Health Legislation Amendment Act (No. 2) 1998
No. 37, 1998
An Act to amend legislation relating to health, and for related purposes
[Assented to 24 April 1998]
The Parliament of Australia enacts:
1 Short title
This Act may be cited as the Health Legislation Amendment Act (No. 2) 1998.
2 Commencement
(1) Subject to this section, this Act commences on the day on which it receives the Royal Assent.
(2) Part 2 of Schedule 4 commences on 1 July 1998.
(3) Items 1 and 2 of Schedule 10 are taken to have commenced on 1 July 1997.
(4) Item 3 of Schedule 10 is taken to have commenced on 30 June 1992, immediately after the commencement of Schedule 2 to the Health, Housing and Community Services Legislation Amendment Act 1992.
(5) Item 4 of Schedule 10 is taken to have commenced on 16 December 1995, immediately after the commencement of item 74 of Schedule 1 to the Human Services and Health Legislation Amendment Act (No. 3) 1995.
(6) Items 6 and 7 of Schedule 10 are taken to have commenced on 29 May 1995, immediately after the commencement of Schedule 1 to the Health Legislation (Private Health Insurance Reform) Amendment Act 1995.
(7) Item 9 of Schedule 10 is taken to have commenced on 16 December 1995, immediately after the commencement of item 22 of Schedule 2 to the Human Services and Health Legislation Amendment Act (No. 3) 1995.
(8) Item 10 of Schedule 10 is taken to have commenced on 1 January 1997, immediately after the commencement of Schedule 3 to the National Health (Budget Measures) Amendment Act 1996.
3 Schedule(s)
Subject to section 2, each Act that is specified in a Schedule to this Act is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Act has effect according to its terms.
Schedule 1—Health insurance business
National Health Act 1953
1 Subsection 67(4) (after paragraph (a) of the definition of health insurance business)
Insert:
(ab) with respect to the happening of an occurrence that ordinarily requires the provision of hospital treatment or relevant health services, whether or not payment of benefits to the insured is dependent upon one or more of the following:
(i) such treatment or services being provided to the insured;
(ii) the insured requiring such treatment or services;
(iii) fees or charges being payable by the insured in relation to the provision of such treatment or services; or
Schedule 2—Agreements and related matters
Part 1—Amendments
National Health Act 1953
1 After section 73ABB
Insert:
73ABC Registered organization to make agreements under Division 4 available to public
(1) Subject to subsection (3), it is a condition of registration of a registered organization that it makes available for scrutiny, by any person who requests it:
(a) copies of hospital purchaser‑provider agreements that the registered organization has entered into; and
(b) copies of practitioner agreements given to the registered organization under subsection 73BDAA(2A); and
(c) copies of medical purchaser‑provider agreements that the registered organization has entered into.
(2) A request may relate to all agreements of one or more kinds, or to one or more specified agreements.
(3) Any copies that the registered organization makes available must have deleted from them:
(a) any information or matter that could identify an individual or a medical practice; and
(b) any information or matter relating to amounts payable:
(i) by the registered organization, or a hospital or day hospital facility, in respect of the rendering of medical treatment by or on behalf of a medical practitioner; or
(ii) by the registered organization in respect of the provision of hospital treatment by a hospital or day hospital facility.
2 At the end of subsection 73BDAA(1)
Add:
; and (d) the practitioner agreement requires the hospital or day hospital facility to maintain the medical practitioner’s professional freedom, within the scope of accepted clinical practice, to identify appropriate treatments in the rendering of professional services to which the agreement applies.
3 After subsection 73BDAA(2)
Insert:
(2A) Subject to subsection (2B), if the hospital purchaser‑provider agreement includes such provisions, it must include a provision requiring the hospital or day hospital facility to give to the registered organization a copy of the practitioner agreement.
(2B) The copy given to the registered organization must have deleted from it any information or matter relating to amounts payable by the hospital or day hospital facility in respect of the rendering of medical treatment by or on behalf of the medical practitioner.
4 At the end of subsection 73BDA(2)
Add:
; and (d) require the organization to maintain the medical practitioner’s professional freedom, within the scope of accepted clinical practice, to identify appropriate treatments in the rendering of professional services to which the agreement applies.
5 Paragraph (ea) of Schedule 1
Omit “The amount”, substitute “Subject to paragraph (eb), the amount”.
6 Paragraph (ea) of Schedule 1
Omit all the words after subparagraph (iv).
7 After paragraph (ea) of Schedule 1
Insert:
(eb) The amount of benefit referred to in paragraph (ea) must not exceed the amount referred to in subparagraph (ea)(iii) or (iv) (whichever is applicable) unless:
(i) the service is rendered by or on behalf of a medical practitioner with whom the organization has a medical purchaser-provider agreement that applies to that service; or
(ii) the service is rendered by or on behalf of a medical practitioner with whom the hospital or day hospital facility in question has a practitioner agreement that applies to the service.
Part 2—Transitional provisions
8 Agreements entered into before commencement need not be disclosed
Section 73ABC of the National Health Act 1953 as inserted by this Act does not apply in relation to hospital purchaser-provider agreements, practitioner agreements and medical purchaser-provider agreements entered into before the commencement of this item.
9 Hospital purchaser-provider agreements entered into before commencement
If:
(a) a hospital purchaser-provider agreement was entered into before the commencement of this item; and
(b) the agreement includes provisions to the effects referred to in subsection 73BDAA(2) of the National Health Act 1953; and
(c) the agreement does not comply with subsection 73BDAA(2A) of the National Health Act 1953 as inserted by this Act;
the fact that the agreement does not so comply does not affect the agreement’s validity or prevent the application, after that commencement, of the National Health Act 1953 (as amended by this Act) in relation to the agreement or to hospital treatment to which the agreement applies.
10 Practitioner agreements entered into before commencement
If:
(a) a practitioner agreement was entered into before the commencement of this item; and
(b) the agreement does not comply with paragraph 73BDAA(1)(d) of the National Health Act 1953 as added by this Act;
the fact that the agreement does not meet those requirements does not affect the agreement’s validity or prevent the application, after that commencement, of section 73BDAA or any other provision of the National Health Act 1953 (as amended by this Act) in relation to the agreement or to a professional service to which the agreement applies.
11 Medical purchaser-provider agreements entered into before commencement
If:
(a) a medical purchaser-provider agreement was entered into before the commencement of this item; and
(b) the agreement does not comply with paragraph 73BDA(2)(d) of the National Health Act 1953 as added by this Act;
the fact that the agreement does not so comply does not affect the agreement’s validity or prevent the application, after that commencement, of the National Health Act 1953 (as amended by this Act) in relation to the agreement or to a professional service to which the agreement applies.
Schedule 3—Health benefits reinsurance arrangements
National Health Act 1953
1 Section 73BB
Repeal the section, substitute:
73BB Determinations by the Council in relation to records of registered health benefits organizations
(1) The Council may determine all or any of the following:
(a) the records that a registered health benefits organization is to maintain to enable the Council to perform its functions in relation to the Health Benefits Reinsurance Trust Fund;
(b) the information drawn from those records that a registered health benefits organization is to give to the Council;
(c) the time within which the information is to be given;
(d) the form in which the information is to be given.
Note: For the Health Benefits Reinsurance Trust Fund see section 73BC.
(2) The determination is to be in writing.
(3) The determination is a disallowable instrument for the purposes of section 46A of the Acts Interpretation Act 1901.
(4) It is a condition of registration of a registered health benefits organization that it must:
(a) comply with determinations under this section that are in force; and
(b) keep the records mentioned in paragraph (1)(a) separate and distinct from any other records it maintains.
2 Subsection 73BC(1)
Repeal the subsection, substitute:
(1) This section provides for:
(a) registered health benefits organizations to make payments into the Health Benefits Reinsurance Trust Fund (established under subsection (2)); and
(b) payments to be made out of the Fund to those organizations for the purpose of reallocating the amounts of benefits paid by the organizations.
The Commonwealth, States and Territories may also make payments into the Fund for this purpose.
3 Subsection 73BC(5A)
Omit “determined pursuant to”, substitute “decided under”.
4 Subsection 73BC(5C)
Repeal the subsection, substitute:
(5C) The principles must include:
(a) principles for determining the method of, and the matters to be taken into account in, calculating the amounts to be paid into the Fund by registered health benefits organizations; and
(b) principles for determining the method of, and the matters to be taken into account in, calculating the amounts to be paid out of the Fund to registered health benefits organizations.
5 Subsection 73BC(12)
Repeal the subsection, substitute:
(12) The Council may decide that an amount is to be paid out of the Fund to a registered health benefits organization.
Schedule 4—The Private Health Insurance Administration Council
Part 1—Amendments commencing on Royal Assent
National Health Act 1953
1 After paragraph 70(1)(a)
Insert:
(ab) a person appointed by the Council; and
2 Subsection 73AB(1)
Omit “and the Council”.
3 Subsection 73AB(4)
Omit “under a hospital purchaser-provider agreement in compliance with a requirement of a kind referred to in paragraph 73BD(2)(c)”.
4 After subsection 73AB(4)
Insert:
(4A) Subsection (4) applies to information given by a hospital or day hospital facility whether or not it was given under a hospital purchaser-provider agreement in compliance with a requirement of a kind referred to in paragraph 73BD(2)(c).
5 Subsection 73AB(5)
Omit “and the Council”.
6 Section 82A (definition of Director)
Repeal the definition.
7 Section 82A
Insert:
Chief Executive Officer means the Chief Executive Officer of the Council referred to in section 82PH.
8 Paragraph 82G(1)(ba)
Omit “registered organizations”, substitute “the Department”.
9 Paragraph 82G(1)(ba)
After “research,”, insert “aggregated data derived from”.
10 At the end of section 82G
Add:
(3) The Secretary must provide the aggregated data referred to in paragraph (1)(ba) to the Council.
11 Paragraphs 82K(1)(a) and 82P(a)
Omit “Director”, substitute “Chief Executive Officer”.
12 Division 7 (heading)
Repeal the heading, substitute:
Division 7—Chief Executive Officer and staff
13 Sections 82PH, 82PJ, 82PK, 82PM and 82PN
Omit “Director” (wherever occurring), substitute “Chief Executive Officer”.
Note: The headings to sections 82PH, 82PJ, 82PM and 82PN are altered by omitting “Director” and substituting “Chief Executive Officer”.
14 Person holding office of Director as at commencement
A person who, immediately before the commencement of this Part, held office as the Director under subsection 82PH(1) of the National Health Act 1953, continues, subject to that Act, to hold office for the remainder of the person’s term of office as if the person had been appointed to the office of Chief Executive Officer of the Council under that subsection as in force after the commencement of this Part.
Part 2—Amendments commencing on 1 July 1998
National Health Act 1953
15 Section 82A (definition of Commissioner)
Omit “section 82C”, substitute “paragraph 82C(1)(a)”.
16 Subsection 82B(2) (note)
Omit “82BA”, substitute “82PAA”.
17 Sections 82BA, 82C, 82CA, 82D and 82E
Repeal the sections, substitute:
82C Constitution of Council
(1) The Council consists of the following members:
(a) a Commissioner of Private Health Insurance Administration;
(b) at least 2, and not more than 4, other members.
(2) The performance of the functions, or the exercise of the powers, of the Council is not affected only because there is a vacancy or vacancies in the membership of the Council.
82D Appointment of members
(1) The members of the Council are to be appointed in writing by the Minister in accordance with the guidelines (if any) made under subsection 82F(1).
(2) The Commissioner is to be appointed on a full-time basis or on a part-time basis.
(3) A member, other than the Commissioner, is to be appointed on a part-time basis.
18 Subsection 82F(2)
Repeal the subsection.
19 At the end of subsection 82N(1)
Add:
; or (c) requested in writing to do so by at least 2 members.
20 Subsection 82N(4)
Repeal the subsection, substitute:
(4) A majority of the members constitutes a quorum.
21 Subsection 82N(6)
Repeal the subsection, substitute:
(6) A question arising at a meeting is decided by a majority of the votes of the members present and voting. The Commissioner has a deliberative vote and, if necessary, also has a casting vote.
22 At the end of Division 4 of Part VIAA
Add:
82PAA Modification of the Commonwealth Authorities and Companies Act 1997
Section 14 of the Commonwealth Authorities and Companies Act 1997 does not apply in relation to the Council.
Schedule 5—The Private Health Insurance Complaints Commissioner
Part 1—Amendments
National Health Act 1953
1 Part VIC (heading)
Repeal the heading, substitute:
Part VIC—Private Health Insurance Ombudsman
2 Subsection 82ZQ(1) (definition of Complaints Commissioner)
Repeal the definition, substitute:
Health Insurance Ombudsman means the Private Health Insurance Ombudsman referred to in section 82ZR.
3 Division 2 of Part VIC (heading)
Repeal the heading, substitute:
Division 2—Private Health Insurance Ombudsman
4 Subsection 82ZR(1)
Omit “Complaints Commissioner”, substitute “Ombudsman”.
Note: The heading to section 82ZR is altered by omitting “Complaints Commissioner” and substituting “Ombudsman”.
5 Subsection 82ZR(1) (note)
Omit “Complaints Commissioner”, substitute “ Health Insurance Ombudsman”.
6 Subsection 82ZR(4)
Omit “Complaints Commissioner”, substitute “Health Insurance Ombudsman”.
7 Section 82ZRAA
Omit “Complaints Commissioner” (wherever occurring), substitute “Health Insurance Ombudsman”.
Note: The heading to section 82ZRAA is altered by omitting “Complaints Commissioner” and substituting “Health Insurance Ombudsman”.
8 Section 82ZRA, paragraph 82ZRB(1)(a), section 82ZRC and subsection 82ZS(1)
Omit “Complaints Commissioner” (wherever occurring), substitute “Health Insurance Ombudsman”.
Note: The heading to section 82ZRC is altered by omitting “Complaints Commissioner” and substituting “Health Insurance Ombudsman”.
9 Paragraph 82ZS(1)(a)
Omit “a contributor to the health benefits fund conducted by a registered organization”, substitute “covered by a private health insurance policy”.
10 At the end of section 82ZS
Add:
(3) In this section:
private health insurance policy means a contract of insurance that was entered into by a registered organization in the course of carrying on a health insurance business within the meaning of section 67.
11 Section 82ZSB
Repeal the section, substitute:
82ZSB Health Insurance Ombudsman may deal with complaints
(1) Subject to subsections (3) and (4) and sections 82ZSBA and 82ZSC, the Health Insurance Ombudsman may deal with a complaint by:
(a) trying at any time to effect a settlement of the complaint by mediating between the complainant and the person or body against whom the complaint was made; or
(b) whether or not mediation has been tried under paragraph (a)—referring the complaint to a registered organization and requesting the organization:
(i) to conduct an investigation in relation to the complaint; and
(ii) to report to the Health Insurance Ombudsman its findings and any action it proposes to take.
(2) Subject to subsections (3) and (4), the Health Insurance Ombudsman may investigate a complaint if:
(a) the complaint is not resolved by mediation under paragraph (1)(a) to the complainant’s satisfaction; or
(b) the Health Insurance Ombudsman is not satisfied with the outcome of a request under paragraph (1)(b).
(3) The Health Insurance Ombudsman must not take any action under subsection (1) or (2) unless the complainant agrees to the action being taken.
(4) The Health Insurance Ombudsman must not take, or continue to take, any action under paragraph (1)(a) or subsection (2) if the complainant withdraws the complaint.
12 Subsection 82ZSBA(1)
Omit “Complaints Commissioner’s”, substitute “Health Insurance Ombudsman’s”.
Note: The heading to section 82ZSBA is altered by omitting “Complaints Commissioner” and substituting “Health Insurance Ombudsman”.
13 Subsection 82ZSBA(1)
Omit “Complaints Commissioner must, subject to subsection (2)”, substitute “Health Insurance Ombudsman must, subject to subsections (2) and (2A)”.
14 Subsection 82ZSBA(2)
Omit “Complaints Commissioner”, substitute “Health Insurance Ombudsman”.
15 After subsection 82ZSBA(2)
Insert:
(2A) The Health Insurance Ombudsman must not refer the matter to the Australian Competition and Consumer Commission if the complainant withdraws the complaint.
16 Subsection 82ZSBA(3)
Omit “Complaints Commissioner”, substitute “Health Insurance Ombudsman”.
17 Paragraph 82ZSBA(3)(b)
Omit “Complaints Commissioner’s”, substitute “Health Insurance Ombudsman’s”.
18 Subsections 82ZSBA(4) and (5)
Omit “Complaints Commissioner” (wherever occurring), substitute “Health Insurance Ombudsman”.
19 Subsection 82ZSC(1)
Omit “Complaints Commissioner’s”, substitute “Health Insurance Ombudsman’s”.
Note: The heading to section 82ZSC is altered by omitting “Complaints Commissioner” and substituting “Health Insurance Ombudsman”.
20 Subsection 82ZSC(1)
Omit “Complaints Commissioner must, subject to subsection (2)”, substitute “Health Insurance Ombudsman must, subject to this section”.
21 Subsection 82ZSC(2)
Omit “Complaints Commissioner”, substitute “Health Insurance Ombudsman”.
22 At the end of section 82ZSC
Add:
(3) The Health Insurance Ombudsman must not refer the matter to the other body if the complainant withdraws the complaint.
23 Section 82ZSD
Omit “Complaints Commissioner”, substitute “Health Insurance Ombudsman”.
Note: The heading to section 82ZSD is altered by omitting “Complaints Commissioner” and substituting “Health Insurance Ombudsman”.
24 At the end of section 82ZSD
Add:
; or (c) recommend that a hospital, day hospital facility or medical practitioner take a specific course of action in relation to the complaint.
25 Subsection 82ZSE(1)
Omit “Complaints Commissioner” (first occurring), substitute “Health Insurance Ombudsman”.
Note: The heading to section 82ZSE is altered by omitting “Complaints Commissioner” and substituting “Health Insurance Ombudsman”.
26 Paragraph 82ZSE(1)(a)
Omit “Complaints Commissioner”, substitute “Health Insurance Ombudsman”.
27 Paragraph 82ZSE(1)(b)
Repeal the paragraph, substitute:
(b) any recommendation to a registered organization made by the Health Insurance Ombudsman under paragraph 82ZSD(a) or (b); or
(c) any recommendation to a hospital, day hospital facility or medical practitioner made by the Health Insurance Ombudsman under paragraph 82ZSD(c).
28 Subsection 82ZSE(2)
Repeal the subsection, substitute:
(2) The Health Insurance Ombudsman must inform the complainant in writing of:
(a) any action taken by a registered organization as a result of an action referred to in paragraph (1)(a); and
(b) any action taken by a registered organization as a result of a recommendation referred to in paragraph (1)(b); and
(c) any action taken by a hospital, day hospital facility or medical practitioner as a result of a recommendation referred to in paragraph (1)(c).
29 Section 82ZSF
Repeal the section.
30 Subsection 82ZSG(1)
Omit “Complaints Commissioner”, substitute “Health Insurance Ombudsman”.
Note: The heading to section 82ZSG is altered by omitting “Complaints Commissioner” and substituting “Health Insurance Ombudsman”.
31 After paragraph 82ZSG(1)(a)
Insert:
(aa) the Health Insurance Ombudsman has dealt, or is dealing, adequately with the complaint; or
(ab) the complainant is capable of assisting the Health Insurance Ombudsman with the investigation into the complaint but does not do so when requested by the Health Insurance Ombudsman; or
(ac) the complainant has exercised, or exercises, a right to have the matter to which the complaint relates reviewed by a court or by a tribunal constituted by or under:
(i) a law of the Commonwealth; or
(ii) a law of a State or Territory; or
(ad) the complainant does not have a sufficient interest in the subject matter of the complaint; or
32 After subsection 82ZSG(1)
Insert:
(1A) The Health Insurance Ombudsman may decide not to investigate, or not to continue to investigate, a complaint if he or she believes that:
(a) the complainant has, or had, a right to have the matter to which the complaint relates reviewed by a court or by a tribunal constituted by or under:
(i) a law of the Commonwealth; or
(ii) a law of a State or Territory;
but has not exercised that right; and
(b) it is reasonable for the complainant to exercise, or it would have been reasonable for the complainant to have exercised, that right.
33 Subsections 82ZSG(2), (3) and (4)
Omit “Complaints Commissioner”, substitute “Health Insurance Ombudsman”.
34 Subsection 82ZSG(5)
Repeal the subsection, substitute:
(5) If the Health Insurance Ombudsman decides not to investigate, or not to continue to investigate, a complaint, he or she must:
(a) tell the complainant of the decision and the reasons for the decision; and
(b) if requested by the complainant—give the complainant written notice of the decision and the reasons for the decision.
35 At the end of Division 3 of Part VIC
Add:
82ZSH Minister may direct Health Insurance Ombudsman to investigate, or to continue to investigate, a complaint
(1) If:
(a) a person makes a complaint; and
(b) the Health Insurance Ombudsman decides not to investigate, or not to continue to investigate, the complaint;
the person may apply, in writing, to the Minister for a direction by the Minister to the Health Insurance Ombudsman to investigate, or to continue to investigate, the complaint.
(2) If the Minister so directs, the Health Insurance Ombudsman must:
(a) investigate, or continue to investigate, the complaint; and
(b) report to the Minister on the findings of his or her investigation.
36 Division 4 of Part VIC (heading)
Repeal the heading, substitute:
Division 4—Health Insurance Ombudsman may conduct investigations
37 Sections 82ZT, 82ZTA, 82ZTB, 82ZTBB and 82ZTC and subsection 82ZTD(1)
Omit “Complaints Commissioner” (wherever occurring), substitute “Health Insurance Ombudsman”.
Note: The headings to sections 82ZT, 82ZTA, 82ZTB, 82ZTBB and 82ZTC are altered by omitting “Complaints Commissioner” and substituting “Health Insurance Ombudsman”.
38 Division 5 of Part VIC (heading)
Repeal the heading, substitute:
Division 5—Provisions relating to the Health Insurance Ombudsman
39 Section 82ZU, subsections 82ZUA(1) and 82ZUB(1) and sections 82ZUBA and 82ZUC
Omit “Complaints Commissioner” (wherever occurring), substitute “Health Insurance Ombudsman”.
Note: The heading to section 82ZUBA is altered by omitting “Complaints Commissioner” and substituting “Health Insurance Ombudsman”.
40 Subsection 82ZUC(2)
Omit “Complaints Commissioner’s”, substitute “Health Insurance Ombudsman’s”.
41 Sections 82ZUD and 82ZUE
Omit “Complaints Commissioner”, substitute “Health Insurance Ombudsman”.
42 Subsections 82ZUF(1) and (2)
Omit “Complaints Commissioner’s”, substitute “Health Insurance Ombudsman’s”.
43 Subsection 82ZUF(2) and section 82ZUG
Omit “Complaints Commissioner” (wherever occurring), substitute “Health Insurance Ombudsman”.
44 Subsection 82ZV(1)
Omit “Complaints Commissioner”, substitute “Health Insurance Ombudsman”.
45 Section 82ZVA
Omit “Complaints Commissioner” (wherever occurring), substitute “Health Insurance Ombudsman”.
46 At the end of Division 6 of Part VIC
Add:
82ZVD Delegation
(1) Subject to subsection (2), the Health Insurance Ombudsman may, by writing under the seal of the Health Insurance Ombudsman, delegate to a member of staff referred to in section 82ZUG all or any of the Health Insurance Ombudsman’s powers and functions.
(2) The Health Insurance Ombudsman must not delegate any of his or her powers and functions under the Commonwealth Authorities and Companies Act 1997.
82ZVE Health Insurance Ombudsman, and staff, not personally liable
(1) Subject to subsection (2) and section 135A, neither the Health Insurance Ombudsman nor a member of staff referred to in section 82ZUG is personally liable to an action or other proceeding for damages in relation to anything done or omitted to be done in good faith:
(a) in the performance or purported performance of any function of the Health Insurance Ombudsman; or
(b) in the exercise or purported exercise of any power of the Health Insurance Ombudsman.
(2) Subsection (1) does not apply to anything done or omitted to be done before the commencement of this section.
Part 2—Transitional provisions
47 Private Health Insurance Complaints Commissioner as at commencement
A person who, immediately before the commencement of this Part, held office under subsection 82ZRA(1) of the National Health Act 1953, continues to hold office, subject to that Act, for the remainder of the person’s term of office as if the person had been appointed to the office of Private Health Insurance Ombudsman under that subsection as in force after the commencement of this Part.
48 Continuation of conciliation after commencement
Section 82ZSF of the National Health Act 1953 as in force immediately before the commencement of this Part continues to apply in relation to a request made by a complainant under that section before that commencement as if that section had not been repealed.
49 Application of new subsection 82ZSG(5)
Subsection 82ZSG(5) of the National Health Act 1953 as substituted by this Act applies only to complaints made after the commencement of this Part.
Schedule 6—Waiting periods
Part 1—Amendments
National Health Act 1953
1 Subparagraph (bc)(i) of Schedule 1
Omit “or illness”, substitute “, illness or condition”.
2 Subparagraph (bc)(ii) of Schedule 1
Omit “9 months”, substitute “12 months”.
3 Subparagraph (j)(i) of Schedule 1
Omit “9 months”, substitute “12 months”.
4 Paragraph (kc) of Schedule 1
Omit “or illness”, substitute “, illness or condition”.
5 Paragraph (kd) of Schedule 1
Omit “or illness” (wherever occurring), substitute “, illness or condition”.
6 Subparagraph (la)(iii) of Schedule 1
Repeal the subparagraph, substitute:
(iii) the comparable benefits arrangement included a benefit (the broadly comparable benefit) that was broadly comparable to the relevant benefit;
7 After paragraph (laa) of Schedule 1
Insert:
(lab) In working out whether a benefit (the original benefit) is broadly comparable to the relevant benefit for the purposes of subparagraph (la)(iii), disregard whether the following facts apply:
(i) the relevant benefit is included in an applicable benefits arrangement under which the organization has, or had, a hospital purchaser-provider agreement with a particular hospital or day hospital facility;
(ii) the original benefit is included in an applicable benefits arrangement under which the other organization does not have a hospital purchaser-provider agreement with that hospital or day hospital facility.
8 Subparagraphs (lb)(i), (ii) and (iii) of Schedule 1
Omit “comparable benefit” (wherever occurring), substitute “broadly comparable benefit”.
9 After paragraph (lb) of Schedule 1
Insert:
(lba) In working out whether a relevant benefit is greater than a broadly comparable benefit for the purposes of subparagraph (lb)(iii), and the extent to which the relevant benefit does not exceed the broadly comparable benefit, disregard whether the following facts apply:
(i) the relevant benefit is included in an applicable benefits arrangement under which the organization has, or had, a hospital purchaser-provider agreement with a particular hospital or day hospital facility;
(ii) the broadly comparable benefit is included in an applicable benefits arrangement under which the other organization does not have a hospital purchaser‑provider agreement with that hospital or day hospital facility.
10 Paragraph (lc) of Schedule 1
Omit “comparable benefit”, substitute “broadly comparable benefit”.
11 Sub-subparagraph (ld)(i)(B) of Schedule 1
Omit “comparable benefit”, substitute “broadly comparable benefit”.
12 Subparagraph (le)(iii) of Schedule 1
Omit “comparable benefit”, substitute “broadly comparable benefit”.
Part 2—Transitional provision
13 Waiting periods applying as at commencement to be preserved
After the commencement of this item, the amendments made to the National Health Act 1953 by items 1 to 5 of this Schedule do not apply, and paragraphs (bc), (j), (kc) and (kd) of Schedule 1 to that Act as in force immediately before that commencement continue to apply, in relation to a contributor’s membership of a health benefits fund if:
(a) immediately before the commencement of this item, the contributor was a member of that fund or any other health benefits fund; and
(b) at all times since that commencement, the contributor has been a member of that fund or any other health benefits fund; and
(c) at all times since that commencement, any waiting periods to which the contributor’s membership has been subject have been affected by the contributor’s membership, before that commencement, of that fund or any other health benefits fund.
Schedule 7—Approved billing agents
Health Insurance Act 1973
1 Subsection 3(1)
Insert:
approved billing agent means a person or body in respect of whom an approval under section 20AB is in force.
2 After subsection 20A(2B)
Insert:
(2C) Subject to subsection (2D), if:
(a) a medicare benefit would, apart from this section, be payable to an eligible person in respect of a professional service rendered to a patient while hospital treatment is provided to the patient in a hospital or a day hospital facility; and
(b) the eligible person requests that the medicare benefit payable in respect of the professional service be paid to the approved billing agent specified in the request; and
(c) any requirements specified in the regulations in relation to such a request have been met; and
(d) the medical practitioner by whom or on whose behalf the professional service was rendered assigns to the approved billing agent his or her right to all amounts that the eligible person would, apart from the assignment, owe to the medical practitioner in relation to the professional service; and
(e) any requirements specified in the regulations in relation to such an assignment have been met;
the eligible person is taken, for the purposes of this Act, to have assigned his or her right to the payment of the medicare benefit to the approved billing agent.
(2D) Subsection (2C) does not apply in relation to a medicare benefit in relation to which subsection (2A) applies.
3 After section 20A
Insert:
20AB Approved billing agents
(1) The Council may, in writing, approve as a billing agent a person who, or body that, has applied for approval.
(2) The application must:
(a) meet any requirements specified in the regulations; and
(b) be accompanied by the fee (if any) specified in the regulations.
Any fee specified in the regulations must be reasonably related to the expenses incurred or to be incurred by the Commonwealth in relation to the application and must not be such as to amount to taxation.
(3) In considering whether to approve a person or body, the Council must comply with any guidelines made in writing by the Minister.
(4) The Council must give to the applicant written notice of the decision whether to approve a person or body.
Note: Section 27A of the Administrative Appeals Tribunal Act 1975 requires the person to be notified of the person’s review rights.
(5) An approval is subject to such conditions as are determined in writing by the Minister from time to time.
(6) Guidelines made under subsection (3) and conditions determined under subsection (5) are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901.
20AC Revoking approvals of billing agents
(1) The Council may revoke the approval of an approved billing agent if the Council is satisfied that:
(a) if the Council were considering whether to approve the billing agent under section 20AB, the guidelines under subsection 20AB(3) would prevent the approval; or
(b) the billing agent has contravened the conditions to which the approval is subject under subsection 20AB(5).
(2) Before deciding to revoke the approval, the Council must notify the billing agent that revocation is being considered. The notice must be in writing and must:
(a) include the Council’s reasons for considering the revocation; and
(b) invite the billing agent to make written submissions to the Council within the period of 28 days (the submission period) after being given the notice.
(3) In deciding whether to revoke the approval, the Council must consider any submissions made to the Council within the submission period.
(4) The Council must give to the billing agent written notice of the decision.
Note: Section 27A of the Administrative Appeals Tribunal Act 1975 requires the person to be notified of the person’s review rights.
(5) If the Council does not give to the billing agent written notice of the decision within the period of 60 days after the end of the submission period, the Council is taken to have decided not to revoke the approval.
20AD Review of decisions
(1) If the Council:
(a) decides not to approve a person or body as a billing agent under section 20AB; or
(b) revokes the approval of a person or body as a billing agent under section 20AC;
the person or body may apply to the Council for reconsideration by the Council of the decision.
(2) On receiving an application under subsection (1) relating to a decision not to approve a person or body as a billing agent under section 20AB, the Council must reconsider the decision and:
(a) affirm the decision; or
(b) approve the person or body as a billing agent.
An approval under paragraph (b) is taken, for the purposes of this Act, to be an approval under section 20AB.
(3) On receiving an application under subsection (1) relating to a revocation of the approval of a person or body under section 20AC, the Council must reconsider the decision and:
(a) affirm the revocation; or
(b) reinstate the approval of the person or body.
A reinstatement under paragraph (b) has effect as if the approval had never been revoked.
(4) The Council must give to the applicant written notice of the Council’s decision on the revocation.
Note: Section 27A of the Administrative Appeals Tribunal Act 1975 requires the person to be notified of the person’s review rights.
(5) Application may be made to the Administrative Appeals Tribunal for review of a decision of the Council under paragraph (2)(a) or (3)(a).
(6) In this section:
decision has the same meaning as in the Administrative Appeals Tribunal Act 1975.
Schedule 8—Medical insurance for visitors to Australia
Health Insurance Act 1973
1 Subsection 126(6)
Repeal the subsection, substitute:
(6) This section does not apply in relation to a contract of insurance in so far as it contains a provision making a person liable to make a payment if an eligible visitor incurs a liability of a kind referred to in subsection (1).
(7) In this section:
eligible visitor means a person who is to be treated as an eligible person for the purposes of this Act during his or her stay in Australia solely because he or she is a person to whom an agreement under subsection 7(1) relates.
insurance means insurance within the meaning of paragraph 51(xiv) of the Constitution.
Schedule 9—Miscellaneous
National Health Act 1953
1 Subsection 68(2)
Omit “(not being a restricted membership organization)”.
2 Paragraph 68(2)(b)
Omit “and”.
3 Paragraph 68(2)(c)
Repeal the paragraph.
4 Subsections 68(2A), (2B), (2C) and (4)
Repeal the subsections.
5 Section 73BDD
Repeal the section.
6 Paragraph 78(1A)(a)
Repeal the paragraph, substitute:
(a) if the change relates to rates of contribution by contributors and paragraph (ab) does not apply—no later than 14 days, or such other period (if any) declared in writing by the Minister, before the change is to come into effect; or
(ab) if:
(i) the change relates to rates of contribution by contributors; and
(ii) the organization applies to the Minister to reduce the period referred to in paragraph (a) in relation to a particular notification; and
(iii) before the change is to come into effect the Minister determines a lesser period;
no later than that lesser period before the change is to come into effect; or
7 After subsection 78(2)
Insert:
(2A) A declaration under paragraph (1A)(a) is a disallowable instrument for the purposes of section 46A of the Acts Interpretation Act 1901.
8 Subsections 78(3) and (4)
Omit “be taken to have”.
9 Section 82ZTBA
Repeal the section.
10 Subsection 105AB(1)
Repeal the subsection.
11 Division 5 of Part VIII
Repeal the Division.
Schedule 10—Minor technical amendments
Health Insurance Act 1973
1 Subsection 3(1) (definition of standard hospital fees)
Repeal the definition.
2 Subsection 3(14)
Repeal the subsection.
3 Subsection 10A (paragraph (c) of the definition of year)
Omit “1 January; or”, substitute “1 January.”
National Health Act 1953
4 Subsection 45E(5)
Omit “and (4A),”, substitute “and (4A).”
5 At the end of paragraph 46A(a)
Add “and”.
6 Division 5 of Part VI
Repeal the heading.
7 Before section 73BE
Insert:
Division 5—Directions by the Minister
8 Subsection 78(5)
Omit “paragraph (4)(c)”, substitute “subsection (4)”.
9 Subsection 84C(1AA)
Omit “is is”, substitute “is”.
10 Paragraphs 87(3A)(e) and (3B)(e)
Omit “;; or”, substitute “; or”.
11 Paragraph (e) of Schedule 1
Omit “nursing home”, substitute “nursing‑home”.
[Minister's second reading speech made in—
House of Representatives on 27 November 1997
Senate on 9 March 1998]