15(1)(a), (b) and (c) of the Act (as in force at the time the computer program was used in relation to the refusal to register the person) applied in relation to the person.

(2) For the purposes of this item, the responsible person is:

 (a) before 1 July 2011—the Chief Executive Officer of Medicare Australia; or

 (b) on or after 1 July 2011—the Chief Executive Medicare.

34  Validation of revocations of persons’ registration as participants in the premiums reduction scheme

(1) If:

 (a) before the commencement time the registration of a person as a participant in the premiums reduction scheme in respect of a complying health insurance policy issued by an insurer was revoked under subsection 23‑30(3) of the Act; and

 (b) a computer program was used in relation to the revocation of the person’s registration in a way that was not authorised by the Act;

the revocation of the person’s registration is taken for all purposes to be, and to have always been, valid and effective as it would have been if, at the time the person’s registration was revoked:

 (c) the Act had authorised the responsible person to arrange for the use of computer programs to revoke the registration of a person as a participant in the premiums reduction scheme in respect of a complying health insurance policy; and

 (d) such arrangements had been in force.

(2) For the purposes of this item, the responsible person is:

 (a) before 1 July 2011—the Chief Executive Officer of Medicare Australia; or

 (b) on or after 1 July 2011—the Chief Executive Medicare.

35  Transitional rules

(1) The Minister may, by legislative instrument, make rules prescribing matters of a transitional nature (including prescribing any saving or application provisions) relating to:

 (a) the enactment of this Act; or

 (b) the amendments of regulations or any other instruments made under any Act, where those amendments are in connection with the enactment of this Act.

(2) To avoid doubt, the rules may not do the following:

 (a) create an offence or civil penalty;

 (b) provide powers of:

 (i) arrest or detention; or

 (ii) entry, search or seizure;

 (c) impose a tax;

 (d) set an amount to be appropriated from the Consolidated Revenue Fund under an appropriation in this Act;

 (e) directly amend the text of this Act.

(3) Items 26 to 31 of this Part do not limit the rules that may be made for the purposes of subitem (1) of this item.

Schedule 3—Assignment of medicare benefits

Part 1—Commencement

Health Insurance Legislation Amendment (Assignment of Medicare Benefits) Act 2024

1  Subsection 2(1) (table item 2)

Repeal the item, substitute:

Part 2—Amendment of the Health Insurance Act 1973

Health Insurance Act 1973

2  At the end of subsection 20A(1)

Add:

Note 3: Regulations made for the purposes of paragraph (1)(d) may operate by reference to a determination made under subsection 20AAB(1).

3  After subsection 20A(1)

Insert:

 (1A) The regulations may provide for and in relation to enduring agreements. An enduring agreement is an agreement under subsection (1) that relates to professional services rendered by, or on behalf of, a professional from time to time.

 (1B) Without limiting paragraph (1)(d) or subsection (1A), the regulations:

 (a) may specify circumstances in which enduring agreements:

 (i) may, or may not, be entered into; or

 (ii) cease to be in effect; and

 (b) may specify kinds of professional services that enduring agreements may, or may not, apply to.

4  Paragraphs 20A(2)(b) and (c)

Repeal the paragraphs, substitute:

 (c) under a complying health insurance policy issued by a private health insurer (the insurer), the assignor or another person is covered (wholly or partly) for liability to pay fees and charges in respect of the professional service; and

5  Subsection 20AAA(2) (note)

After “the assignor”, insert “, or, if the medicare benefit relates to a professional service rendered to another eligible person, that other person,”.

6  Subsection 20AAA(3) (note 2)

Omit “must give the assignor a notification as soon as practicable after a request is modified under paragraph (3)(b)”, substitute “must, if asked to, give the assignor a copy of the terms of a request that is modified as mentioned in paragraph (3)(b)”.

7  Subsection 20AAA(4) (note)

After “the assignor”, insert “, or, if the medicare benefit relates to a professional service rendered to another eligible person, that other person,”.

8  Subsection 20AAA(6) (note)

After “the assignor”, insert “, or, if the medicare benefit relates to a professional service rendered to another eligible person, that other person,”.

9  After section 20AAA

Insert:

20AAB  Minister may determine categories of professional services

 (1) The Minister may, by legislative instrument, determine:

 (a) categories of professional services; and

 (b) the professional services that are in specified categories.

Note: For specification by class, see subsection 13(3) of the Legislation Act 2003.

 (2) Regulations made for the purposes of paragraph 20A(1)(d) may operate by reference to a determination made under subsection (1) of this section.

10  Paragraph 127(3)(d)

Repeal the paragraph, substitute:

 (d) the insurer or approved billing agent does not give a notification to the assignor or, if the medicare benefit relates to a professional service rendered to another eligible person, to that other person:

 (i) in accordance with any requirements specified in the regulations; and

 (ii) within 6 months of the payment.

11  Paragraph 127(5)(d)

Repeal the paragraph, substitute:

 (d) the assignor asks the responsible provider for a copy of the terms of the request, as modified; and

 (e) the responsible provider does not ensure that the assignor is given a copy of the terms of the request, as modified, as soon as practicable after the assignor asks for it.

Schedule 4—Bonded Medical Program

Part 1—Repayment of education costs

Division 1—Main amendments

Health Insurance Act 1973

1  Subparagraph 124ZEA(5)(b)(i)

Omit “paragraph 124ZG(1)(a) or (c)”, substitute “paragraph 124ZG(1)(c)”.

2  Subparagraph 124ZEA(5)(b)(ii)

Omit “paragraph 124ZG(1)(a) or (c)”, substitute “paragraph 124ZG(1)(c)”.

3  Subsection 124ZH(1)

Repeal the subsection, substitute:

 (1) This section applies if, at a time when a person is a bonded participant:

 (a) the person has completed their course of study in medicine at an Australian university; and

 (b) the person breaches the condition mentioned in paragraph 124ZG(1)(c).

4  Paragraph 124ZH(4)(b)

Omit “paragraph 124ZG(1)(a) or (c) (as applicable)”, substitute “paragraph 124ZG(1)(c)”.

5  Paragraph 124ZT(3)(f)

Omit “paragraph 124ZG(1)(a) or (c)”, substitute “paragraph 124ZG(1)(c)”.

6  Application of amendments

The amendments made by this Division apply in relation to a breach of a condition mentioned in paragraph 124ZG(1)(a) or (c) of the Health Insurance Act 1973 whether the breach occurs before, on or after the commencement of this item.

Division 2—Other amendments

Health Insurance Act 1973

7  Subsection 124ZQ(1)

Omit “person’s census date for the second year of the person’s course of study in medicine”, substitute “person completes their course of study in medicine”.

8  Application of amendments

The amendments made by this Division apply in relation to a person who withdraws from the Bonded Medical Program before, on or after the commencement of this item.

Part 2—Medicare benefits

Health Insurance Act 1973

9  Subparagraph 124ZEA(5)(c)(ii)

Repeal the subparagraph.

10  Section 124ZJ

Repeal the section.

11  Subsections 124ZQ(3) to (5)

Repeal the subsections.

Part 3—Bonded Medical Program rules

Health Insurance Act 1973

12  After paragraph 124ZT(3)(d)

Insert:

 (da) that a bonded participant is taken to have completed a return of service obligation despite anything in Subdivision B;

 (db) that work completed by a person who is a bonded participant (including work completed before the person became a bonded participant) is taken to qualify for completing the person’s return of service obligation, despite anything in Subdivision B;

13  At the end of subsection 124ZT(3)

Add:

 ; (h) the waiver or refund (wholly or in part) of any amount mentioned in subsection 124ZH(2) or 124ZQ(1).

[Minister’s second reading speech made in—

House of Representatives on 4 September 2025

Senate on 27 October 2025]