NATIONAL HEALTH AMENDMENT ACT (No. 3) 1978
No. 189 of 1978
An Act to amend the National Health Act 1953.
BE IT ENACTED by the Queen, and the Senate and House of Representatives of the Commonwealth of Australia, as follows:
Short title, &c.
1. (1) This Act may be cited as the National Health Amendment Act (No. 3) 1978.
(2) The National Health Act 1953 is in this Act referred to as the Principal Act.
Commencement
2. This Act shall come into operation on the day on which it receives the Royal Assent.
Interpretation
3. Section 66 of the Principal Act is amended by inserting in sub-section (1), before the definition of “insured nursing home patient”, the following definition:
“‘improper discrimination’ means a discrimination that is related to all or any of the following matters:
(a) the suffering by a person from a chronic disease, illness or other medical condition or from a disease, illness or medical condition of a particular kind;
(b) the age of a person;
(c) the frequency of the rendering of professional services to a person;
(d) the amount, or extent, of the benefits to which a person becomes, or has become, entitled during a period;
(e) any matter prescribed for the purposes of this paragraph;”.
Directions by the Minister to registered organizations
4. Section 73be of the Principal Act is amended by adding at the end thereof the following sub-sections:
“(2) The power to give a direction with respect to any matter referred to in a paragraph of sub-section (1) (including a matter prescribed for the purposes of paragraph (e) of that sub-section) includes a power to give such directions as the Minister considers necessary from time to time to achieve all or any of the following objectives:
(a) The objective of preventing, or reducing the extent of, discrimination against some of the contributors to a medical benefits fund conducted by a registered organization, where the discrimination is in the scope or level of benefits available to such contributors in respect of professional services rendered on or after 1 November 1978 and is, in the opinion of the Minister, an improper discrimination.
(b) The objective of preventing, or reducing the extent of, any reduction in the scope or level of benefits, or preventing the withdrawal of benefits, in respect of professional services rendered on or after 1 November 1978, being benefits available to contributors to a medical benefits fund conducted by a registered organization who were contributors to that fund before that date, where, in the opinion of the Minister, the reduction or withdrawal would be a result of the administration by the organization of the rules of the organization in a manner different from the manner in which those rules were administered before that date.
(c) The objective of preventing any reduction in the scope or level of benefits payable to persons who are contributors to a medical benefits fund conducted by a registered organization, being benefits in respect of professional services rendered on or after 1 November 1978, to a scope or level below the scope or level applicable under a basic table.
(d) The objective of preventing, or reducing the extent of, discrimination against some of the contributors to a hospital benefits fund conducted by a registered organization, where the discrimination is in the scope or level of benefits available to such contributors in respect of the hospitalization of persons in a hospital on or after 1 May 1978 and is, in the opinion of the Minister, discrimination that is related to the question whether, having regard to the medical condition of the persons hospitalized, such hospitalization is necessary, desirable or appropriate.
“(3) Where the Minister gives a direction which he considers necessary to achieve an objective specified in sub-section (2), the direction shall include a statement to the effect that the Minister considers the direction necessary to achieve the objective.
“(4) A direction referred to in sub-section (3) may, if the Minister considers it proper to do so for the purpose of adequately achieving the objective specified in the direction, include, as part of the direction, requirements with respect to the reconsideration by the organization to which the direction relates of claims dealt with by the organization before the direction takes effect, and the organization shall, in reconsidering a claim in accordance with such a requirement, deal with the claim as if the direction had been in force at the time when the claim was first considered.
“(5) The Minister shall, as soon as practicable after giving a direction referred to in sub-section (3), cause a copy of the direction to be laid before each House of the Parliament.
“(6) Either House of the Parliament, within 15 sitting days of that House after a copy of a direction has been laid before that House under sub-section (5), may, in pursuance of a motion upon notice, pass a resolution disallowing the direction.
“(7) If neither House of the Parliament passes a resolution in accordance with sub-section (6) disallowing a direction, the direction takes effect on the day immediately following the last day upon which such a resolution could have been passed.
“(8) If, before the expiration of 15 sitting days of a House of the Parliament after a copy of a direction has been laid before that House—
(a) that House is dissolved or, being the House of Representatives, expires, or the Parliament is prorogued; and
(b) a resolution disallowing the direction has not been passed by that House,
the copy of the direction shall, for the purposes of this section, be deemed to have been laid before that House on the first sitting day of that House after the dissolution, expiry or prorogation, as the case may be.”.
5. After section 73bfa of the Principal Act the following section is inserted:
Direction to reinstate person as contributor to a registered organization
“73bfb. (1) Where—
(a) a registered organization cancels the membership of a person as a contributor to a medical benefits fund conducted by it; and
(b) the person believes that the cancellation constitutes an improper discrimination against him,
the person may request the Minister to direct the organization to reinstate him as a contributor to that fund in respect of the table to which he was contributing before the cancellation of his membership.
“(2) A request under sub-section (1)—
(a) shall be made by delivering the request to the Director for the State or Territory in respect of which the organization is registered; and
(b) shall be accompanied by a statement setting out the grounds on which the person making the request holds the belief referred to in paragraph (b) of sub-section (1).
“(3) The Minister shall, as soon as practicable after a request is made to him under sub-section (1)—
(a) inform the registered organization concerned that the request has been made;
(b) furnish to the registered organization a copy of the grounds that accompanied the request in accordance with paragraph (b) of sub-section (2); and
(c) require the registered organization to furnish to him, in writing, within 14 days after receipt of the request—
(i) a statement of its general practice in respect of the cancellation of membership of persons as contributors to the fund concerned; and
(ii) any comments it wishes to make concerning the grounds referred to in paragraph (b).
“(4) Where a person makes a request under sub-section (1) with respect to a medical benefits fund conducted by a registered organization, the Minister shall, as soon as practicable after the expiration of 14 days after the requirement referred to in paragraph (c) of sub-section (3) was made—
(a) if—
(i) after consideration of the grounds that accompanied the request and of any statement and comments furnished by the organization, he is of the opinion that the cancellation of the membership of the person as a contributor constitutes an improper discrimination against the person; or
(ii) the organization has failed to furnish a statement in pursuance of a requirement referred to in paragraph (c) of sub-section (3),
direct the organization to reinstate the person as a contributor to that medical benefits fund in respect of the table to which he was contributing before the cancellation of his membership; or
(b) in any other case—refuse to give that direction.
“(5) A reference in this section to the reinstatement of a person shall be read as a reference to reinstatement of such a kind that, by virtue of the reinstatement, the person is to be treated as if his membership of the registered organization concerned had never been cancelled.”.
Guidelines for optional tables
6. Section 73e of the Principal Act is amended by inserting after sub-section (6) the following sub-sections:
“(6a) Where the Minister makes a determination under sub-section (2) that revokes or varies guidelines in force under sub-section (2) or fixes further guidelines under that sub-section, that determination does not affect any declaration by the Minister under sub-section (5) that was made before the making of that determination, but the Minister may, by instrument in writing, revoke that declaration if he is satisfied that, by reason of the making of that determination, the table to which that declaration relates no longer complies with the guidelines in force under sub-section (2) with respect to hospital benefits tables or medical benefits tables, as the case may be.
“(6b) The Minister shall, as soon as practicable after revoking a declaration under sub-section (6a)—
(a) notify the registered organization concerned accordingly; and
(b) cause a copy of the instrument of revocation to be laid before each House of the Parliament.
“(6c) Either House of the Parliament, within 15 sitting days of that House after a copy of an instrument of revocation has been laid before that House under sub-section (6b), may, in pursuance of a motion upon notice, pass a resolution disallowing the revocation.
“(6d) If neither House of the Parliament passes a resolution in accordance with sub-section (6c) disallowing a revocation, the revocation takes effect on the day immediately following the last day upon which such a resolution could have been passed.
“(6e) If, before the expiration of 15 sitting days of a House of the Parliament after a copy of an instrument of revocation has been laid before that House—
(a) that House is dissolved or, being the House of Representatives, expires, or the Parliament is prorogued; and
(b) a resolution disallowing the revocation has not been passed by that House,
the copy of the instrument shall, for the purposes of this section, be deemed to have been laid before that House on the first sitting day of that House after the dissolution, expiry or prorogation, as the case may be.”.
Conduct of medical benefits funds or hospital benefits funds
7. Section 74b of the Principal Act is amended by inserting in paragraph (c) “and, in the case of a direction to which sub-section (7) of section 73be applies, has taken effect” after “organization”.
Changes of rules, &c., by registered organizations
8. Section 78 of the Principal Act is amended—
(a) by omitting sub-section (2) and substituting the following sub-section:
“(2) If the Minister considers that a change notified under sub-section (1)—
(a) makes provision for a new table of benefits to be offered by the organization; or
(b) alters or affects—
(i) the benefits, the amounts of the benefits or the conditions relating to the provision of the benefits provided by the organization in accordance with a basic table;
(ii) the amounts of the contributions, or the conditions relating to the payment of the contributions, for benefits in accordance with any table; or
(iii) the assets, income, expenditure, or the probable income or expenditure, of the organization,
the Minister shall make a declaration, in writing, accordingly and, thereupon, the change is inoperative and has no legal effect unless and until the Minister’s approval of the change has been given in accordance with this section.”;
(b) by inserting after sub-section (3) the following sub-section:
“(4) Where a change referred to the Committee under sub-section (3) makes provision for a new table of benefits, not being a basic table, the Committee, in its consideration of that change, and the Minister, in considering whether to approve or refuse to approve that change, shall take account only of the amounts of the contributions, and the conditions (if any) relating to the payment of the contributions, for benefits in accordance with that table.”; and
(c) by inserting after sub-section (8) the following sub-section:
“(8a) The Minister shall not approve a change referred to in sub-section (1) that—
(a) makes provision for a new table of benefits; or
(b) alters or affects the amounts of the contributions, or the conditions relating to the payment of the contributions, for benefits in accordance with any table,
if he is of the opinion that the change would bring about an improper discrimination against some of the contributors to a medical benefits fund conducted by the organization with respect to the amounts or rates of their contributions.”.
Applications for review by Tribunal
9. Section 105ab of the Principal Act is amended—
(a) by adding at the end of sub-section (4) “, other than a direction referred to in sub-section (3) of section 73be”; and
(b) by inserting after sub-section (4) the following sub-section:
“(4aa) An application may be made to the Tribunal for review of a decision of the Minister under section 73bfb directing a registered organization to reinstate a person as a contributor to a medical benefits fund conducted by it.”.