Statutory Rules 1987 No. 1651

Health Insurance Commission Regulations2

(Amendment)

I, THE GOVERNOR-GENERAL of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulations under the Health Insurance Commission Act 1973.

Dated 29 July 1987.

N. M. STEPHEN

Governor-General

By His Excellency’s Command,

Neal Blewett

Minister of State for Community Services and Health

Commencement

1. These Regulations shall come into operation on 1 August 1987.

Principal Regulations

2. In these Regulations, “Principal Regulations” means the Health Insurance Commission Regulations.

Interpretation

3. Regulation 2a of the Principal Regulations is amended by inserting before the definition of “officer” the following definition:

“ ‘Health Insurance Act’ means the Health Insurance Act 1973;”.

Additional functions of the Commission: investigations relating to excessive services

4. Regulation 3 of the Principal Regulation is amended:

(a) by omitting from subregulation (1) the definitions of “Health Insurance Act” and “initiation of a pathology service”;

(S.R. 194/87)—Cat. No. 15/21.7.1987

(b) by omitting subparagraphs (2) (a) (i) and (ii) and substituting the following subparagraphs:

“(i) to prevent the rendering of excessive services by a practitioner or an optometrist;

(ii) to facilitate the detection of cases where excessive services have been so rendered and the identification of those services;”;

(d) by omitting from subparagraph (2) (c) (ii) “, 19d (7)” and substituting “or 19d (7), section 23dp or subsection”.

5. After regulation 3 of the Principal Regulations the following regulation is inserted:

Additional functions of the Commission: pathology services

“3a. (1) In this regulation, unless the contrary intention appears:

‘approved pathology authority’ has the same meaning as in the Health Insurance Act;

‘approved pathology practitioner’ has the same meaning as in the Health Insurance Act;

‘excessive pathology service’ has the same meaning as in the Health Insurance Act;

‘initiate’, in relation to a pathology service, has the same meaning as in the Health Insurance Act;

‘Medicare Participation Review Committee’ has the same meaning as in Part Vb of the Health Insurance Act;

‘practitioner’ has the same meaning as in Part Vb of the Health Insurance Act.

“(2) For the purposes of subsection 8e (1) of the Act, the following functions are prescribed:

(a) to devise and implement measures intended:

(i) to prevent the initiation of excessive pathology services by a practitioner;

(ii) to facilitate the detection of cases where excessive pathology services have been initiated and the identification of those services; and

(iii) to prevent, or facilitate the detection of, activities related to claims for payment, or the receipt, of Medicare benefits that may constitute an offence under the Health Insurance Act or the Crimes Act 1914;

(b) to investigate cases where there are reasonable grounds to suspect that a practitioner may have initiated excessive pathology services and, where an investigation discloses that there is sufficient evidence to warrant a referral of the case investigated to the Medicare

Participation Review Committee, to refer the case and the information obtained in the course of the investigation, with appropriate comments and recommendations, to the Minister;

(d) to repay fees pursuant to section 23dj of the Health Insurance Act;

(e) in order to enable the Minister to perform his or her functions under sections 23dc and 23df of the Health Insurance Act:

(i) to process, on behalf of the Minister, applications for the Minister’s acceptance of undertakings given by persons who wish to become approved pathology practitioners or approved pathology authorities, respectively; and

(ii) to undertake, on behalf of the Minister, any investigations and inquiries that are necessary or expedient in relation to applications for acceptance of undertakings and refer to the Minister:

(a) any information obtained in the course of the investigations or inquiries, being information relevant to the acceptance or otherwise of an undertaking; and

(b) any comments and recommendations arising from the investigations and inquiries that the Commission considers appropriate;

(f) in order to enable the Minister to perform his or her functions under sections 23dl, 23dm, 23do and 23dp of the Health Insurance Act, to undertake, on behalf of the Minister, any investigations and inquiries that are necessary or expedient in relation to:

(i) the compliance with, or the breach of, an undertaking given by a person who is or was an approved pathology practitioner or an approved pathology authority;

(ii) the detection of the initiation of excessive pathology services;

(iii) the review of a decision of the Minister to refuse to accept an undertaking given under subsection 23dc (1) or 23df (1) of the Health Insurance Act; and

(iv) the detection of offences in relation to requests of the kind referred to in section 16a of the Health Insurance Act;

and to refer to the Minister:

(v) any information obtained in the course of the investigations or inquiries, being information relevant to the matters in relation to which the investigations or inquiries were undertaken; and

(vi) any comments and recommendations arising from the investigations or inquiries that the Commission considers appropriate;

(g) in order to enable a Medicare Participation Review Committee to perform its functions under Part Vb of the Health Insurance Act:

(i) to undertake on behalf of the Committee any investigations and inquiries that are necessary or expedient in relation to a matter in respect of which the Committee was established;

(ii) to refer to the Committee any information obtained in the course of the investigations or inquiries, being information relevant to the matter in respect of which the Committee was established; and

(iii) to refer to the Committee any comments and recommendations arising from the investigation or inquiries that the Commission considers appropriate; and

(h) to provide such clerical and administrative services in relation to a matter specified in paragraph (e), (f) or (g) as the Minister or Committee, as the case may be, may require.”.

NOTES

1. Notified in the Commonwealth of Australia Gazette on 31 July 1987.

2. Statutory Rules 1975 No. 27 as amended by 1976 Nos. 21 and 146; 1982 No. 249; 1983 Nos. 88 and 152; 1984 No. 321; 1985 Nos. 41 and 70; 1986 No. 127; Act No. 54, 1983.

Printed by Authority by the Commonwealth Government Printer