Health Insurance Amendment Act 1979

No. 53 of 1979

An Act to amend the Health Insurance Act 1973, and for other purposes.

BE IT ENACTED by the Queen, and the Senate and House of Representatives of the Commonwealth of Australia, as follows:

PART I—PRELIMINARY

Short title, &c.

1. (1) This Act may be cited as the Health Insurance Amendment Act 1979.

(2) The Health Insurance Act 1973 is in this Act referred to as the Principal Act.

Commencement

2. (1) Subject to this section, this Act shall come into operation on the day on which it receives the Royal Assent.

(2) Section 9 and Part III shall come into operation on 1 July 1979.

(3) Sections 5, 6 and 7 shall come into operation on 1 September 1979.

PART II—AMENDMENTS OF THE PRINCIPAL ACT

Interpretation

3. Section 3 of the Principal Act is amended—

(a) by inserting after paragraph (a) of the definition of “approved pathology practitioner” in sub-section (1) the following paragraph:

“(aa) the Northern Territory;”;

(b) by inserting in sub-section (1), after the definition of “nursing care”, the following definition:

“‘nursing-home type patient’, in relation to a hospital, means an in-patient in a hospital who has been such an inpatient for a continuous period exceeding 60 days commencing on or after 1 July 1979, but does not include an in-patient in respect of whom there is in force a certificate given under section 3b;”;

“‘patient contribution’ means—

(a) in relation to a nursing-home type patient of a recognized hospital in a State, or an internal Territory, that is a party to an agreement under section 30 that provides for an eligible person (other than a hospital insured person) who is a nursing-home type patient of a recognized hospital to be required to make a patient contribution, calculated in accordance with the agreement, in respect of his care and treatment for each day as an in-patient in the hospital, an amount equal to the amount of that patient contribution;

(b) in relation to a nursing-home type patient of a recognized hospital in the Australian Capital Territory, such amount as is determined by the Minister from time to time for the purposes of this paragraph; or

(i) where the patient occupies an approved bed in the hospital as a hospital patient and, by reason of that occupation, a supplementary daily bed payment is payable under section 34—an amount equal to the amount of the patient contribution in relation to a nursing-home type patient of a recognized hospital in the State or internal Territory in which the private hospital is situated; or

(ii) in any other case—an amount equal to the amount in force, from time to time, for the purposes of sub-paragraph 47(2)(b)(iii) of the National Health Act 1953,

for each day on which the nursing-home type patient is an in-patient in the private hospital;”;

(d) by inserting in sub-section (1), after the definition of “registered person”, the following definition:

“‘standard hospital fees’, in relation to a State or an internal Territory, means the fees charged for the provision of hospital treatment for each day 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—

(a) is not a nursing-home type patient; and

(b) is not entitled to receive compensation or damages in respect of the costs of that hospital treatment;”; and

(e) by adding at the end thereof the following sub-sections:

“(11) For the purpose of ascertaining, for the purposes of the definition of ‘nursing-home type patient’ in sub-section (1), whether an in-patient in a hospital has been such an in-patient for a continuous period exceeding 60 days, there shall be taken into account—

(a) any earlier period (excluding any days before 1 July 1979) during which that patient was an in-patient in that hospital, or in another hospital, that forms one continuous period with the current period of hospitalization of that patient; or

(b) if there are 2 or more earlier periods (excluding any days before 1 July 1979) during which that patient was an inpatient in that hospital, or in another hospital, that form one continuous period with one another and with the current period of hospitalization of that patient—those earlier periods.

“(12) For the purposes of sub-section (11), 2 periods, being periods during which a patient was, or is, an in-patient in a hospital (whether or not the same hospital), that are separated from each other by a period of not more than 7 days during which a patient was not an in-patient in any hospital shall be deemed to form one continuous period with one another.”.

4. After section 3a of the Principal Act the following section is inserted:

Certification of hospital patient as needing acute care, &c.

“3b. (1) For the purposes of the definition of ‘nursing-home type patient’ in sub-section 3 (1), a medical practitioner may, at any time, certify that, in his opinion, a person who is an in-patient in a hospital is, and will continue to be for at least the period that the certificate is in force, in need of—

(a) acute care;

(b) professional attention for an acute phase of the patient’s condition;

(d) continued management, for medical reasons, as an in-patient.

“(2) A certificate given under sub-section (1) ceases to be in force on—

(a) the expiration of a period of 30 days commencing on the day on which it is given; or

(b) such date before that expiration as is specified in the certificate.”.

Entitlement to Commonwealth medical benefit

5. (1) Section 10 of the Principal Act is amended—

(a) by inserting after sub-section (1) the following sub-section:

“(1a) If the amount of the fee specified in respect of a professional service in the table in relation to the State in which the service is rendered is $20 or less and paragraph (2) (a) or (b) does not apply in relation to the service, no Commonwealth medical benefit is payable in respect of the service.”; and

(b) by omitting paragraph (c) of sub-section (2) and substituting the following paragraph:

“(c) in any other case—the amount (if any) by which the fee specified in respect of the service in the table in relation to the State in which the service is rendered exceeds $20.”.

(2) The amendments made by sub-section (1) do not affect the amount of Commonwealth medical benefit in respect of a professional service the medical expenses in respect of which were incurred before the commencement of this section.

Medical benefit in respect of 2 or more operations

6. Section 15 of the Principal Act is amended by omitting from sub-section (1) “calculating the amount of a Commonwealth medical benefit payable” and substituting “ascertaining whether Commonwealth medical benefit is payable, or calculating the amount of a Commonwealth medical benefit payable,”.

Administration of anaesthetic and assistance at operation

7. Section 16 of the Principal Act is amended by omitting from sub-section (4) “calculating the amount of Commonwealth medical benefit payable” and substituting “ascertaining whether Commonwealth medical benefit is payable, or calculating the amount of a Commonwealth medical benefit payable,”.

Supplementary daily bed payments to private hospitals

8. Section 34 of the Principal Act is amended by inserting after sub-section (7) the following sub-sections:

“(7a) It is a condition of the payment of supplementary daily bed payments under this section to an organization that the organization require any nursing-home type patient of the hospital who is a hospital patient to pay to the organization an amount equal to the patient contribution in relation to that patient for each day on which that patient is an in-patient in the hospital.

“(7b) The reference in sub-sections (2) and (7) to the provision of care and treatment without charge to eligible persons who are hospital patients, and the reference in sub-section (4) to the occupation without charge of a bed by an eligible person who is a hospital patient, shall, in so far as they relate to nursing-home type patients, be read as a reference to the provision of care and treatment to those patients or the occupation of beds by those patients, as the case may be, without any charge other than the charge required to comply with the condition set out in sub-section (7a).”.

Payments by the Commonwealth

9. Section 125 of the Principal Act is amended—

(a) by omitting sub-section (1) and substituting the following sub-sections:

“(1) All amounts payable by the Commonwealth under Part II or under an arrangement in force under section 129a shall be paid out of the Trust Account established by the National Welfare Fund Act 1943 and known as the National Welfare Fund.

“(1a) The reference in sub-section (1) to amounts payable by the Commonwealth under Part II shall be read as including a reference to amounts of medical benefits that became payable under Part II of this Act as in force before 1 November 1978 and have not been paid before the commencement of this subsection.”; and

(b) by omitting from sub-section (2) “or under an arrangement in force under section 129a”.

Schedule 2

10. Schedule 2 to the Principal Act is amended—

(a) by omitting from paragraph 7 “An eligible person” and substituting “Subject to paragraph 7a, an eligible person”; and

(b) by inserting after paragraph 7 the following paragraph:

“7a. Where an eligible person referred to in paragraph 7 is a nursing-home type patient of a recognized hospital, he is to be required to make a patient contribution, calculated in accordance with the agreement, in respect of his care and treatment for each day as an in-patient in the hospital.”.

PART III–AMENDMENTS OF OTHER ACTS

Amendment of Health Insurance Amendment Act (No. 2) 1978

11. Section 43 of the Health Insurance Amendment Act (No. 2) 1978 is repealed.

Amendment of Health Insurance Commission Act 1973

12. Section 8d of the Health Insurance Commission Act 1973 is repealed.

PART IV—TRANSITIONAL PROVISIONS

Agreements under section 30 of the Principal Act to continue in force

13. (1) An agreement in force immediately before the commencement of this section under section 30 of the Principal Act continues in force, after the commencement of this section, notwithstanding the amendments made by section 10 of this Act, but may be varied, at any time, by an agreement made under sub-section 30(3) of the Health Insurance Act 1973.

(2) Any variation referred to in sub-section (1), to the extent that it makes provision in relation to nursing-home type patients, shall not take effect before 1 July 1979.

Postponement of operation of definition of “patient contribution”

14. The definition of “patient contribution” set out in paragraph 3(c) does not operate in relation to a nursing-home type patient in a private hospital in a State or internal Territory unless and until—

(a) in the case of a State or the Northern Territory—the agreement under section 30 of the Health Insurance Act 1973 between the Commonwealth and that State or the Northern Territory, as the case may be, makes provision in relation to nursing-home type patients; or

(b) in the case of the Australian Capital Territory—there is in force, for the purposes of paragraph (b) of that definition, an amount determined by the Minister.

Northern Territory to be deemed approved pathology practitioner as from 1 January 1979

15. For the purposes of the Health Insurance Act 1973, the Northern Territory shall be deemed to have been, and to be, an approved pathology practitioner in relation to any pathology service rendered by the Northern Territory at any time on or after 1 January 1979 and before the date of commencement of this section.