National Health (Circumstances for Payment of Supplier of Pharmaceutical Benefits) Amendment Determination 2002 (No. 1)

I, JENNIFER MARETTE BADHAM, Acting Assistant Secretary, Better Medication Management System Implementation Taskforce (BMMS Implementation Taskforce), Department of Health and Ageing, delegate of the Minister for Health and Ageing, make this Determination under subsection 99 (8) of the National Health Act 1953.

Dated 25 June 2002

JM BADHAM

1 Name of Determination

  This Determination is the National Health (Circumstances for Payment of Supplier of Pharmaceutical Benefits) Amendment Determination 2002 (No. 1).

2 Commencement

  This Determination commences on 1 July 2002.

3 Amendment of National Health (Circumstances for Payment of Supplier of Pharmaceutical Benefits) Determination 2002

  Schedule 1 amends the National Health (Circumstances for Payment of Supplier of Pharmaceutical Benefits) Determination 2002.

Schedule 1 Amendments

(section 3)

Do not delete: Schedule Part Placeholder

[1] Paragraph 5 (1) (c)

omit

Commission either:

insert

Commission:

[2] Subparagraph 5 (1) (c) (i)

omit

cannot pass the validity test; or

insert

passes the validity test; and

[3] Subparagraph 5 (1) (c) (ii)

omit

if the medicare number passes the validity test,

[4] Paragraph 7 (c)

substitute

 (c) in processing the claim, the Health Insurance Commission finds that:

 (i) the medicare number passes the validity test; and

 (ii) the approved supplier has made a previous claim including the number as a medicare number applicable to the person; and

 (iii) in processing the previous claim, the Health Insurance Commission found that:

 (A) the medicare card on which the medicare number appears had been cancelled by the Health Insurance Commission and a new medicare card had not been issued in relation to that medicare number; or

 (B) the expiry date for the medicare number had passed and a new medicare card had not been issued in relation to that medicare number; or

 (C) the name of the person did not correspond with the name of the person held in the records of the Health Insurance Commission as being the person to whom the medicare number applies; or

 (D) the medicare number was no longer applicable to the person but the medicare card on which the medicare number appears, or would appear if it were applicable, was valid for another person listed on that medicare card; and