EXPLANATORY STATEMENT
Health and Other Services (Compensation) Act 1995
Provision of Information (Bulk Payment Agreements) Determination 2006
The Health and Other Services (Compensation) Act 1995 (“the Act”) establishes a scheme for the recovery of Medicare benefits and nursing home benefits/residential care subsidies paid in respect of an injury for which compensation becomes payable under a judgment, settlement or reimbursement arrangement. Under the Act, the compensation payer or insurer is prohibited from paying the compensable person any part of the compensation until specified requirements of the Act are met.
Subsection 34(1) of the Act allows the Chief Executive Officer of Medicare Australia (the CEO) to enter into bulk payment agreements (BPA) on behalf of the Commonwealth with persons who are, or may become, liable to make payments to the Commonwealth under the Act.
The effect of entry into a BPA is to exempt the person with whom the BPA is made, and any compensable person concerned, from some of the obligations under the Act. The BPA becomes the primary mechanism for regulating and administering the person’s obligations under the Act.
Entering into a BPA is entirely voluntary and designed to facilitate compliance with the Act in cases where there are large numbers of claims.
Subsection 34(1) of the Act requires that a BPA contain certain provisions. Those provisions include an obligation for the person to give the CEO information of a kind, and in a way, specified in a determination made by the CEO under subsection 34(2) of the Act. Subsection 34(3) of the Act provides that the determination may require the giving of detailed information about settlements, judgments and reimbursement arrangements that occur within the period in which the BPA applies.
Subsection 34(4) of the Act provides that determinations under subsection 34(2) are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901 and hence are legislative instruments (paragraph 6(d) of the Legislative Instruments Act 2003 (the Legislative Instruments Act) refers).
The new determination (Provision of Information (Bulk Payment Agreements) Determination 2006) specifies the information about judgments, settlements and reimbursement arrangements to be provided to the CEO under a BPA, specifically:
- the date of the judgment, settlement or reimbursement arrangement;
- the full names and addresses, dates of birth and Medicare numbers (if known) of all the compensable persons to whom the judgment, settlement or reimbursement arrangement relates;
- the amount of compensation to be paid under the judgment or settlement;
- a description of the injury;
- the date of injury; and
- a copy of the relevant order or agreement.
The determination also specifies the ways in which this information may be provided. The information must be given to the CEO in writing (certified copies of documents where indicated) and sent via the post or by facsimile.
The information that must be given to the CEO is similar to that which is normally obtained in compensation cases where a BPA is not in place.
The Provision of Information (Bulk Payment Agreement) Determination 2006 also revokes the previous determination. Part of the rationale for the making of a new determination is to reflect the changed arrangements associated with the transition of the Health Insurance Commission to Medicare Australia.
The commencement date for the Determination is the day after it is registered.
No consultation was undertaken under section 17 of the Legislative Instruments Act before the Provision of Information (Bulk Payment Agreement) Determination 2006 was made as it is of a minor or machinery nature and does not substantially alter existing arrangements.
Overview
The Provision of Information (Bulk Payment Agreements) Determination 2006 is an instrument under the Health and Other Services (Compensation) Act 1995, which seeks to establish a scheme for the recovery of Medicare benefits and nursing home benefits/residential care subsidies paid in respect of an injury for which compensation becomes payable. The Act aims to ensure that compensation payers or insurers do not pay any part of the compensation until certain requirements are met. To facilitate compliance with the Act, particularly in cases with numerous claims, the Act allows the Chief Executive Officer of Medicare Australia to enter into voluntary bulk payment agreements (BPA) with persons liable to make payments to the Commonwealth. This Determination specifies the type of information related to judgments, settlements, and reimbursement arrangements that must be provided to the CEO under a BPA, thereby regulating and administering the person's obligations under the Act. The Determination also revokes the previous one, reflecting the transition of the Health Insurance Commission to Medicare Australia.
Scope and Application
The Provision of Information (Bulk Payment Agreements) Determination 2006, made under the Health and Other Services (Compensation) Act 1995, applies to persons and entities that enter into bulk payment agreements (BPA) with the Chief Executive Officer of Medicare Australia. These agreements are voluntary arrangements designed to streamline the process of compliance for compensation payers or insurers when multiple claims are involved. The Act applies to the Commonwealth jurisdiction, and the determination serves to outline the specific information that must be provided to the CEO under these agreements. This includes details such as the date of the judgment, settlement, or reimbursement arrangement, the full names and personal details of the compensable persons involved, the amount of compensation, a description of the injury, the date of the injury, and a copy of the relevant order or agreement. The information must be delivered to the CEO in writing, either by post or via facsimile, and certified copies of documents may be required where specified. The determination also revokes the previous one, reflecting the transition from the Health Insurance Commission to Medicare Australia. This legislative instrument is considered minor and of a machinery nature, thus consultation under the Legislative Instruments Act was not undertaken before its creation.
Key Provisions
The Provision of Information (Bulk Payment Agreements) Determination 2006 (F2006L02450) outlines the specific details and requirements for bulk payment agreements (BPAs) under the Health and Other Services (Compensation) Act 1995 (the Act). These agreements, facilitated by the Chief Executive Officer (CEO) of Medicare Australia, are voluntary mechanisms designed to streamline the recovery of Medicare benefits and nursing home benefits/residential care subsidies from compensation payers. Section 34(1) of the Act allows the CEO to enter into BPAs, which then become the primary means of regulating and administering the obligations of the parties under the Act. These agreements are particularly useful in managing large numbers of claims efficiently.
Under the new Determination, parties entering into a BPA must provide detailed information about judgments, settlements, and reimbursement arrangements to the CEO. This includes the date of such events, full names and contact details of compensable persons, compensation amounts, injury descriptions, dates of injury, and copies of relevant orders or agreements. The information must be provided in writing and sent via post or fax, as specified in the Determination. This mirrors the information typically gathered in compensation cases without a BPA, ensuring consistency in the information flow. Additionally, the Determination revokes the previous provision, reflecting the transition of the Health Insurance Commission to Medicare Australia.
Parties governed by a BPA under the Act have specific obligations to comply with. They must furnish the detailed information specified in the Determination to the CEO in a timely manner, ensuring accuracy and completeness. Failure to provide the required information can lead to complications in the recovery process and potential breaches of the Act. Compliance with these obligations is essential for maintaining the integrity of the compensation recovery scheme.
Failure to adhere to the provisions of the Determination and the Act can lead to various consequences. While the specific offences, penalties, or civil/criminal consequences are not detailed in the Determination, it is clear that non-compliance with the Act’s requirements can result in legal actions. The Act prohibits compensation payers or insurers from making payments to the compensable person until the specified requirements are met. Therefore, any breach of the obligations under a BPA can lead to enforcement actions by the CEO or other relevant authorities, potentially resulting in financial penalties or other legal repercussions for the non-compliant party. The Act ensures that the compensation recovery process is administered effectively and fairly, protecting the interests of all parties involved.