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Health Legislation Amendment Act 1983

No. 54 of 1983

TABLE OF PROVISIONS

PART I—PRELIMINARY

Section

1. Short title

2. Commencement

PART II—AMENDMENTS OF THE HEALTH INSURANCE ACT 1973

3. Principal Act

4. Interpretation

5. Repeal of sections 3a and 3b and substitution of new section-

3b. Certification of in-patient as needing acute care

6. Minister may vary Part 7 of table

7. Disadvantaged persons, being immigrants or refugees

8. Insertion of new section after section 5j

6. Certain persons in Australia to be treated as eligible persons, &c.

9. Heading to Part II

10. Interpretation

11. Medicare benefits calculated by reference to fees

12. Repeal of section 10 and substitution of new section—

10. Entitlement to medicare benefit

13. Increased fee in complex cases

14. Appeal from decision on increased fee

15. Medicare benefit not to exceed medical expenses incurred

16. Medicare benefit in respect of 2 or more operations

17. Forms of undertaking for approved pathology practitioners


TABLE OF PROVISIONS—continued

Section

18. Medicare benefit not payable in respect of certain medical expenses

19. Medicare benefit not payable where compensation, &c., payable

20. Medicare benefit not payable in respect of certain professional services

21. Regulations may provide that medicare benefit be not payable in respect of prescribed class of professional services

22. Medicare benefit not payable in respect of professional services rendered by or on behalf of disqualified practitioners

23. Particulars of disqualifications under section 19b to be published, & c.

24. Persons entitled to medicare benefits

25. Repeal of section 20a and substitution of new section—

20a. Assignment of medicare benefit

26. Claims for medicare benefit

27. Repeal of sections 20c to 20f (inclusive)

28. Medical services outside Australia

29. Undertakings with respect to pensioners

30. Common form of undertaking

31. Repeal of section 23e and substitition of new sections—

23e. Interpretation

23f. Agreement with States for provision of hospital and other health services

23g. Payments in respect of recognized hospitals in the Australian Capital Territory

23h. Minister may formulate principles for certain purposes

32. Repeal of section 24 and substitution of new sections—

23j. Approval in principle of private hospital

24. Approval of premises as a private hospital

33. Repeal of section 25 and substitution of new section—

25. Issue of certificates relating to approval and categorization

34. Display of certificates relating to approval and categorization

35. Repeal of section 27 and substitution of new section—

27. Inspection of, and of records of, private hospitals

36. Notice to person ceasing to be proprietor of hospital

37. Repeal of section 29 and substitution of new sections—

29. Revocation of approval of premises as hospital

29a. Variation of categorization of particular private hospitals

29b. Variation of conditions to which an approval is subject

38. Agreements with States and Northern Territory for provision of hospital services

39. Insertion of new section after section 30—

31. Categorization of private hospitals

40. Repeal of section 33 and substitution of new section—

33. Daily bed payments

41. Claims to proprietors of private hospitals

42. Certain daily bed payments not payable where compensation, & c, is payable to patient

43. Repeal of section 36 and substitution of new section—

36. Power to obtain information

44. Access to premises

45. Insertion of new sections after section 37—

38. Review of decisions

38a. Statements to accompany notification of decision

46. Recognition of consultant physician, &c.

47. Heading to Division 2 of Part V

48. Interpretation

49. Medicare Benefits Advisory Committee

50. Functions of Committee

51. Interpretation

52. Recommendation by Committee

53. Determination by Minister

54. Interpretation

55. Recommendation by Committee

56. Determination by Minister

57. Insertion of new sections before section 128—

126. Prohibition of certain medical insurance

127. Assignor of medicare benefit to be given copy of assignment, &c.

TABLE OF PROVISIONS—continued

Section

58. Bribery, &c.

59. Officers to observe secrecy

60. Repeal of section 130c and 130d

61. Delegation

62. Regulations

63. Consequential amendments

64. Insertion of new Schedule 2

PART III—AMENDMENTS OF THE HEALTH INSURANCE COMMISSION ACT 1973

65. Principal Act

66. Interpretation

67. Insertion of new section after section 4—

5. Medicare functions of Commission

68. Medibank private functions

69. Application of National Health Act and Health Insurance Act

70. Additional functions relating to health matters

71. Prescribed functions

72. Delegation

73. Insertion of new section after section 8h

8j. Directions by Minister

74. Constitution of Commission

75. Repeal of section 15 and substitution of new section—

15. Disclosure of interests

76. Termination of appointment of part-time Commissioner

77. Termination of appointment of General Manager

78. Moneys to be paid to the Commission for purposes of Part II or 11b

79. Insertion of new section after section 33—

34. Estimates

80. Financial policy concerning medibank private functions

81. Insertion of new sections after section 34a

34b. Apportionment of assets of Commission

34c. Apportionment of expenditure of Commission

82. Repeal of section 35 and substitution of new section—

35. Bank accounts

83. Borrowing and investment by Commission

84. Advances by the Commonwealth

85. Insertion of new sections before section 42—

41a. Delegation of powers by Minister

41b. Modification of provisions to accommodate additional functions

41c. Protection of the medicare name and symbol

41d Forfeiture of articles, &c.

41e. Sections 41c and 41d not to limit other laws

86. Annual report of Commission

87. Certain functions performed before Royal Assent

PART IV—AMENDMENTS OF THE NATIONAL HEALTH ACT 1953

88. Principal Act

89. Interpretation

90. Waiting period

91. Interpretation

92. Travel allowance

93. Heading to Part VI

94. Interpretation

95. Application by organizations for registration as hospital benefits organizations

96. Applications by organizations for registration as health benefits organizations

97. Insertion of new section after section 68—

68a. Special procedures for dealing with certain applications under section 68

98. Registration

TABLE OF PROVISIONS—continued

Section

99. Insertion of new section 73aa

73aa. Effect of a grant of registration under sub-section 73 (2).

100. Conditions of registration

101. Insertion of new sections after section 73ba

73baa. Registered organization not to carry on other business, & c.

73bab. Minimum reserves

73bac. Exemption from section 73baa or 73bab

102. Reinsurance Account in health benefits funds

103. Health Benefits Reinsurance Trust Fund

104. Remuneration and allowances of Trustees of Health Benefits Reinsurance Fund

105. Directions by Minister to registered organizations

106. Minister may give directions to registered organizations concerning management practices

107. Directions subject to Parliamentary disallowance

108. Refusal to admit person as contributor on ground of health

109. Refusal of contributions of patients in institution

110. Directions to reinstate person as contributor to registered organization

111. Minister may require information to be furnished

112. Directions by Minister

113. Exemption of professional services and associated hospital treatment from basic table

114. Determination of certain hospital benefits by Permanent Head

115. Conduct of health benefits funds

116. Registered organization to keep records and furnish information

117. Examination of records, books and accounts of registered organizations

118. Annual report by Permanent Head

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

120. Cancellation of registration of organization

121. Offences

122. Interpretation

123. Investigation of organization by inspector

124. Report of inspector

125. Application for judicial management or winding up of a fund

126. Insertion of new section after section 82zg

82zga. Certain funds conducted by registered organizations to be wound up

127. Order of Court to be binding on all persons, & c.

128. Insertion of new part after Part VIa

PART VIb—MERGER OF HEALTH BENEFITS FUNDS

82zn. Interpretation

82zp. Merger of funds

129. Applications for review by Tribunal

130. Evidence

131. Schedule

PART V—AMENDMENTS OF OTHER ACTS

132. Amendments of other Acts

PART VI—TRANSITIONAL

133. Interpretation

134. Continued operation of Health Insurance Act and National Health Act

135. Acts Interpretation Act not affected

136. Regulations


TABLE OF PROVISIONS—continued

SCHEDULE 1

Consequential amendments of the Health Insurance Act 1973

SCHEDULE 2

Schedule to be added at the end of the Health Insurance Act 1973

SCHEDULE 3

Schedule to be substituted for the Schedule to the National Health Act 1953

SCHEDULE 4

Consequential amendments of other Acts


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Health Legislation Amendment Act 1983

No. 54 of 1983

 

An Act to amend the Health Insurance Act 1973, the Health Insurance Commission Act 1973 and the National Health Act 1953, and certain other Acts and for related purposes

[Assented to 1 October 1983]

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

PART I—PRELIMINARY

Short title

1. This Act may be cited as the Health Legislation Amendment Act 1983.

Commencement

2. (1) Sections 1, 2 and 3, sub-sections 4 (1), 31 (1) and 32 (4), (5), (6), (7) and (8), sections 39, 45, 64, 65, 66, 67, 70 to 82 (inclusive), sub-section 83 (1), sections 85, 86, 87 and 88, sub-section 89 (2), sections 95 to 99 (inclusive), sub-sections 115 (1), 119 (1) and 120 (1) and sections 123, 124, 126, 128 and 129 shall come into operation on the day on which this Act receives the Royal Assent.

(2) The remaining provisions of this Act shall come into operation on 1 February 1984.

(3) The amendment made by sub-section 115 (1) shall be deemed to have taken effect on 8 November 1982.

PART II—AMENDMENTS OF THE HEALTH INSURANCE ACT 1973

Principal Act

3. The Health Insurance Act 19731 is in this Part referred to as the Principal Act.

Interpretation

4. (1) Section 3 of the Principal Act is amended by omitting from sub-section (1) the definition of proprietor and substituting the following definition:

“‘proprietor, in relation to premises, means the person, authority or body of persons having effective control of the premises, whether or not he or it is the holder of an estate or interest in the premises;.

(2) Section 3 of the Principal Act is amended—

(a) by omitting from the definition of agreement in sub-section (1) section 30 and substituting section 23f;

(b) by omitting paragraph (a) of the definition of approved pathology practitioner in sub-section (1);

(c) by omitting from sub-section (1) the definitions of Australian resident and Commonwealth medical benefit and substituting the following definitions:

“‘Australian resident means a person who is ordinarily resident in Australia and includes a person domiciled in Australia but does not include a person who is—

(a) the head of a diplomatic mission, or the head of a consular post, established in Australia;

(b) a member of the staff of a diplomatic mission, or a member of the consular staff of a consular post, established in Australia; or

(c) a member of the family of a person referred to in paragraph (a) or (b), being a member who forms part of the household of that person,

being a person who is not an Australian citizen and is not a person domiciled in Australia;

“‘Commission means the Health Insurance Commission established under the Health Insurance Commission Act 1973;”;


(d) by omitting paragraph (a) of the definition of dependant in sub-section (1);

(e) by omitting from sub-section (1) the definition of eligible pensioner;

(f) by omitting from sub-section (1) the definitions of hospital and hospital insured person and substituting the following definition:

“‘hospital means a recognized hospital, a private hospital or a hospital that is declared by the Minister, by writing signed by him, to be a hospital for the purposes of this definition;;

(g) by omitting from sub-section (1) the definition of medically insured person and substituting the following definition:

“‘medicare benefit means a medicare benefit under Part II;;

(h) by omitting 60 days commencing on or after 1 July 1979 from the definition of nursing-home type patient in sub-section (1) and substituting 35 days;

(j) by inserting after the definition of Permanent Head in sub-section (1) the following definition:

“‘person domiciled in Australia means a person whose domicile is in Australia, other than a person in respect of whom the Minister is satisfied that the persons permanent place of abode is outside Australia;;

(k) by omitting from sub-section (1) the definition of private hospital and substituting the following definition:

“‘private hospital means—

(a) a private hospital within the meaning of Part III; or

(b) premises, not being a recognized hospital, included in a class of premises that, under an agreement, are to be taken to be private hospitals for the purposes of the agreement;;

(m) by omitting from paragraph (c) of the definition of recognized hospital in sub-section (1) an internal Territory and substituting the Australian Capital Territory (including the Jervis Bay Territory);

(n) by omitting from sub-section (1) the definition of registered person;

(o) by omitting from sub-section (7) who is an eligible pensioner or;

(p) by omitting from sub-section (7) all the words after claim lodged before (first occurring) and substituting the following words and paragraphs:

1 November 1982 and—

(c) if paragraph 4c (1) (a) applied to the person immediately before the day on which the person became such a disadvantaged person—the pension that was being paid to or in respect of the person was granted pursuant to a claim lodged before 1 November 1982; or


(d) if paragraph 4c (1) (b) applied to the person immediately before the day on which the person became such a disadvantaged person—the pension that would, if the person were not a person to whom paragraph 4c (1) (b) applied, have been payable to or in respect of the person, was granted pursuant to a claim lodged before 1 November 1982.;

(q) by omitting sub-sections (8) and (9);

(r) by omitting from sub-section (10) sub-sections (7) and (9) and substituting sub-section (7);

(s) by omitting from sub-section (11) 60 and substituting 35; and

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

(15) For the purposes of the definition of recognized hospital in sub-section (1), State includes the Northern Territory.

(16) In approving a form for the purposes of the definition of approved form in sub-section (1), the Minister may specify a disc, tape, film or other medium as the means by which the information to be contained in the form is to be or may be set out..

5. (1) Sections 3a and 3b of the Principal Act are repealed and the following section is substituted:

Certification of in-patient as needing acute care

3b. (1) A medical practitioner may give a certificate in writing in accordance with the approved form stating that, in his opinion, a person who is an in-patient in a hospital is, or will be, in need of acute care for at least the period specified in the certificate, being a period commencing not later than 7 days after the certificate is given and ending not later than 30 days after the commencement of the period.

(2) A certificate under sub-section (1) comes into force on the commencement of the period specified in the certificate and continues in force until the expiration of that period.

(3) Where a certificate is given under sub-section (1) by a medical practitioner in respect of a person but is not in force, and the medical practitioner becomes of the opinion that the person will no longer be in need of acute care for at least the period specified in the certificate, he shall revoke the certificate, but nothing in this sub-section precludes him from giving a certificate under sub-section (1) in respect of the person that specifies a period shorter than that first-mentioned period.

(4) Where a certificate given by a medical practitioner in respect of a person is in force under sub-section (1) and the medical practitioner becomes of the opinion that the person is no longer in need of acute care, he shall revoke the certificate.


(5) Where a certificate has been given under sub-section (1), the Permanent Head—

(a) may, of his own motion, within 14 days after he became aware of the giving of the certificate; and

(b) shall, within 14 days after an application in writing is made to him by a registered organization, being an application made within 60 days after the certificate was given,

request a Committee to review the certificate.

(6) After reviewing a certificate given under sub-section (1), the Committee shall, if it is of the opinion that the certificate should be varied or revoked, recommend to the Permanent Head accordingly.

(7) Upon the receipt of a recommendation for the variation or revocation of a certificate, the Permanent Head may, by writing signed by him, vary or revoke the certificate with effect from the date on which the certificate was given or such later date as he specifies, but nothing in this sub-section requires him to act in accordance with the recommendation.

(8) The Permanent Head may, in relation to each State and each Territory, establish a Committee or Committees to be known as the Acute Care Advisory Committee, or the Acute Care Advisory Committees, for the State or Territory.

(9) A Committee shall consist of such persons as, subject to and in accordance with the regulations, the Permanent Head appoints.

(10) A member of a Committee shall be paid such fees and allowances as are determined by the Remuneration Tribunal and shall hold office on such terms and conditions as the Permanent Head determines.

(11) In this section, Committee means an Acute Care Advisory Committee established under this section..

(2) Notwithstanding the repeal of section 3b of the Principal Act effected by sub-section (1) of this section, a certificate given by a medical practitioner in force under sub-section 3b (1) of the Principal Act immediately before the date of commencement of this section certifyng 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 acute care, continues in force, on and after that date, as if it had been given under sub-section 3b (1) of the Principal Act as amended by this section.

Minister may vary Part 7 of table

6. Section 4a of the Principal Act is amended by omitting from sub-section (1) Medical and substituting Medicare.

Disadvantaged persons, being immigrants or refugees

7. Section 5 of the Principal Act is amended by inserting in sub-section (2) and before 1 February 1984after 1 March 1981 (wherever occurring).


8. After section 5j of the Principal Act the following section is inserted:

Certain persons in Australia to be treated as eligible persons, &c.

6. (1) The Minister may, by order in writing, declare that a specified person, or every person included in a specified class of persons, being a person who, but for this sub-section, would not be an eligible person for the purposes of this Act, shall, or shall in specified circumstances (whether circumstances that occurred before or occur after the making of the order) in which he was or is in Australia, be treated as having been or as being an eligible person for the purposes of this Act.

(2) The Minister may, by order in writing, declare that, notwithstanding anything in this Act, a specified person, or every person included in a specified class of persons, being a person who, but for this sub-section, would be an eligible person for the purposes of this Act, shall, or shall in specified circumstances, be treated as if he were not an eligible person for the purposes of this Act.

(3) The Minister may, by order in writing, declare that, notwithstanding anything contained in this Act, a specified person, or every person included in a specified class of persons, being a person who, but for this sub-section, would not be an Australian resident for the purposes of section 21, shall, or shall in specified circumstances in which he is outside Australia, be treated as if he were an Australian resident for those purposes.

(4) Nothing in any other provision of this Act shall be taken, by implication, to limit the generality of this section.

(5) Where an order is made under this section specifying a class of persons a copy of the order shall be published in the Gazette.

(6) Sections 48, 49, 49a and 50 of the Acts Interpretation Act 1901 apply in relation to orders made under sub-section (2) as if in those sections references to regulations were references to orders, references to a regulation were references to an order and references to a repeal were references to a revocation.

(7) An order made under this section shall be deemed not to be a statutory rule within the meaning of the Statutory Rules Publication Act 1903, but sub-sections 5 (3) to (3c) (inclusive) of that Act apply in relation to an order in like manner as they apply in relation to a statutory rule.

(8) For the purposes of the application of sub-section 5 (3b) of the Statutory Rules Publication Act 1903, in accordance with sub-section (7), the reference in that first-mentioned sub-section to the Minister of State for Administrative Services shall be read as the reference to the Minister administering this Act..

Heading to Part II

9. The heading to Part II of the Principal Act is omitted and the following heading is substituted:


“PART II—MEDICARE BENEFITS”.

Interpretation

10. Section 8 of the Principal Act is amended by inserting and paragraph 17 (1) (aa) after 16c.

Medicare benefits calculated by reference to fees

11. Section 9 of the Principal Act is amended by omitting Commonwealth medical benefits and substituting Medicare benefits.

12. Section 10 of the Principal Act is repealed and the following section is substituted:

Entitlement to medicare benefit

10. (1) Where, on or after 1 February 1984, medical expenses are incurred in respect of a professional service rendered in Australia to an eligible person, medicare benefit calculated in accordance with sub-section (2) is payable, subject to and in accordance with this Act, in respect of that professional service.

(2) A medicare benefit under sub-section (1) in respect of a professional service is an amount equal to—

(a) 85% of the fee specified in respect of the service in the table in relation to the State in which the service is rendered; or

(b) if the amount calculated under paragraph (a) is less by more than $10 than the fee from which it is calculated—an amount that is less by $10 than that fee.

(3) Subject to this Act, where—

(a) a claim (in this sub-section referred to as the threshold claim) for medicare benefit is made by a claimant in respect of a professional service—

(i) which was rendered to a person, being either the claimant or another person (in this sub-section referred to as the patient); and

(ii) in respect of which the medical expenses are incurred by the claimant in a year,

and the claim is accepted for payment by the Commission;

(b) the claimant has, or another claimant or other claimants has or have, made other claims (in this sub-section referred to as the prior claims) for medicare benefit in respect of professional services—

(i) which were rendered to the patient; and

(ii) in respect of which the medical expenses were incurred by the relevant claimant in that year,

and the prior claims were accepted for payment by the Commission before the time when the threshold claim is accepted for payment (in this sub-section referred to as the relevant time); and


(c) the Commission is satisfied at the relevant time that—

(i) the first-mentioned claimant has paid the medical expenses in respect of the professional service to which the threshold claim relates;

(ii) a claimant has, or claimants have, paid the medical expenses in respect of professional services to which some or all of the prior claims accepted by the Commission for payment before the relevant time relate;

(iii) the sum of the patient contributions in respect of the prior claims referred to in sub-paragraph (ii) is less than the relevant amount for that year; and

(iv) the sum of the patient contribution in respect of the threshold claim and the patient contributions in respect of the prior claims referred to in sub-paragraph (ii) is equal to or exceeds the relevant amount for that year,

the medicare benefit payable—

(d) in respect of the professional service to which the threshold claim relates—shall be increased by the amount of the excess (if any) referred to in sub-paragraph (c) (iv);

(e) in respect of a professional service—

(i) to which a prior claim accepted for payment by the Commission before the relevant time relates; and

(ii) in relation to which the Commission becomes satisfied, after the relevant time, that the claimant has paid the medical expenses,

shall be increased by an amount equal to the patient contribution in respect of that claim; and

(f) in respect of a professional service—

(i) to which a claim for medicare benefit that is accepted for payment by the Commission after the relevant time relates;

(ii) which was rendered to the patient; and

(iii) in respect of which the medical expenses are incurred by the claimant in that year,

shall be increased by an amount equal to the patient contribution in respect of that claim.

(4) Where an amount calculated in accordance with sub-section (2) is not a multiple of 5 cents, the amount of cents shall be increased to the nearest higher amount that is a multiple of 5 cents.

(5) For the purposes of sub-sections (3) and (6), but without prejudice to the meaning of an expression in any other provision of this Act—

(a) where a person to whom medicare benefit is payable in respect of a professional service is given or sent a cheque under sub-section 20 (2) for the amount of the medicare benefit, the person shall be taken to


have paid so much of the medical expenses in respect of that service as is represented by the amount of the medicare benefit;

(b) the question when medical expenses are incurred in respect of professional services relating to prescribed items shall, notwithstanding anything in this Act, be determined in accordance with the regulations; and

(c) a reference to a professional service is a reference to a professional service (including a medical service rendered outside Australia)—

(i) in respect of which medicare benefit is payable; and

(ii) the medical expenses in respect of which exceed the amount of medicare benefit that, but for sub-section (3), would be payable in respect of the service.

(6) In this section—

patient contribution, in relation to a claim for medicare benefit in respect of a professional service, means an amount equal to the difference between—

(a) the fee specified in respect of the service in the table in relation to the State in which the service is rendered or, if the medical expenses in respect of the service are less than that fee, those medical expenses; and

(b) the amount of medicare benefit that, but for sub-section (3), would be payable in respect of the service;

relevant amount means—

(a) in relation to a year, being the period of 5 months commencing on 1 February 1984—$62.50 or, if a higher amount is prescribed for the purposes of this paragraph, that higher amount; or

(b) in relation to the year commencing on 1 July 1984 or a subsequent year—$150, or if a higher amount is prescribed for the purposes of this paragraph in respect of that year, that higher amount;

year means—

(a) the period of 5 months commencing on 1 February 1984;

(b) the year commencing on 1 July 1984; or

(c) a subsequent year commencing on a 1 July..

Increased fee in complex cases

13. Section 11 of the Principal Act is amended—

(a) by omitting paragraph (1) (a) and substituting the following paragraph:

(a) a claim for a medicare benefit in respect of a professional service is lodged with the Commission; and;

(b) by omitting from sub-paragraph (2) (b) Medical and substituting Medicare; and

(c) by omitting from sub-section (5) all the words after notice and substituting in writing, inform the claimant accordingly.


Appeal from decision on increased fee

14. Section 12 of the Principal Act is amended by omitting from sub-sections (2) and (6) Medical and substituting Medicare.

Medicare benefit not to exceed medical expenses incurred

15. Section 14 of the Principal Act is amended by omitting Commonwealth medical benefit and substituting medicare benefit.

Medicare benefit in respect of 2 or more operations

16. Section 15 of the Principal Act is amended by omitting from sub-section (1) Commonwealth medical benefit (wherever occurring) and substituting medicare benefit.

Forms of undertaking for approved pathology practitioners

17. Section 16b of the Principal Act is amended by omitting from sub-sections (3), (3a), (4), (4a) and (5) Medical Benefits (wherever occurring) and substituting Medicare Benefits.

Medicare benefit not payable in respect of certain medical expenses

18. (1) Section 17 of the Principal Act is amended—

(a) by inserting after paragraph (a) the following paragraph:

(aa) the service related to a prescribed item and was rendered—

(i) to an in-patient of a recognized hospital;

(ii) in a recognized hospital, to an out-patient of the hospital; or

(iii) in a case to which neither sub-paragraph (i) nor (ii) applies, to a patient at a recognized hospital—

(a) in a State that is a party to an agreement under section 23f that declares the State to be a State to which this sub-sub-paragraph applies;

(b) if the Northern Territory is a party to an agreement under section 23f that he declares this sub-sub-paragraph to be applicable to the Northern Territory—in the Northern Territory; or

(C) in the Australian Capital Territory (including the Jervis Bay Territory),

by a medical practitioner—

(iv) in respect of whom there was not in force an approved agreement; or

(v) in respect of whom there was in force an approved agreement but who was acting otherwise than in accordance with the approved agreement;; and


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

(2) Where an amount of medicare benefit is paid to a practitioner, being an amount that, by virtue of paragraph (1) (aa), is not payable, the amount so paid is recoverable in a court of competent jurisdiction as a debt due to the Commonwealth.

(3) Where a medical practitioner acting in accordance with an approved agreement in force in respect of him renders on his own behalf a professional service that relates to an item prescribed for the purposes of paragraph (1) (aa) in a recognized hospital—

(a) to an in-patient or out-patient of the hospital; or

(b) if sub-paragraph (1) (aa) (iii) applies in relation to the hospital—to a patient at the hospital,

medicare benefit in respect of that service shall not be taken not to be payable by reason only that payment of the medical expenses in respect of that service has been made or is to be made to the hospital but nothing in this sub-section shall be taken to affect the meaning of any expression used in paragraph (1) (a) in circumstances to which this sub-section does not apply.

(4) A reference in this section to an approved agreement is a reference to an agreement in writing between a medical practitioner and a recognized hospital—

(a) that is entered into on or after 1 February 1984;

(b) that makes provision with respect to the right of the medical practitioner to render professional services that relate to items prescribed for the purposes of paragraph (1) (aa) on his own behalf to in-patients or out-patients of the hospital, and, if sub-paragraph (1) (aa) (iii) applies in relation to the hospital, to other patients at the hospital; and

(c) if the Minister has, by instrument in writing published in the Gazette, formulated guidelines with which agreements under this section are to comply—that is in accordance with those guidelines..

(2) Where the Minister is satisfied that, if an agreement in writing between a medical practitioner and a recognized hospital entered into before 1 February 1984 had been entered into on or after 1 February 1984, the agreement would, or would but for the inclusion or omission of such matters as he thinks appropriate, have been an approved agreement for the purposes of section 17 of the Principal Act as amended by this Act, the Minister shall, by writing signed by him, determine that, until a specified date, the agreement shall be taken to be an approved agreement for the purposes of that section of that Act as so amended.

(3) Section 131 of the Health Insurance Act 1973 applies in relation to the Ministers powers under sub-section (2) of this section in like manner as it applies in relation to the Ministers powers under that Act.


Medicare benefit not payable where compensation, &c, payable

19. Section 18 of the Principal Act is amended by omitting from sub-sections (1), (2), (3), (4) and (5) Commonwealth medical benefit (wherever occurring) and substituting medicare benefit.

Medicare benefit not payable in respect of certain professional services

20. Section 19 of the Principal Act is amended by omitting Commonwealth medical benefit (wherever occurring) and substituting medicare benefit.

Regulations may provide that medicare benefit be not payable in respect of prescribed class of professional services

21. Section 19a of the Principal Act is amended—

(a) by omitting from sub-section (1) Commonwealth medical benefits and substituting medicare benefits; and

(b) by omitting from sub-section (2) Medical and substituting Medicare.

Medicare benefit not payable in respect of professional services rendered by or on behalf of disqualified practitioners

22. Section 19b of the Principal Act is amended by omitting from sub-section (6) Commonwealth medical benefit and substituting medicare benefit.

Particulars of disqualifications under section 19b to be published, &c.

23. Section 19c of the Principal Act is amended by omitting from sub-section (10) any registered organization and substituting the Commission.

Persons entitled to medicare benefits

24. Section 20 of the Principal Act is amended—

(a) by inserting in sub-section (1) by the Commission on behalf of the Commonwealth after payable; and

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

(2) Where a person to whom a medicare benefit is payable under sub-section (1) in respect of a professional service has not paid the medical expenses that he has incurred in respect of that professional service, he shall not be paid the medicare benefit but, if he so requests, there shall, in lieu of that payment, be given to him personally, or sent to him by post at his last-known address, a cheque for the amount of the medicare benefit drawn in favour of the person by whom, or on whose behalf, the professional service was rendered..


25. Section 20a of the Principal Act is repealed and the following section is substituted:

Assignment of medicare benefit

20a. (1) Where a medicare benefit is payable to an eligible person in respect of a professional service rendered to the eligible person or to another eligible person, the first-mentioned eligible person and the person by whom, or on whose behalf, the professional service is rendered (in this sub-section referred to as the practitioner) may enter into an agreement, in accordance with the approved form, under which—

(a) the first-mentioned eligible person assigns his right to the payment of the medicare benefit to the practitioner; and

(b) the practitioner accepts the assignment in full payment of the medical expenses incurred in respect of the professional service by the first-mentioned eligible person.

(2) Where a practitioner determines that a pathology service is necessary to be rendered to an eligible person, the person to whom medicare benefit would be payable in respect of that service may, in accordance with the approved form, make an offer to the approved pathology practitioner by whom, or on whose behalf, the pathology service is to be rendered to enter into an agreement with him under sub-section (1), when the pathology service is so rendered, with respect to the medicare benefit payable in respect of the pathology service so rendered.

(3) Where an assignment under this section takes effect, or an agreement under this section is entered into, with respect to a medicare benefit, the medicare benefit is, subject to section 20b, payable in accordance with the assignment or the agreement, as the case may be.

(4) A reference in this section to a person by whom a professional service is rendered shall be read as not including a reference to a person (in this sub-section referred to as the agent) who renders a professional service on behalf of another person or of an organization, but the agent may, if so authorized by that other person or that organization, on behalf of that other person or that organization, enter into an agreement under sub-section (1).

(5) An assignment of a medicare benefit shall not be made except in accordance with this section..

Claims for medicare benefit

26. Section 20b of the Principal Act is amended—

(a) by omitting paragraph (1) (a) and substituting the following paragraph:

(a) in respect of a professional service other than a professional service referred to in paragraph (b)—shall be made in accordance with the approved form and lodged with the Commission; or;


(b) by omitting from paragraph (1) (b) 1 September 1981 or such later date as is prescribed—shall be lodged with the relevant medical benefits organization and substituting such date (if any) as is prescribed—shall be made in accordance with the approved form and lodged with the Commission;

(c) by omitting from paragraph (2) (b) Department and substituting Commission;

(d) by omitting paragraphs (3) (a) and (b);

(e) by omitting from paragraphs (3) (c) and (d) 20a (4) and substituting20a (1); and

(f) by omitting sub-sections (4) and (5).

Repeal of sections 20c to 20f (inclusive)

27. Sections 20c to 20f (inclusive) of the Principal Act are repealed.

Medical services outside Australia

28. Section 21 of the Principal Act is amended—

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

(1) Subject to this section, where, on or after 1 February 1984, medical expenses are incurred by an Australian resident in respect of a medical service specified in an item that is rendered outside Australia to the Australian resident or to another Australian resident by, or on behalf of, a prescribed person, medicare benefit is payable in respect of that medical service as if that medical service had been rendered in New South Wales by, or on behalf of, a medical practitioner.;

(b) by inserting in sub-section (2) by the Commission on behalf of the Commonwealth after payable;

(c) by adding at the end of paragraph (4) (b) ; and; and

(d) by omitting paragraphs (4) (d) and (e).

Undertakings with respect to pensioners

29. Section 23 of the Principal Act is repealed.

Common form of undertaking

30. Section 23a of the Principal Act is amended by omitting paragraph (2) (d).

31. (1) Section 23e of the Principal Act is repealed and the following sections are substituted:

Interpretation

23e. (1) For the purposes of this Part (including Schedule 2)—

(a) a reference to a State includes a reference to the Northern Territory;

(b) a reference to the Australian Capital Territory includes a reference to the Jervis Bay Territory;


(c) a reference to a category, in relation to a private hospital, is a reference to a category specified in pursuance of sub-section 31 (1);

(d) a reference in a provision of this Part to the Minister for Health of a State is a reference to—

(i) unless sub-paragraph (ii) applies—

(a) in the case of a State other than the Northern Territory—the person who is the Minister of the Crown of the State; or

(b) in the case of the Northern Territory—the person holding ministerial office under section 36 of the Northern Territory (Self-Government) Act 1978,

who is responsible or principally responsible for the administration of matters relating to health in the State; or

(ii) if the person referred to in sub-paragraph (i) authorizes another person to act on his behalf for the purposes of that provision—the person so authorized; and

(e) a State is a non-participating State until, by reason of an election made under an agreement entered into between the Commonwealth and that State under section 23f, the State assumes responsibility for the payment of daily bed payments (however described) in respect of hospitals situated in that State that are private hospitals for the purposes of that agreement.

(2) Where the Minister is required by a provision of this Part to have regard to the views of a Minister for Health of a State, nothing in this Part shall be taken to preclude him from having regard to any other relevant matters.

Agreement with States for provision of hospital and other health services

23f. (1) The Commonwealth may enter into an agreement with a State for and in relation to the provision of hospital services and other health services on and after 1 February 1984 to eligible persons.

(2) An agreement referred to in sub-section (1) shall be in terms that give effect substantially to the Heads of Agreement specified in Schedule 2 but may include provision with respect to other matters, including points of understanding between the parties to the agreement.

(3) The Commonwealth may, from time to time, enter into agreements varying an agreement under sub-section (1), but so that the agreement as so varied shall comply with sub-section (2).

(4) An agreement entered into under sub-section (3) may be expressed to have taken effect from a date earlier than the date upon which that agreement was entered into.


Payments in respect of recognized hospitals in the Australian Capital Territory

23g. (1) In this section—

prescribed hospital authority means the Capital Territory Health Commission established under the Health Commission Ordinance 1975 of the Australian Capital Territory as amended and in force from time to time;

relevant hospital means a recognized hospital that is situated in the Australian Capital Territory;

relevant period means the period commencing on 1 February 1984 and ending on 30 June 1984 and each succeeding period of one year ending on a 30 June before 1 July 1987.

(2) There is payable by the Commonwealth, in respect of a relevant period, to the prescribed hospital authority, an amount equal to the sum of—

(a) the amount determined by the Minister to represent revenue foregone by relevant hospitals during that period in respect of the provision of hospital services to eligible persons;

(b) the amount determined by the Minister to represent revenue foregone by relevant hospitals during that period in respect of the provision, without charge, of out-patient services at those hospitals;

(c) the amount determined by the Minister to represent additional expenditure incurred by relevant hospitals during that period in respect of the provision, without charge, of professional services to persons who, being private patients, elect to become hospital patients; and

(d) the amount (if any) determined by the Minister to represent any additional cost to, or revenue foregone by, relevant hospitals during that period, being a cost or revenue of the kind that has been taken into account in determining the amount payable by the Commonwealth to the States in respect of recognized hospitals in the States in pursuance of the agreements entered into under section 23f.

(3) There is payable by the Commonwealth, in respect of a relevant period, to the prescribed hospital authority an amount determined by the Minister to be appropriate for expenditure during that period upon health services other than hospital services in the Australian Capital Territory.

(4) A payment under sub-section (2) or (3) is subject to such terms and conditions as the Minister determines having regard to the terms and conditions specified in relation to the States in the Heads of Agreement set out in Schedule 2, and to the terms and conditions of the agreements with the States made under section 23f, in relation to payments of a similar nature that are made to the States.

(5) Payments under sub-sections (2) and (3) shall be made in such amounts, and at such times, as the Minister determines.


Minister may formulate principles for certain purposes

23h. (1) The Minister may formulate principles to be complied with by him in the exercise of any of his powers under sub-sections 23j (1), (2) and (3) and 24 (2) and (5) and sections 29a and 29b of this Act and sub-section 32 (4) of the Health Legislation Amendment Act 1983.

(2) The Minister shall not formulate principles under sub-section (1) unless he has, at the time of so formulating those principles, consulted with the Minister for Health for each State that is at that time a non-participating State and has had regard to any views of that other Minister expressed in the course of that consultation.

(3) Sections 48, 49, 49a and 50 of the Acts Interpretation Act 1901 apply in relation to principles formulated under sub-section (1) as if in those sections references to regulations were references to principles, references to a regulation were references to a principle and references to a repeal were references to a revocation.

(4) Principles formulated under sub-section (1) shall be deemed not to be statutory rules within the meaning of the Statutory Rules Publication Act 1903, but sub-sections 5 (3) to (3c) (inclusive) of that Act apply in relation to such principles in like manner as they apply to statutory rules.

(5) For the purposes of the application of sub-section (3b) of section 5 of the Statutory Rules Publication Act 1903 in accordance with sub-section (4), the reference in that first-mentioned sub-section to the Minister of State for Administrative Services shall be read as the reference to the Minister administering this Act.

(6) Section 5 of the Evidence Act 1905 applies to a principle formulated by the Minister under sub-section (1) of this section in like manner as that section applies to an order made by the Minister..

(2) Section 23e of the Principal Act is amended by adding at the end thereof the following sub-section:

(3) In this Part—

private hospital means premises in relation to which an approval as a private hospital under section 24 is in effect;

proprietor, in relation to a private hospital, means a proprietor, as defined by sub-section 3 (1), of the premises that are approved under section 24 as a private hospital..

32. (1) Section 24 of the Principal Act is repealed and the following sections are substituted:

Approval in principle of private hospital

23j. (1) Upon application made in accordance with the approved form by a person who is, or intends to become, the proprietor of premises and who proposes to apply for the approval of those premises under section 24 as a


private hospital, the Minister may, in his discretion, grant to the applicant a certificate in writing—

(a) stating that, if, at any time within the period of 12 months after the grant of the certificate, the applicant applies under sub-section 24 (1) for the approval of the premises as a private hospital, that last-mentioned application will not be refused unless the Minister is not satisfied that the premises comply, at that time, with specifications set out in the certificate;

(b) stating that, if that approval is granted, the category of private hospital to which the premises will be determined to belong will be the category of private hospital specified in the certificate; and

(c) stating that, if that approval is granted, the number of beds that will be determined in relation to the premises for the purposes of paragraph 24 (5) (a) will not be less than the number of beds specified in the certificate.

(2) Upon application made in accordance with the approved form by the proprietor of a private hospital who proposes to cause an alteration of, or addition to, the premises occupied by the private hospital, being an alteration or addition the purpose of which is, or the effect of which will be, to enable the number of beds available in the private hospital to be increased, the Minister may, in his discretion, grant to the applicant a certificate in writing—

(a) approving that alteration or addition; and

(b) stating that if, at any time within the period of 12 months after the grant of the certificate, the alteration or addition has been completed and the applicant applies under sub-section 29b (1) for the Minister to vary the conditions applicable to the private hospital by substituting for the number of approved beds determined in relation to the private hospital for the purposes of paragraph 24 (5) (a) a number of approved beds not exceeding such other number as is specified in the certificate, that last-mentioned application will not be refused.

(3) Upon application made in accordance with the approved form by the holder of a certificate in force under sub-section (1) or (2), the Minister may, in his discretion,-vary the certificate—

(a) by deleting the period specified in the certificate (including a period substituted by virtue of a previous application or applications of this sub-section) and substituting such longer period as he determines;

(b) by deleting the number of approved beds specified in the certificate (including a number substituted by virtue of a previous application or applications of this sub-section) and substituting such other number as he determines; or

(c) in the case of a certificate granted under sub-section (1)—by deleting the category of private hospital specified in the certificate and substituting such other category of private hospital as he determines.


(4) The Minister, in exercising his powers under sub-section (1), (2) or (3) to grant or vary a certificate, shall comply with any relevant principles in force under section 23h.

(5) The Minister shall not exercise his powers under sub-section (1), (2) or (3) in relation to premises that are situated in a State unless that State is a non-participating State and he has consulted with the Minister for Health of that State and has had regard to any views of that other Minister expressed in the course of that consultation.

(6) A certificate under this section comes into force on the day on which it is granted and subject to sub-section (7), remains in force—

(a) in the case of a certificate in respect of premises that are situated in the Australian Capital Territory—until the expiration of the period specified in the certificate; or

(b) in the case of a certificate in respect of premises that are situated in a State—until the expiration of the period specified in the certificate or the time when the State ceases to be a non-participating State, whichever first occurs.

(7) Where premises to which a certificate under sub-section (1) relates are approved as a private hospital under sub-section 24 (1), the certificate ceases to be in force.

(8) Upon application in writing by the holder of a certificate in force under this section, the Minister shall revoke the certificate.

(9) Where the Minister makes a decision under sub-section (1), (2) or (3) refusing to grant or vary a certificate, he shall cause to be served, either personally or by post, on the applicant for the certificate or the variation, a notice in writing setting out that decision.

Approval of premises as a private hospital

24. (1) Subject to this section, upon application in accordance with the approved form by the proprietor of premises who holds a certificate in force under sub-section 23j (1) in relation to those premises, the Minister shall, if he is satisfied that the premises comply with the specifications set out in the certificate—

(a) approve the premises to which the certificate relates as a private hospital;

(b) determine, in accordance with the certificate, the category of private hospital to which the premises belong; and

(c) determine, in accordance with the certificate, the number of approved beds in relation to the premises for the purposes of paragraph (5) (a),

but, if he is not so satisfied, he shall refuse the application.

(2) Subject to this section, upon application in accordance with the approved form by the proprietor of premises not being a proprietor who holds a


certificate in force under sub-section 23j (1) in relation to those premises, the Minister may, in his discretion—

(a) approve the premises as a private hospital;

(b) determine the category of private hospital to which the premises belong; and

(c) determine the number of approved beds in relation to the premises for the purposes of paragraph (5) (a).

(3) The Minister, in exercising his powers under sub-section (2) or (5), shall comply with any relevant principles in force under section 23h.

(4) The Minister shall not exercise a power under sub-section (2) in relation to premises that are situated in a State unless that State is a non-participating State and he has consulted with the Minister for Health of that State and has had regard to any views of that other Minister expressed in the course of that consultation.

(5) The approval of premises as a private hospital under this section is subject to the following conditions:

(a) a condition that the number of beds available in the hospital will not at any time exceed such number as is determined by the Minister to be the number of approved beds in relation to the hospital;

(b) that no alteration of, or addition to, the premises the purpose of which is, or the effect of which will be, to enable the number of beds in the private hospital to be increased will be commenced unless the proprietor of the premises is the holder of a certificate in force under sub-section 23j (2) approving that alteration or addition; and

(c) such other conditions as the Minister determines.

(6) The approval of premises that are situated in a State as a private hospital ceases to have effect for the purposes of this Act, when the State ceases to be a non-participating State.

(7) Where the Minister makes a decision under this section refusing to approve an application for approval of premises as a private hospital, he shall cause to be served, either personally or by post, on the applicant for that approval a notice in writing setting out that decision..

(2) The following provisions of this section apply to any premises in respect of which an approval as a hospital under section 24 of the Principal Act was in force immediately before 1 February 1984 and which was, immediately before that date, a private hospital.

(3) For the purposes of the Principal Act as amended by this Act, premises to which this sub-section applies shall be treated, on and after 1 February 1984, as if those premises had been approved as private hospitals on that date under section 24 of that Act as so amended and as if the Minister had, at the time of the approval—

(a) for the purposes of the application of the condition set out in paragraph (5) (a) of that section to that approval—determined under


that paragraph the number of approved beds in relation to those premises to be the number of beds to which the approval of those premises as in force immediately before that date related; and

(b) if the approval of premises to which this sub-section applies was subject to any conditions under sub-section 24 (4) of the Principal Act immediately before that date—determined those conditions under paragraph (5) (c) of that section,

and any failure before 1 February 1984 to comply with any condition to which the approval of the premises was subject under sub-section 24 (4) of the Principal Act shall be deemed to be a failure to comply with the corresponding condition to which the approval of the premises is subject by virtue of this sub-section.

(4) Where the Minister is satisfied that premises will, on 1 February 1984, become premises to which sub-section (2) applies he shall, before 1 February 1984, determine the category of private hospital to which those premises belong and where he makes such a determination, the determination shall, on and after 1 February 1984, be deemed to have been made under sub-section 24 (2) of the Principal Act as amended by this Act.

(5) The Minister, in exercising his powers under sub-section (4), shall comply with any relevant principles in force under section 23h of the Principal Act as amended by this Act.

(6) The Minister shall not determine, under sub-section (4), the category of a private hospital situated in a non-participating State unless he has consulted with the Minister for Health of that State and has had regard to any views of that other Minister expressed in the course of that consultation.

(7) Sub-section 23e (1) of the Health Insurance Act 1973 applies in relation to sub-section (6) of this section as if the reference in paragraph (1) (d) of that sub-section of that Act to a provision of Part III of that Act were a reference to sub-section (6) of this section.

(8) Sub-section 23e (2) and section 131 of the Health Insurance Act 1973 apply in relation to the Ministers powers under sub-section (4) of this section in like manner as they apply in relation to the Ministers powers under that Act.

33. Section 25 of the Principal Act is repealed and the following section is substituted:

Issue of certificates relating to approval and categorization

25. (1) Upon approval of premises as a private hospital, the Minister shall cause to be issued to the proprietor of the hospital a certificate of approval in accordance with the approved form, specifying the category of private hospital to which the premises belong and setting out the conditions to which the approval of the premises is subject.

(2) Where the approval of premises as a private hospital has been revoked under section 29, the determination of the category of private hospital


to which premises belong has been varied under section 29a or a condition to which the approval of premises as a private hospital is subject has been varied under section 29B, the Minister shall cause to be issued to the proprietor of the hospital a new certificate of approval, in accordance with the approved form..

Display of certificates relating to approval and categorization

34. Section 26 of the Principal Act is amended—

(a) by omitting from sub-section (1) hospital (first occurring) and substituting private hospital; and

(b) by omitting from sub-section (2) as a hospital is revoked or varied and substituting as a private hospital ceases to have effect under section 24 or is revoked or suspended under section 29, the determination of the category of private hospital to which the premises belong is varied under section 29a or a condition to which the approval of the premises is subject is varied under section 29B,.

35. Section 27 of the Principal Act is repealed and the following section is substituted:

Inspection of, and of records of, private hospitals

27. (1) A person authorized in writing by the Minister to act under this section may, at any reasonable time—

(a) enter and inspect premises in respect of which an approval under section 24 is in effect or an application for such an approval has been made; and

(b) in relation to any premises in respect of which an approval under section 24 is in effect—inspect any books, documents or other records on these premises that relate to the operation of those premises as a private hospital.

(2) The occupier of premises referred to in sub-section (1) shall provide the authorized person with all reasonable facilities and assistance for the effective exercise of his powers under this section.

Penalty: $1,000..

Notice by person ceasing to be proprietor of hospital

36. Section 28 of the Principal Act is amended—

(a) by inserting in sub-sections (1) and (2) private before hospital (wherever occurring); and

(b) by adding at the end of sub-section (2) and state whether it is intended to continue to operate the premises as a private hospital.

37. Section 29 of the Principal Act is repealed and the following sections are substituted:


Revocation of approval of premises as hospital

29. (1) Where the Minister—

(a) considers that premises approved as a private hospital have, since approval of the premises was granted, ceased to operate as a private hospital; or

(b) receives an application, in writing, by the proprietor of premises in relation to which an approval of a private hospital is in effect for revocation of the approval of the premises,

he may revoke, or suspend for such period as he thinks fit, the approval of the premises.

(2) Where—

(a) the Minister receives, whether before or after the commencement of this section, a notice under section 28 in respect of premises in relation to which an approval as a private hospital is in effect;

(b) the Minister is satisfied that a condition determined by him under sub-section 24 (5) has not been complied with in respect of premises in relation to which an approval as a private hospital is in effect; or

(c) the proprietor or one of the proprietors of premises in relation to which an approval as a private hospital is in effect is convicted of an offence against, or arising out of, section 129aa,

the Minister may revoke, or suspend for such period as he thinks fit, the approval of the premises.

(3) The reference in paragraph (2) (c) to a conviction of an offence includes a reference to the making of an order under sub-section 19b (1) of the Crimes Act 1914 in relation to an offence.

(4) Where the Minister revokes or suspends the approval of premises as a hospital under sub-section (1) or (2) he shall, by notice in writing, inform the proprietor of the hospital.

Variation of categorization of particular private hospitals

29a. (1) Subject to this section, upon application made in accordance with the approved form by the proprietor of a private hospital for a variation in the category to which the private hospital belongs, the Minister may, in his discretion, vary the determination under section 24 of that category, with effect from such date as he thinks fit, by substituting for that category such other category as he determines to be appropriate, and shall, by notice in writing served either personally or by post, notify the applicant of his decision on the application.

(2) Subject to this section, the Minister may, of his own motion, vary the determination under section 24 of the category of private hospital to which a private hospital belongs, with effect from such date as he thinks fit, by substituting for that category such other category as he determines to be appropriate and, where he does so, he shall, by notice in writing served personally or by post, notify the proprietor of the hospital accordingly.


(3) The Minister, in exercising his powers under sub-sections (1) or (2), shall comply with any relevant principles in force under section 23h.

(4) The Minister shall not vary a determination of the category to which a private hospital situated in a State belongs unless he has consulted the Minister for Health of that State and has had regard to any views of that other Minister expressed in the course of that consultation.

Variation of conditions to which an approval is subject

29b. (1) Subject to this section, upon application in accordance with the approved form by the proprietor of a private hospital who holds a certificate in force under sub-section 23j (2) in relation to the alteration of, or addition to, the premises occupied by the hospital, the Minister shall, if he is satisfied that the alteration or addition has been completed, vary the conditions applicable to the private hospital, with effect from such date as he thinks fit, by substituting for the number of approved beds determined in relation to the private hospital for the purposes of paragraph 24 (5) (a) such other number of approved beds as he determines, being a number of approved beds that does not exceed the number of approved beds specified in the certificate.

(2) Subject to this section, upon application made in accordance with the approved form by the proprietor of a private hospital, the Minister may, in his discretion, with effect from such date as he thinks fit, vary the conditions applicable to the private hospital by substituting for the number of approved beds determined in relation to the private hospital for the purposes of paragraph 24 (5) (a) such other number of approved beds as he determines to be appropriate.

(3) Subject to this section, the Minister may, of his own motion and with effect from such date as he thinks fit, vary the conditions applicable to the private hospital by substituting for the number of approved beds determined in relation to the private hospital for the purposes of paragraph 24 (5) (a) such other number of approved beds as he determines to be appropriate.

(4) Subject to this section, upon application made in accordance with the approved form by the proprietor of a private hospital, the Minister may, in his discretion, revoke or vary in such manner as he thinks appropriate, with effect from such date as he thinks fit, the conditions applicable to the private hospital under paragraph 24 (5) (c).

(5) Subject to this section, the Minister may, of his own motion and with effect from such date as he thinks fit, revoke or vary in such manner as he thinks appropriate, the conditions applicable to the private hospital under paragraph 24 (5) (c).

(6) Where the Minister makes a decision under a preceding provision of this section in relation to a private hospital, he shall cause to be served on the proprietor of the hospital, either personally or by post, a notice in writing setting out that decision.


(7) The Minister, in exercising his powers under sub-section (1), (2), (3), (4) or (5), shall comply with any relevant principles in force under section 23h.

(8) The Minister shall not, under sub-section (1), (2), (3), (4) or (5), revoke or vary a condition to which the approval of a private hospital situated in a State is applicable unless he has consulted the Minister for Health of that State and has had regard to any views of that other Minister expressed in the course of that consultation..

Agreements with States and Northern Territory for provision of hospital services

38. (1) Section 30 of the Principal Act is repealed.

(2) An agreement between the Commonwealth and South Australia or Tasmania that was in force immediately before 1 February 1984 under section 30 of the Principal Act ceases to have effect upon that date, except in so far as that agreement relates to the provision of hospital services before that date.

39. After section 30 of the Principal Act the following section is inserted:

Categorization of private hospitals

31. (1) The Minister may, by order in writing published in the Gazette, specify categories of private hospital for the purposes of this Part and, in relation to each category, an amount of daily bed payment.

(2) An order under sub-section (1) takes effect at the beginning of the day on which it is published in the Gazette.

(3) The Minister shall not exercise his powers under sub-section (1) unless he has consulted with the Minister for Health for each non-participating State and has had regard to any views of that other Minister expressed in the course of that consultation..

40. Section 33 of the Principal Act is repealed and the following section is substituted:

Daily bed payments

33. (1) In respect of any day on which an eligible person is an in-patient for a period of more than 8 hours at a private hospital situated in the Australian Capital Territory or in a non-participating State, there is payable by the Commonwealth to the proprietor of the private hospital in respect of each such in-patient a daily bed payment of the amount that was on that day specified in an order that is in force under sub-section 31 (1) in relation to the category of private hospitals to which that hospital belongs.

(2) Where the charge (if any) made by the proprietor of a private hospital in respect of the occupancy for a day of an approved bed by an in-patient at the hospital is less than the amount of the daily bed payment that, but for this sub-section, would be payable under sub-section (1) in respect of that in-patient for that day, the daily bed payment in respect of that in-patient for that day shall not exceed the amount of that charge.


(3) Where the average cost to the proprietor of a private hospital of maintaining an approved bed occupied by an in-patient at the hospital for a day is less than the amount of the daily bed payment that, but for this sub-section would be payable under sub-section (1) in respect of each in-patient at that hospital for that day, the daily bed payment in respect of each in-patient at that hospital for that day shall not exceed the amount of that average cost.

(4) For the purposes of this section, the day of admission and day of discharge or death of an in-patient at a hospital shall be counted together as one day..

Claims by proprietors of private hospitals

41. Section 35 of the Principal Act is amended by inserting after paragraph (a) the following paragraph:

(aa) shall be signed by a person, being the proprietor of the private hospital or an agent of the proprietor, authorized by the Permanent Head to sign claims under this section;.

Certain daily bed payments not payable where compensation, &c, is payable to patient

42. Section 35a of the Principal Act is amended by omitting from paragraph (1) (a) a private hospital and substituting the proprietor of a private hospital.

43. Section 36 of the Principal Act is repealed and the following section is substituted:

Power to obtain information

36. (1) Where the Minister has reason to believe that a person, being the holder or one of the holders of a certificate in force under section 23J, an applicant or one of the applicants for such a certificate, an applicant or one of the applicants for an approval under section 24 or the proprietor or one of the proprietors of a private hospital, is capable of furnishing information that is relevant to the exercise of the Ministers powers under this Part or to the payment of an amount under section 33, the Minister may, by notice in writing served, either personally or by post, on the person, require the person to furnish to the Minister, by writing signed by the person or, in the case of a body corporate, by a competent officer of the body corporate, within the time and in the manner specified in the notice, any such information.

(2) A person shall not—

(a) refuse or fail to comply with a notice under sub-section (1) to the extent that the person is capable of complying with it; or

(b) in purported compliance with such a notice, furnish information that is to his knowledge false or misleading in a material particular.

Penalty: $1,000.

(3) A person is not excused from furnishing information in pursuance of this section on the ground that the information might tend to incriminate the


person or render the person liable to a penalty, but the information is not admissible in evidence against the person—

(a) in the case of a person not being a body corporate—in any criminal proceedings other than proceedings under, or arising out of, this section; or

(b) in the case of a body corporate—in any criminal proceedings other than proceedings under, or arising out of, this Act or the National Health Act 1953

Access to premises

44. Section 37 of the Principal Act is amended by omitting from sub-sections (2), (3) and (6) relating to the occupation of approved beds in a hospital (wherever occurring) and substituting relevant to the exercise of a power conferred on the Minister by this Part or to the payment of an amount under section 33.

45. After section 37 of the Principal Act the following sections are inserted in Part III:

Review of decisions

38. (1) In this section, reviewable decision of the Minister means a decision of the Minister, or of a delegate of the Minister—

(a) made on or after 1 February 1984 under sub-section 23J (1), (2) or (3), 24 (1), (2) or (5), 29 (1) or (2), 29a (1) or (2) or 29b (1), (2), (3), (4) or (5) of this Act; or

(b) made under sub-section 32 (4) of the Health Legislation Amendment Act 1983.

(2) A person affected by a reviewable decision of the Minister who is dissatisfied with the decision may, by notice in writing given to the Minister within the period of 28 days after the day on which the decision first comes to the notice of the person, or within such further period as the Minister, (either before or after the expiration of that period), by notice in writing served, either personally or by post, on the person, allows, request the Minister to reconsider the decision.

(3) There shall be set out in the request the reasons for making the request.

(4) Upon the receipt of the request, the Minister shall reconsider the decision and may affirm or revoke the decision or vary the decision in such a manner as he thinks fit.

(5) Where the Minister affirms, revokes or varies a decision, he shall, by notice in writing served on the person who made the request, inform the person of the result of his reconsideration of the decision, set out the findings on material questions of fact, refer to the evidence or other material on which those findings were based and give his reasons for affirming, revoking or varying the decision, as the case may be.


(6) Applications may be made to the Administrative Appeals Tribunal for review of reviewable decisions that have been affirmed or varied under sub-section (4).

(7) Notwithstanding sub-section 43 (6) of the Administrative Appeals Tribunal Act 1975, a reviewable decision of the Minister as varied by the Administrative Appeals Tribunal, or a decision made by the Administrative Appeals Tribunal in substitution for a reviewable decision of the Minister, has effect on and from the day on which the decision of the Administrative Appeals Tribunal comes into operation.

(8) A reference in sub-section (7) to a reviewable decision of the Minister shall be read as a reference to a reviewable decision that has been affirmed or varied under sub-section (4).

Statements to accompany notification of decision

38a. (1) Where a reviewable decision of the Minister within the meaning of section 38 is made and notice in writing of the decision is given to a person affected by the decision, that notice shall include a statement to the effect that—

(a) the person may, if he is dissatisfied with the decision, seek a reconsideration to the decision by the Minister in accordance with sub-section 38 (2); and

(b) a person whose interests are affected by the decision may, subject to the Administrative Appeals Tribunal Act 1975, if he is dissatisfied with a decision made by the Minister upon that reconsideration confirming or varying the first-mentioned decision, make application to the Administrative Appeals Tribunal for review of the decision so confirmed or varied.

(2) Where the Minister confirms or varies a decision under sub-section 38 (4) and gives to a person notice in writing of the confirmation of variation of the decision, that notice shall include a statement to the effect that a person whose interests are affected by the decision may, subject to the Administrative Appeals Tribunal Act 1975, if he is dissatisfied with the decision so confirmed or varied, make application to the Administrative Appeals Tribunal for review of the decision.

(3) Any failure to comply with the requirements of sub-section (1) or (2) in relation to a decision does not affect the validity of the decision..

Recognition of consultant physician, &c.

46. Section 61 of the Principal Act is amended by omitting from sub-section (8) medical benefit and substituting medicare benefit.

Heading to Division 2 of Part V

47. The Heading to Division 2 of Part V of the Principal Act is amended by omitting Medical and substituting Medicare.


Interpretation

48. Section 65 of the Principal Act is amended by omitting Medical from the definition of Committee and substituting Medicare.

Medicare Benefits Advisory Committee

49. (1) Section 66 of the Principal Act is amended—

(a) by omitting Medical from sub-section (1) and substituting Medicare; and

(b) by adding at the end of sub-section (2) the following words and such other organizations and associations as the Minister considers appropriate.

(2) The Medical Benefits Advisory Committee established under section 66 of the Principal Act and in existence immediately before the commencement of this section continues in existence under the name Medicare Benefits Advisory Committee as if it had been established under section 66 of that Act as amended by this Act and a reference in any law of the Commonwealth other than this Act to the Medical Benefits Advisory Committee shall be construed as a reference to that Committee as so continued in existence and as constituted from time to time.

Functions of Committee

50. Section 67 of the Principal Act is amended by omitting from paragraph (1) (aa) medical and substituting medicare.

Interpretation

51. Section 79 of the Principal Act is amended—

(a) by omitting from paragraph (1b) (a) medical benefit and substituting medicare benefit;

(b) by adding at the end of paragraph (1b) (a) ; and; and

(c) by omitting paragraphs (1b) (c) and (d).

Recommendation by Committee

52. Section 105 of the Principal Act is amended—

(a) by omitting from sub-sections (2), (2a) and (3) medical benefit (wherever occurring) and substituting medicare benefit;

(b) by omitting from paragraphs (2) (f) and (3) (d) all the words after payable by the and substituting practitioner to the Commonwealth; and

(c) by omitting from paragraph (2a) (g) all the words after payable by the and substituting first-mentioned person to the Commonwealth.

Determination by Minister

53. Section 106 of the Principal Act is amended by omitting sub-section (4).


Interpretation

54. Section 106a of the Principal Act is amended—

(a) by omitting from paragraph (2) (a) medical benefit and substituting medicare benefit;

(b) by adding at the end of paragraph (2) (c) ; and; and

(c) by omitting paragraphs (2) (e) and (f).

Recommendation by Committee

55. Section 106fj of the Principal Act is amended—

(a) by omitting from sub-sections (2), (3) and (4) medical benefit (wherever occurring) and substituting medicare benefit;

(b) by omitting from paragraph (2) (g) all the words after payable by and substituting the optometrist to the Commonwealth;

(c) by omitting from paragraph (3) (g) all the words after payable by and substituting the first-mentioned person to the Commonwealth; and

(d) by omitting from paragraph (4) (e) all the words after payable by and substituting the participating optometrist to the Commonwealth.

Determination by Minister

56. Section 106fk of the Principal Act is amended by omitting sub-section (4).

57. Before section 128 of the Principal Act the following sections are inserted in Part VII:

Prohibition of certain medical insurance

126. (1) A person shall not make a contract of insurance with another person that contains a provision purporting to make the first-mentioned person liable to indemnify the other person in respect of loss arising out of the incurring by the other person of a liability to pay medical expenses in respect of the rendering in Australia of a professional service for which medicare benefit is, or but for sub-section 18 (4) would be, payable.

Penalty: $1,000.

(2) Where there is a contract of insurance (whether made before or after the commencement of this section) under which the insurer is liable to indemnify a person in respect of loss arising out of the incurring by that person of liability to pay medical expenses in respect of the rendering in Australia of a professional service, there is an implied condition in the contract that the insurer is not liable for loss arising out of the incurring of liability to pay medical expenses in respect of the rendering in Australia of a professional service in respect of which a medicare benefit is, or but for sub-section 18 (4) would be, payable.


(3) Where—

(a) the proper law of a contract of insurance would, but for a term that it should be the law of some other country or a term to the like effect, be part of the law of any part of Australia; or

(b) a contract of insurance contains a term that purports to substitute, or has the effect of substituting, provisions of the law of some other country or of a State or Territory for all or any of the provisions of this section,

this section applies to the contract notwithstanding that term.

(4) Any term of a contract of insurance (including a term that is not set out in the contract but is incorporated in the contract by another term of the contract) that purports to exclude, restrict or modify or has the effect of excluding, restricting or modifying the application in relation to that contract of all or any of the provisions of this section is void.

(5) A term of a contract shall not be taken to exclude, restrict or modify the application of a provision of this section unless the term does so expressly or is inconsistent with that provision.

(6) In this section, insurance means insurance to which paragraph 51 (xiv) of the Constitution is applicable.

Assignor of medicare benefit to be given copy of assignment, &c.

127. (1) A person (in this section referred to as the practitioner) shall not enter into an agreement under sub-section 20a (1) with another person (in this section referred to as the patient) for the assignment to the practitioner of the right to the payment of a medicare benefit in respect of a professional service (not being an agreement entered into by way of the acceptance of an offer to assign under sub-section 20a (2)), unless the practitioner—

(a) causes the particulars relating to the professional service that are required by the form approved for the purposes of sub-section 20a (1) to be set out in the agreement to be so set out in the agreement before the patient signs the agreement; and

(b) causes a copy of the agreement to be given to the patient as soon as practicable after the patient signs the agreement.

(2) A person who, without reasonable excuse, contravenes sub-section (1), is guilty of an offence punishable on conviction by a fine not exceeding $1,000 or imprisonment for a period not exceeding 3 months, or both..

Bribery, &c.

58. Section 129aa of the Principal Act is amended—

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

(1a) A person who, being a practitioner, without reasonable excuse, asks, receives or obtains, or agrees to receive or obtain, any property, benefit or advantage of any kind for himself or any other person from a proprietor of a private hospital or from a person acting


on behalf of such a proprietor on the understanding that the first-mentioned person will, in any manner, do any act or thing the purpose of which is, or the effect of which will be, to enable a person to be admitted as an in-patient in the hospital, being an in-patient in respect of whom a benefit is payable by a registered organization or an amount of daily bed payment is payable under section 33, is guilty of an offence against this section.

(1b) A person who, being a proprietor or one of the proprietors of a private hospital or a person acting on behalf of such a proprietor, in order to influence or affect a practitioner in the doing of any act or thing the purpose of which is, or the effect of which will be, to enable a person to be admitted as an in-patient in the hospital, being an in-patient in respect of whom a benefit is payable by a registered organization or an amount of daily bed payment is payable under section 33, without reasonable excuse, gives or confers, or agrees to give or confer, to or on the practitioner or any other person any property, benefit or advantage of any kind, is guilty of an offence against this section.;

(b) by inserting after sub-section (5) the following sub-sections:

(5a) Where a person is convicted of an offence against this section by virtue of sub-section (1a) or (1b) in relation to the admission of a person as an in-patient in a hospital, the court may, in addition to imposing a penalty in respect of the offence—

(a) order him to pay to the Commonwealth an amount equal to the sum of any amounts paid by way of daily bed payments under section 33 in respect of that in-patient; or

(b) order him to pay to a registered organization an amount equal to the sum of any benefits paid by the registered organization in respect of that in-patient.

(5b) Where a person is liable to pay an amount to the Commonwealth under sub-section (5a), the amount may be deducted from any other amount that is payable to the person under this Act or the National Health Act 1953 and, where an amount is so deducted, the other amount shall, notwithstanding the deduction, be deemed to have been paid in full to the person.; and

(c) by omitting from sub-section (6) the definition of pathology service and substituting the following definitions:

“‘pathology service means a pathology service in respect of which a medicare benefit has been paid or may become payable;

proprietor, in relation to a private hospital, means the proprietor, as defined by sub-section 3 (1), of the premises occupied by the hospital..


Officers to observe secrecy

59. Section 130 of the Principal Act is amended—

(a) by inserting in sub-sections (3), (6) and (7) or the General Manager of the Commission after Permanent Head (wherever occurring); and

(b) by inserting in sub-section (5) , by the Commission after the Commonwealth.

Repeal of sections 130c and 130d

60. Sections 130c and 130d of the Principal Act are repealed.

Delegation

61. Section 131 of the Principal Act is amended—

(a) by omitting from sub-section (1) of the Department of Health; and

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

(4) In this section, officer means—

(a) an officer of the Department;

(b) a member of the Commission; or

(c) a member of the staff of the Commission referred to in sub-section 28 (1) of the Health Insurance Commission Act 1973..

Regulations

62. Section 133 of the Principal Act is amended by inserting after sub-section (1) the following sub-section:

(1a) In sub-section (1), the expressions private hospital and proprietor have the same meaning as in Part III..

Consequential amendments

63. The Principal Act is amended as set out in Schedule 1.

Insertion of new Schedule 2

64. The Principal Act is amended by adding at the end thereof the Schedule set out in Schedule 2 to this Act.

PART III—AMENDMENTS OF THE HEALTH INSURANCE COMMISSION ACT 1973

Principal Act

65. The Health Insurance Commission Act 19732 is in this Part referred to as the Principal Act.


Interpretation

66. Section 3 of the Principal Act is amended—

(a) by adding at the end of the definition of function or by or under any other Act;

(b) by omitting this Act from the definition of power and substituting or under this Act or by or under any other Act; and

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

(2) In this Act—

(a) a reference to the medicare functions of the Commission is a reference to the functions referred to in section 5;

(b) a reference to the medibank private functions of the Commission is a reference to the functions conferred on the Commission by Part IIa;

(c) a reference to medicare expenditure of the Commission is a reference to—

(i) expenditure of the Commission wholly and exclusively related to the medicare functions of the Commission; and

(ii) expenditure that is, under sub-section 34c (2), to be treated as wholly and exclusively related to the medicare functions of the Commission; and

(d) a reference to medibank private expenditure of the Commission is a reference to—

(i) expenditure of the Commission wholly and exclusively related to the medibank private functions of the Commission; and

(ii) expenditure of the Commission that is, under sub-section 34c (2), to be treated as wholly and exclusively related to the medibank private functions of the Commission..

67. (1) After section 4 of the Principal Act the following section is inserted in Part II:

Medicare functions of Commission

5. The medicare functions of the Commission are—

(a) the planning and establishment of the organization required to enable the Commission to perform the functions that will, on and after 1 February 1984, be conferred on it by or under the Health Insurance Act 1973; and

(b) on and after that date, such functions as are conferred on the Commission by or under the Health Insurance Act 1973.

(2) All payments made, and other acts and things done, by or on behalf of the Commission or the Commonwealth on or after 29 June 1983 and before the commencement of this section in relation to the planning and establishment by


the Commission of the organization required to administer a health insurance scheme to provide benefits in respect of medical, optometrical, dental and pathology services to all Australian residents, being Australian residents within the meaning of the Health Insurance Act 1973, shall be deemed to have been lawfully made and done.

Medibank, private functions

68. Section 8a of the Principal Act is amended—

(a) by omitting from sub-section (1) are to conduct a medical benefits fund or a hospital benefits fund or both, and substituting include the functions of conducting a health benefits fund;

(b) by omitting from sub-section (2) medical benefits fund or a hospital and substituting health; and

(c) by omitting sub-section (3).

Application of National Health Act and Health Insurance Act

69. Section 8b of the Principal Act is amended—

(a) by omitting from sub-section (2) medical benefits organization, or as a registered hospital and substituting health; and

(b) by omitting from sub-section (2) all the words after other and substituting registered health benefits organization.

Additional functions relating to health matters

70. Section 8c of the Principal Act is amended by omitting Part IIa and substituting Parts II and IIa.

Prescribed functions

71. (1) Section 8e of the Principal Act is amended by adding at the end of sub-section (1) and such functions in relation to other matters relating to health as are prescribed..

(2) Regulation 3 of the Health Insurance Commission Regulations is repealed.

Delegation

72. Section 8h of the Principal Act is amended—

(a) by omitting from sub-section (1) any of its powers under this Act and substituting all or any of its powers under this Act or under any other law of the Commonwealth; and

(b) by inserting in sub-section (2) or that other law, as the case may be after this Act.

73. After section 8h of the Principal Act the following section is inserted in Part IIc:

Directions by Minister

8j. (1) The Commission, in performing its functions or exercising its powers, is subject to any written directions given by the Minister.


(2) A direction received by the Commission under sub-section (1) shall be set out in the report of the Commission under section 42 with respect to its operations during the year in which the direction was received.

(3) Sections 48, 49, 49a and 50 of the Acts Interpretation Act 1901 apply in relation to directions under sub-section (1) as if in those sections references to regulations were references to directions, references to a regulation were references to a direction and references to a repeal were references to a revocation..

Constitution of Commission

74. (1) Section 10 of the Principal Act is amended by omitting from paragraph (1) (c) 5 and substituting 7.

(2) The amendment made by sub-section (1) does not affect the appointment of a member of the Commission holding office immediately before the commencement of that sub-section.

75. Section 15 of the Principal Act is repealed and the following section is substituted:

Disclosure of interests

15. (1) A Commissioner who has a direct or indirect pecuniary interest in a matter being considered or about to be considered by the Commission shall, as soon as possible after the relevant facts have come to his knowledge, disclose the nature of his interest at a meeting of the Commission.

(2) A disclosure under sub-section (1) shall be recorded in the minutes of the meeting of the Commission and the Commissioner shall not, unless the Minister otherwise directs—

(a) be present during any deliberation of the Commission with respect to that matter; or

(b) take part in any decision of the Commission with respect to that matter..

Termination of appointment of part-time Commissioner

76. Section 17 of the Principal Act is amended by inserting in paragraph (2) (b) , without reasonable excuse, after fails.

Termination of appointment of General Manager

77. Section 26 of the Principal Act is amended by inserting in paragraph (2) (b) , without reasonable excuse, after fails.

Moneys to be paid to the Commission for purposes of Part II or IIb

78. Section 33 of the Principal Act is amended by omitting a function and substituting the medicare functions of the Commission or any additional functions that are conferred on it.

79. After section 33 of the Principal Act the following section is inserted:


Estimates

34. (1) The Commission shall prepare estimates, in such form as the Minister directs, of receipts and expenditure of the Commission related to the performance of its medicare functions for each financial year and, if the Minister so directs, for any other period specified by the Minister, and the Commission shall submit estimates so prepared to the Minister not later than such date as the Minister directs.

(2) Moneys of the Commission shall not be expended by way of medicare expenditure of the Commission otherwise than in accordance with estimates of expenditure approved by the Minister..

Financial policy concerning medibank private functions

80. Section 34a of the Principal Act is amended by omitting from sub-section (1) functions (first occurring) and substituting medibank private functions.

81. After section 34a of the Principal Act the following sections are inserted:

Apportionment of assets of Commission

34b. (1) The Commission shall, from time to time, by instrument in writing—

(a) identify assets of, or in the custody of, the Commission as assets held by the Commission primarily for the performance of its medicare functions; and

(b) identify assets of, or in the custody of, the Commission as assets held by the Commission primarily for the performance of its medibank private functions.

(2) The Minister shall, by writing signed by him, determine principles for fixing, in relation to any asset of the Commission that is or might be used by the Commission in the performance of both its medicare functions and its medibank private functions, a rental for the use of that asset.

(3) Where the Commission, in the performance of its medicare functions, uses during any period an asset that has been identified under sub-section (1) as an asset held by the Commission primarily for the performance of its medibank private functions, the Commission shall cause to be withdrawn from an account maintained by it under sub-section 35 (1) and paid into an account maintained by it under sub-section 35 (2) such amounts as are from time to time determined by the Commission, in accordance with the principles determined by the Minister under sub-section (2), to represent the rental in relation to that use of that asset during that period.

(4) Where the Commission, in the performance of the medibank private functions, uses during any period an asset that has been identified under sub-section (1) as an asset held by the Commission primarily for the performance of its medicare functions, the Commission shall cause to be


withdrawn from an account maintained by it under sub-section 35 (2) and paid into an account maintained by it under sub-section 35 (1) such amounts as are from time to time determined by the Commission, in accordance with the principles determined by the Minister under sub-section (2), to represent the rental in relation to that use of that asset during that period.

Apportionment of expenditure of Commission

34c. (1) The Minister shall, by writing signed by him, determine principles in accordance with which there may be ascertained, in respect of expenditure of the Commission related to the performance of both its medicare functions and its medibank private functions, the amount of that expenditure that is to be treated, for the purposes of this Act, as expenditure wholly and exclusively related to the performance of its medicare functions and the amount of that expenditure that is to be treated, for the purposes of this Act, as expenditure wholly and exclusively related to the performance of its medibank private functions.

(2) The Commission shall, in respect of expenditure of the Commission related to the performance of both its medicare functions and its medibank private functions—

(a) ascertain, in accordance with the principles applicable under sub-section (1), the amount of that expenditure that is to be treated as expenditure wholly and exclusively related to the performance of its medicare functions and treat the amount so ascertained as expenditure of that kind for the purposes of this Act; and

(b) ascertain, in accordance with the principles applicable under sub-section (1), the amount of that expenditure that is to be treated as expenditure wholly and exclusively related to the performance of its medibank private functions and treat the amount so ascertained as expenditure of that kind for the purposes of this Act.

(3) For the purposes of the National Health Act 1953, an amount that is to be treated in the manner referred to in paragraph (2) (b) shall be deemed to be an amount of costs incurred by the Commission in carrying on business as a registered health benefits organization.

(4) In this section, a reference to expenditure includes a reference to provision for expenditure..

82. Section 35 of the Principal Act is repealed and the following section is substituted:

Bank accounts

35. (1) The Commission shall open and maintain with an approved bank or approved banks an account or accounts for the purpose of the performance of its medicare functions.


(2) The Commission shall open and maintain with an approved bank or approved banks an account or accounts for the purposes of the performance of its medibank private functions.

(3) The Commission shall pay into an account or accounts maintained by it under, sub-section (1) all moneys paid to the Commission in connection with its medicare functions and, subject to sub-section (5), shall not withdraw from such an account any moneys other than amounts required to be expended in connection with those functions.

(4) The Commission shall pay into an account or accounts maintained by it under sub-section (2) all moneys paid to the Commission in connection with the performance of its medibank private functions and, subject to sub-section (5), shall not withdraw from such an account any moneys other than amounts required to be expended in connection with those functions.

(5) Where moneys are required for expenditure by the Commission in connection with the performance of both its medicare functions and its medibank private functions—

(a) the Commission may withdraw those moneys from an account maintained by it under sub-section (1), but, if it does so, shall, as soon as practicable, withdraw from an account maintained by it under sub-section (2) an amount equal to the amount of that expenditure that is to be treated, for the purposes of this Act, as expenditure wholly and exclusively related to the performance of its medibank private functions and pay that amount into an account maintained by it under sub-section (1); or

(b) the Commission may withdraw those moneys from an account maintained by it under sub-section (2), but, if it does so, shall, as soon as practicable, withdraw from an account maintained by it under sub-section (1) an amount equal to the amount of that expenditure that is to be treated, for the purposes of this Act, as expenditure wholly and exclusively related to the performance of its medicare functions and pay that amount into an account maintained by it under sub-section (2).

(6) A reference in a provision of this section to an approved bank is a reference to a bank approved for the purposes of that provision by the Treasurer, or by a person who has been authorized by the Treasurer to give approvals under section 63d of the Audit Act 1901.

Borrowing and investment by Commission

83. (1) Section 36 of the Principal Act is amended—

(a) by omitting from sub-section (1) its own and substituting any;

(b) by omitting from sub-section (2) functions and substituting medibank private functions;

(c) by omitting from sub-section (5) functions and substituting medibank private functions; and


(d) by omitting sub-section (6) and substituting the following sub-section:

(6) Moneys held by the Commission for the performance of its medicare functions that are not immediately required by the Commission for the performance of those functions, may be invested by the Commission—

(a) on deposit with an approved bank within the meaning of sub-section 63e(2) of the Audit Act 1901;

(b) in Commonwealth securities; or

(c) in any other manner approved by the Treasurer,

and any income derived from investments so made shall be paid to the Commonwealth..

(2) Section 36 of the Principal Act is amended by inserting before sub-section (7) the following sub-sections:

(6a) Where moneys held by the Commission for the performance of its medibank private functions are not immediately required by the Commission for the performance of those functions, the moneys may be invested by the Commission in such manner as the Commission considers fit and any income derived from investments so made shall be apportioned between the health benefits funds conducted by it in accordance with principles in force under sub-section (6b).

(6b) The Minister shall, by writing signed by him, determine principles in accordance with which there may be ascertained, in respect of income derived from investments made in pursuance of sub-section (6a), the proportion or amount (if any) of that income that should be apportioned by the Commission to each health benefits fund conducted by it.

(6c) Sub-sections (6a) and (6b) have effect notwithstanding anything contained in the National Health Act 1953.

(3) Any investments made before 1 February 1984 under sub-section 36 (6) of the Principal Act shall be treated, on and after that date, as if they had been made under and in accordance with sub-section 36(6a) of the Principal Act as amended by this Act.

Advances by the Commonwealth

84. (1) Section 36a of the Principal Act is amended by omitting from sub-section (1) establish and conduct medical benefit funds and hospital and substitute conduct health.

(2) Any advance made by the Minister for Finance to the Commission under sub-section 36a(1) of the Principal Act shall be deemed to have been made for the purpose of assisting the Commission to conduct health benefits funds.

85. Before section 42 of the Principal Act the following sections are inserted in Part VI:


Delegation of powers by Minister

41a. (1) The Minister may, either generally or as otherwise provided by the instrument of delegation, by writing signed by him, delegate to any person all or any of his powers under this Act, other than this power of delegation.

(2) A power so delegated, when exercised by the delegate shall, for the purposes of this Act, be deemed to have been exercised by the Minister.

(3) A delegation under this section does not prevent the exercise of a power by the Minister.

Modification of provisions to accommodate additional functions

41b. (1) Where functions are, after the commencement of this section, conferred upon the Commission under Part IIb, the regulations may make provision for modifications of the provisions of Part V and section 42 in or in connection with their application to the activities of the Commission in the performance of those functions.

(2) In sub-section (1), modification includes the alteration of a provision, the addition or omission of a provision or the substitution of a new provision for an existing provision.

Protection of the ‘medicare’ name and symbol

41c. (1) A person who—

(a) uses the name medicare, or a prescribed symbol, in connection with a business, trade, profession or occupation;

(b) sells, offers for sale, exposes for sale or lets for hire, or otherwise has in his possession for sale or hire, goods to which the name medicare or a prescribed symbol has been applied;

(c) uses the name medicare or a prescribed symbol in relation to goods or to the promotion, by any means, of the supply or use of goods; or

(d) imports into Australia for sale, or for use for the purposes of any business, trade, profession or occupation, any article to which the name medicare or a prescribed symbol has been applied outside Australia,

is guilty of an offence against this section.

(2) Where the name medicare or a prescribed symbol—

(a) is used as, or as part of, the name or emblem of an association;

(b) is used as, or as part of, the name or emblem of a newspaper or magazine owned by, or published by or on behalf of, an association; or

(c) is used by an association in connection with any activity of the association so as to imply that the association is in any way connected with the Commonwealth or the Commission,

then—

(d) if the association is a body corporate—the association; or


(e) if the association is not a body corporate—every member of the committee of management or other governing body of the association,

is guilty of an offence against this section.

(3) A person who is guilty of an offence against this section is punishable, upon conviction—

(a) in the case of a person not being a body corporate—by a fine not exceeding $2,000; or

(b) in the case of a person being a body corporate—by a fine not exceeding $4,000.

(4) The conviction of a person of an offence against this section in respect of the use of a name or prescribed symbol does not prevent a further conviction of that person in respect of the use of that name or prescribed symbol at any time after the first-mentioned conviction.

(5) For the purposes of this section—

(a) a reference to the name medicare shall be read as including a reference to a name or expression that so nearly resembles the name medicare as to be capable of being mistaken for the name medicare;

(b) a reference to an official medicare symbol shall be read as a reference to a symbol declared by the regulations to be an official medicare symbol;

(c) a reference to a prescribed symbol shall be read as a reference to an emblem, brand, design, symbol, logo or mark that—

(i) is identical with an official medicare symbol; or

(ii) so nearly resembles an official medicare symbol as to be capable of being mistaken for an official medicare symbol;

(d) a name or a prescribed symbol shall be deemed to be applied to goods if it—

(i) is woven in, impressed on, worked into or affixed to the goods; or

(ii) is applied to a covering, label, reel or thing in or with which the goods are supplied;

(e) a name or a prescribed symbol shall be deemed to be used in relation to goods, or to the promotion of the supply or use of goods, if it is used in a sign, advertisement (whether printed, broadcast or televised), invoice, catalogue, price list or other document in relation to goods; and

(f) the reference in paragraph (d) to a covering includes a reference to a stopper, glass, bottle, vessel, box, capsule, case, frame or wrapper and the reference in that paragraph to a label includes a reference to a band or ticket.

(6) Proceedings under this section shall not be instituted without the consent in writing of the Attorney-General.


(7) Subject to sub-section (9), nothing in this section affects any rights conferred by law on a person in respect of—

(a) a trade mark registered under the Trade Marks Act 1955, being a trade mark that was so registered before the date of commencement of this section; or

(b) a design registered under the Designs Act 1906, being a design that was so registered before the commencement of this section.

(8) Subject to sub-section (9), nothing in this section affects the use, or any rights conferred by law relating to the use, of a name or a symbol on or after the date of commencement of this section if—

(a) within the prescribed period before that date, the person used the name or symbol in good faith in a manner mentioned in sub-section (1) or (2); or

(b) immediately before that date the person would have been entitled to prevent another person from passing off, by means of the use of that name or symbol or of a similar name or symbol, goods or services as the goods or services of that first-mentioned person.

(9) No action or proceeding, whether criminal or civil, lies against the Commonwealth or the Commission for or in relation to the use by the Commonwealth or the Commission of the name medicare or of an official medicare symbol.

(10) To the extent that sub-section (9) results in an acquisition of property from any person, the Commonwealth is liable to pay to that person such compensation as is agreed upon between them or, in default of agreement, as is determined by the Federal Court of Australia.

(11) The Federal Court of Australia has jurisdiction with respect of matters arising under sub-section (10).

Forfeiture of articles, &c.

41d. All articles or goods by means of which, or in relation to which, an offence against sub-section 41c (1) is committed are forfeited to the Commonwealth.

Sections 41c and 41d not to limit other laws

41e. The provisions of sections 41c and 41d are in addition to, and not in substitution for, the provisions of any other law (whether a law of the Commonwealth or a law of a State or Territory) that confers rights or powers on the Commonwealth or the Commission, including, but without limiting the generality of the foregoing, rights or powers to institute civil or criminal proceedings for the protection of the property or interests of the Commonwealth or of the Commission..


Annual report of Commission

86. Section 42 of the Principal Act is amended by inserting after sub-section (2) the following sub-section:

(3) The Commission shall include in its report under sub-section (1) in respect of the year ending on 30 June 1984 and in its report in respect of each subsequent year—

(a) the principles that were applicable in accordance with sub-sections 34b (2), 34c (1) and 36 (6b) during the year; and

(b) a statement as to whether those principles differed from the principles that were applicable in the preceding year, and, if they differed, as to the manner in which they differed..

Certain functions performed before Royal Assent

87. (1) Where, at any time during the period commencing on 29 June 1983 and ending on the day immediately preceding the date of commencement of this section—

(a) any moneys of the Commission, not being moneys that were paid to the Commission under section 33 of the Principal Act, were expended in connection with the performance of medicare planning operations of the Commission and the medibank private functions of the Commission—the Commission shall cause an amount equal to so much of the total amount so expended as the Minister, by writing signed by him, determines to have been expended in connection with the performance of medicare planning operations to be withdrawn from an account maintained by it under sub-section 35 (1) of the Principal Act as amended by this Act and paid by it into an account maintained by it under sub-section 35 (2) of the Principal Act as so amended;

(b) the Commission, in the performance of the medicare planning operations of the Commission, used an asset of, or in the custody of, the Commission that is subsequently identified under section 34b of the Principal Act as amended by this Act as an asset primarily held by the Commission for the performance of its medibank private functions—the Commission shall cause an amount that the Minister determines, by writing signed by him, to be appropriate, having regard to principles of the kind determined by him under section 34b of the Principal Act as amended by this Act in relation to the use of assets, to be withdrawn from an account maintained by it under sub-section 35 (1) of the Principal Act as so amended and paid by it into an account maintained by it under sub-section 35 (2) of the Principal Act as so amended; and

(c) the Commission, in the performance of its medibank private functions, used an asset of, or in the custody of, the Commission that is subsequently identified under section 34b of the Principal Act as amended by this Act as an asset primarily held by the Commission for the performance of its medicare functions—the Commission shall cause an amount that the Minister, by writing signed by him,


determines to be appropriate, having regard to principles of the kind determined by him under section 34b of the Principal Act as amended by this Act in relation to the use of assets, to be withdrawn from an account maintained by it under sub-section 35 (2) of the Principal Act as so amended and paid by it into an account maintained by it under sub-section 35 (1) of the Principal Act as so amended.

(2) The report of the Commission under sub-section 42 (1) of the Principal Act as amended by this Act in respect of the year ending on 30 June 1984 shall set out the determinations made by the Minister under sub-section (1) of this section.

(3) If, before the commencement of this section, the Commission has opened an account to hold moneys paid to it in relation to medicare planning operations of the Commission, it shall, as soon as practicable after the commencement of this section, cause the moneys standing to the credit of that account to be transferred to an account maintained by it under sub-section 35 (1) of the Principal Act as amended by this Act.

(4) Section 41a of the Health Insurance Commission Act 1973 applies in relation to the Ministers powers under this section in like manner as it applies in relation to the Ministers powers under that Act.

(5) In this section, a reference to the medicare planning operations of the Commission is a reference to the planning and establishment by the Commission of the organization referred to in sub-section 67 (2).

PART IV—AMENDMENTS OF THE NATIONAL HEALTH ACT 1953

Principal Act

88. The National Health Act 19533 is in this Part referred to as the Principal Act.

Interpretation

89. (1) Section 4 of the Principal Act is amended—

(a) by inserting after the definition of basic hospital benefits table or basic table the following definition:

“‘basic private table or basic table, in relation to a registered health benefits organization, means a table that incorporates a range of benefits of the following kinds and no other benefits:

(a) in respect of hospital treatment provided to persons as in-patients in a hospital in the State or Territory to which the table relates, being patients who are not nursing-home type patients—benefits equal to the amount of the standard hospital fees in relation to that State or Territory;


(b) in respect of hospital treatment provided to persons as in-patients in a hospital other than a private hospital in the State or Territory to which the table relates, being nursing-home type patients—benefits equal to the amount of the standard hospital fees in relation to that State or Territory less the amount of the patient contribution in relation to that patient for each day on which that patient is an in-patient in the hospital;

(c) in respect of hospital treatment provided to persons as in-patients in a private hospital in a State or Territory to which the table relates, being nursing-home type patients—

(i) an amount equal to the fees or charges incurred in respect of the hospital treatment for the patient concerned (excluding any amount of daily bed payment payable to the hospital in respect of the patient concerned in accordance with section 33 of the Health Insurance Act 1973) less the amount of the patient contribution in relation to the patient concerned for each day on which that patient was an in-patient in the hospital; or

(ii) the amount of the standard hospital fees in relation to that State or Territory,

whichever is the lesser amount;

(d) in respect of hospital treatment provided to persons as in-patients in a hospital in a State or Territory (other than the State or Territory to which the table relates)—benefits equal to—

(i) an amount of benefits, calculated in accordance with paragraph (a), (b) or (c), whichever is appropriate, on the basis that the hospital is situated in the State or Territory to which the table relates; or

(ii) an amount of benefits, calculated in accordance with paragraph (a), (b) or (c), whichever is appropriate, on the basis that the table relates to the State or Territory in which the hospital is situated,

whichever is the greater amount;

(e) such other benefits (if any) as are prescribed for the purposes of this definition;;

(b) by inserting in the definition of contributor in sub-section (1) a health benefits fund, after in relation to;

(c) by inserting in the definition of dependant (first occurring) in sub-section (1) a health benefits fund, after contributor to;


(d) by inserting in the definition of organization in sub-section (1) a health benefits fund, after conducts;

(e) by inserting after the definition of records in sub-section (1) the following definition:

“‘registered health benefits organization means an organization registered under Part VI for the purpose of conducting a health benefits fund or health benefits funds;; and

(f) by inserting after the definition of restricted membership organization in sub-section (1) the following definition:

“‘supplementary hospital table, in relation to a registered health benefits organization, means a table of benefits that—

(a) is not a basic table; and

(b) includes benefits in respect of—

(i) the provision of hospital treatment in a single room in a hospital other than a private hospital; or

(ii) the provision of hospital treatment in a private hospital;.

(2) Section 4 of the Principal Act is amended by adding at the end thereof the following sub-section:

(6) In this Act, unless the contrary intention appears, a reference to a hospital benefits fund, a medical benefits fund, or a health benefits fund, conducted by a registered organization in respect of a State or Territory shall, in relation to a restricted membership organization registered in respect of that State or Territory, be read as including a reference to the hospital benefits fund, medical benefits fund or health benefits fund, as the case may be, conducted by that organization in respect of that State or Territory and every other State or Territory in respect of which the organization is registered..

Waiting period

90. Section 4a of the Principal Act is amended by adding at the end thereof the following sub-section:

(2a) Where, in accordance with the rules of a registered health benefits organization, a contributor to a health benefits fund conducted by the organization, being a contributor in accordance with the basic table or the supplementary hospital table in relation to that organization, is not entitled to fund benefits in respect of services, treatment or care if rendered or given before the expiration of a specified period commencing on the date on which he becomes a contributor for benefits in accordance with that table, that specified period shall be deemed to be a waiting period for the purposes of this Act in relation to that contributor..

Interpretation

91. Section 12 of the Principal Act is amended by omitting from paragraph (2) (b) (ii) approved under section 24 of the Health Insurance Act 1973.


Travel allowance

92. Section 17 of the Principal Act is amended by omitting from sub-paragraph (5) (b) (i) 30 and substituting 23f.

Heading to Part VI

93. The heading to Part VI of the Principal Act is omitted and the following heading is substituted:

“PART VI—HEALTH BENEFITS ORGANIZATIONS”.

Interpretation

94. Section 66 of the Principal Act is amended—

(a) by omitting from sub-section (1) the definition of ordinary contributor; and

(b) by inserting after sub-section (4) the following sub-section:

(5) For the purposes of this Part, a registered health benefits organization shall be deemed to carry on business as a registered health benefits organization in a State or Territory if, for the purposes of, or purposes related to, the enrolment of contributors to a health benefits fund conducted by it or the payment of benefits to such contributors—

(a) it uses premises in that State or Territory; or

(b) it uses, in that State or Territory, the services of a servant or agent..

Applications by organizations for registration as hospital benefits organizations

95. (1) Section 67 of the Principal Act is repealed.

(2) An application under section 67 of the Principal Act that had been lodged before the date of commencement of this section but had not been finally dealt with before that date shall be deemed, for the purposes of the Principal Act as amended by this Act, to have been withdrawn on that date.

Applications by organizations for registration as health benefits organizations

96. (1) Section 68 of the Principal Act is amended—

(a) by omitting from sub-section (1) hospital benefits and substituting health benefits;

(b) by omitting from sub-section (2) hospital benefits (first, second, third and fourth occurring) and substituting health benefits;

(c) by omitting from sub-paragraph (2) (c) (v) Hospital Benefits and substituting Health Benefits;

(d) by omitting from sub-paragraph (2) (c) (vi) (whether a medical benefits fund or a hospital benefits fund);

(e) by omitting from sub-section (3) hospital benefits (wherever occurring) and substituting health benefits;


(f) by omitting from sub-section (4) hospital benefits (first, second, third and fourth occurring) and substituting health benefits;

(g) by adding at the end of sub-paragraph (4) (c) (iii) or;

(h) by omitting from sub-paragraph (4) (c) (iv) Hospital Benefits and substituting Health Benefits;

(j) by omitting from sub-paragraph (4) (c) (iv) or; and

(k) by omitting sub-paragraph (4) (c) (v).

(2) An application under section 68 of the Principal Act that had been lodged before the date of commencement of this section but that had not been finally dealt with before that date shall be deemed, for all purposes of the Principal Act as amended by this Act, to have been withdrawn on that date.

97. After section 68 of the Principal Act the following section is inserted:

Special procedures for dealing with certain applications under section 68

68a. Where an application under section 68 for registration as a registered health benefits organization in respect of a State or Territory is made before 1 December 1983 or such later date as the Minister, upon application made to him before 1 December 1983, in special circumstances, allows and the organization making the application is, at the time of the making of the application, a registered hospital benefits organization or a registered medical benefits organization, or both, in respect of that State or Territory—

(a) the manner and form in which that application is to be lodged shall be determined by the Minister by notice in writing published in the Gazette;

(b) the Minister may refuse to consider that application unless the organization furnishes to him, in support of that application, such documents and information, including documents and information concerning the constitution, the articles of association, or the rules, of the organization as he, by notice in writing served, either personally or by post, on the public officer of the organization, requires;

(c) the organization is not eligible to be so registered unless the rules of the organization make such provision, in relation to the contributors to a medical benefits fund or a hospital benefits fund conducted by the organization in respect of that State or Territory, as the Minister, by notice in writing published in the Gazette, determines; and

(d) sections 69, 70, 71, 72 and 72a do not apply to or in relation to that application..

Registration

98. (1) Section 73 of the Principal Act is amended—

(a) by inserting in sub-section (1) in relation to an application under section 68 other than an application to which section 68a relates after the Committee;

(b) by omitting from sub-section (1) and, if he grants the application, he shall register the organization accordingly;


(c) by omitting sub-section (2) and substituting the following sub-sections:

(2) Where an organization makes an application to which section 68a relates and the Minister—

(a) is satisfied that the organization is eligible to make that application; and

(b) having regard to the matters referred to in paragraphs 72a (a), (c), (d) and (e), considers it appropriate to do so,

the Minister shall grant the application, subject to such terms and conditions (if any) as he thinks fit, and, in any other case, he shall refuse the application.

(2aa) For the purposes of sub-sections (1) and (2), there shall be a register called The Register of Health Benefits Organizations and, where the Minister, under sub-section (1) or (2), grants an application, the name of the applicant organization and such other particulars as are prescribed shall be entered forthwith upon the register and the organization shall be taken to be registered with effect from 1 February 1984 or the date on which the organization made the application, whichever is the later.

(2ab) Where the Minister determines, under sub-section (1) or (2) that the registration of an organization as a registered health benefits fund shall be subject to terms and conditions, that registration shall be taken to be subject to those terms and conditions with effect from the date from which the registration of the organization is to be taken to have effect.

(2ac) Notwithstanding the grant under sub-section (2) of an application for registration of an organization as a registered health benefits organization in respect of a State or of the Northern Territory, the registration of that organization as a registered health benefits organization in respect of the State or Territory shall not come into effect if, before 1 February 1984, an application is made to the Federal Court of Australia under section 82z or 82zg in relation to any fund conducted by that organization under this Act in respect of that State or Territory.;

(d) by omitting from sub-section (3) a register and substituting the register; and

(e) by omitting from sub-section (4) A register and substituting The register.

(2) Notwithstanding the amendments of the Principal Act made by sub-section (1)—

(a) an organization that was, immediately before the date upon which this Act receives the Royal Assent, a registered medical benefits organization or a registered hospital benefits organization continues to be a registered medical benefits organization or registered hospital benefits organization until the registration of that organization as a registered medical benefits organization or registered hospital benefits


organization, as the case may be, is cancelled under section 73aa or 79 of the National Health Act 1953; and

(b) the terms and conditions to which the registration of that organization as a registered medical benefits organization or as a registered hospital benefits organization was subject under section 73 of the Principal Act as in force immediately before the date on which this Act receives the Royal Assent continue, subject to the provisions of this Act and to the regulations, to be conditions to which that registration is subject until the organization ceases to be a registered medical benefits organization or a registered hospital benefits organization, as the case may be.

99. After section 73a of the Principal Act the following section is inserted:

Effect of a grant of registration under sub-section 73 (2)

73aa. Where an organization becomes, by reason of the Minister having granted under sub-section 73 (2) an application under section 68, a registered health benefits organization in respect of a State or the Northern Territory with effect from 1 February 1984, and that organization was, immediately before that date, a registered hospital benefits organization, a registered medical benefits organization, or both, in respect of that State or Territory, then, by force of this section—

(a) the registration of that organization as a registered hospital benefits organization, as a registered medical benefits organization, or as both a registered hospital benefits organization and a registered medical benefits organization, in respect of that State or Territory, shall be taken to have been cancelled on that date but the hospital benefits fund, the medical benefits fund, or both the hospital benefits fund and the medical benefits fund, as the case requires, conducted by that organization in respect of that State or Territory shall not be wound up;

(b) the assets of the hospital benefits fund, of the medical benefits fund or of both the hospital benefits fund and the medical benefits fund, as the case requires, conducted by the organization in respect of that State or Territory shall, with effect from that date, constitute the initial assets of the health benefits fund that, under the rules of the organization, is to be conducted by the organization in respect of that State or Territory; and

(c) the organization shall become liable, with effect from that date, to meet from the health benefits fund conducted by it in respect of that State or Territory all the liabilities, whether present or contingent, which, if the hospital benefits fund, the medical benefits fund, or both the hospital benefits fund and the medical benefits fund, conducted by it in respect of that State or Territory, as the case requires, had continued to be conducted, the organization would have been required to meet from one or other of those funds..


Conditions of registration

100. (1) Section 73ba of the Principal Act is amended by omitting shall, whether the registration was effected before, or is effected after, the commencement of this section and substituting as a registered health benefits organization shall, with effect from the date of its registration.

(2) Notwithstanding the amendment made by sub-section (1), the conditions to which registration of an organization as a registered medical benefits organization or as a registered hospital benefits organization was subject under section 73ba of the Principal Act immediately before the date on which this Act receives Royal Assent shall continue to be conditions to which that registration is subject until the cancellation of that registration under section 73aa or 79 of the Principal Act as amended by this Act and, in the case of such an organization that becomes a registered health benefits organization, shall, subject to the regulations, continue to be conditions to which that registration is subject in relation to any health insurance business carried on by it that relates to matters that took place before 1 February 1984.

101. After section 73ba of the Principal Act the following sections are inserted:

Registered organization not to carry on other business, &c.

73baa. (1) It is a condition of registration of a registered health benefits organization, other than a friendly society, that it shall not carry on any business other than business as a registered organization.

(2) Where a registered health benefits organization, being a friendly society, carries on a business other than business as a registered organization, it is a condition of registration of the organization that moneys standing to the credit of a health benefits fund conducted by it shall not be invested in the first-mentioned business.

Minimum reserves

73bab (1) It is a condition of registration of a registered health benefits organization that the value of the assets of a health benefits fund conducted by the organization shall at all times exceed the sum of—

(a) the amount (if any) by which the sum of the amounts debited to that fund during the last preceding prescribed period of the organization exceeds the amount of income received during that period from assets of that fund consisting of investments;

(b) the liabilities that are required to be met out of the fund;

(c) the amount of any subsisting guarantee, not falling within paragraph (b), given by the organization in relation to a prescribed company or, if the organization conducts 2 or more funds, so much of that amount as the Minister, by instrument in writing, determines; and

(d) the amount equal to the sum of the amounts of payments by way of calls in respect of shares in a prescribed company, not falling within paragraph (b), that the organization is, or could become, liable to pay


or, if the organization conducts 2 or more funds, so much of that amount as the Minister, by instrument in writing, determines.

(2) A reference in this section to the assets of a health benefits fund conducted by a registered organization does not include a reference to—

(a) a loan to, debenture of, or share in, a prescribed company;

(b) an asset that is mortgaged or charged for the benefit of a prescribed company to the extent that it is so mortgaged or charged; or

(c) a loan to a person who, when the loan was made, was a director of a prescribed company.

(3) In this section—

debenture, in relation to a company, includes debenture, stock, bonds, notes and any other securities of the company whether constituting a charge on the assets of the company or not;

prescribed company, in relation to a registered organization, means—

(a) a company in which the organization has a controlling interest or in which the organization and another registered organization or other registered organizations together have a controlling interest; or

(b) a company (not being the organization) that is related to a company referred to in paragraph (a),

but does not include another registered organization;

prescribed period, in relation to a registered organization, means a period of 2 months ending on the last day of any month of the year;

share, in relation to a company, means a share in the capital of the company, and includes stock.

(4) For the purposes of this section, the question whether companies are related to each other shall be determined in the same manner as the question whether corporations within the meaning of the Companies Act 1981 are related to each other would be determined under that Act.

Exemption from section 73baa or 73bab

73bac (1) Upon application in writing made to the Minister by a registered organization, the Minister may, by notice in writing served, either personally or by post, on the public officer of the organization, exempt the organization from compliance with all or any of the conditions referred to in sections 73baa and 73bab.

(2) An exemption under sub-section (1) in relation to a registered organization has effect—

(a) in respect of such period as is specified in the notice; and

(b) subject to such other terms and conditions (if any) as are specified in the notice,

and the Minister may, at any time, by direction in writing served, either personally or by post, on the public officer of the organization, revoke the exemption..


Reinsurance Account in health benefits funds

102. (1) Section 73bb of the Principal Act is amended—

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

(1) It is a condition of registration of a registered health benefits organization that, on and from the date of its registration, it shall establish and maintain a Reinsurance Account in the health benefits fund, or in each of the health benefits funds, from time to time conducted by it.;

(b) by omitting from sub-section (2) or an optional table;

(c) by omitting sub-sections (3), (4) and (5) and substituting the following sub-sections:

(3) Where, in any period of 12 months, the number of patient days of a contributor exceeds the prescribed number of patient days, this section applies to the contributor in respect of that period of 12 months.

(4) Where this section applies to a contributor in respect of a period of 12 months, the organization concerned may debit to the Reinsurance Account maintained by it in the health benefits fund concerned the amounts of any payments of any benefits made out of that fund in accordance with a basic table to the contributor in respect of any patient day during that period after the day in that period on which the prescribed number of patient days was reached, not being a patient day in respect of which an amount has been debited to the Reinsurance Account by reason of a previous application of this section.;

(d) by omitting sub-section (6);

(e) by omitting from sub-section (7) hospital benefits and substituting health benefits;

(f) by omitting sub-section (9);

(g) by inserting in sub-section (11), before the definition of hospital treatment, the following definition:

“‘basic table includes, in relation to a registered health benefits organization that was, immediately before 1 February 1984, a registered hospital benefits organization, the table that was the basic table in relation to that registered hospital benefits organization;;

(h) by omitting from sub-section (11) the definition of optional table; and

(j) by omitting from sub-section (12) hospital benefits (first occurring) and substituting health benefits.

(2) Notwithstanding the amendments made by sub-section (1), section 73bb of the Principal Act continues, subject to the regulations, to apply in relation to a registered hospital benefits organization.


Health Benefits Reinsurance Trust Fund

103. (1) Section 73bc of the Principal Act is amended—

(a) by omitting from sub-section (1) hospital benefits and substituting health benefits;

(b) by omitting from sub-section (2) Hospital Benefits and substituting Health Benefits;

(c) by omitting from sub-section (6) 1 October 1976 or the date of its registration, whichever is the later, and substituting the date of its registration,;

(d) by omitting from sub-sections (6), (8), (9), (10) and (12) hospital benefits (wherever occurring) and substituting health benefits; and

(e) by omitting from sub-section (13) Hospital Benefits and substituting Health Benefits.

(2) The Hospital Benefits Reinsurance Trust Fund in existence immediately before the commencement of this section pursuant to section 73bc of the Principal Act continues in existence under the name Health Benefits Reinsurance Trust Fund as if it had been established under section 73bc of the Principal Act as amended by this Act and the Trustees of the first-mentioned Fund continue to hold office as if they had been appointed under that last-mentioned section.

(3) Notwithstanding the amendments made by sub-section (1), section 73bc of the Principal Act continues to apply in relation to a registered hospital benefits organization, but, for the purposes of that section as so continuing to apply, a reference in that section to the Hospital Benefits Reinsurance Trust Fund shall be construed as a reference to the Health Benefits Reinsurance Trust Fund.

Remuneration and allowances of Trustees of Health Benefits Reinsurance Fund

104. Section 73bd of the Principal Act is amended by omitting Hospital Benefits and substituting Health Benefits.

Directions by Minister to registered organizations

105. (1) Section 73be of the Principal Act is amended—

(a) by omitting from paragraphs (1) (a), (b) and (c) medical benefits fund or a hospital and substituting health;

(b) by omitting from paragraph (1) (d) funds, being medical benefits funds or hospital benefits funds or a medical benefits fund and a hospital benefits fund, and substituting health benefits funds;

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

(2) The power to give a direction with respect to any matter referred to in sub-section (1) (including a matter prescribed for the purposes of paragraph (e) of that sub-section) includes a power to give such directions as the Minister considers necessary from time to time to achieve the objective of preventing, or reducing the extent of,


discrimination against some of the contributors to a health benefits fund conducted by a registered organization, where the discrimination is in the scope or level of benefits available to such contributors in respect of the hospitalization of persons in a hospital and is, in the opinion of the Minister, discrimination that is related to the question whether, having regard to the medical condition of the person hospitalized, such hospitalization is necessary, desirable or appropriate.; and

(d) by omitting from sub-section (3) an objective and substituting the objective.

(2) Notwithstanding the amendments made by sub-section (1), any directions given by the Minister under section 73be of the Principal Act continue in force, subject to the regulations, as if those amendments had not been made.

Minister may give directions to registered organizations concerning management practices

106. Section 73bea of the Principal Act is repealed.

Directions subject to Parliamentary disallowance

107. Section 73beb of the Principal Act is amended by omitting from sub-section (1) or given under section 73bea and substituting or served under sub-section 73bac (2).

Refusal to admit person as contributor on ground of health

108. Section 73bf of the Principal Act is amended by inserting a health benefits fund, before a medical benefits fund (wherever occurring).

Refusal of contributions of patients in institution

109. Section 73bfa of the Principal Act is amended by inserting a health benefits fund or before a hospital benefits fund (wherever occurring).

Directions to reinstate person as contributor to registered organization

110. Section 73bfb of the Principal Act is amended by adding at the end thereof the following sub-section:

(6) This section applies in relation to the status of a person as a contributor to a basic table of a health benefits fund in like manner as it applies in relation to the membership of a person as a contributor to a medical benefits fund..

Minister may require information to be furnished

111. Section 73bg of the Principal Act is repealed.

Directions by Minister

112. Section 73bh of the Principal Act is amended by inserting a registered health benefits organization, before a registered medical benefits organization.


Exemption of professional services and associated hospital treatment from basic table

113. (1) Section 73f of the Principal Act is amended—

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

(1) A registered organization may make application to the Minister for an exemption from the requirement to include in the basic table provided, or intended to be provided, for the benefit of contributors to a health benefits fund conducted, or to be conducted, by it—

(a) any benefits in respect of any day on which hospital treatment is provided to a person for the purpose of permitting the rendering to the person of a professional service, or professional services, of a kind or kinds specified in the application and no other professional service; and

(b) any benefits, other than benefits determined by the Permanent Head or the Minister under section 73g, in respect of any day on which the hospital treatment is provided to a person for the purpose of permitting the rendering to the person of a professional service, or professional services, of a kind or kinds specified in the application together with a professional service that is not a professional service of a kind specified in the application.;

(b) by omitting from paragraph (2b) (a) a basic table, to a medical benefits fund, or to a hospital benefits fund, and substituting the basic table, to a health benefits fund;

(c) by omitting from sub-section (2b) a basic table, in respect of the rendering of professional service, or the provision of hospital treatment and substituting the basic table, in respect of the provision of hospital treatment; and

(d) by omitting from sub-section (3) or as a registered hospital benefits organization, as the case may be.

(2) An exemption granted by the Minister before 1 February 1984 under section 73f of the Principal Act in respect of benefits contained in the basic hospital benefits table provided to contributors to a hospital benefits fund the assets of which become, by virtue of section 73aa, the initial assets of a health benefits fund with effect from 1 February 1984, shall have effect, on and after that date as if—

(a) section 73f of the Principal Act as amended by this Act had been in force at the time when the exemption was granted and the exemption had been granted under that section; and

(b) any period during which a person was a contributor to the basic hospital benefits table of the hospital benefits fund that is continuous with a period during which that person was a contributor to the basic table of the health benefits fund were a period of contribution to the basic table of the health benefits fund.


Determination of certain hospital benefits by Permanent Head

114. Section 73g of the Principal Act is amended by omitting from the definition of claim to which this section applies in sub-section (1) (sb) and substituting (p).

Conduct of health benefits funds

115. (1) Section 74b of the Principal Act is amended by omitting from paragraph (c) (7a) of section 73be and substituting 73beb (4).

(2) Section 74b of the Principal Act is amended by inserting health benefits fund, after conduct a.

Registered organization to keep records and furnish information

116. (1) Section 74c of the Principal Act is amended—

(a) by inserting in sub-section (1) health benefits fund, after any; and

(b) by omitting from sub-section (2) (k) and substituting (h).

(2) Notwithstanding the amendments made by sub-section (1), section 74c of the Principal Act continues in force, subject to the regulations, on and after that date in respect of the operation by a registered organization of any medical benefits fund or hospital benefits fund that was conducted by it before that date.

Examination of records, books and accounts of registered organizations

117. Section 75 of the Principal Act is amended by inserting in sub-section (6) 73aa or after under section.

Annual report by Permanent Head

118. Section 76a of the Principal Act is amended—

(a) by inserting in sub-section (2) health benefits fund, after each;

(b) by omitting from sub-section (2) or, if the fund includes a special account in respect of the part of the fund other than the special account; and

(c) by omitting sub-section (3).

Changes of rules, &c, by registered organizations

119. (1) Section 78 of the Principal Act is amended by inserting after sub-section (1) the following sub-section:

(1a) Sub-section (1) does not apply in relation to a change made by a registered organization for the purpose only of enabling the organization to make an application under section 68 to which section 68a relates..

(2) Section 78 of the Principal Act is amended—

(a) by omitting from sub-section (2) all the words preceding the Minister shall and substituting the following:

If the Minister considers that a change notified under sub-section (1) alters or affects the benefits, the amounts of the benefits or the


conditions relating to the provision of the benefits provided by the organization in accordance with the basic table,;

(b) by inserting in sub-section (5) any health benefits fund, before any medical benefits fund (wherever occurring);

(c) by omitting sub-sections (8a) and (9); and

(d) by omitting from sub-section (11) contributions or benefits, or both, and substituting benefits.

(3) Where the Minister has made a declaration under sub-section 78 (2) of the Principal Act in respect of a change notified by an organization under sub-section (1) of that section, section 78 of the Principal Act continues to apply, subject to the regulations, on and after 1 February 1984 in relation to that change as if the amendments made by sub-section (1) had not been made.

Cancellation of registration of organization

120. (1) Section 79 of the Principal Act is amended by adding at the end thereof the following sub-sections:

(5) The Minister shall cancel the registration of a registered medical benefits organization or a registered hospital benefits organization in respect of a State or Territory if he is satisfied that the business of the medical benefits fund or hospital benefits fund conducted by the organization in respect of that State or Territory has, in accordance with an approval granted under Part VIb, been transferred to a fund conducted by another registered organization.

(6) The Minister shall cancel the registration of a registered medical benefits organization, or a registered hospital benefits organization, being in either case a restricted membership organization, if he is satisfied that the business of the medical benefits fund or hospital benefits fund conducted by the organization has, in accordance with an approval granted under Part VIb, been transferred to a fund conducted by another registered organization..

(2) Section 79 of the Principal Act is amended—

(a) by omitting sub-sections (1) and (2);

(b) by omitting from sub-sections (3) and (4) hospital benefits (wherever occurring) and substituting health benefits; and

(c) by omitting sub-sections (5) and (6) and substituting the following sub-sections:

(5) The Minister shall cancel the registration of a registered health benefits organization in respect of a State or Territory if he is satisfied that the business of a health benefits fund in respect of that State or Territory conducted by it has, in accordance with an approval granted under Part VIb, been transferred to a fund conducted by another registered organization.

(6) The Minister shall cancel the registration of a registered health benefits organization, being a restricted membership organization, if he is satisfied that the business of a health benefits fund conducted by it


has, in accordance with an approval granted under Part VIb, been transferred to a fund conducted by another registered organization..

(3) Where a medical benefits fund or a hospital benefits fund conducted by an organization is wound up on or after 1 February 1984 in pursuance of an application made to the Federal Court of Australia under Part VIa of the National Health Act 1953, or the business of a medical benefits fund or a hospital benefits fund conducted by an organization is, in accordance with an approval granted under Part VIb of that Act, transferred on or after that date to a fund conducted by another registered organization, section 79 of that Act as in force immediately before that date continues to apply in relation to the registration of that organization as if the amendments made by sub-section (2) had not been made.

Offences

121. Section 82 of the Principal Act is amended—

(a) by omitting sub-sections (3), (4) and (5) and substituting the following sub-section:

(3) A person shall not make a representation which implies that a person who pays contributions to an organization is or may be entitled to receive, by reason of his being a member of that organization, a payment from the Commonwealth of an amount in respect of hospital treatment received by him.

Penalty: $200 or imprisonment for 6 months.;

(b) by omitting from sub-section (6) or nursing home care; and

(c) by omitting from sub-section (6) hospital benefits (wherever occurring) and substituting health benefits.

Interpretation

122. Section 82q of the Principal Act is amended by inserting in the definition of fund in sub-section (1) a health benefits fund, after means.

Investigation of organization by inspector

123. Section 82r of the Principal Act is amended—

(a) by omitting from sub-section (1) a registered organization;

(b) by omitting paragraph (1) (a) and substituting the following paragraphs:

(a) a registered organization is, or is about to become, unable to meet its liabilities;

(aa) the affairs of a registered organization are being, or are about to be, carried on in a manner that is not in the best interests of the contributors to a fund conducted by the organization; or; and

(c) by omitting from paragraph (1) (b) has and substituting a registered organization has.


Report of inspector

124. Section 82w of the Principal Act is amended by inserting in paragraph (2) (a) or the question whether the affairs of the organization are being, or are about to be, carried on in a manner that is not in the best interests of the contributors to a fund conducted by the organization after liabilities.

Application for judicial management or winding up of a fund

125. Section 82z of the Principal Act is amended by inserting in sub-section (2) a health benefits fund, after in respect of.

126. After section 82zg of the Principal Act the following section is inserted:

Certain funds conducted by registered organizations to be wound up

82zga. (1) An organization that is a registered hospital benefits organization, or a registered medical benefits organization, or both, in respect of a State or Territory, not being an organization in respect of which the Minister has, under section 73, granted an application to which section 68a relates for registration as a registered health benefits organization in respect of that State or Territory, shall, if it has not made such an application before 1 February 1984, apply to the Court as soon as is practicable after 1 February 1984, but not later than 31 July 1984, under section 82zg for the hospital benefits fund, the medical benefits fund, or both the hospital benefits fund and the medical benefits fund, as the case may be, conducted by that organization in respect of that State or Territory to be wound up.

(2) Where an organization fails to comply with sub-section (1) in relation to a fund conducted by it, the Minister shall, as soon as practicable after 31 July 1984, apply to the Court under sub-section 82z (2) for an order that the fund be wound up.

(3) Where a registered organization makes an application to the Court at any time after the commencement of this section under section 82zg for a hospital benefits fund or medical benefits fund conducted by the organization to be wound up, or the Minister makes an application to the Court at any time after 31 July 1984 under sub-section 82z (2) for that fund to be wound up, the scheme for the winding up of the fund that is required by section 82zg or 82z, as the case requires, to be furnished to the Court in respect of that application shall make provision, in the event that the assets of the fund exceed its liabilities on the winding up, for the refunding to each person who was a relevant contributor to the fund, in respect of the contributions paid to the fund by him, of an amount equal to so much of the excess as bears to the amount of the excess the same proportion as the sum of the contributions made by the relevant contributor in respect of the relevant period bears to the sum of the contributions made by all relevant contributors in respect of the relevant period.

(4) After 31 January 1984 an organization that is required to make an application under sub-section (1) for the winding up of a fund conducted by it


or that would be so required if it had not already made such an application shall not—

(a) accept contributions to the fund other than contributions payable in respect of a period before 1 February 1984;

(b) enrol new contributors to the fund;

(c) pay out of that fund any benefits in respect of any matter arising on or after 1 February 1984; or

(d) apply any moneys or other assets of the fund otherwise than for the purpose of meeting the liabilities of the organization in conducting the fund or in accordance with the scheme for the winding up of the fund that has been approved by the Court under this Part.

(5) For the purposes of this section—

relevant contributor in respect of a medical benefits fund or a hospital benefits fund in relation to which an application for winding up is made, means a person who was a contributor to that fund on the day immediately before the commencement of the period of 6 months (or, if another period is prescribed by the regulations for the purposes of this definition, that other period) that immediately preceded the making of that application;

relevant period means such period as is prescribed for the purposes of this definition..

Order of Court to be binding on all persons, &c.

127. Section 82zl of the Principal Act is amended by adding at the end of sub-section (2) as continued in force by Part VI of the Health Legislation Amendment Act 1983.

128. After Part VIa of the Principal Act the following Part is inserted:

“PART VIb—MERGER OF HEALTH BENEFITS FUNDS

Interpretation

82zn. (1) In this Part, fund means a health benefits fund, a hospital benefits fund or a medical benefits fund.

(2) For the purposes of this Part, the Australian Capital Territory shall be deemed to form part of the State of New South Wales.

Merger of funds

82zp. (1) Subject to this section, upon application made in accordance with the approved form by 2 or more registered organizations proposing the transfer, in accordance with a scheme specified in the application, to a fund conducted by one of the organizations in respect of a State or the Northern Territory of the business of the fund or funds conducted by the other


organization or the other organizations in respect of that State or Territory, the Minister shall, by writing signed by him, approve the transfer unless—

(a) action is being taken under Part VIa in relation to all or any of those organizations; or

(b) the Minister proposes to take action under Part VIa in relation to all or any of those organizations.

(2) The Minister may refuse to consider an application under sub-section (1) unless each of the registered organizations concerned furnishes such information (if any) and produces such documents (if any) as the Minister, by notice in writing served, either personally or by post, on the public officer of the organization, requests.

(3) A scheme for the transfer of the business of a fund conducted by a registered organization to a fund conducted by another registered organization shall provide for—

(a) the transfer of the contributors from the one fund to the other; and

(b) such other matters (if any) as are prescribed.

(4) The Minister may refuse to approve a scheme under sub-section (1), until such alterations are made to the scheme as he considers desirable.

(5) Upon the grant of an approval under sub-section (1) in relation to a scheme, the scheme has effect, by force of this sub-section, according to its tenor..

Applications for review by Tribunal

129. Section 105ab of the Principal Act is amended by adding at the end thereof the following sub-section:

(9) An application may be made to the Tribunal for review of a decision of the Minister under paragraph 68a (b)..

Evidence

130. Section 139a of the Principal Act is amended by inserting after paragraph (1) (a) the following paragraph:

(aa) an organization was or was not registered as a registered health benefits organization, or was or was not so registered in respect of a specified State or the Northern Territory;.

Schedule

131. The Schedule to the Principal Act is omitted and the Schedule set out in Schedule 3 to this Act is substituted.

PART V—AMENDMENTS OF OTHER ACTS

Amendments of other Acts

132. The Acts specified in Schedule 4 are amended as set out in that Schedule.


PART VI—TRANSITIONAL

Interpretation

133. In this Part, modification includes the alteration of a provision, the addition or omission of a provision or the substitution of a new provision for an existing provision.

Continued operation of Health Insurance Act and National Health Act

134. (1) Notwithstanding the amendments made, and the repeals effected, by the provisions of Part II that come into operation on 1 February 1984, the Health Insurance Act 1973 as in force immediately before that date continues in force on and after that date, subject to such modifications as are prescribed, in relation to any matter arising out of or relevant to the rendering of a professional service or a medical service before that date as if those amendments and repeals had not been made or effected.

(2) Notwithstanding the amendments made, and the repeals effected, by the provisions of Part IV that come into operation on 1 February 1984, the regulations may make provision for applying on and after that date specified provisions of the National Health Act 1953, subject to such modifications as are prescribed, in relation to any matter arising out of or relevant to the carrying on of business by a registered medical benefits organization or a registered hospital benefits organization before that date as if those amendments and repeals had not been made or effected.

Acts Interpretation Act not affected

135. Nothing in this Part affects the operation of section 8 of the Acts Interpretation Act 1901.

Regulations

136. The Governor-General may make regulations—

(a) prescribing all matters required or permitted by this Act to be prescribed; or

(b) making provision for and in relation to any matter arising from, consequential upon or otherwise connected with the operation of this Act.

—————


SCHEDULE 1 Section 63

CONSEQUENTIAL AMENDMENTS OF THE HEALTH INSURANCE ACT 1973

1. The following provisions of the Health Insurance Act 1973 are amended by omitting Commonwealth medical benefit (wherever occurring) and substituting medicare benefit:

Sections 11, 13, 16, 16a, 17, 19d, 20, 20b, 21 and 42b.

2. The following provisions of the Health Insurance Act 1973 are amended by omitting Permanent Head (wherever occurring) and substituting Commission:

Sections 11, 12, 20b and 67.

————

SCHEDULE 2 Section 64

Schedule to be added at the end of the Health Insurance Act 1973

SCHEDULE 2 Section 23f

HEADS OF AGREEMENT

1. The agreement is to relate to a specified period but may provide for the extension of that period.

2. The agreement is to list the hospitals in the State that are to be recognized hospitals for the purposes of the agreement but may provide for the making of alterations to the list.

3. The agreement is to provide for the payment by the Commonwealth to the State of amounts for the purposes of reimbursing the State for—

(a) revenue losses and additional costs resulting from the removal of in-patient and out-patient fees for eligible persons who elect to be treated free as hospital patients in recognized hospitals;

(b) revenue losses resulting from a reduction in fees for private patients in recognized hospitals; and

(c) certain expenditure for health purposes other than hospital services.

4. The agreement is to provide for the Commonwealth to vary the amount of its payments to take account of movements in costs and utilization of hospital and other health services.

5. The agreement is to provide for the State to ensure that care and treatment of a kind specified in the agreement will be available to all eligible persons without charge as public patients in recognized hospitals.

6. The agreement is to provide for the State to ensure that medical practitioners will not render on their own behalf in recognized hospitals in the State professional services in respect of which medicare benefit would not be payable by reason of paragraph 17 (1) (aa) of this Act.

7. The agreement is to specify certain charges to apply in recognized hospitals.

8. The agreement is to make provision in relation to assumption by the State of the responsibility for making daily bed payments to hospitals that are private hospitals for the purposes of the agreement.

9. The agreement is to provide for the creation of consultative bodies to consider matters relating to the agreement.

10. The agreement is to make provision in relation to the provision by the State to the Commonwealth of statistical and other information..


SCHEDULE 3 Section 131

Schedule to be substituted for the Schedule to the National Health Act 1953

SCHEDULE Section 73ba

CONDITIONS OF REGISTRATION OF AN ORGANIZATION

(a) The organization will not carry on business in Australia as a registered health benefits organization except in a State or Territory in respect of which it is registered as a registered health benefits organization.

(b) The organization will permit any contributor to a health benefits fund conducted by it to contribute for benefits in respect of himself and his dependants (if any) in accordance with the basic table.

(c) The organization will not offer to the contributors to a health benefits fund conducted by it, whether on its own behalf or on behalf of another person or organization, health insurance in respect of nursing home care.

(d) The amount of fund benefits payable to a contributor by the organization in respect of hospital treatment or other service will not exceed the fees or charges incurred in respect of that hospital treatment or other service.

(e) The amount of fund benefit payable by the organization to a contributor in respect of hospital treatment for a nursing home type patient will not exceed an amount equal to the fees or charges incurred in respect of that hospital treatment (excluding any amount of daily bed payment payable to the hospital in respect of the patient in accordance with section 33 of the Health Insurance Act 1973) less the amount of the patient contribution in relation to the patient for each day on which the patient was an in-patient in the hospital.

(f) The organization will not permit a person to contribute for benefits in accordance with a supplementary hospital table unless the person also contributes for benefits in accordance with a basic table.

(g) Where a contributor to a health benefits fund conducted by the organization, being a contributor for benefits in accordance with a basic table has ceased to pay contributions, the organization will —

(i) permit the contributor, at any time before the expiration of a period of 2 months after the expiration of the period in respect of which he has paid contributions, to pay contributions due in respect of the period (in this paragraph referred to as the period in arrears) commencing on the expiration of the period in respect of which he has paid contributions and ending not later than the date on which he makes the payment; and

(ii) if a contributor makes the payment referred to in sub-paragraph (i), permit the contributor to continue to be eligible for benefits in accordance with the basic table in respect of the period in arrears.

(h) The organization will institute, and maintain, in a form and manner satisfactory to the Minister, a record of the contributors, and of the dependants of the contributors, to each health benefits fund conducted by it.

(j) Where the rules of the organization provide for a waiting period with respect to contributors for benefits in accordance with a basic table, that waiting period will not exceed—

(i) in respect of hospital treatment or other service related to an obstetric condition— 9 months; or

(ii) in respect of any other hospital treatment or other service—2 months.

(k) Where the rules of the organization provide for a waiting period in relation to contributors for benefits in accordance with a basic table or a supplementary hospital table in respect of pre-existing ailments, being ailments of a kind that are determined by the Minister by writing signed by him, to be ailments to which this condition applies—

(i) the waiting period in relation to a contributor for benefits in accordance with a basic table shall not exceed the period of 24 months commencing on the date on which the contributor commenced to contribute for benefits in accordance with that basic table; and

(ii) the waiting period in relation to a contributor for benefits in accordance with a supplementary hospital table shall not exceed the period of 24 months commencing on the date on which the contributor commenced to contribute for benefits in accordance with that supplementary hospital table.

SCHEDULE 3—continued

(1) The organization will not provide for a waiting period for contributors for benefits in accordance with a basic table who have transferred to a health benefits fund conducted by the organization from—

(i) another health benefits fund conducted by the organization;

(ii) a hospital benefits fund or a medical benefits fund the assets of which have, by force of section 73aa, become the initial assets of that health benefits fund; or

(iii) a health benefits fund, a hospital benefits fund or a medical benefits fund conducted by another organization whose registration under Part VI has been cancelled or is under consideration by the Minister with a view to cancellation.

(m) The organization will not, in determining, in relation to any contributor to a basic table or to any contributor included in a class or kind of contributors to a basic table—

(i) whether or not benefits are payable in accordance with the table;

(ii) if benefits are payable in accordance with the table—the amount of the benefits so payable; or

(iii) the amount of the contributions payable in respect of the table,

have regard to any of the following matters:

(iv) the suffering by the contributor , or a dependant of the contributor, from a chronic disease, illness or other medical condition or from a disease, illness or medical condition of a particular kind;

(v) the age of the contributor or of a dependant of a contributor;

(vi) the frequency of the rendering of professional services to the contributor or to a dependant of a contributor;

(vii) the amount, or extent, of the benefits to which the contributor becomes, or has become, entitled during a period;

(viii) any matter prescribed for the purpose of this sub-paragraph.

(n) Where a claim for a benefit payable by the organization out of a health benefits fund conducted by it is, or has been, lodged with the organization, the organization will pay that claim within 2 months, or such longer period as the Permanent Head approves in a particular case, after—

(i) the date of commencement of this condition; or

(ii) the date of lodgment of the claim with the organization,

whichever is the later date.

(o) Where an exemption has been granted under section 73f in relation to a basic table of a health benefits fund conducted by the organization, the organization will, within a period of one month after the granting of the exemption—

(i) furnish to all contributors to a health benefits fund conducted by the organization; and

(ii) publish in a manner satisfactory to the Minister, for the information of persons who may wish to become contributors to a health benefits fund conducted by the organization,

the particulars of the exemption, including the date upon which the exemption takes effect and the description of the hospital treatment affected by the exemption, and a statement setting out the effect of the exemption on the rights of contributors.

(p) Where—

(i) an exemption is in force under section 73F in relation to the organization;

(ii) at any time during the period of 3 months from the granting of that exemption, a contributor, in accordance with a basic table, to a health benefits fund conducted by the organization, being a person who became, or last became, such a contributor before the granting of the exemption, transfers to another registered organization and becomes a contributor, in accordance with a basic table, to a health benefits fund conducted by the other organization; and

(iii) that person, as such a contributor in relation to the other organization, is subject to a waiting period commencing from the date of that transfer,

the first-mentioned organization will continue to treat that person, during that waiting period, as a contributor, in accordance with a basic table, to the relevant health benefits fund conducted by that first-mentioned organization and, for that purpose, will disregard the exemption.

(q) The organization will comply with any direction of the Minister under this Act served on it..


SCHEDULE 4 Section 132

CONSEQUENTIAL AMENDMENTS OF OTHER ACTS

Act

Amendment

Income Tax Assessment Act 1936

Sub-paragraph 23 (eb) (i)—

Insert a registered health benefits organization, before a registered medical benefits organization.

Sub-section 121c (1a)—

Insert health benefits fund, after sickness benefits fund,.

Paragraph 159r (1a) (a)—

Insert, to a health benefits fund after hospital benefits fund.

Insurance Act 1973

Sub-section 3 (1) (paragraph (k) of the definition of insurance business)—

Insert a registered health benefits organization, before a registered medical benefits organization.

NOTES

1. No. 42, 1974, as amended. For previous amendments, see No. 58, 1975; Nos. 59, 91, 101 and 109, 1976; No. 75, 1977; Nos. 89 and 133, 1978; Nos. 53 and 123, 1979; No. 132, 1980; No. 118, 1981; and Nos. 49 and 112, 1982.

2. No. 41, 1974, as amended. For previous amendments, see Nos. 61, 91 and 100, 1979; Nos. 36 and 134, 1978; and No. 53, 1979.

3. No. 95, 1953, as amended. For previous amendments, see No. 68, 1955; Nos. 55 and 95, 1956; No. 92, 1957; No. 68, 1958; No. 72, 1959; No. 16, 1961; No. 82, 1962; No. 77, 1963; No. 37, 1964; Nos. 100 and 146, 1965; No. 44, 1966; Nos. 14 and 100, 1967; No. 100, 1968; No. 102, 1969; No. 41, 1970; No. 85, 1971; No. 114, 1972; Nos. 49 and 202, 1973; No. 37, 1974; Nos. 1, 13 and 93, 1975; Nos. 1, 60, 91, 99, 108, 157 and 177, 1976; Nos. 98 and 100, 1977; Nos. 36, 88, 132 and 189, 1978; Nos. 54, 91 and 122, 1979; Nos. 117 and 131, 1980; Nos. 40, 74, 118 and 176, 1981; Nos. 49 and 112, 1982; and No. 35, 1983.