NATIONAL HEALTH AMENDMENT ACT (No. 2) 1976

No. 99 of 1976

An Act to amend the National Health Act 1953, and for related purposes.

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. 2) 1976.

(2) The National Health Act 19532 is in this Act referred to as the Principal Act.

Commencement.

2. This Act shall come into operation on 1 October 1976, immediately after the provisions of the National Health Amendment Act 1976 referred to in sub-section 2(2) of that Act come into operation.

Interpretation.

3. Section 4 of the Principal Act is amended—

(a) by omitting from the definition of “registered hospital benefits organization” in sub-section (1) the words “, or deemed to be registered,”;

(b) by omitting from the definition of “registered medical benefits organization” in sub-section (1) the words or deemed to be registered,”;

(c) by omitting from the definition of “registered organization” in sub-section (1) the words “, or deemed to be registered,”; and

(d) by omitting the definitions of “ ‘the standard hospital benefits table’ or ‘the standard table’” and “ ‘the standard medical benefits table’ or ‘the standard table’ ” in sub-section (1) and substituting the following definitions:—

“‘the standard hospital benefits table’ or ‘the standard table’ means, in relation to a registered hospital benefits organization, in respect of a State or Territory—benefits of the following kinds:—

(a) in respect of hospital treatment provided to persons as in-patients of a hospital in that State or Territory—benefits equal to the fees charged for the provision of hospital treatment in a recognized hospital in that State or Territory in respect of a private patient in other than a single room, being a patient who is not entitled to receive compensation or damages in respect of the costs of that hospital treatment;

(b) in respect of hospital treatment provided to persons as in-patients of a hospital in any other State or Territory—benefits equal to—

(i) the fees charged for the provision of hospital treatment in a recognized hospital in the State or Territory to which the table relates in respect of a private patient in other than a single room, being a patient who is not entitled to receive compensation or damages in respect of the costs of that hospital treatment; or

(ii) in fees charged for the provision of hospital treatment in a recognized hospital in the State or Territory in which the hospital is situated in respect of such a patient,

whichever are the greater;

(c) in respect of professional services rendered to persons as in-patients of a recognized hospital, whether situated in the State or Territory to which the table relates or elsewhere, by medical practitioners employed by, or under arrangements made by, the hospital—benefits equal to the charges made by the hospital for the provision of those services to patients who are not entitled to receive compensation or damages in respect of the cost of those services;

(d) in respect of out-patient services provided to persons by a hospital in a State or Territory in which recognized hospitals make charges for the provision of out-patient services—

(i) if that hospital is a recognized hospital—benefits equal to the charges made by that hospital for the provision of those services to persons who are not entitled to receive compensation or damages in respect of the cost of those services; or

(ii) if that hospital is not a recognized hospital—benefits equal to the charges made by that hospital for the provision of those services or the charges made by recognized hospitals in that State or Territory for the provision of services of that kind to persons who are not entitled to receive compensation or damages in respect of the cost of those services, whichever are the less;

(e) benefits of the kind referred to in sub-section (1) of section 73c; and

(f) such other benefits (if any) as are prescribed for the purposes of this definition in relation to registered hospital benefits organizations or a class of registered hospital benefits organizations in which the organization is included;

“‘the standard medical benefits table’ or ‘the standard table’ means, in relation to a registered medical benefits organization, in respect of a State or Territory—a range of benefits corresponding to the medical benefits payable, in respect of services rendered to eligible persons, under Part II of the Health Insurance Act 1973 and such other benefits (if any) as are prescribed for the purposes of this definition in relation to registered medical benefits organizations or a class of registered medical benefits organizations in which the organization is included;

Interpretation.

4. Section 38 of the Principal Act is amended by omitting sub-section (2).

Additional benefit payable in respect of nursing home care.

5. Section 57b of the Principal Act is amended—

(a) by omitting from sub-section (1) the words “a prescribed person” and substituting the words “an eligible person for the purposes of Part II of the Health Insurance Act 1973”; and

(b) by omitting sub-section (1a).

Direction that additional Commonwealth benefit and fund benefit in respect of nursing home care not to be subject to reduction.

6. Section 57c of the Principal Act is amended—

(a) by omitting from paragraph (a) the words “in that nursing home who are prescribed persons for the purposes of sub-section (1) of section 57b” and substituting the words “referred to in sub-section (1) of section 57b who are in that nursing home”; and

(b) by adding at the end of paragraph (b) the words “or dependants of contributors”.

Saving.

7. Sections 65 of the Principal Act is repealed.

Interpretation.

8. Section 66 of the Principal Act is amended by omitting from sub-section (1) the definition of “pre-existing ailment” and substituting the following definition:—

“‘pre-existing ailment’, in relation to a contributor, means—

(a) an illness or disability of the contributor, or of a dependant of the contributor, in respect of which rules of the organization concerned excluding or limiting eligibility for benefits apply by reason of the fact that symptoms of the illness or disability were in evidence before, or within a specified period after, a particular time; or

(b) pregnancy or other obstetric condition of the contributor, or of a dependant of the contributor, in respect of which rules of the organization concerned excluding or limiting eligibility for benefits apply by reason that contributions commenced less than a specified period before the expected date of confinement;

Applications by organizations for registration as medical benefits organizations.

9. Section 67 of the Principal Act is amended—

(a) by adding at the end of sub-paragraph (i) of paragraph (c) of sub-section (2) the words “or dependants of such contributors”; and

(b) by adding at the end of sub-paragraph (i) of paragraph (c) of sub-section (4) the words “or dependants of such contributors”.

Application by organizations for registration as hospital benefits organizations.

10. Section 68 of the Principal Act is amended—

(a) by adding at the end of sub-paragraph (i) of paragraph (c) of sub-section (2) the words “or dependants of such contributors”; and

(b) by adding at the end of sub-paragraph (i) of paragraph (c) of sub-section (4) the words “or dependants of such contributors”.

Registration.

11. Section 73 of the Principal Act is amended by omitting paragraph (d) of sub-section (7) and substituting the following paragraph:—

“(d) the fact that the registration is subject to conditions set out in this Division; and”.

Conditions of registration.

12. Section 73ba of the Principal Act is amended—

(a) by inserting in sub-section (1), after the words “organization shall”, the words “, whether the registration was effected before, or is effected after, the commencement of this section,”;

(b) by omitting paragraph (i) of sub-section (1) and substituting the following paragraph:—

“(i) a condition that a contributor to a medical benefits fund or a hospital benefits fund conducted by the organization, being a contributor for benefits in accordance with the standard table, who has ceased to pay contributions may, at any time before the expiration of a period, being a period of not less than 2 months, specified in the rules of the organization, pay the contributions due in respect of the period (in this sub-paragraph referred to as the ‘period in arrears’) commencing on the expiration of the period in respect of which he had paid contributions and ending not earlier than the date on which he made the payment and that, if he does so, he is, under the rules of the organization, to continue to be eligible for benefits in respect of the period in arrears;”; and

(c) by omitting sub-section (2).

13. Section 73bb of the Principal Act is repealed and the following section substituted:—

Reinsurance Account in hospital benefits fund.

“73bb. (1) It is a condition of registration of a registered hospital benefits organization that, as on and from 1 October 1976 or the date of its registration, whichever is the later, it shall establish and maintain a Reinsurance Account in the hospital benefits fund, or in each of the hospital benefits funds, from time to time conducted by it.

“(2) For the purposes of this section, where hospital benefits have been paid, or are payable, by a registered organization to a contributor, in accordance with the standard table, in respect of the provision of hospital treatment on any day—

(a) if the treatment was so provided for 1 person only—that day counts as 1 patient day of the contributor; or

(b) if the treatment was so provided for 2 or more persons—that day counts, subject to sub-section (8), as a number of patient days of the contributor equal to the number of those persons.

“(3) Where, within a period of 12 months commencing on a day that counts as a patient day or patient days of a contributor (being a day on or after the commencing date of the contributor and not being a day within a period of 12 months in respect of which this section has previously become applicable to the contributor) the number of patient days of the contributor counted from and including that day reaches the prescribed number of patient days, this section applies to the contributor in respect of that period of 12 months.

“(4) Subject to sub-section (5), where this section applies to a contributor in respect of a period of 12 months—

(a) the organization concerned may debit to the Reinsurance Account maintained by it in the hospital benefits fund concerned the amounts of any payments of any benefits made out of that fund, in accordance with the standard table, to the contributor in respect of any part of that period of 12 months after the day in that period on which the prescribed number of patient days was reached; and

(b) where such a debit is made, the organization shall credit to the Reinsurance Account amounts of any contributions in respect of the standard table made by the contributor to the fund in respect of the part of that period of 12 months after the day referred to in paragraph (a).

“(5) Sub-section (4) does not authorize a registered organization to debit to the Reinsurance Account maintained by it in a hospital benefits fund the amounts of any payments of any benefits made out of that fund in respect of any period before 1 October 1976 or to credit to such an account any contributions made by a contributor in respect of any such period.

“(6) A registered organization may debit to the Reinsurance Account maintained by it in a hospital benefits fund the amount of any reasonable management expenses approved by the Minister after he has consulted with the Trustees appointed under section 73bc.

“(7) A registered organization—

(a) shall maintain such records relating to the operation of the Reinsurance Account maintained by it in a hospital benefits fund as the Minister determines from time to time;

(b) shall keep the records referred to in paragraph (a) separate and distinct from any other records maintained by the organization; and

(c) shall furnish to the Permanent Head, at such times as the Minister determines, such information drawn from the records referred to in paragraph (a) as the Minister requires.

“(8) Where, on the day referred to in sub-section (4), the number of patient days of the contributor from the beginning of the relevant period of 12 months increases from a number that is less than the prescribed number of patient days to a number that exceeds that prescribed number by reason of hospital treatment being received by 2 or more persons on that day, the organization may, for the purposes of this section, treat the hospital treatment provided on that day for any of those persons, to a number equal to the excess number of patient days, as having been provided on the next following day.

“(9) For the purposes of this section, the commencing date of a contributor to a registered organization is—

(a) if the contributor was a special account contributor of that organization on 30 September 1976 and hospital benefits have been paid, or are payable, to the contributor by the organization in respect of hospital treatment for each of the 35 days immediately preceding 1 October 1976—27 August 1976;

(b) if the registered organization is satisfied that the contributor was a special account contributor of another registered organization on 30 September 1976 and that hospital benefits have been paid, or are payable, to the contributor by that other registered organization in respect of hospital treatment for each of the 35 days immediately preceding 1 October 1976—27 August 1976;

(c) if the contributor was a special account contributor of the organization on 30 September 1976 to whom paragraph (a) does not apply—1 October 1975;

(d) if the registered organization is satisfied that the contributor was a special account contributor of another registered organization on 30 September 1976 to whom paragraph (b) does not apply—1 October 1975; and

(e) in any other case—1 October 1976 or the day on which he becomes a contributor to the hospital benefits fund of the organization, whichever is the later day.

“(10) Where a contributor to a registered organization was a special account contributor of the organization on 30 September 1976, or a registered organization is satisfied that a contributor to the organization was a special account contributor of another organization on that date, any hospital benefits paid or payable to the contributor by the organization, or any hospital benefits that the organization is satisfied were paid or are payable to the contributor by another registered organization, in respect of hospital treatment provided before 1 October 1976 for the contributor or a dependant of the contributor shall, in the application of this section in relation to the contributor, be treated as if those benefits were paid, or were payable, to the contributor by the organization of which he is, for the time being, a contributor, in accordance with the standard table, in respect of hospital treatment.

“(11) In this section—

‘hospital treatment’ includes, where appropriate, both hospital treatment and professional services;

‘prescribed number of patient days’ means 35 patient days or such other number of patient days as is prescribed by the regulations.”.

14. Section 73bf of the Principal Act is repealed and the following section substituted:—

Direction to admit person as contributor to a registered organization.

“73bf. (1) Where—

(a) a registered organization refuses to admit a person as a contributor, in respect of the standard table, to a medical benefits fund or a hospital benefits fund conducted by it; and

(b) the person believes that the refusal was due to the past or present state of health of himself or of 1 or more of his dependants,

the person may request the Minister to direct the organization to admit him as a contributor in respect of the standard table to that fund.

“(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 admission of persons as contributors, in respect of the standard table, 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 or a hospital 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 satisfied that there are reasonable grounds for believing that the refusal to admit the person as a contributor, in respect of the standard table, to the fund was due to the past or present state of health of the person or of 1 or more of his dependants; or

(ii) the organization has failed to furnish a statement in pursuance of the requirement referred to in paragraph (c) of sub-section (3),

direct the organization to admit the person as a contributor, in respect of the standard table, to that fund; or

(b) in any other case—refuse to give that direction.

“(5) A direction under this section shall not require a restricted membership organization to admit as a contributor to a medical benefits fund or a hospital benefits fund, as the case may be, a person who is not eligible, in accordance with the rules of the organization, for membership of that fund.”.

Information for Health Insurance Commission and Department of Health.

15. Section 73bg of the Principal Act is amended—

(a) by omitting from sub-section (1) the words “the Health Insurance Act 1973-1976” and substituting the words “Part V, or Division 1a of Part VI, of this Act, or under the Health Insurance Act 1973,”; and

(b) by adding at the end thereof the following sub-section:—

“(3) the Health Insurance Commission shall, when required to do so by the Minister, furnish to the Permanent Head such information in the possession of the Commission, including information furnished to the Commission in pursuance of a direction given under sub-section (2), as the Minister considers necessary to be furnished to assist the Permanent Head in connexion with the payment of benefits under Part V or Division 1a of Part VI.”.

Conditions of registration relating to nursing home care.

16. Section 73c of the Principal Act is amended—

(a) by omitting from sub-section (1) the words “hospital benefit fund” (wherever occurring) and substituting the words “hospital benefits fund”;

(b) by omitting from sub-section (2) the words “hospital benefit fund” and substituting the words “hospital benefits fund”;

(c) by inserting in sub-section (2), after the word “organization”, the words “or a dependant of such a contributor”;

(d) by inserting in sub-paragraph (i) of paragraph (a) of subsection (3), after the word “contributor”, the words “or a dependant of a contributor”; and

(e) by omitting paragraphs (b) and (c) of sub-section (3) and substituting the following paragraphs:—

“(b) a rule that, where a Commonwealth benefit under section 57b is payable in respect of a contributor or a dependant of a contributor for a day on which the contributor or the dependant receives nursing home care in a nursing home, no benefit referred to in sub-section (1) is payable in respect of that contributor or that dependant for that day; and

“(c) a rule that benefit referred to in sub-section (1) is not payable in respect of a contributor or a dependant of a contributor for a day in respect of which Commonwealth benefit under section 56 is not payable in respect of that contributor or that dependant.”.

17. Section 73d of the Principal Act is repealed and the following section substituted:—

Provision of services by organizations.

“73d. (1) Where a registered organization provides, or arranges for the provision of, services or treatment of any kind for all or any of its contributors or dependants of those contributors, the Minister may, at the request of the organization, direct that, to such extent as he directs, the provision of those services or of that treatment shall be treated, for the purposes of this Act, as the payment by the organization of benefits in respect of those services or that treatment.

“(2) A request by a registered organization under sub-section (1)—

(a) shall be made by delivering the request to the Director for the State or Territory in which the organization is registered; and

(b) may specify the extent to which the organization desires to treat the provision of the services or treatment to which the request relates in the manner referred to in that sub-section.

“(3) The Minister shall, as soon as practicable after a request is made by a registered organization under this section, give, or refuse to give, the direction requested by the organization.

“(4) As soon as practicable after the Minister gives a direction under sub-section (1) in relation to an organization, the Minister shall notify the organization accordingly and forward a copy of the direction to the organization.

“(5) As soon as practicable after the Minister refuses to give a direction that has been requested by an organization, he shall notify the organization accordingly.

“(6) Where the Minister notifies an organization—

(a) that he has refused to give a direction requested by the organization; or

(b) that he has given a direction requested by the organization but has directed that the provision of the services or treatment concerned shall be treated in the manner referred to in sub-section (1) otherwise than as specified in the request,

the Minister shall furnish to the organization, with the notification, particulars of his reasons for so doing.

Changes of rules, &c., by registered organizations.

18. Section 78 of the Principal Act is amended by omitting from sub-section (7) the words “of sub-section (6) of section 73” and substituting the words “of section 73b”.

Provisions applicable to persons ceasing to be pensioners.

19. Section 81a of the Principal Act is amended by adding at the end thereof the following sub-section:—

“(3) Sub-section (2) does not apply to or in relation to a claim for fund benefit lodged in respect of a professional service or hospital treatment rendered on or after 1 October 1976.”.

20. After Division 1 of Part VI of the Principal Act the following Division is inserted:—

“Division 1a—Benefits for Certain Contributors to Standard Hospital Benefits Tables

Commonwealth subsidy.

“82aa. (1) Where—

(a) a contributor to a registered organization included in a class of contributors described in Column 1 of the following table has paid contributions, in respect of a period, to the organization for benefits in accordance with the standard hospital benefits table;

(b) the contributor did not pay contributions, in respect of that period, to that organization, or to any other registered organization, for benefits in accordance with the standard medical benefits table; and

(c) the rate per week at which the contributor would, if he had been contributing in respect of that period for medical benefits in accordance with the standard medical benefits table and hospital benefits in accordance with the standard hospital benefits table, have been liable to pay contributions to the organization for those hospital benefits exceeds the rate specified in Column 2 opposite to the description of that class of contributor in Column 1,

benefit is payable to the organization, in respect of the contributor, for the period at a rate per week equal to the excess or the rate specified in Column 3 opposite to the description of that class of contributors in Column 1, whichever is the less:—

“(2) In sub-section (1)—

(a) a reference to contributors at the single rate is a reference to contributors for benefits only in respect of themselves; and

(b) a reference to contributors at the family rate is a reference to contributors other than contributors referred to in paragraph (a).

“(3) The regulations may provide that this Act shall have effect as if the table in sub-section (1) were varied by substituting another amount for an amount set out in that table.

“(4) Regulations under this section shall, unless sooner repealed, cease to be in force on the day next following the fifteenth sitting day of the House of Representatives after the expiration of a period of 12 months commencing on the day on which the regulations are notified in the Gazette, and shall be deemed to have been repealed on that first-mentioned day.

Claims for payments.

“82ab. (1) For the purpose of obtaining payment of benefit under this Division, a registered organization shall submit—

(a) as soon as practicable after the expiration of a quarter, or of such other period as the Permanent Head permits, a claim, in the authorized form, for benefit payable in respect of that quarter or period; and

(b) such information relating to the claim as is shown in the form to be required or as the Permanent Head requests.

“(2) Payment of benefit under this Division shall not be made except in respect of amounts included in a claim duly made and in relation to which any necessary information has been duly furnished.

“(3) In this section, ‘quarter’ means the period of 3 months commencing on 1 October 1976 or a subsequent period of 3 months.

Benefit to be paid out of moneys appropriated for the purpose.

“82ac. Payments under this Division shall only be made out of moneys appropriated by the Parliament for the purpose.”.

Payment of benefits.

21. Section 82d of the Principal Act is amended—

(a) by inserting in sub-section (1a), after the word “contributor”, the words “or a dependant of the contributor”;

(b) by inserting in sub-section (4), after the words “the contributor” (first occurring), the words “or a dependant of the contributor”; and

(c) by inserting in sub-section (4), after the words “the contributor” (second occurring), the words “or of that dependant, as the case may be,”.

Applications for review by Tribunal.

22. Section 105ab of the Principal Act is amended by inserting after sub-section (4) the following sub-section:—

“(4a) An application may be made to the Tribunal for review of—

(a) the refusal by the Minister to give a direction requested by a registered organization under sub-section (1) of section 73d; or

Eighth Schedule.

(b) a direction by the Minister, under sub-section (1) of section 73d, as to the extent to which the provision of a service or of treatment by a registered organization is to be treated in the manner referred to in that sub-section.”.

23. (1) The Eighth Schedule to the Principal Act is amended by omitting the table and substituting the following table:—

(2) The amendment made by sub-section (1) shall be deemed to have come into operation on 1 February 1976.

(3) The National Health (Variation of Nursing Home Benefits) (No. 4) Regulations (being Statutory Rules 1976, No. 20) are repealed.

Amendment of National Health Amendment Act 1976.

24. Section 43 of the National Health Amendment Act 1976 is amended by adding at the end thereof the following sub-sections:—

“(2) Notwithstanding that the registration of an organization is cancelled, or cancelled in respect of a particular State or Territory, under section 42 with effect on 1 October 1976, for the purpose of the application of the Principal Act in accordance with sub-section (1) from and including that date to and including 30 June 1978, the organization shall be deemed to continue to be a registered organization or to be registered in respect of that State or Territory, as the case may be.

“(3) Notwithstanding that the registration of an organization that was, immediately before 1 October 1976, maintaining a special account established by the organization for the purposes of Division 2 of Part VI of the National Health Act 1953 is cancelled, or cancelled in respect of a particular State or Territory, under section 42 with effect on that date, for the purpose of the application of that Division from and including that date to and including 30 September 1978, the organization shall be deemed to continue to be a registered organization or to be registered in respect of that State or Territory, as the case may be.”.