Health Legislation (Private Health Insurance Reform) Amendment Act 1995

No. 41 of 1995

An Act to amend the National Health Act 1953, the Health Insurance Act 1973 and the Health Insurance Commission Act 1973, and for related purposes

[Assented to 29 May 1995]

The Parliament of Australia enacts:

Short title

1. This Act may be cited as the Health Legislation (Private Health Insurance Reform) Amendment Act 1995.

Commencement

2.(1) Sections 1, 2 and 3 commence on the date of Royal Assent or 1 April 1995, whichever is the later.

(2) Section 4 and Schedule 1 commence on the date of Royal Assent or 1 April 1995, whichever is the later.

(3) Section 5 and Schedule 2 commence on 1 October 1995.

(4) Section 6 and Schedule 3 commence on 1 July 1996.

(5) Section 7 and Schedule 4 commence on 1 July 1997.

Principal Act

3. In this Act, "Principal Act" means the National Health Act 19531.

Amendments commencing on 1 April 1995 or Royal Assent, whichever is later

4.(1) The Principal Act is amended as set out in Part 1 of Schedule 1.

(2) The Health Insurance Act 19732 is amended as set out in Part 2 of Schedule 1.

Amendments commencing on 1 October 1995

5.(1) The Principal Act is amended as set out in Part 1 of Schedule 2.

(2) The Health Insurance Commission Act 19733 is amended as set out in Part 2 of Schedule 2.

Amendments commencing on 1 July 1996

6. The Principal Act is amended as set out in Schedule 3.

Amendments commencing on 1 July 1997

7.(1) The Principal Act is amended as set out in Schedule 4.

(2) Until 1 July 1998, references in paragraphs (bc), and (j) to (kc) of Schedule 1 to the National Health Act 1953 to an applicable benefits arrangement are taken to include references to a basic table or supplementary hospital table within the meaning of the National Health Act 1953 as in force immediately before 1 July 1997.

____________

SCHEDULE 1 Section 4

AMENDMENTS COMMENCING ON 1 APRIL 1995 OR ROYAL ASSENT,
WHICHEVER IS LATER

PART 1—AMENDMENTS OF THE NATIONAL HEALTH ACT 1953

1. Subsection 4(1) (paragraph (da) of the definition of "basic private table" or "basic table"):

Omit the paragraph.

2. Subsection 4(1) (definition of "records"):

Omit "Commonwealth medical benefits or fund benefits by contributors or registered persons", substitute "fund benefits by contributors".

3. Subsection 4(1) (paragraph (a) of the definition of "supplementary hospital table"):

Omit the paragraph, substitute:

"(a) is not an applicable benefits arrangement; and".

4. Subsection 4(1) (definition of "day hospital facility"):

Omit the definition, substitute:

" 'day hospital facility' means:

(a) premises that were, immediately before 1 April 1995, a day hospital facility (within the meaning of this section as in force at that time), other than premises in respect of which a declaration under subsection 5B(2) is in force; and

(b) premises in respect of which a declaration under subsection 5B(1) is in force;".

5. Subsection 4(1):

Insert:

" 'applicable benefits arrangement' has the meaning given in section 5A;

'Hospital Casemix Protocol' means the Hospital Casemix Protocol prescribed for the purposes of paragraph 73BD(2)(c);

'hospital purchaser-provider agreement' means an agreement entered into under section 73BD;

'medical purchaser-provider agreement' means an agreement entered into under section 73BDA;

'practitioner agreement' means an agreement of the kind referred to in subsection 73BDAA(1);".

SCHEDULE 1—continued

6. Subsection 4(1AA):

Omit "shall, for the purposes of paragraph (da) of the definition of 'basic private table' or 'basic table' in subsection (1), be deemed", substitute "is taken, for the purposes of subparagraph (a)(ii) and paragraph (b) of the definition of 'applicable benefits arrangement' in subsection 5A(1), ".

7. Subsection 4(1BA):

Omit the subsection.

8. Subsection 4A(1):

Omit the subsection.

9. Subsection 4A(2A):

(a) Omit "the basic table", substitute "an applicable benefits arrangement".

(b) Omit "that table", substitute "that arrangement or table".

10. After section 5:

Insert:

Applicable benefits arrangement

"5A.(1) A reference in this Act to an applicable benefits arrangement is a reference to an arrangement that a registered organization has entered into with some or all of the contributors to a health benefits fund conducted by the organization under which the contributors are covered (wholly or partly) for liability to pay fees and charges:

(a) in respect of:

(i) some or all hospital treatment provided to a patient by a hospital or a day hospital facility with which the organization has a hospital purchaser-provider agreement; and

(ii) all professional services that are rendered to the patient by a medical practitioner while that hospital treatment is being provided, and that are professional services in respect of which a medicare benefit is payable; or

(b) in respect of some or all professional services that are rendered to a patient by a medical practitioner while hospital treatment is provided to the patient in a hospital or a day hospital facility, and that are professional services in respect of which a medicare benefit is payable;

and includes a reference to a basic table of the organization.

SCHEDULE 1—continued

"(2) For the avoidance of doubt, the application of subsection (1) is not affected by:

(a) the existence or non-existence of a medical purchaser-provider agreement between the organization and a medical practitioner referred to in that subsection; or

(b) the existence or non-existence of a hospital purchaser-provider agreement between the organization and a hospital or day hospital facility referred to in that subsection; or

(c) the existence or non-existence of a practitioner agreement between a hospital or day hospital facility referred to in that subsection and a medical practitioner referred to in that subsection.

"(3) In this section:

'medical practitioner' includes:

(a) an accredited dental practitioner; and

(b) a dental practitioner approved by the Minister for the purposes of the definition of 'professional service' in subsection 3(1) of the Health Insurance Act 1973.

Declarations in relation to day hospital facilities

"5B.(1) The Minister may, in writing, declare premises specified in the declaration to be a day hospital facility for the purposes of this Act and the Health Insurance Act 1973.

"(2) The Minister may, in writing, declare premises specified in the declaration, being premises that were, immediately before the commencement of this section, a day hospital facility within the meaning of subsection 4(1) as in force at the time, not to be a day hospital facility for the purposes of this Act and the Health Insurance Act 1973.

"(3) A declaration under subsection (1) may be expressed to take effect from a day earlier than the day on which the declaration is made (not being a day earlier than the day on which the premises specified in the declaration were licensed, under the law of the State in which they are located, to operate as a day hospital facility).

"(4) A decision whether to make a declaration under this section must be in accordance with any guidelines in force under subsection (5).

"(5) The Minister may, by written instrument, make guidelines relating to the making of such decisions.

"(6) The guidelines are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901.".

SCHEDULE 1—continued

11. Subsections 66(3) and (4):

Omit the subsections.

12. After section 67A:

Insert:

"Division 2—Registration".

13. Subsection 73(2AA):

(a) Omit "subsections (1) and (2)", substitute "subsection (1)".

(b) Omit "subsection (1) or (2)", substitute "subsection (1)".

14. Subsection 73(2AB):

Omit "subsection (1) or (2) that the registration of an organization as a registered health benefit fund", substitute "subsection (1) that the registration of an organization".

15. Subsection 73(2AC):

Omit the subsection.

16. After section 73:

Insert:

"Division 3—Conditions of registration".

17. After section 73A:

Insert:

Registered health benefits organization to provide information

"73AB.(1) It is a condition of registration of a registered organization that it must, in accordance with this section, give to the Department and the Council:

(a) the information required under the Hospital Casemix Protocol; or

(b) so much of that information as is in the organization's possession or control;

except so far as the Secretary has agreed that the information need not be given.

"(2) The information must be provided in respect of:

(a) each period of one calendar month; or

(b) if the Secretary determines in writing that a longer period is to apply in relation to the organization—that longer period.

SCHEDULE 1—continued

"(3) The information must be provided:

(a) not earlier than 3 months after the period under subsection (2) to which it relates; and

(b) not later than one week after the end of that 3 months.

"(4) The information must relate to each patient, in relation to whom the organization was given information by a hospital or day hospital facility under a hospital purchaser-provider agreement in compliance with a requirement of a kind referred to in paragraph 73BD(2)(c), who was discharged by the hospital or day hospital facility during the period under subsection (2) to which the information relates.

"(5) Information given under this section is taken, for the purposes of the Privacy Act 1988, to have been obtained only for the purposes of modelling, evaluation and research by the Department and the Council.

Registered health benefits organization not to discriminate

"73ABA. It is a condition of registration of a registered organization that it must expressly undertake not to discriminate against an eligible contributor on the grounds of race, sex or sexuality.".

18. Section 73BA:

Add at the end:

"(2) In Schedule 1, unless the contrary intention appears:

'medical practitioner' includes:

(a) an accredited dental practitioner; and

(b) a dental practitioner approved by the Minister for the purposes of the definition of 'professional service' in subsection 3(1) of the Health Insurance Act 1973; and

(c) a person on whose behalf a medical practitioner (within the meaning of subsection 3(1) of the Health Insurance Act 1973), or a dental practitioner of a kind referred to in paragraph (a) or (b), renders a professional service.".

19. Subsection 73BB(2):

Omit the subsection, substitute:

"(2) For the purposes of subsections (3), (4) and (8), if:

(a) benefits have been paid, or are payable, by a registered organization, in accordance with an applicable benefits arrangement or a supplementary hospital table, in respect of the provision of treatment, a service or another matter, for a person or persons, in relation to a particular day; and

SCHEDULE 1—continued

(b) the person has not, or the persons have not, reached the prescribed age on that day;

then:

(d) if such a matter was provided for 2 or more such persons—that day counts, subject to subsection (8), as a number of patient days of the contributor equal to the number of those persons.".

20. Subsection 73BB(4):

Omit "a basic table (whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba) of the Schedule)", substitute "an applicable benefits arrangement".

21. After subsection 73BB(4):

Insert:

"(4A) For the purposes of subsection (4), the amount of a payment, made in accordance with an applicable benefits arrangement other than a basic table, in respect of a patient day is taken to be the amount of the payment divided by the episode duration in relation to the payment.".

22. Subsection 73BB(5):

Omit "a basic table (whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba) of the Schedule)", substitute "an applicable benefits arrangement".

23. After subsection 73BB(5):

Insert:

"(6) For the purposes of subsection (5), the amount of a payment, made in accordance with an applicable benefits arrangement other than a basic table, is taken to be the amount worked out by:

(a) dividing the amount of the payment by the episode duration in relation to the payment; and

(b) multiplying the result by the number of days in the episode duration that occurred on or after the person reached the prescribed age.".

24. Subsection 73BB(11):

Insert:

" 'episode duration' in relation to a particular kind of payment made in accordance with an applicable benefits arrangement other than a basic table,

SCHEDULE 1—continued

means the number of days worked out in accordance with the information provided by the hospital or day hospital facility concerned to the registered organization under the Hospital Casemix Protocol.".

25. After subsection 73BB(11):

Insert:

"(11A) A reference in this section to an applicable benefits arrangement is a reference to an applicable benefits arrangement whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba) of Schedule 1.".

26. Paragraphs 73BB(12)(a), (b) and (c):

Omit the paragraphs, substitute:

"(a) those benefits are taken to be hospital benefits; and

(b) those benefits are taken to be included in an applicable benefits arrangement of the organization.".

27. Subsection 73BC(1):

After "the Commonwealth" insert "and the States and Territories".

28. After subsection 73BC(3):

Insert:

"(4) Amounts received from the States or Territories for payment into the Fund form part of the Fund.".

29. Paragraph 73BC(5)(a):

Omit "in the financial year ending on 30 June 1989".

30. After section 73BC:

Insert:

"Division 4—Purchaser-provider agreements

Hospital purchaser-provider agreements

"73BD.(1) A registered organization may enter into an agreement, with a hospital or a day hospital facility, that includes provisions to the effect that:

(a) except to the extent (if any) provided in the agreement, the hospital or day hospital facility agrees to accept payment by the organization in satisfaction of any amount that would, apart from the agreement, be owed to the hospital or day hospital facility, in relation to an episode of hospital treatment, by an eligible contributor (see subsection (3)); and

SCHEDULE 1—continued

(b) payments by the organization to the hospital or day hospital facility in respect of episodes of hospital treatment are to be:

(i) casemix episodic payments (see subsection (4)); or

(ii) casemix episodic payments in respect of specified kinds of episodes of hospital treatment and, in respect of any other kind of episode of hospital treatment, payments made in accordance with the appropriate basic table or supplementary hospital table; or

(iii) payments made in accordance with the appropriate basic table or supplementary hospital table.

"(2) The agreement must also:

(a) specify the level of accommodation that the hospital or day hospital facility is to provide to eligible contributors (see subsection (3)) to a health benefits fund in respect of such episodes of hospital treatment; and

(b) require the hospital or day hospital facility to render, in respect of an episode of hospital treatment, a single account covering:

(i) all hospital services and related services; and

(ii) all professional services (if any) to which a practitioner agreement with the hospital or day hospital facility applies;

but not covering any professional services to which no such practitioner agreement applies; and

(c) require the hospital or day hospital facility to give to the organization, within the time specified in subsection (ii), the information specified in the Hospital Casemix Protocol prescribed by regulation made for the purposes of this paragraph, except so far as the Secretary has agreed that the information need not be given; and

(d) require the hospital or day hospital facility, in accordance with subsection (6), to inform any eligible contributor in respect of whom hospital treatment is to be provided at the hospital or day hospital facility of the amounts that the eligible contributor will be liable to pay to the hospital or day hospital facility in respect of the hospital treatment; and

(e) require the hospital or day facility to provide, in respect of an episode of hospital treatment, all reasonable assistance to the organization to enable the organization to verify:

SCHEDULE 1—continued

(i) the essential variables for accurate casemix assignment; and

(ii) the payability of amounts by the organization under the agreement; and

(iii) the payability of other amounts by the organization relating to professional services rendered in connection with the hospital treatment.

"(3) For the purposes of paragraphs (1)(a), (2)(a) and (2)(d) and subsection (6), a person is an eligible contributor in relation to an episode of hospital treatment if:

(a) the person is a contributor to a health benefits fund conducted by the organization; and

(b) under the terms on which the person is a contributor, the person is covered (wholly or partly) in respect of the episode of hospital treatment.

"(4) For the purposes of paragraph (1)(b), a payment by the organization to the hospital or day hospital facility in respect of an episode of hospital treatment is a casemix episodic payment if:

(a) the episode of hospital treatment is an episode of a kind:

(i) specified in the List of Australian National Diagnosis Related Groups prescribed by the regulations; or

(ii) otherwise specified in the regulations; and

(b) the amount and structure of the payment is as set out in the agreement or may be worked out in accordance with the agreement.

"(5) Information referred to in paragraph (2)(c) must be given to the organization within 6 weeks after the patient to whom the information relates has been discharged from the hospital or day hospital facility in question.

"(6) For the purposes of paragraph (2)(d), the eligible contributor must be informed:

(a) where practicable, at any time before the admission for the hospital treatment in question; or

(b) otherwise—as soon after the admission as the circumstances reasonably permit.

"(7) Nothing in this section is to be taken as precluding natural persons from making arrangements for themselves, or for other natural persons wholly or partially dependent upon them, for the provision to them of hospital, medical or related services directly with hospitals.

SCHEDULE 1—continued

Extension of hospital purchaser-provider agreements to cover rendering of some professional services

"73BDAA.(1) This section applies if:

(a) a hospital or a day hospital facility has entered into an agreement (the 'practitioner agreement') with a medical practitioner relating to the rendering of professional services by the medical practitioner at the hospital or day hospital facility; and

(b) under the practitioner agreement, the medical practitioner agrees, except to the extent (if any) provided in the agreement, to accept payment by the hospital or day hospital facility in satisfaction of any amount that would, apart from the agreement, be owed to the medical practitioner in relation to professional services to which the agreement applies; and

(c) the practitioner agreement requires the medical practitioner, in accordance with subsection (3), to inform any eligible contributor (see subsection (4)) in respect of whom such professional services are rendered of any amounts that the eligible contributor will be liable to pay to the medical practitioner in respect of the professional services.

"(2) A hospital purchaser-provider agreement between a registered organization and the hospital or day hospital facility may include provisions to the effect that:

(a) except to the extent (if any) provided in the hospital purchaser-provider agreement, the hospital or day hospital facility agrees to accept payment by the organization in satisfaction of any amount that would, apart from the hospital purchaser-provider agreement, be owed to the hospital or day hospital facility, in relation to a professional service to which the practitioner agreement applies, by an eligible contributor (see subsection (4)); and

(b) the organization agrees to accept assignments under subsection 20A(2A) of the Health Insurance Act 1973 of the medicare benefits payable in respect of the professional service.

"(3) For the purposes of paragraph (1)(c), the eligible contributor must be informed:

(a) where practicable, at any time before the professional service is rendered; or

(b) otherwise—as soon after the professional service is rendered as the circumstances reasonably permit.

SCHEDULE 1—continued

"(4) For the purposes of paragraphs (1)(c) and (2)(a) and subsection (3), a person is an eligible contributor in relation to a professional service if:

(a) the person is a contributor to a health benefits fund conducted by the organization; and

(b) under the terms on which the person is a contributor, the person is covered (wholly or partly) in respect of the professional service.

"(5) A reference in this section to a professional service is a reference to a professional service:

(a) that is rendered to a patient by a medical practitioner while hospital treatment is provided to the patient in a hospital or a day hospital facility; and

(b) in respect of which a medicare benefit is payable.

"(6) In this section:

'medical practitioner' includes:

(a) an accredited dental practitioner; and

(b) a dental practitioner approved by the Minister for the purposes of the definition of 'professional service' in subsection 3(1) of the Health Insurance Act 1973; and

Medical purchaser-provider agreements

"73BDA.(1) A registered organization may enter into an agreement, with a medical practitioner, that includes provisions to the effect that:

(a) except to the extent (if any) provided in the agreement, the medical practitioner agrees to accept payment by the organization in satisfaction of any amount that would, apart from the agreement, be owed to the medical practitioner, in relation to a professional service, by an eligible contributor (see subsection (4)); and

(b) the organization agrees to accept assignments under subsection 20A(2A) of the Health Insurance Act 1973 of the medicare benefits payable in respect of the professional service;

and that specifies the amount that is payable by the organization to the medical practitioner under the agreement, or specifies the way in which such an amount is to be worked out.

SCHEDULE 1—continued

"(2) The agreement must also:

(a) require the medical practitioner to forward to the organization all accounts for amounts of the kind referred to in paragraph (1)(a); and

(b) require the medical practitioner to specify in each such account any amounts that an eligible contributor (see subsection (4)) will be liable to pay to the medical practitioner in respect of the professional service in question; and

(c) require the medical practitioner, in accordance with subsection (5), to inform the eligible contributor in respect of whom the professional service is to be rendered of any amounts that the eligible contributor can reasonably be expected to pay to the medical practitioner in respect of the professional service.

"(3) The agreement may apply to all professional services rendered by the medical practitioner or may be limited to professional services of the kinds specified in the agreement.

"(4) For the purposes of paragraphs (1)(a), (2)(b) and (2)(c) and subsection (5), a person is an eligible contributor in relation to a professional service if:

(a) the person is a contributor to a health benefits fund conducted by the organization; and

(b) under the terms on which the person is a contributor, the person is covered (wholly or partly) in respect of the professional service.

"(5) For the purposes of paragraph (2)(c), the eligible contributor must be informed:

(a) where practicable, at any time before the professional service is rendered; or

(b) otherwise—as soon after the professional service is rendered as the circumstances reasonably permit.

"(6) A reference in this section to a professional service is a reference to a professional service:

(a) that is rendered to a patient by a medical practitioner while hospital treatment is provided to the patient in a hospital or a day hospital facility; and

(b) in respect of which a medicare benefit is payable.

SCHEDULE 1—continued

"(7) In this section:

'medical practitioner' includes:

(a) an accredited dental practitioner; and

(b) a dental practitioner approved by the Minister for the purposes of the definition of 'professional service' in subsection 3(1) of the Health Insurance Act 1973; and

"(8) Nothing in this section is to be taken as preventing natural persons from making arrangements for themselves, or for other natural persons wholly or partially dependent upon them, for the provision to them of medical or related services in a hospital, directly with a medical practitioner.

"Division 5—Directions by the Minister

Certain documents not liable to duty etc.

"73BDB. The following are not subject to any duty or charge under any law of a State or Territory, or any law of the Commonwealth that applies only in relation to a Territory:

(a) a hospital purchaser-provider agreement, to the extent that the agreement provides for payments of a kind referred to in paragraph 73BD(1)(a) or 73BDAA(2)(a) or assignments of medicare benefits of a kind referred to in paragraph 73BDAA(2)(b);

(b) a practitioner agreement, to the extent that the agreement provides for payments of a kind referred to in paragraph 73BDAA(1)(b);

(c) a medical purchaser-provider agreement, to the extent that the agreement provides for payments of a kind referred to in paragraph 73BDA(1)(a) or assignments of medicare benefits of a kind referred to in paragraph 73BDA(1)(b).

Application of the Trade Practices Act 1974

"73BDC.(1) Subject to subsection (2), this Division does not affect the operation of the Trade Practices Act 1974.

"(2) Nothing in this Division is to be taken as specifically authorising or approving any act or thing for the purposes of subsection 51(1) of the Trade Practices Act 1974.

SCHEDULE 1—continued

Purchaser-Provider Panel

"73BDD.(1) There is established a panel, known as the Purchaser-Provider Panel, to monitor the operation of this Division, and of hospital purchaser-provider agreements and medical purchaser-provider agreements, and to report to the Minister as provided by this section.

"(2) The panel consists of members appointed by the Minister for periods not exceeding 2 years in accordance with this subsection:

(a) the Complaints Commissioner (who shall chair the panel);

(b) 2 members appointed by the Minister following consultation with the medical profession, including specialist practitioners;

(c) 2 members appointed by the Minister following consultations with organizations concerned with the provision of services by private hospitals;

(d) 2 members appointed by the Minister following consultations with registered organizations;

(e) 2 members appointed by the Minister following consultations with organizations concerned with the provision of services by public hospitals;

(f) 2 members appointed by the Minister following consultations with organizations representing consumers.

"(3) The performance of the functions of the panel is not affected by a vacancy or vacancies in the membership of the panel.

"(4) Members of the panel may be reappointed after a term of appointment has expired.

"(5) Any statistics, information or data provided to the panel in the course of its activities by a registered organization, hospital, medical practitioner, or agency of the Commonwealth shall not be in a form in which the personal or medical particulars of a patient or patients can be identified or inferred.

"(6) For the purposes of the Privacy Act 1988, the panel is to be taken to have obtained that information only for the purposes of discharging its functions.

"(7) Unless both parties to a hospital or medical purchaser-provider agreement give their consent in writing, no agreements or provisions of an agreement may be required by the panel to be furnished to it.

SCHEDULE 1—continued

"(8) Subject to subsection (9), no later than 1 October each year the panel shall provide to the Minister a written report on the operation of this Division, and of hospital purchaser-provider agreements and medical purchaser-provider agreements, during the immediately preceding financial year and such reports may contain any recommendations the panel thinks fit to make.

"(9) The Minister must cause a copy of each report received from the panel under subsection (8) to be presented to each House of the Parliament within 15 sitting days of that House after receiving it.

"(10) The panel will be disbanded no later than 30 June 1997.".

31. Subsection 73BE(5):

Omit "a basic table", substitute "an applicable benefits arrangement".

32. Paragraph 73BF(1)(a):

Omit "a basic table", substitute "an applicable benefits arrangement".

33. Subsection 73BF(1):

Omit "that table", substitute "that applicable benefits arrangement".

34. Subparagraphs 73BF(3)(c)(i) and 73BF(4)(a)(i):

Omit "the table", substitute "the applicable benefits arrangement".

35. Paragraph 73BF(4)(a):

Omit "the table" (last occurring), substitute "the applicable benefits arrangement".

36. Subsection 73BFA(1):

(a) Omit "a basic table", substitute "an applicable benefits arrangement".

(b) Omit "the basic table", substitute "the arrangement".

37. Subparagraph 73BFA(3)(c)(i):

Omit "a basic table", substitute "an applicable benefits arrangement".

38. Subsection 73BFB(1):

Omit "the table", substitute "the applicable benefits arrangement".

39. Paragraph 73BFB(4)(a):

Omit "the table", substitute "the applicable benefits arrangement".

SCHEDULE 1—continued

40. After section 73D:

Insert:

''Division 6—Miscellaneous''.

41. Sections 73F and 73G:

Repeal the sections, substitute:

The Private Patients' Hospital Charter

"73F.(1) The Minister may, by notice published in the Gazette, issue a statement, to be called the Private Patients' Hospital Charter, that:

(a) informs people of what they could, as contributors, reasonably require from registered organizations, medical practitioners, hospitals and day hospital facilities; and

(b) advises people of matters to consider in making decisions about becoming contributors to such funds.

"(2) The Private Patients' Hospital Charter is a disallowable instrument for the purposes of section 46A of the Acts Interpretation Act 1901.

Liability for disclosure of information

"73G.(1) No action (whether criminal or civil) lies against a person for breach of a duty of confidence, or breach of a similar obligation, in relation to the disclosure of information under a hospital purchaser-provider agreement in compliance with a requirement of a kind referred to in paragraph 73BD(2)(c) or (e).

"(2) No action (whether criminal or civil) lies against a hospital or a day hospital facility, or a person acting on behalf of a hospital or a day hospital facility, for breach of a duty of confidence, or breach of a similar obligation, in relation to the disclosure of information if the disclosure is reasonably necessary in connection with:

(a) making a payment under an applicable benefits arrangement or assessing whether or not to make such a payment; or

(b) any other matter relating to the operation of an applicable benefits arrangement.

"(3) This section has effect despite:

(a) any law (whether written or unwritten) of the Commonwealth, a State or a Territory; and

(b) any contract, arrangement or understanding;

to the contrary.".

SCHEDULE 1—continued

42. Subsection 75(6):

Omit "section 73AA or 79", substitute "section 79".

43. Subsection 78(1):

Omit all the words after "the registered organization" (last occurring), substitute "must ensure that the Secretary receives notification of the change in accordance with this section.".

44. After subsection 78(1):

Insert:

"(1A) The notification must be received:

(a) if the change relates to rates of contribution by contributors—no later than 7 days, or such lesser period (if any) determined by the Minister on application from the organization, before the change is to come into effect; or

(b) in any other case—no later than 60 days, or such lesser period (if any) determined by the Minister on application from the organization, before the change is to come into effect.

"(1B) Within a reasonable time after receiving the notification, the Secretary must give the organization written acknowledgment of its receipt.

"(1C) The notification must be in writing in a form approved by the Minister.".

45. Subsection 82(6):

Omit "to contributors to the organization".

46. After paragraph 82G(k):

Insert:

"(l) to distribute copies of the Private Patients' Hospital Charter issued under section 73F to registered organizations for distribution and display by the organizations;

(la) to make copies of the Charter available to members of the public on request at each of its offices accessible to the public;

(lb) where appropriate, to publicise the existence and availability of the Charter in its brochures and other documents, concerning health insurance, made available to the public;".

47. After section 132:

Insert the following Division:

SCHEDULE 1—continued

"Division 5—Aggregate Billing Advisory Committee

"132A.(1) The Minister is to establish an Aggregate Billing Advisory Committee.

"(2) The Committee is to consist of the following members:

(a) the Secretary to the Department (who shall chair the Committee);

(b) a member nominated by each of the following:

(i) the Australian Medical Association;

(ii) the Australian Private Hospitals Association;

(iii) the Australian Catholic Hospitals Association;

(iv) the Australian Hospitals Association;

(v) the Australian Health Insurance Association;

(vi) the Council of Procedural Specialists;

(d) 2 other members nominated by the Minister, only one of whom may be an employee of the Department.

"(3) If the person referred to in paragraph (2)(b) is not available to serve as a member, that person may nominate a person to be a member of the Committee in his or her place.

"(4) The Minister is to determine the terms and conditions of appointment, including remuneration and allowances, if any, of a person who is a member of the Committee. Arty such remuneration or allowances are to be paid out of monies appropriated by the Parliament for the purpose.

"(5) The functions of the Committee are:

(a) to investigate the most appropriate way of moving to a system of aggregate billing for an episode of hospital treatment (covering all hospital services and related services including medical services); and

(b) to recommend to the Minister the most appropriate method of achieving aggregate billing by 1 July 1998.

"(6) The recommendation referred to in paragraph (5)(b):

(a) must be made not later than 1 January 1997; and

(b) must be tabled in each House of the Parliament within 15 sitting days of that House of being received by the Minister.

"(7) Following tabling of the recommendation the Minister may determine that the Committee is no longer required and may terminate the membership of the persons referred to in subsection (2).".

SCHEDULE 1—continued

48. Subsection 140(2):

Omit "the basic table", substitute "an applicable benefits arrangement".

49. Paragraph (b) of Schedule 1:

Omit the paragraph, substitute:

"(b) Subject to the condition set out in paragraph (ba), the organization will permit:

(i) any contributor to a health benefits fund conducted by it; and

(ii) any person who is eligible to become such a contributor;

to contribute for benefits in respect of the contributor and the contributor's dependants (if any), or in respect of the person and the person's dependants (if any), in accordance with any applicable benefits arrangement of the organization.".

50. Subparagraph (ba)(i) of Schedule 1:

Omit "the basic table", substitute "an applicable benefits arrangement of the organization".

51. Paragraph (ba) of Schedule 1:

Omit "the basic table" (last occurring), substitute "that arrangement".

52. Subparagraph (bc)(i) of Schedule 1:

Omit the subparagraph, substitute:

"(i) in relation to benefits in respect of a matter related to an ailment or illness the signs or symptoms of which, in the opinion of a medical practitioner appointed by the organization, existed at any time during the 6 months preceding the day on which the contributor made the election—12 months; or".

53. After paragraph (be) of Schedule 1:

Insert:

"(bd) The organization will have in force an applicable benefits arrangement under which contributors are entitled to contribute for benefits in respect of:

(i) all episodes of hospital treatment to which paragraph 73BD(4)(a) applies; and

(ii) all professional services rendered to a patient, while hospital treatment is provided to the patient in a hospital or a day hospital facility, being professional services in respect of which a medicare benefit is payable; and

SCHEDULE 1—continued

(iii) all episodes of hospital treatment to which a basic table of the organization could apply,

(be) The organization will permit all contributors to a health benefits fund conducted by the organization, and all persons who are eligible to become such contributors, to contribute for benefits in accordance with that applicable benefits arrangement.".

54. After paragraph (c) of Schedule 1:

Insert:

"(ca) The organization will not refuse or fail to enter into a hospital purchaser-provider agreement with a hospital or a day hospital facility solely because of one or more of the following:

(i) the number of beds that the hospital or day hospital facility has;

(ii) the range of hospital treatments that the hospital or day hospital facility provides;

(iii) the fact that a particular person, or a person of a particular kind, owns or has an interest in the hospital or day hospital facility;

(iv) the fact that a particular person, or a person of a particular kind, does not own or have an interest in the hospital or day hospital facility.".

55. Paragraph (d) of Schedule 1:

Omit the paragraph, substitute:

"(d) The amount of fund benefit payable by the organization in respect of hospital treatment for a person who is not a nursing-home type patient will not exceed the fees or charges incurred in respect of that hospital treatment.".

56. Paragraph (e) of Schedule 1:

Omit "to a contributor".

57. After paragraph (e) of Schedule 1:

Insert:

"(ea) The amount of benefit payable by the organization in respect of a professional service that:

(i) is rendered to a patient while hospital treatment is provided to the patient in a hospital or a day hospital facility; and

SCHEDULE 1—continued

(ii) is a professional service in respect of which a medicare benefit is payable;

must be an amount at least equal to:

(iii) if the medical expenses incurred in respect of the service are greater than or equal to the Schedule fee (within the meaning of Part II of the Health Insurance Act 1973) in respect of the service—25% of that Schedule fee; or

(iv) if medical expenses incurred in respect of the service are less than that Schedule fee—the amount (if any) by which the medical expenses exceed 75% of that Schedule fee;

but, if the service is rendered by or on behalf of a medical practitioner with whom the organization does not have a medical purchaser-provider agreement that applies to that service, the amount of benefit payable must not exceed the amount referred to in subparagraph (iii) or (iv) (whichever is applicable).".

58. Paragraph (f) of Schedule 1:

Omit "a basic table", substitute "an applicable benefits arrangement of the organization".

59. Paragraph (g) of Schedule 1:

Omit "a basic table", substitute "an applicable benefits arrangement of the organization".

60. Subparagraph (g)(ii) of Schedule 1:

Omit "the basic table", substitute "that arrangement".

61. After paragraph (h) of Schedule 1:

Insert:

"(ha) The organization will make freely available to the contributors to a health benefits fund conducted by it up-to-date lists of:

(i) the hospitals and day hospital facilities with which it has hospital purchaser-provider agreements; and

(ii) the persons with whom it has medical purchaser-provider agreements.

(hb) The organization will, at the request of a contributor to a health benefits fund conducted by it, give to a hospital, day hospital facility or medical practitioner such information that the organization has that will enable or assist:

SCHEDULE 1—continued

(i) the hospital or day hospital facility to comply, in relation to the contributor, with any requirements of the kind referred to in paragraph 73BD(2)(d) that are included in a hospital purchaser-provider agreement between the organization and the hospital or day hospital facility; or

(ii) the medical practitioner to comply, in relation to the contributor, with any requirements of the kind referred to in paragraph 73BDAA(1)(c) that are included in a practitioner agreement between the medical practitioner and a hospital or day hospital facility; or

(iii) the medical practitioner to comply, in relation to the contributor, with any requirements of the kind referred to in paragraph 73BDA(2)(c) that are included in a medical purchaser-provider agreement between the organization and the medical practitioner;

as the case requires,

(he) The organization will:

(i) make copies of the Private Patients' Hospital Charter issued under section 73F available to contributors to any health benefits funds conducted by it; and

(ii) at each of its business premises accessible to the public, make copies of the Charter available to members of the public on request; and

(iii) at each such premises, display at least one copy of the Charter; and

(iv) where appropriate, publicise the existence and availability of the Charter in its brochures and other documents, concerning health insurance, made available to the public".

62. Paragraph (j) of Schedule 1:

Omit "a basic table", substitute "an applicable benefits arrangement of the organization".

63. Paragraph (k) of Schedule 1:

(a) Omit "a basic table" (first occurring), substitute "an applicable benefits arrangement of the organization".

(b) Omit ", being ailments of a kind that are determined by the Minister by writing signed by him or her, to be ailments to which this condition applies".

SCHEDULE 1—continued

64. Subparagraph (k)(i) of Schedule 1:

(a) Omit "a basic table", substitute "an applicable benefits arrangement of the organization".

(b) Omit "that basic table", substitute "that arrangement".

65. After paragraph (k) of Schedule 1:

Insert:

"(ka) If:

(i) an applicable benefits arrangement to which a waiting period referred to in paragraph (j) or (k) applies had wholly or partly replaced another applicable benefits arrangement of the organization (the 'previous benefits arrangement'); and

(ii) immediately before the replacement, the contributor had been a contributor for benefits in accordance with the previous benefits arrangement; and

(iii) immediately before the replacement, the contributor had served the whole or a part of another waiting period in relation to the previous benefits arrangement;

the organization must count the contributor's service of the other waiting period towards the waiting period referred to in paragraph (j) or (k), at least so far as the first-mentioned arrangement entitles the contributor to benefits equivalent to the benefits to which he or she was entitled under the previous benefits arrangement.

(kb) If:

(i) an applicable benefits arrangement to which a waiting period referred to in paragraph (j) or (k) applies had wholly or partly replaced a supplementary hospital table of the organization; and

(ii) immediately before the replacement, the contributor had been a contributor for benefits in accordance with the supplementary hospital table; and

(iii) immediately before the replacement, the contributor had served the whole or a part of another waiting period in relation to the supplementary hospital table;

SCHEDULE 1—continued

the organization must count the contributor's service of the other waiting period towards the waiting period referred to in paragraph (j) or (k), at least so far as the arrangement entitles the contributor to benefits equivalent to the benefits to which he or she was entitled under the supplementary hospital table,

(kc) For the purposes of paragraph (k), a pre-existing ailment is an ailment or illness the signs or symptoms of which, in the opinion of a medical practitioner appointed by the organization, existed at any time during the 6 months preceding the day on which the contributor began contributions to the organization for:

(i) benefits in accordance with the applicable benefits arrangement or supplementary hospital table referred to in that paragraph; or

(ii) if applicable, benefits in accordance with the previous benefits arrangement referred to in paragraph (ka) or the replaced supplementary hospital table referred to in paragraph (kb).

(kd) In forming an opinion referred to in subparagraph (bc)(i) or paragraph (kc), the medical practitioner appointed by the organization must have regard to any information relating to the ailment or illness that was given to him or her by the medical practitioner who treated the ailment or illness.".

66. Paragraph (la) of Schedule 1:

Omit the paragraph, substitute:

"(la) For the purposes of the conditions set out in paragraphs (ld) and (le), a person (the 'relevant person') is a transferred contributor in relation to a benefit (the 'relevant benefit') included in an applicable benefits arrangement or a supplementary hospital table or other table of the organization if the following conditions are satisfied:

(i) the relevant person is, in relation to the organization, a contributor for benefits in accordance with the arrangement or table;

(ii) at the time of becoming such a contributor, or within 7 days or such longer period as the rules of the organization allow before that time, the relevant person was, in relation to another health benefits organization, a contributor for benefits in accordance with a comparable benefits arrangement (see paragraph (laa));

SCHEDULE 1—continued

(iii) the comparable benefits arrangement included a benefit (the 'comparable benefit') that was comparable to the relevant benefit;

(iv) at the time of becoming a contributor for benefits in accordance with the applicable benefits arrangement, supplementary hospital table or other table, the person had paid all contributions due to the other organization.

(1aa) The reference in subparagraph (la)(ii) to a comparable benefits arrangement is a reference to:

(i) if the relevant benefit is included in an applicable benefits arrangement (other than a basic table), whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba)—an applicable benefits arrangement (other than a basic table), whether or not modified by such an election, of the other health benefits organization; or

(ii) if the relevant benefit is included in a basic table, whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba)—a basic table, whether or not modified by such an election, of the other health benefits organization; or

(iii) if the relevant benefit is included in a supplementary hospital table—a supplementary hospital table of the other health benefits organization; or

(iv) if the relevant benefit is included in a table other than a basic table or a supplementary hospital table—a table other than a basic table or a supplementary hospital table of the other health benefits organization.".

67. Sub-subparagraph (ld)(i)(A) of Schedule 1:

Omit "applicable table", substitute "applicable benefits arrangement, supplementary hospital table or other table".

68. Paragraph (m) of Schedule 1:

Omit "to a basic table" (wherever occurring).

69. Subparagraphs (m)(i), (ii) and (iii) of Schedule 1:

Omit "the table", substitute "an applicable benefits arrangement of the organization".

SCHEDULE 1—continued

70. Paragraphs (o) and (p) of Schedule 1:

Omit the paragraphs, substitute:

"(o) The organization will comply with any request by the Commission for access to any document in the possession or under the control of the organization that relates directly or indirectly to payment of a medicare benefit to the organization because of subsection 20A(2A) of the Health Insurance Act 1973.

(p) The organization will retain such a document for the period of 2 years starting:

(i) if the document relates to payment of a medicare benefit in respect of professional services for which one claim for an amount of benefit was lodged with the organization—on the day on which that claim was lodged; or

(ii) if the document relates to payment of a medicare benefit in respect of professional services for which 2 or more claims for an amount of benefit were lodged with the organization—on the day on which the last of those claims was so lodged.".

PART 2—AMENDMENTS OF THE HEALTH INSURANCE ACT 1973

71. Paragraph 10(2)(a):

Omit "paragraph (da) of the definition of 'basic private table' or 'basic table' in subsection 4(1)", substitute "subparagraph (a)(ii) and paragraph (b) of the definition of 'applicable benefits arrangement' in subsection 5A(1)".

72. Subsection 10AC(1) (definition of "relevant service"):

73. Section 14:

Add at the end:

"(2) Subsection (1) does not apply if:

(a) the rendering of the professional service is covered by a medical purchaser-provider agreement; and

(b) the amount payable under the agreement for the professional service is not determined on a fee for service basis.".

SCHEDULE 1—continued

74. After subsection 20A(2):

Insert:

"(2A) Where:

(a) a medicare benefit would, apart from this section, be payable to an eligible person in respect of a professional service rendered to a patient while hospital treatment is provided to the patient in a hospital or a day hospital facility; and

(b) the eligible person has entered into an arrangement with a registered organization under which he or she is covered (wholly or partly) for liability to pay fees and charges in respect of that professional service; and

(i) the organization has a medical purchaser-provider agreement with the medical practitioner by whom or on whose behalf the professional service was rendered; or

(ii) the organization has a hospital purchaser-provider agreement with the hospital or day hospital facility, and the hospital or day hospital facility has a practitioner agreement, with the medical practitioner by whom or on whose behalf the professional service was rendered, that applies to the professional service; and

(d) the agreement applies to the professional service;

the eligible person is taken, for the purposes of this Act, to have assigned his or her right to the payment of the medicare benefit to the organization.

"(2B) Despite subsection (4), in subsection (2A):

'medical practitioner' includes:

(a) an accredited dental practitioner; and

(b) a dental practitioner approved by the Minister for the purposes of the definition of 'professional service' in subsection 3(1); and

(c) a person on whose behalf a medical practitioner (within the meaning of subsection 3(1)), or a dental practitioner of a kind referred to in paragraph (a) or (b), renders a professional service.".

75. Section 23EA:

(a) Before "The Minister may" in subsection (1), insert "Subject to subsection (4)".

(b) After subsection (3) insert the following subsection:

SCHEDULE 1—continued

"(3A) For the purposes of this Act and the National Health Act 1953, a declared private hospital must provide data specified in the Hospital Casemix Protocol:

(a) in a patient identifiable state, to a registered private health insurance organization which has an applicable benefits agreement with the patient; and

(b) in a patient de-identified state to a data bureau established, no later than 1 January 1996, by statute, for the purpose of receiving and disseminating such data; and

(c) the role and responsibilities of the data bureau shall be defined by statute after appropriate consultations with registered organizations, hospitals and medical practitioners, and with due reference to the data requirements of the Hospital Casemix protocol.".

76. Section 23EA:

Add at the end:

"(4) A decision whether to make a declaration under this section must be in accordance with any guidelines in force under subsection (5).

"(5) The Minister may, by written instrument, make guidelines relating to the making of such decisions.

"(6) The guidelines are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901.".

77. Section 39 (definition of "eligible person"):

Omit "a basic table", substitute "an applicable benefits arrangement".

78. Subsection 126(5A):

Omit "the basic table", substitute "an applicable benefits arrangement".

____________

SCHEDULE 2 Section 5

AMENDMENTS COMMENCING ON 1 OCTOBER 1995

PART 1—AMENDMENTS OF THE NATIONAL HEALTH ACT 1953

1. Subsection 4(1) (definition of "contributor"):

Omit "a health benefits fund", substitute "the health benefits fund".

2. Subsection 4(1) (definition of "dependant" (first occurring)):

Omit "a health benefits fund", substitute "the health benefits fund".

3. Subsection 4(1) (definition of "registered health benefits organization"):

Omit "or health benefits funds".

4. Subsection 4(1) (definition of "waiting period"):

Omit the definition, substitute:

" 'waiting period', in relation to a contributor to the health benefits fund conducted by a registered organization, means a period:

(a) that starts on the day on which the contributor becomes a contributor for benefits in accordance with an applicable benefits arrangement, supplementary hospital table or other table of benefits of the organization; and

(b) during which, under the rules of the organization, the contributor is not entitled to fund benefits in accordance with that arrangement or table.".

5. Subsection 4(6):

Omit the subsection.

6. Section 4A:

Repeal the section.

7. Subsection 5A(1):

Omit "a health benefits fund", substitute "the health benefits fund".

8. Subsections 66(5), (6) and (7):

Omit the subsections.

9. Subsection 67(4) (definition of "health insurance business"):

Add at the end the following note:

"Note: Subsections (5) and (6) deal with the application of this definition in respect of employee health benefits schemes.".

SCHEDULE 2—continued

10. Subsection 67(4):

Insert:

" 'employee health benefits scheme' means an arrangement that provides for an employer to arrange payment in respect of the whole or part of the fees and charges incurred by an employee of the employer in relation to hospital treatment or an ancillary health benefit, even if the arrangement:

(a) is a minor or incidental part of the employer's business; or

(b) does not require the employee to pay any contributions; or

(c) does not require the employee to pay contributions that reflect the value of the benefits that the employer is providing under the arrangement; or

(d) provides for the employer to make payments in relation to hospital treatment, or an ancillary health benefit, provided to a person other than the employee; or

(e) confers on the employer or another person a discretion whether to make payments;

but does not include:

(f) an arrangement that is the subject of an agreement to which Part VIB of the Industrial Relations Act 1988 applies, being an agreement:

(i) that has been certified by, or the implementation of which has been approved by, the Australian Industrial Relations Commission under that Part before 1 January 1995; and

(ii) a copy of which has been given to the Minister; or

(g) an arrangement that the Minister determines in writing not to be an employee health benefits scheme;".

11. Section 67:

Add at the end:

"(5) Subject to subsection (6), an employee health benefits scheme is not precluded from constituting a health insurance business within the meaning of this section, even though it does not constitute a business of undertaking liability by way of insurance, if:

(a) the employer is a body corporate to which paragraph 51(xx) of the Constitution applies; or

(b) the employer is a body corporate incorporated in a Territory; or

"(6) Subsection (5) does not apply in relation to an employee health benefits scheme to the extent (if any) that the scheme constitutes State insurance within the meaning of paragraph 51(xiv) of the Constitution.

SCHEDULE 2—continued

"(7) The Minister must not make a determination under paragraph (g) of the definition of 'employee health benefits scheme' in subsection (4) in relation to an arrangement that is the subject of an agreement to which Part VIB of the Industrial Relations Act 1988 applies.".

12. Subsections 68(1), (IB), (1C) and (ID):

Omit the subsections.

13. Subsection 68(2):

Omit "in a State".

14. Paragraph 68(2)(a):

Omit "in respect ofthat State".

15. Paragraph 68(2)(b):

Omit "in that State" and all the words from and including "and if, in accordance with those rules" to and including "in the Northern Territory".

16. Subparagraph 68(2)(c)(ii):

Omit the subparagraph, substitute:

"(ii) costs incurred by the organization wholly or exclusively in the carrying on of business as a registered health benefits organization;".

17. Subparagraph 68(2)(c)(iii):

Omit "in that State" and all the words from and including "or if, in accordance with the rules" to and including "in the Northern Territory".

18. Subparagraph 68(2)(c)(iv):

Add at the end "or".

19. Subparagraph 68(2)(c)(v):

Omit "; or".

20. Subparagraph 68(2)(c)(vi):

Omit the subparagraph.

21. Paragraph 68(2A)(c):

Omit "specifying, or applies to carry on business as a registered health benefits organization in, the State concerned", substitute ", or applies to carry on business as a registered health benefits organization,".

SCHEDULE 2—continued

22. Subsection 68(3):

Omit the subsection.

23. Subsection 68(4):

Omit "in any State".

24. Subsections 69(1) and (2):

Omit ", or for permission to carry on business".

25. Section 71:

Omit "or for permission to carry on business".

26. Section 72:

Omit", or permission to carry on business as a registered health benefits organisation, as the case requires, ".

27. Section 72A:

Omit all the words from and including "or for permission to carry on business" to and including "shall also take into account", substitute ", and the Minister, in exercising the Minister's powers with respect to such an application, must consider whether the organization is eligible to be registered and must also take into account".

28. Paragraph 72A(a):

Omit "relevant fund or funds", substitute "fund".

29. Paragraphs 72A(b) and (c):

Omit "or those funds".

30. Paragraph 72A(d):

Omit "or each of those funds".

31. Subsection 73(2A):

Omit "or to carry on business" and "or a relevant fund".

32. Paragraph 73(7)(b):

Omit the paragraph.

33. Subsections 73(9) and (10):

Omit the subsections.

34. Section 73BA:

Add at the end:

"(3) Determinations made under paragraph (bga) of the conditions set out in Schedule 1 are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901".

SCHEDULE 2—continued

35. Subsection 73BAB(1):

Omit ", where it conducts only one health benefits fund, the value of the assets of that fund shall", substitute "the value of the assets of the health benefits fund conducted by it must".

36. Subsections 73BAB(1A) and (IB):

Omit the subsections.

37. Subsection 73BAB(2):

Omit "a health benefits fund", substitute "the health benefits fund".

38. Subsection 73BB(1):

Omit ", or in each of the health benefits funds, from time to time".

39. Subsection 73BB(4):

Omit "the health benefits fund concerned", substitute "its health benefits fund".

40. Subsection 73BB(5) and paragraph 73BB(7)(a):

Omit "a health benefits fund", substitute "its health benefits fund".

41. Subsection 73BC(12):

Omit "a health benefits fund", substitute "the health benefits fund".

42. Paragraphs 73BD(2)(a), 73BD(3)(a), 73BDAA(4)(a) and 73BDA(4)(a):

Omit "a health benefits fund", substitute "the health benefits fund".

43. Paragraphs 73BE(1)(a), (b) and (c):

Omit "a health benefits fund", substitute "the health benefits fund".

44. Paragraph 73BE(1)(d):

Omit the paragraph.

45. Subsection 73BE(2):

Omit "a health benefits fund", substitute "the health benefits fund".

46. Paragraph 73BF(1)(a):

Omit "a health benefits fund", substitute "the health benefits fund".

47. Subsection 73BF(1):

Omit "that fund", substitute "the fund".

SCHEDULE 2—continued

48. Paragraph 73BF(2)(a):

Omit the paragraph, substitute:

"(a) shall be made by sending the request to the Secretary; and".

49. Subparagraph 73BF(3)(c)(i):

Omit "the fund concerned", substitute "the fund conducted by the organization".

50. Paragraph 73BF(4)(a):

Omit "that fund", substitute "the fund".

51. Subsection 73BF(5):

Omit "a health benefits fund", substitute "the health benefits fund conducted by it".

52. Subsection 73BFA(1):

Omit "a health benefits fund", substitute "the health benefits fund".

53. Paragraph 73BFA(2)(a):

Omit the paragraph, substitute:

"(a) shall be made by sending the request to the Secretary; and".

54. Subparagraph 73BFA(3)(c)(i):

Omit "the fund concerned", substitute "the fund conducted by the organization".

55. Subsections 73BFA(4) and (5):

Omit "a health benefits fund", substitute "the health benefits fund".

56. Paragraph 73BFB(1)(a):

Omit "a health benefits fund", substitute "the health benefits fund".

57. Subsection 73BFB(1):

Omit "that fund", substitute "the fund".

58. Paragraph 73BFB(2)(a):

Omit the paragraph, substitute:

"(a) shall be made by sending the request to the Secretary; and".

59. Subparagraph 73BFB(3)(c)(i):

Omit "the fund concerned", substitute "the fund conducted by the organization".

SCHEDULE 2—continued

60. Subsection 73BFB(4):

Omit "a health benefits fund", substitute "the health benefits fund".

61. Paragraph 73BFB(4)(a):

Omit "that health benefits fund", substitute "the fund".

62. Paragraph 73D(2)(a):

Omit the paragraph, substitute:

"(a) shall be made by sending the request to the Secretary; and".

63. After section 73D:

Insert:

"Division 5A—Removal of hospitals etc. from non-contracted benefits

Definitions

"73E. In this Division, unless the contrary intention appears:

'determination' means a determination under section 73EA;

'treatment' means:

(a) hospital treatment, and related services, provided by or on behalf of a hospital or day hospital facility; and

(b) any professional service rendered to a patient while that hospital treatment is provided to the patient at the hospital or day hospital facility.

Determinations relating to non-contracted benefits in respect of particular treatments at particular hospitals etc.

"73EA.(1) A registered organization, a State, a Territory or the National Health and Medical Research Council may apply in writing to the Minister for a determination relating to episodes of treatment of a particular kind provided at a hospital or day hospital facility specified in the application.

"(2) If the Minister is satisfied that the standard of treatment of that kind provided at that hospital or day hospital facility is unacceptable, the Minister may, by written notice given to the hospital or day hospital facility, determine that subparagraph (ii) of the condition set out in paragraph (bh) of Schedule 1 no longer applies in respect of episodes of treatment of that kind provided at that hospital or day hospital facility.

"(3) The determination must be made in accordance with the guidelines issued under section 73EB.

SCHEDULE 2—continued

"(4) The Minister must:

(a) cause copies of the determination to be given to each registered organization; and

(b) cause a copy of the determination to be published in the Gazette.

"(5) If the Minister decides not to make a determination, he or she must notify in writing the registered organization that applied for the determination, and the hospital or day hospital facility in question, accordingly.

Guidelines for making determinations

"73EB.(1) The Minister must issue written guidelines setting out the grounds for deciding whether the standard of treatment of a particular kind provided at a hospital or day hospital facility is unacceptable.

"(2) The guidelines may also specify matters to which the Minister must have regard in considering whether any such grounds, or particular grounds, exist.

"(3) Guidelines issued under this section are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901.

Effect of determinations

"73EC.(1) A registered organization is not obliged under an applicable benefits arrangement to pay a benefit in relation to the provision of an episode of treatment if:

(a) at all times during which the episode of treatment was being provided, a determination was in force in respect of episodes of treatment of that kind; and

(b) the episode of treatment in question was provided at the hospital or day hospital facility to which the determination applied; and

(c) the benefit would, but for this subsection, be a benefit of a kind referred to in subparagraph (ii) of the condition set out in paragraph (bh) of Schedule 1.

"(2) Subsection (1) has effect despite:

(a) subparagraph (ii) of the condition set out in paragraph (bh) of Schedule 1; and

(b) the applicable benefits arrangement in question.

"(3) This section does not affect the payability of benefits by a registered organization in respect of episodes of treatment provided in a hospital or day hospital facility with which the registered organization has a hospital purchaser-provider agreement.

SCHEDULE 2—continued

Revocation of determinations

"73ED.(1) A hospital or day hospital facility to which a determination applies in respect of a particular kind of episodes of treatment may apply in writing to the Minister for the determination to be revoked.

"(2) If the Minister is satisfied that there are no longer grounds on which he or she could reasonably find, in accordance with the guidelines issued under section 73EB, that the standard of treatment of that kind provided by that hospital or day hospital facility is unacceptable, the Minister must, by written notice given to the hospital or day hospital facility, revoke the determination.

"(3) The Minister must not revoke the determination without having first:

(a) caused each registered organization to be notified that he or she is considering whether to revoke the determination; and

(b) caused to be published in the Gazette a notice to the effect that he or she is considering whether to revoke the determination.

"(4) If the Minister revokes the determination, he or she must:

(a) cause copies of the notice of revocation to be given to each registered organization; and

(b) cause a copy of the notice of revocation to be published in the Gazette.

"(5) If the Minister decides not to revoke the determination, he or she must notify in writing the hospital or day hospital facility that applied for the revocation, and each registered organization, accordingly.

Date of effect of revocation

"73EE.(1) Subject to subsection (2), a revocation of a determination has effect:

(a) on the day specified in the notice of revocation as the day on which it is to have effect; or

(b) if no such day is specified in the notice—on the day on which a copy of the notice is published in the Gazette.

"(2) If, apart from this subsection, the revocation would have effect within 12 months after the day on which the determination was made, the revocation is taken to come into effect 12 months after that day.".

64. Section 74B:

Omit "a health benefits fund", substitute "its health benefits fund".

SCHEDULE 2—continued

65. Section 74BA:

Omit "a health benefits fund" (wherever occurring), substitute "the health benefits fund".

66. Subsection 74C(1):

Omit "any health benefits fund", substitute "the health benefits fund".

67. Subsection 79(3):

Omit "all health benefits funds conducted by the organization have", substitute "the health benefits fund conducted by the organization has".

68. Subsection 79(5):

Omit "or funds".

69. Subsection 79(6):

(a) Omit "a health benefits fund", substitute "the health benefits fund".

(b) Omit "a fund", substitute "the fund".

70. Paragraph 82(1)(a):

Omit "or for permission to carry on business as a registered health benefits organization".

71. After paragraph 82G(b):

Insert:

"(ba) to obtain from registered organizations, for the purposes of modelling, evaluation and research, information referred to in the Hospital Casemix Protocol, being information of a kind determined in writing by the Minister for the purposes of this paragraph;".

72. Section 82G:

Add at the end:

"(2) Determinations under paragraph (1)(ba) are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901.".

73. After paragraph 82G(m):

Insert:

"(ma) to collect and disseminate information about private health insurance, for the purpose of enabling people to make informed choices about private health insurance;".

SCHEDULE 2—continued

74. Subsection 82PA(2):

Omit "each health benefits fund", substitute "the health benefits fund".

75. Subsection 82Q(1) (definition of "affairs"):

Omit "the conducting of a fund by the organization", substitute "the organization's conducting of its fund".

76. Paragraph 82R(1)(aa):

Omit "a fund", substitute "the fund".

77. Subsection 82R(2):

Omit "a fund", substitute "the fund".

78. Subsection 82W(2):

Omit "a fund" (wherever occurring), substitute "the fund".

79. Subsection 82Z(1):

Omit ", or one or more of the funds, ".

80. Subsection 82Z(2):

Omit the subsection, substitute:

"(2) Where the Minister is satisfied that a registered organization has, in respect of its health benefits fund, contravened:

(a) a provision of this Act or the regulations; or

(b) a term or condition of registration imposed on the organization by or under this Act; or

(d) the Council's rules;

the Minister may apply to the Court for an order that the fund be placed under judicial management or be wound up.".

81. Subsections 82ZA(1) and (4):

Omit "a fund", substitute "the fund".

82. Section 82ZD:

Omit "a fund of a registered organization", substitute "the fund of a registered organization".

83. Subsection 82ZE(1):

Omit "a fund of a registered organization", substitute "the fund of a registered organization".

SCHEDULE 2—continued

84. Paragraph 82ZE(1)(a) and subsection 82ZE(2):

Omit "a fund conducted by another registered organization", substitute "the fund conducted by another registered organization".

85. Subsection 82ZF(1):

Omit "a fund conducted by another registered organization", substitute "the fund conducted by another registered organization".

86. Subsection 82ZF(2):

Omit "a fund" (wherever occurring), substitute "the fund".

87. Subsection 82ZG(1):

Omit ", or one or more of the funds, ".

88. Subsection 82ZG(2):

Omit "or funds concerned".

89. Subsection 82ZK(3):

Omit "a fund" (wherever occurring), substitute "the fund".

90. Subsection 82ZN(2):

Omit the subsection.

91. Subsection 82ZP(1):

Omit the subsection, substitute:

"(1) Two or more registered organizations may apply in the approved form to the Minister for approval of:

(a) the transfer to the fund conducted by one of the organizations of the business of the fund conducted by the other organization; or

(b) the transfer to the fund conducted by one of the organizations of the business of the funds conducted by the other organizations;

being a transfer in accordance with a scheme specified in the application.

"(1A) Subject to this section, the Minister must, by writing signed by the Minister, approve the transfer unless:

(a) action is being taken under Part VIA in relation to all or any of the organizations; or

(b) the Minister proposes to take action under Part VIA in relation to all or any of those organizations.".

92. Subsection 82ZP(3):

Omit "of the business of a fund conducted by a registered organization to a fund conducted by another registered organization".

SCHEDULE 2—continued

93. Paragraph 82ZP(3)(a):

Omit the paragraph, substitute:

"(a) the transfer to one fund of the contributors from the other fund or funds (as the case may be); and".

94. After Part VIB:

Insert:

"PART VIC—PRIVATE HEALTH INSURANCE COMPLAINTS COMMISSIONER

"Division 1—Preliminary

Interpretation

"82ZQ.(1) In this Part:

'complainant' means a person or body who has made a complaint;

'complaint' means a complaint made under section 82ZS;

'Complaints Commissioner' means the Private Health Insurance Complaints Commissioner referred to in section 82ZR;

'medical practitioner' includes:

(a) an accredited dental practitioner; and

(b) a dental practitioner approved by the Minister for the purposes of the definition of 'professional service' in subsection 3(1) of the Health Insurance Act 1973; and

'personal information' means information or an opinion (including information or an opinion forming part of a database), whether true or not, and whether recorded in a material form or not, about an individual whose identity is apparent, or can reasonably be ascertained, from the information or opinion;

'private health insurance arrangement' includes any of the following:

(a) an applicable benefits arrangement;

(b) a hospital purchaser-provider agreement;

(d) a medical purchaser-provider agreement;

(e) a supplementary hospital table or any other table of a registered organization;

SCHEDULE 2—continued

(f) an arrangement that a registered organization has entered into, with contributors to the health benefits fund conducted by the organization, under which those contributors contribute for benefits in accordance with a supplementary hospital table or any other table of the registered organization.

"(2) For the purposes of this Part, a reference to a person or body against whom a complaint is made is a reference to any of the following:

(a) a hospital or a day hospital facility;

(b) a medical practitioner;

whose conduct, or failure to act, is the subject of the complaint.

"Division 2—Complaints Commissioner

Private Health Insurance Complaints Commissioner

"82ZR.(1) There is to be a Private Health Insurance Complaints Commissioner, who is to be a corporation with perpetual succession.

"(2) The corporation is to have a seal, and may sue or be sued in its corporate name.

"(3) All courts, judges and persons acting judicially must take judicial notice of the corporation's seal affixed to documents and must presume that it was duly affixed.

"(4) At all times after the first appointment of a person to the office of Complaints Commissioner, the corporation continues to exist despite any vacancy in that office.

Appointment

"82ZRA.(1) The Minister may appoint the Complaints Commissioner in accordance with the guidelines under section 82ZRB.

"(2) The Complaints Commissioner is to be appointed on a full-time basis or a part-time basis.

Guidelines

"82ZRB.(1) The Minister may, in writing, make guidelines relating to:

(a) the appointment of the Complaints Commissioner; and

(b) the terms and conditions on which he or she holds office; and

"(2) The guidelines are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901.

SCHEDULE 2—continued

Functions of Complaints Commissioner

"82ZRC. The functions of the Complaints Commissioner are as follows:

(a) to deal with complaints made under section 82ZS;

(b) to conduct investigations under sections 82ZT and 82ZTA;

(d) to make recommendations to the Minister or the Department about regulatory practices and/or industry practices relating to registered organizations;

(e) to make copies of the Private Patients' Hospital Charter issued under section 73F available to members of the public on request at every office of the Complaints Commissioner accessible to the public;

(f) where appropriate, to publicise the existence and availability of the Charter in its brochures and other documents, concerning health insurance, made available to the public;

(g) to promote a knowledge and understanding of his or her functions;

(h) any other functions that are incidental to the performance of any of the preceding functions.

"Division 3—Complaints

Who may make a complaint?

"82ZS.(1) A complaint may be made to the Complaints Commissioner by any of the following:

(a) a person who is, or was at the time of the incident to which the complaint relates, a contributor to the health benefits fund conducted by a registered organization;

(b) a hospital or a day hospital facility;

(d) a registered organization.

"(2) A complaint may be made by a person on behalf of a person or body referred to in subsection (1).

Grounds for complaint

"82ZSA. The complaint may be about any matter arising out of or connected with a private health insurance arrangement.

SCHEDULE 2—continued

Complaints Commissioner may deal with complaints

"82ZSB.(1) Subject to subsection (3), the Complaints Commissioner may deal with a complaint by referring the complaint to a registered organization and requesting the organization:

(a) to conduct an investigation in relation to the complaint; and

(b) to report to the Complaints Commissioner its findings and any action it proposes to take.

"(2) Subject to subsection (3), if the Complaints Commissioner is not satisfied with the outcome of his or her request under subsection (1), he or she may investigate the complaint.

"(3) The Complaints Commissioner must not take any action under this section unless the complainant agrees to the action being taken.

Complaints Commissioner may refer matters to the Trade Practices Commission

"82ZSBA.(1) If, in the Complaints Commissioner's opinion, a complaint raises a matter that could be dealt with more effectively or conveniently by the Trade Practices Commission, the Complaints Commissioner must, subject to subsection (2), refer the matter to the Trade Practices Commission.

"(2) The Complaints Commissioner must not refer the matter to the Trade Practices Commission unless the complainant agrees to the referral.

"(3) If the Complaints Commissioner refers the matter to the Trade Practices Commission, he or she must:

(a) give written notice to the complainant stating that the matter has been so referred; and

(b) give to the Trade Practices Commission any information or documents that relate to the complaint and that are in the Complaints Commissioner's possession or under his or her control.

"(4) The Trade Practices Commission may hold an investigation into the matter and, if it decides to do so, it must, within 30 working days after the referral, report to the Complaints Commissioner on:

(a) the conduct of the investigation; and

(b) any findings that it has made as a result of the investigation.

"(5) If the Trade Practices Commission decides not to hold an investigation into the matter, it must, within 30 working days after the referral, give to the Complaints Commissioner a written notice informing the Complaints Commissioner of its decision and of the reasons for its decision.

SCHEDULE 2—continued

"(6) In this section:

'working day' means a day that is not a Saturday or Sunday or a public holiday in any State or Territory.

Complaints Commissioner may refer matters to other bodies

"82ZSC.(1) If, in the Complaints Commissioner's opinion, a complaint raises a matter that could be dealt with more effectively or conveniently by another body, the Complaints Commissioner must, subject to subsection (2), refer the matter to that body.

"(2) The Complaints Commissioner must not refer the matter to the other body unless the complainant agrees to the referral.

Complaints Commissioner may make recommendations

"82ZSD. The Complaints Commissioner may, after receiving a report from a registered organization or after investigating a complaint:

(a) recommend that a registered organization take a specific course of action in relation to the complaint, and/or make changes to its rules; or

(b) recommend that a registered organization request a hospital, day hospital facility or medical practitioner take a specific course of action in relation to the complaint.

Complaints Commissioner must keep complainant informed

"82ZSE.(1) The Complaints Commissioner must inform the complainant of:

(a) any action taken by the Complaints Commissioner under section 82ZSB or section 82ZSC; or

(b) any recommendation made by the Complaints Commissioner under section 82ZSD;

and the reasons for that action or recommendation.

"(2) The Complaints Commissioner must inform the complainant, in writing, of any action taken by a registered organization as a result of an action or recommendation referred to in paragraph (1)(a) or (b).

Conciliation

"82ZSF.(1) If the complaint is not resolved, by action taken under section 82ZSB or by recommendations made under section 82ZSD, to the satisfaction of the complainant, he or she may request that the Complaints Commissioner try to effect a settlement of the complaint by conciliating between the complainant and the person or body against whom the complaint was made.

SCHEDULE 2—continued

"(2) The Complaints Commissioner may, if he or she receives such a request, try to effect a settlement of the complaint by conciliating between the complainant and the person or body against whom the complaint was made.

Complaints Commissioner may decide not to investigate

"82ZSG.(1) The Complaints Commissioner may decide not to investigate, or not to continue to investigate, a complaint if he or she believes that:

(a) the person or body against whom the complaint is made:

(i) has dealt, or is dealing, adequately with the complaint; or

(ii) has not yet had an adequate opportunity to deal with the complaint; or

(b) the matter is trivial; or

"(2) The Complaints Commissioner may decide not to investigate a complaint if he or she is satisfied that the complainant has not taken reasonable steps to negotiate a settlement of the complaint with the person or body against whom the complaint is made.

"(3) The Complaints Commissioner may decide not to take any action in relation to a complaint if the incident to which the complaint relates occurred more than 12 months before the complaint is made.

"(4) If a complainant does not agree to a matter relating to his or her complaint being referred to another body under section 82ZSC, the Complaints Commissioner may decide not to investigate, or not to continue to investigate, the complaint.

"(5) If the Complaints Commissioner decides not to investigate, or not to continue to investigate, a complaint, he or she must give the complainant written notice of the decision and the reasons for the decision.

"Division 4—Complaints Commissioner may conduct investigations

Complaints Commissioner may initiate investigations

"82ZT. The Complaints Commissioner may, on his or her own initiative, investigate the practices and procedures of a registered organization.

Minister may request Complaints Commissioner to conduct investigations

"82ZTA.(1) The Minister may request the Complaints Commissioner to investigate the practices and procedures of a registered organization.

SCHEDULE 2—continued

"(2) If the Minister makes such a request the Complaints Commissioner must conduct an investigation.

"(3) The Complaints Commissioner must report to the Minister on the findings of his or her investigation.

Complaints Commissioner may examine records etc.

"82ZTB. The Complaints Commissioner may, in conducting an investigation under section 82ZT or 82ZTA, examine the following:

(a) the records of a registered organization;

(b) the rules of a registered organization.

Complaints Commissioner free to consult Purchaser-Provider Panel

"82ZTBA. The Complaints Commissioner may, in the course of investigating complaints and preparing reports or recommendations for the Minister, consult with the Purchaser-Provider Panel.

Complaints Commissioner to consult with Trade Practices Commission

"82ZTBB. Where, in the opinion of the Complaints Commissioner, there is prima facie evidence of conduct of the nature of a restrictive trade practice within the meaning of the Trade Practices Act 1974, the Complaints Commissioner must consult with the Trade Practices Commission and have regard to the advice of the Trade Practices Commission on the matter before reporting on it.

Complaints Commissioner may make recommendations to registered organizations

"82ZTC.(1) The Complaints Commissioner may, as a result of an investigation conducted under section 82ZT or 82ZTA, recommend to:

(a) a registered organization that a specific course of action be taken and/or that changes be made to its rules; or

(b) a hospital, a day hospital facility or a medical practitioner that a specific course of action be taken.

"(2) If the Complaints Commissioner makes a recommendation under subsection (1), he or she may request the registered organization, the hospital, the day hospital facility or the medical practitioner to report to the Complaints Commissioner on any action taken as a result of that recommendation.

SCHEDULE 2—continued

Protection from civil actions

"82ZTD.(1) Civil proceedings do not lie against a person in respect of loss, damage or injury of any kind suffered by another person because a statement was made in good faith to the Complaints Commissioner in connection with an investigation.

"(2) A reference in subsection (1) to making a statement includes a reference to giving a document or information.

"Division 5—Provisions relating to the Commissioner

Validity of appointments

"82ZU. The appointment of a person as Complaints Commissioner is not invalid merely because there was a defect or irregularity in connection with the appointment.

Acting appointments

"82ZUA.(1) The Minister may appoint a person to act as the Complaints Commissioner:

(a) during a vacancy in the office of Complaints Commissioner (whether or not an appointment has previously been made to the office); or

(b) during any period, or during all periods, when the Complaints Commissioner is absent from duty or from Australia or is, for any other reason, unable to perform the duties of the office.

"(2) Anything done by or in relation to a person purporting to act under an appointment under this section is not invalid merely because:

(a) the occasion for the appointment had not arisen; or

(b) there was a defect or irregularity in, or in connection with, the appointment; or

(d) the occasion for the person to act had not arisen or had ceased.

Remuneration and allowances

"82ZUB.(1) The Complaints Commissioner is to be paid:

(a) such remuneration as is determined by the Remuneration Tribunal; and

(b) such allowances as are prescribed.

"(2) This section has effect subject to the Remuneration Tribunal Act 1973.

SCHEDULE 2—continued

Outside employment

"82ZUC.(1) A person who holds the office of Complaints Commissioner on a full-time basis must not engage in any paid employment outside the duties of that office without the Minister's written approval.

"(2) A person who holds the office of Complaints Commissioner on a part-time basis must not engage in any paid employment that, in the Minister's opinion, conflicts with the proper performance of the Complaints Commissioner's functions.

Leave of absence

"82ZUD.(1) Subject to section 87E of the Public Service Act 1922, if the Complaints Commissioner holds office on a full-time basis, he or she has such recreation leave entitlements as are determined by the Remuneration Tribunal.

"(2) The Minister may grant the Complaints Commissioner leave of absence, other than recreational leave, on such terms and conditions as to remuneration or otherwise as the Minister determines in writing.

Resignation

"82ZUE. The Complaints Commissioner may resign by writing signed and delivered to the Minister.

Termination of appointment

"82ZUF.(1) The Minister may terminate the Complaints Commissioner's appointment for misbehaviour or physical or mental incapacity.

"(2) The Minister must terminate the Complaints Commissioner's appointment if the Complaints Commissioner:

(a) becomes bankrupt, applies to take the benefit of any law for the relief of bankrupt or insolvent debtors, compounds with creditors or makes an assignment of remuneration for their benefit; or

(b) is appointed on a full-time basis and is absent from duty, except on leave of absence, for 14 consecutive days or for 28 days in any 12 months; or

(c) is appointed on a full-time basis and engages, except with the Minister's approval, in paid employment outside the duties of his or her office; or

(d) is appointed on a part-time basis and engages in paid employment that, in the Minister's opinion, conflicts with the proper performance of his or her duties.

SCHEDULE 2—continued

Staff

"82ZUG.(1) The Complaints Commissioner may employ such staff as he or she thinks necessary to employ to assist him or her in the performance of his or her functions and the exercise of his or her powers.

"(2) The Complaints Commissioner may arrange with the Secretary of a Department of the Australian Public Service for the services of officers or employees in the Department to be made available to the Complaints Commissioner.

"(3) The terms and conditions of staff employed by the Complaints Commissioner are such as are determined by the Complaints Commissioner from time to time.

"Division 6—Miscellaneous

Minister may issue guidelines

"82ZV.(1) The Minister may issue guidelines concerning the use and security of any personal information collected by the Complaints Commissioner in the course of his or her investigations under this Part.

"(2) The guidelines are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901,

Application of Division 3 of Part XI of the Audit Act 1901

"82ZVA.(1) The Complaints Commissioner is taken to be an authority to which Division 3 of Part XI of (he Audit Act 1901 applies.

"(2) The annual report of the Complaints Commissioner under section 63M of that Act as applied by this section must include a summary of:

(a) the number and nature of complaints received under section 82ZS; and

(b) the outcomes of any actions taken, recommendations made or investigations conducted in relation to such complaints; and

(d) investigations (if any) conducted by the Complaints Commissioner under section 82ZT; and

(e) requests (if any) by the Minister under section 82ZTA that the Complaints Commissioner conduct an investigation; and

(f) the outcomes of investigations conducted under sections 82ZT and 82ZTA.

SCHEDULE 2—continued

Victimisation

"82ZVB.(1) A person must not commit an act of victimisation against another person.

Penalty: Imprisonment for 6 months.

"(2) For the purposes of subsection (1), a person is taken to commit an act of victimisation against another person if the first-mentioned person subjects, or threatens to subject, the other person to any detriment on the ground that the other person has made, or proposes to make, a complaint under this Part.

Collection of levy

"82ZVC.(1) Levy is due and payable at the end of 14 days after a day fixed, by regulations made under the Private Health Insurance Complaints Levy Act 1995 for the payment of levy, as a day on which levy is payable.

"(2) Levy that is due and payable may be recovered by the Commonwealth as a debt due to the Commonwealth.

"(3) In this section:

'levy' means a levy payable by a registered organization under the Private Health Insurance Complaints Levy Act 1995".

95. After subsection 105AB(4A):

Insert:

"(4B) An application may be made to the Tribunal for review of:

(a) a decision of the Minister to make, or not to make, a determination under section 73EA; or

(b) a decision of the Minister to revoke, or not to revoke, such a determination under section 73ED.".

96. Subsection 140(2):

Omit the subsection, substitute:

"(2) The regulations may provide that a specified provision of this Act relating to an applicable benefits arrangement does not apply, or applies with specified modifications, in respect of a specified registered health benefits organization.".

97. Paragraphs (b), (ba), (bb) and (be) of Schedule 1:

Omit "a health benefits fund", substitute "the health benefits fund".

SCHEDULE 2—continued

98. After paragraph (be) of Schedule 1:

Insert:

"(bf) Each applicable benefits arrangement of the organization must provide for benefits to be payable in respect of all kinds of hospital treatment that are one or more of the following:

(i) palliative care;

(ii) rehabilitation;

(iii) psychiatric care.

(bg) Subject to the condition set out in paragraph (d), the levels of benefits payable in respect of those kinds of hospital treatment must equal or exceed the respective levels of benefits determined for the purposes of paragraph (bj) in respect of those kinds of hospital treatment.

(bh) The organization will include in each of its applicable benefits arrangements under which contributors are entitled to contribute for benefits in respect of the provision of some or all kinds of episodes of hospital treatment:

(i) benefits that are payable in respect of such an episode of hospital treatment, provided in a hospital or day hospital facility with which the organization does not have a hospital purchaser-provider agreement covering episodes of hospital treatment of that kind, in situations of emergency; and

(ii) benefits that are payable in respect of such an episode of hospital treatment, provided in a hospital or day hospital facility with which the organization does not have a hospital purchaser-provider agreement covering episodes of hospital treatment of that kind, otherwise than in situations of emergency.

(bi) Subject to the condition set out in paragraph (d), the level of benefit payable in respect of an episode of hospital treatment under subparagraph (i) of the condition set out in paragraph (bh) must equal or exceed:

(i) the average level of benefit payable by the organization in respect of an episode of hospital treatment of that kind in the hospitals or day hospital facilities with which the organization has hospital purchaser-provider agreements; or

SCHEDULE 2—continued

(ii) the level of benefit that would have been payable if subparagraph (ii) of that condition had applied in respect of the episode of hospital treatment;

whichever is higher,

(bj) Subject to the condition set out in paragraph (d), the level of benefit payable in respect of an episode of hospital treatment under subparagraph (ii) of the condition set out in paragraph (bh) must equal or exceed:

(i) the level of benefit determined in writing by the Minister for the purposes of this paragraph in respect of episodes of hospital treatment of that kind; or

(ii) if more than one level of benefit has been so determined in respect of episodes of hospital treatment of that kind (see paragraph (bk))—whichever of those levels of benefit is applicable to the circumstances in which the episode of hospital treatment was provided.

(bk) A determination for the purposes of paragraph (bj) may specify different levels of benefit in respect of the same kind of episode of hospital treatment, each such level of benefit being applicable to the circumstances specified in the determination to be applicable to that level of benefit.

(bl) The conditions set out in paragraphs (bh), (bi), (bj) and (bk) do not apply in respect of episodes of hospital treatment in recognized hospitals.".

99. Paragraph (c) of Schedule 1:

Omit "a health benefits fund", substitute "the health benefits fund".

100. After paragraph (ea) of Schedule 1:

Insert:

"(eb) The amount of benefit payable by the organization in respect of hospital treatment must not be the amount payable in accordance with the basic table unless that is the amount payable by the organization in respect of the treatment, under a hospital purchaser-provider agreement, to the hospital or a day hospital facility in which the treatment was provided,

(ec) The condition set out in paragraph (eb) does not apply in respect of episodes of hospital treatment in recognized hospitals.".

101. Paragraph (g) of Schedule 1:

Omit "a health benefits fund", substitute "the health benefits fund".

SCHEDULE 2—continued

102. Paragraph (h) of Schedule 1:

Omit "each health benefits fund", substitute "the health benefits fund".

103. Paragraphs (ha) and (hb) of Schedule 1:

Omit "a health benefits fund", substitute "the health benefits fund".

104. Subparagraph (hc)(i) of Schedule 1:

Omit "any health benefits funds", substitute "the health benefits fund".

105. Paragraph (I) of Schedule 1:

Omit "a health benefits fund" (first occurring), substitute "the health benefits fund".

106. Subparagraph (1)(i) of Schedule 1:

After "conducted" insert ", before 1 July 1995, ".

107. Subparagraph (1)(iii) of Schedule 1:

Omit "a health benefits fund", substitute "the health benefits fund".

108. Paragraph (n) of Schedule 1:

Omit "a health benefits fund", substitute "the health benefits fund".

PART 2—AMENDMENTS OF THE HEALTH INSURANCE COMMISSION ACT 1973

109. Subsection 8A(1):

Omit "in respect of a State or of the Northern Territory".

110. After subsection 8A(1):

Insert:

"(1A) The Commission must conduct the health benefits fund in each State and the Northern Territory.".

____________

SCHEDULE 3 Section 6

AMENDMENTS COMMENCING ON 1 JULY 1996

1. Subsection 67(4) (definition of "employee health benefits scheme"):

Omit all the words from and including "but does not include:", substitute "but does not include an arrangement that the Minister determines in writing not to be an employee health benefits scheme;".

2. Subsection 67(7):

Omit "paragraph (g) of".

3. Paragraphs (bi) and (ec) of Schedule 1:

Omit the paragraphs.

4. Saving provision

A determination of the Minister under paragraph (g) of the definition of "employee health benefits scheme" in subsection 67(4) of the National Health Act 1953 that was in force immediately before the commencement of item 1 of this Schedule continues in force after that commencement as if it had been made under that definition as amended by that item.

_____________

SCHEDULE 4 Section 7

AMENDMENTS COMMENCING ON 1 JULY 1997

1. Subsection 4(1) (paragraph (a) of the definition of "waiting period"):

Omit ", supplementary hospital table or other", substitute "or".

2. Subsection 4(1) (definition of "basic private table" or "basic table"):

Omit the definition.

3. Subsection 4(1) (definitions of "supplementary hospital table", "type-A professional attention", "type-B professional attention" and "type-C professional attention"):

Omit the definitions.

4. Sections 4B, 4C, 4D and 5:

Repeal the sections.

5. Subsection 5A(1):

Omit "; and includes a reference to a basic table of the organization".

6. Subsections 73BB(2) and 73BB(4):

Omit "or a supplementary hospital table".

7. Subsection 73BB(4A):

Omit "other than a basic table".

8. Subsection 73BB(5):

Omit "or a supplementary hospital table".

9. Subsection 73BB(6):

Omit "other than a basic table".

10. Subsection 73BB(11) (definition of "episode duration"):

Omit "other than a basic table".

11. Paragraph 73BD(1)(b):

Omit the paragraph, substitute:

"(b) payments by the organization to the hospital or day hospital facility in respect of episodes of hospital treatment are to be casemix episodic payments (see subsection (4)).".

12. Subsection 82ZQ(1) (paragraphs (e) and (f) of the definition of "private health insurance arrangement"):

Omit "supplementary hospital table or any other".

SCHEDULE 4—continued

13. Subparagraph (bd)(ii) of Schedule 1:

Omit "; and".

14. Subparagraph (bd)(iii) of Schedule 1:

Omit the subparagraph.

15. Paragraphs (eb) and (f) of Schedule 1:

Omit the paragraphs, substitute:

"(f) The amount of benefit payable by an organization in respect of hospital treatment must be an amount that is payable under an applicable benefits arrangement.".

16. Paragraph (k) of Schedule 1:

Omit the paragraph, substitute:

"(k) If the rules of the organization provide for a waiting period in relation to contributors for benefits in accordance with an applicable benefits arrangement of the organization (whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba)) in respect of pre-existing ailments, the waiting period will not exceed the period of 12 months commencing on the date on which a contributor commenced to contribute for benefits in accordance with that arrangement.".

17. Paragraph (kb) of Schedule 1:

Omit the paragraph.

18. Subparagraph (kc)(i) of Schedule 1:

Omit "or supplementary hospital table".

19. Subparagraph (kc)(ii) of Schedule 1:

Omit "or the replaced supplementary hospital table referred to in paragraph (kb)".

20. Paragraph (la) of Schedule 1:

Omit "supplementary hospital table or other".

21. Subparagraph (la)(iv) of Schedule 1:

Omit ", supplementary hospital table or other", substitute "or".

22. Subparagraph (Iaa)(i) of Schedule 1:

Omit "(other than a basic table)" (wherever occurring).

23. Subparagraphs (laa)(ii) and (iii) of Schedule 1:

Omit the subparagraphs.

SCHEDULE 4—continued

24. Subparagraph (laa)(iv) of Schedule 1:

Omit "other than a basic table or a supplementary hospital table" (wherever occurring).

25. Sub-subparagraph (ld)(i)(A) of Schedule 1:

Omit ", supplementary hospital table or other", substitute "or".

NOTES

1. National Health Act 1953

No. 95, 1953, as amended. For previous amendments, see No. 68, 1955; Nos. 55 and 95, 1956; No. 92, 1957; No. 68, 1958; No. 72, 1959; No. 16, 1961; No. 82, 1962; No. 77, 1963; No. 37, 1964; Nos. 100 and 146, 1965; No. 44, 1966; Nos. 14 and 100, 1967; No. 100, 1968; No. 102, 1969; No. 41, 1970; No. 85, 1971; No. 114, 1972, Nos. 49 and 202, 1973; No. 37, 1974; Nos. 1, 13 and 93, 1975; Nos. 1, 60, 91, 99, 108, 157 and 177, 1976; Nos. 98 and 100, 1977; Nos. 36, 88, 132 and 189, 1978; Nos. 54, 91 and 122, 1979; Nos. 117 and 131, 1980; Nos. 40, 74, 92, 118, 163 and 176, 1981; Nos. 49, 80 and 112, 1982; Nos. 35, 54 and 139, 1983; Nos. 46, 63, 72, 120, 135 and 165, 1984; Nos. 24, 53, 65, 70, 95, 127 and 167, 1985; Nos. 28, 75, 94 and 115, 1986; Nos. 22, 44, 72, 118, 131 and 132, 1987; Nos. 79, 87, 99 and 155, 1988; No. 95, 1989; Nos. 3, 84, 106 and 141, 1990; Nos. 6, 68, 70, 73, 83, 84, 115, 116, 119, 122, 141, 169, 175, 208 and 211, 1991; Nos. 70, 81, 88, 136, 192, 200 and 204, 1992; Nos. 28, 61, 76 and 106, 1993; Nos. 12, 22, 23, 63, 78, 80, 85, 116 and 174, 1994; and No. 24, 1995.

2. Health Insurance Act 1973

No. 42, 1974, as amended. For previous amendments, see No. 58, 1975; Nos. 59, 91, 101, 109 and 157, 1976; No. 75, 1977; Nos. 36, 89 and 133, 1978; Nos. 53 and 123, 1979; No. 132, 1980; Nos. 118 and 176, 1981; Nos. 49, 80 and 112, 1982; Nos. 54 and 139, 1983; Nos. 15, 46, 63, 120, 135 and 165, 1984; Nos. 24, 65, 70, 95 and 167, 1985; Nos. 28, 75 and 94, 1986; Nos. 44, 131, 132 and 141, 1987; Nos. 85, 87, 99 and 155, 1988; Nos. 59, 84, 95 and 164, 1989; Nos. 3, 106 and 141, 1990; Nos. 6, 57, 68, 70, 73, 84, 116, 141, 171, 172, 175, 190, 193 and 211, 1991; Nos. 88, 136, 192, 204, 226, 229 and 230, 1992; No. 76, 1993; and Nos. 12, 22, 60, 85, 116 and 174, 1994.

3. Health Insurance Commission Act 1973

No. 41, 1974, as amended. For previous amendments, see Nos. 61, 91 and 100, 1976; Nos. 36 and 134, 1978; No. 53, 1979; Nos. 54 and 115, 1983; No. 63, 1984; Nos. 65 and 167, 1985; No. 75, 1986; Nos. 75 and 99, 1988; Nos. 119 and 122, 1991; Nos. 94 and 136, 1992; No. 29, 1993; and Nos. 80, 84 and 174, 1994.

[Minister's second reading speech made in—

House of Representatives on 2 February 1995

Senate on 28 February 1995]

Health Legislation (Private Health Insurance Reform) Amendment Act 1995

Administered by Department of Health, Disability and Ageing

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