National Health (Pharmaceutical Benefits) Regulations (Amendment) 1991 No. 1
EXPLANATORY STATEMENT
Statutory Rules 1991 No. 1
National Health Act 1953
National Health (Pharmaceutical Benefits) Regulations (Amendment)
Apart from section 140 of the National Health Act 1953 (the Act), which provides that the Governor-General may make Regulations for the purposes of the Act, certain other provisions in the Act also specifically provide for matters to be prescribed by Regulation. Paragraph 84DA(3)(b) of the Act provides for the prescribing of particulars to be included in an application for a Safety Net Concession Card.
The Social Welfare Legislation (Pharmaceutical Benefits) Amendment Act 1990 and the Community Services and Health Legislation Amendment Act 1990 introduced changes to the pharmaceutical benefits safety net scheme contained in Division 1A, Part VII of the National Health Act 1953 (the Act). Instead of eligibility for free pharmaceutical benefits being based on the number of pharmaceutical benefits purchased during a calendar year, eligibility will now be based on the amount of money spent. A person who either individually or as a family spends $300 on pharmaceutical benefits in a calendar year will qualify to receive further pharmaceutical benefits at a rate of $2.50 until a further $50 is spent (unless that person qualifies to be treated as a concessional beneficiary). Once that target is reached that person is issued with an Entitlement Card entitling him/her to receive pharmaceutical benefits without charge for the remainder of the calendar year.
Persons who are eligible to receive pharmaceutical benefits at the $2.50 rate before becoming entitled to free pharmaceutical benefits are to be issued with Concession Cards. The Community Services and Health Legislation Amendment Act (No. 2) 1990 provides for this.
New regulation 9AA inserted into the National Health (Pharmaceutical Benefits) Regulations sets out the particulars which paragraph 84DA(3)(b) of the Act provides should be prescribed as particulars to be included in an application for a Concession Card.
New regulations 9AB and 9AC set out procedures for applying for an additional or replacement Concession Card. New regulations 9AD and 9AE set up a procedure whereby the refusal of the Secretary to issue an additional or replacement Concession Card is to be subject to review by the Administrative Appeals Tribunal. These provisions mirror the existing provisions relating to the issue of additional or replacement Entitlement Cards.
The other amendments are merely consequential amendments.
Overview
The National Health (Pharmaceutical Benefits) Regulations (Amendment) 1991 No. 1, made under the National Health Act 1953, were enacted to address the changes introduced by the Social Welfare Legislation (Pharmaceutical Benefits) Amendment Act 1990 and the Community Services and Health Legislation Amendment Act 1990. These amendments aimed to shift the eligibility criteria for free pharmaceutical benefits from a system based on the number of pharmaceutical benefits purchased during a calendar year to one based on the amount of money spent. Specifically, the new regulations focus on the particulars to be included in applications for Safety Net Concession Cards, the procedures for applying for additional or replacement Concession Cards, and the review process for refusals of such applications. The enacting body was the Parliament, with the objective of aligning the regulatory framework with the updated safety net scheme to ensure a seamless transition and effective administration of the new eligibility criteria.
Scope and Application
The National Health (Pharmaceutical Benefits) Regulations (Amendment) 1991 No. 1 modifies the National Health Act 1953 to alter the pharmaceutical benefits safety net scheme. This legislation applies to individuals and families in Australia who are eligible for pharmaceutical benefits under the scheme, which now hinges on the amount of money spent on pharmaceuticals in a calendar year, rather than the number of benefits purchased. Specifically, those who spend $300 on pharmaceutical benefits during a year are entitled to further benefits at a rate of $2.50 until an additional $50 is spent, after which they receive benefits without charge for the remainder of the year. The Act also mandates the issuance of Concession Cards to those eligible for benefits at the $2.50 rate prior to qualifying for free benefits. The regulations set out particulars for applications for Concession Cards, procedures for applying for additional or replacement cards, and establish a review process for refusals by the Secretary, overseen by the Administrative Appeals Tribunal. These amendments apply across Australia, aligning with the jurisdictional reach of the National Health Act 1953.
Key Provisions
The National Health (Pharmaceutical Benefits) Regulations (Amendment) 1991 No. 1 primarily introduces changes to the application process for Concession Cards under the National Health Act 1953 (the Act). Section 84DA(3)(b) of the Act, which mandates the particulars to be included in an application for a Safety Net Concession Card, is updated to ensure that these particulars are clearly defined. Regulation 9AA, newly inserted, specifies the details that need to be included in such applications, ensuring clarity and consistency in the process. Additionally, regulations 9AB and 9AC lay out the procedures for applying for additional or replacement Concession Cards, while regulations 9AD and 9AE establish a review mechanism for any refusals by the Secretary to issue these cards, mirroring existing provisions for Entitlement Cards.
The Act imposes several obligations on the parties involved. Firstly, applicants for a Concession Card must provide specific particulars as outlined in regulation 9AA. This includes personal information and details about pharmaceutical benefits spent, ensuring that all necessary documentation is submitted. Furthermore, applicants must adhere to the procedures specified in regulations 9AB and 9AC when applying for additional or replacement Concession Cards. If the Secretary refuses to issue a card, applicants have the right to seek a review by the Administrative Appeals Tribunal, as per regulations 9AD and 9AE, ensuring that the decision-making process is fair and transparent.
In terms of consequences for non-compliance, the regulations do not explicitly state penalties for failing to provide the required particulars in an application or for procedural errors in applying for a Concession Card. However, any actions that result in a failure to comply with the Act or the regulations may lead to administrative consequences, such as delays in processing or the denial of a card. For instance, if an application is incomplete or incorrect, it may be rejected by the Secretary, and the applicant may need to resubmit the application with the correct information. Additionally, if the refusal to issue a card is deemed unjust, the applicant can seek a review by the Administrative Appeals Tribunal, which may result in the card being issued if the Tribunal finds in the applicant's favour.