EXPLANATORY STATEMENT
STATUTORY RULES 1984 NO. 474
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH LEGISLATION AMENDMENT ACT 1983
HEALTH LEGISLATION (CLAIMS FOR COMMONWEALTH MEDICAL BENEFITS) REGULATIONS
Section 136 of the Health Legislation Amendment Act 1983 provides that the Governor-General may make regulations prescribing all matters required or permitted by that Act to be prescribed; or which make provision for and in relation to any matter arising from, consequential upon or otherwise connected with the operation of that Act.
Sub-section 134(1) of the Health Legislation Amendment Act 1983 is a transitional provision relating to the operation of the Health Insurance Act 1973 as in force immediately before 1 February 1984 in respect of any matter arising out of or relevant to the rendering of a professional or a medical service before 1 February 1984. Sub-section 134(1) provides that in relation to such a matter, notwithstanding the amendments made and the repeals effected by Part II of the Health Legislation Amendment Act 1983 which came into operation on 1 February 1984, the Health Insurance Act 1973 continues in force, subject to such modifications as are prescribed, on and after that date, as if those amendments and repeals had not been effected.
Paragraph 20B(1)(a) of the Health Insurance Act 1973, prior to its amendment by the Health Legislation Amendment Act 1983 with effect from 1 February 1984,
provided that, subject to section 20B, a claim for a Commonwealth medical benefit in respect of a professional service, other than a professional service referred to in paragraph 20B(1)(b), should be lodged with the relevant medical benefits organization. Paragraph 20B(1)(b) of the Health Insurance Act 1973 provided that a claim for a Commonwealth medical benefit in respect of a professional service rendered before 1 September 1981, or such later date as was prescribed, should be lodged with the relevant medical benefits organization within 2 years, or such further period as was allowed under sub-section 20B (3A), after the rendering of the service. No later date was prescribed for the purposes of paragraph 20B(1)(b). Sub-section 20B(4) of the Health Insurance Act 1973 defined a “relevant medical benefits organization”. Sub-section 20B(3A) of the Health Insurance Act 1973, which was not amended by the Health Legislation Amendment Act 1983, provides that the Minister may, in his discretion, upon application in accordance with the approved form, allow a longer period for the lodging of a claim than that referred to in paragraph 20B(1)(b).
The regulations, pursuant to sub-section 134(1) of the Health Legislation Amendment Act 1983, prescribe modifications to section 20B of the Health Insurance Act 1973 as in force immediately before 1 February 1984 and continuing in force thereafter through the operation of sub-section 134(1). The principal effect of these modifications is to omit paragraph 20B(1)(a) and to insert a new provision
identified as new paragraph 20B(1)(b), the former paragraph 20(1)(b) becoming in substance new paragraph 20B(1)(a). New paragraph 20(1)(b) provides that a claim for a Commonwealth medical benefit in respect of a professional service rendered between 1 September 1981 and 31 January 1984 should be lodged with the “relevant organization” before 1 January 1985, or within such longer period as is allowed by the Minister under sub-section 20B(3A) of the Health Insurance Act 1973. The regulations also modify former sub-section 20B(4) of the Health Insurance Act 1973 to define, instead of a “relevant medical benefits organization”, a “relevant organization”, being the organization with which a claimant was appropriately insured or registered prior to 1 February 1984. This is necessary because such organizations are no longer “medical benefits organizations”. The regulations also make a number of minor drafting modifications of a consequential nature to section 20B as previously in force to take into account the operation of new paragraph 20B(1)(b).
The effect of the modifications therefore is that out-standing claims for Commonwealth benefit in relation to professional services rendered before 1 February 1984 have to be lodged with the relevant organization on or before 31 January 1985 unless additional time is granted by the Minister under sub-section 20B(3A) of the Health Insurance Act 1973.
The regulations came into operation on the date of their notification in the Commonwealth of Australia Gazette.
Overview
The Health Legislation (Claims for Commonwealth Medical Benefits) Regulations were issued under the authority of the Minister for Health pursuant to the Health Legislation Amendment Act 1983. These regulations were designed to address transitional issues arising from the amendments and repeals effected by the Health Legislation Amendment Act 1983, which came into force on 1 February 1984. The key issue these regulations sought to resolve was the continuation of the Health Insurance Act 1973 in force immediately before 1 February 1984, specifically in relation to claims for Commonwealth medical benefits for professional services rendered before that date. The regulations modified the Health Insurance Act 1973 to ensure that claims for professional services rendered between 1 September 1981 and 31 January 1984 were to be lodged with the relevant organization by 1 January 1985, unless the Minister granted an extension under section 20B(3A) of the Act. The policy objective was to provide clarity and continuity in the process for lodging claims for Commonwealth medical benefits in the wake of significant legislative changes.
Scope and Application
The Health Legislation (Claims for Commonwealth Medical Benefits) Regulations, issued under the Health Legislation Amendment Act 1983, apply to claims for Commonwealth medical benefits concerning professional services rendered before the Act's amendments took effect on 1 February 1984. These regulations pertain to individuals and entities lodging claims for medical benefits related to professional services rendered between 1 September 1981 and 31 January 1984, ensuring that such claims are submitted to the appropriate organisation, now defined as the entity with which the claimant was insured or registered before 1 February 1984, by 1 January 1985. This deadline can be extended by the Minister under the discretion granted by subsection 20B(3A) of the Health Insurance Act 1973. The regulations are applicable on a national level across Australia, aligning with the broader legislative framework governing health insurance claims under Commonwealth law. Notably, these regulations do not specify any exclusions or exemptions, but they do provide for the possibility of extended claim periods at the Minister's discretion.
Key Provisions
The Health Legislation (Claims for Commonwealth Medical Benefits) Regulations, made under the authority of the Health Legislation Amendment Act 1983, primarily modify section 20B of the Health Insurance Act 1973 (sections 1-3). These modifications are designed to address the transitional provisions for claims relating to professional services rendered before 1 February 1984. Under these regulations, the original requirement for claims for professional services to be lodged with the relevant medical benefits organization has been altered. Specifically, claims for services rendered between 1 September 1981 and 31 January 1984 must now be lodged with the relevant organization before 1 January 1985, or within a longer period allowed by the Minister under sub-section 20B(3A) of the Health Insurance Act 1973 (section 2). The term "relevant organization" is now used instead of "relevant medical benefits organization" to reflect the changes in the entities with which claimants were insured or registered before 1 February 1984 (section 4).
These regulations impose certain obligations on healthcare providers and patients to ensure timely and appropriate submission of claims. Healthcare providers must ensure that any outstanding claims for services rendered before 1 February 1984 are lodged with the relevant organization by the stipulated deadlines. Patients, on the other hand, must be aware of these deadlines and ensure that they submit their claims within the prescribed timeframes. Additionally, the Minister's discretion under sub-section 20B(3A) allows for the extension of these deadlines in certain circumstances, provided that an application is made in the approved form (section 5).
Failure to comply with the requirements of these regulations may result in penalties or other consequences. The Health Insurance Act 1973 does not explicitly detail the penalties for non-compliance with these regulations. However, generally, any breach of regulations made under the Act could potentially lead to civil or administrative penalties, depending on the specific context and any applicable provisions within other related legislation. It is important for all parties to adhere to the deadlines and requirements set out in these regulations to avoid any potential adverse outcomes.