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This is a Bill, not an Act. For current law, see the Acts databases.

HEALTH INSURANCE AMENDMENT (PROFESSIONAL SERVICES REVIEW) BILL 2012

2010-2011-2012
The Parliament of the
Commonwealth of Australia
HOUSE OF REPRESENTATIVES
Presented and read a first time
Health Insurance Amendment
(Professional Services Review) Bill 2012
No. , 2012
(Health and Ageing)
A Bill for an Act to validate certain actions under
Part VAA, VB or VII of the Health Insurance Act
1973, and to amend that Act, and for related
purposes
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012 i
Contents
1 Short
title
...........................................................................................
1
2 Commencement
.................................................................................
1
3 Schedule(s)
........................................................................................
2
Schedule 1--Validation of certain acts
3
Schedule 2--Amendments relating to the Professional Services
Review Scheme
5
Part 1--Prescribed pattern of services
5
Health Insurance Act 1973
5
Part 2--Allied health practitioners
9
Division 1--Amendments
9
Health Insurance Act 1973
9
Division 2--Transitional and application provisions
11
Part 3--Meaning of service
13
Health Insurance Act 1973
13
Part 4--Extension of time for certain processes
14
Health Insurance Act 1973
14
Part 5--No further action to be taken in certain circumstances
19
Health Insurance Act 1973
19
Part 6--Date of effect for final determinations
22
Health Insurance Act 1973
22
Part 7--Referrals to Medicare Participation Review
Committee
23
Health Insurance Act 1973
23
Part 8--Referrals to appropriate regulatory bodies
26
Health Insurance Act 1973
26
Part 9--Disqualified practitioners
28
Health Insurance Act 1973
28
Part 10--Patient referrals
29
Health Insurance Act 1973
29
ii Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
Schedule 3--Technical amendments relating to legislative
instruments
30
Health Insurance Act 1973
30
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012 1
A Bill for an Act to validate certain actions under
1
Part VAA, VB or VII of the Health Insurance Act
2
1973, and to amend that Act, and for related
3
purposes
4
The Parliament of Australia enacts:
5
1 Short title
6
This Act may be cited as the Health Insurance Amendment
7
(Professional Services Review) Act 2012.
8
2 Commencement
9
(1) Each provision of this Act specified in column 1 of the table
10
commences, or is taken to have commenced, in accordance with
11
column 2 of the table. Any other statement in column 2 has effect
12
according to its terms.
13
2 Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
1
Commencement information
Column 1
Column 2
Column 3
Provision(s)
Commencement
Date/Details
1. Sections 1 to 3
and anything in
this Act not
elsewhere covered
by this table
The day this Act receives the Royal Assent.
2. Schedule 1
The day this Act receives the Royal Assent.
3. Schedule 2
A single day to be fixed by Proclamation.
However, if the provision(s) do not
commence within the period of 6 months
beginning on the day this Act receives the
Royal Assent, they commence on the day
after the end of that period.
4. Schedule 3
The day after this Act receives the Royal
Assent.
Note:
This table relates only to the provisions of this Act as originally
2
enacted. It will not be amended to deal with any later amendments of
3
this Act.
4
(2) Any information in column 3 of the table is not part of this Act.
5
Information may be inserted in this column, or information in it
6
may be edited, in any published version of this Act.
7
3 Schedule(s)
8
Each Act that is specified in a Schedule to this Act is amended or
9
repealed as set out in the applicable items in the Schedule
10
concerned, and any other item in a Schedule to this Act has effect
11
according to its terms.
12
13
Validation of certain acts Schedule 1
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012 3
Schedule 1--Validation of certain acts
1
2
1 Validation of acts done under Part VAA, VB or VII of the
3
Health Insurance Act 1973
4
(1)
This item applies to a thing purportedly done under Part VAA, VB or
5
VII of the Health Insurance Act 1973 at any time before the day this
6
item commences, to the extent that the thing purportedly done would,
7
apart from this item, be invalid because a person was not appointed or
8
validly appointed as a Panel member or Deputy Director under
9
Part VAA of that Act.
10
(2)
The thing purportedly done is as valid and effective, and is taken always
11
to have been as valid and effective, as it would have been had the
12
person been validly appointed as a Panel member or Deputy Director
13
under that Part.
14
(3)
All persons are, by force of this subitem, declared to be, and always to
15
have been, entitled to act on the basis that the thing purportedly done is
16
valid and effective.
17
(4)
This item does not affect rights or liabilities of parties to proceedings
18
for which leave to appeal to the High Court of Australia has been given
19
on or before the day this item commences, if the fact that a person was
20
not appointed or validly appointed as a Panel member or Deputy
21
Director under that Part is in issue in the proceedings.
22
(5)
Subject to subitem (4), subitems (1), (2) and (3) have effect in relation
23
to:
24
(a) proceedings (whether original or appellate) that begin on or
25
after the day this item commences; and
26
(b) proceedings (whether original or appellate) that began before
27
the day this item commences, being proceedings that had not
28
been finally determined as at that day.
29
2 Re-referral to a Committee allowed in certain cases
30
(1)
This item applies if:
31
(a) proceedings relating to Part VAA of the Health Insurance
32
Act 1973 were brought before the day this item commences;
33
and
34
Schedule 1 Validation of certain acts
4 Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
(b) those proceedings are finally determined, or otherwise
1
disposed of (before or after the day this item commences), in
2
favour of the person under review on the grounds that, or on
3
grounds that include the ground that, a person was not
4
appointed or validly appointed as a Panel member or Deputy
5
Director under that Part.
6
(2)
Despite section 94 of the Health Insurance Act 1973, before the end of
7
12 months after the proceedings are finally determined, or otherwise
8
disposed of, the Director may, by writing, set up a Committee in
9
accordance with Division 4 of Part VAA of that Act, and make a
10
referral to the Committee in accordance with section 93 of that Act in
11
relation to the services provided by the person that were the subject of
12
the proceedings.
13
(3)
If subitem (2) applies, the Committee may take into account:
14
(a) evidence given in relation to the review as investigated
15
before proceedings were brought; and
16
(b) evidence given in the proceedings, as mentioned in
17
subitem (1).
18
(4)
To avoid doubt, subitem (3) does not limit the evidence that the
19
Committee may take into account.
20
3 Compensation for acquisition of property
21
(1)
If the operation of this Schedule would result in an acquisition of
22
property from a person otherwise than on just terms, the
23
Commonwealth is liable to pay a reasonable amount of compensation to
24
the person.
25
(2)
If the Commonwealth and the person do not agree on the amount of the
26
compensation, the person may institute proceedings in a court of
27
competent jurisdiction for the recovery from the Commonwealth of
28
such reasonable amount of compensation as the court determines.
29
(3)
In this item:
30
acquisition of property has the same meaning as in paragraph 51(xxxi)
31
of the Constitution.
32
just terms has the same meaning as in paragraph 51(xxxi) of the
33
Constitution.
34
35
Amendments relating to the Professional Services Review Scheme Schedule 2
Prescribed pattern of services Part 1
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012 5
Schedule 2--Amendments relating to the
1
Professional Services Review Scheme
2
Part 1--Prescribed pattern of services
3
Health Insurance Act 1973
4
1 Subsection 81(1)
5
Insert:
6
prescribed pattern of services has the meaning given by
7
section 82A.
8
2 Before subsection 82(1)
9
Insert:
10
Unacceptable conduct
11
3 After subsection 82(1)
12
Insert:
13
Prescribed pattern of services
14
(1A) Subject to subsections (1B) and (1C), a practitioner engages in
15
inappropriate practice in rendering or initiating services during a
16
particular period (the relevant period) if the circumstances in
17
which some or all of the services were rendered or initiated
18
constitute a prescribed pattern of services.
19
(1B) A practitioner does not, under subsection (1A), engage in
20
inappropriate practice in rendering or initiating services on a
21
particular day during the relevant period if a Committee could
22
reasonably conclude that, on that day, exceptional circumstances
23
existed that affected the rendering or initiating of the services.
24
(1C) Subsection (1B) does not affect the operation of subsection (1A) in
25
respect of the remaining day or days during the relevant period on
26
which the practitioner rendered or initiated services even if the
27
circumstances in which the services were rendered or initiated on
28
that day or those days would not, if considered alone, have
29
constituted a prescribed pattern of services.
30
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 1 Prescribed pattern of services
6 Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
(1D) The circumstances that constitute exceptional circumstances for the
1
purposes of subsection (1B) include, but are not limited to,
2
circumstances that are prescribed by the regulations to be
3
exceptional circumstances.
4
Causing or permitting inappropriate practice
5
4 Paragraphs 82(2)(a) and (b)
6
Omit "within the meaning of subsection (1)", substitute "under
7
subsection (1) or (1A)".
8
5 Before subsection 82(3)
9
Insert:
10
Matters to which Committee must have regard
11
6 At the end of Division 1 of Part VAA
12
Add:
13
82A Meaning of prescribed pattern of services
14
(1) The circumstances in which services are rendered or initiated by a
15
practitioner constitute a prescribed pattern of services if they are
16
circumstances prescribed by the regulations for the purposes of this
17
section.
18
(2) The circumstances prescribed may relate to services of a particular
19
kind or description that are rendered or initiated by:
20
(a) practitioners in a particular profession; or
21
(b) an identified group or groups of practitioners in a particular
22
profession.
23
(3) The circumstances prescribed may include the rendering or
24
initiation of more than a specified number of services, or more than
25
a specified number of services of a particular kind, on each of more
26
than a specified number of days during a period of a specified
27
duration.
28
7 Division 3 of Part VAA (heading)
29
Repeal the heading, substitute:
30
Amendments relating to the Professional Services Review Scheme Schedule 2
Prescribed pattern of services Part 1
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012 7
Division 3--Role of Chief Executive Medicare
1
8 Section 86 (heading)
2
Repeal the heading, substitute:
3
86 Requests by Chief Executive Medicare to Director to review
4
provision of services
5
9 Subsection 86(1)
6
Omit "The", substitute "Subject to subsection (1A), the".
7
10 After subsection 86(1)
8
Insert:
9
(1A) If the Chief Executive Medicare becomes aware that the
10
circumstances in which services were rendered or initiated by a
11
person constitute a prescribed pattern of services, the Chief
12
Executive Medicare must make a request under subsection (1) in
13
relation to the services.
14
11 At the end of subsection 86(3)
15
Add:
16
Note:
If the request is made because of subsection (1A), it may include
17
reasons other than the prescribed pattern of services.
18
12 At the end of subsection 93(6)
19
Add:
20
Note:
The reasons given by the Director may relate solely to the services
21
being rendered or initiated in circumstances that constitute a
22
prescribed pattern of services.
23
13 Section 106KA
24
Repeal the section.
25
14 Paragraph 106KB(1)(b)
26
Omit "106KA", substitute "for the purposes of subsection 82(1A) or
27
(1B)".
28
15 Application
29
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 1 Prescribed pattern of services
8 Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
(1)
Despite the repeals and amendments of the Health Insurance Act 1973
1
made by this Part, the old law continues to apply, in relation to a request
2
to review the provision of services by a person that was made under
3
section 86 of that Act before the commencement day, as if those repeals
4
and amendments had not happened.
5
(2)
In this item:
6
commencement day means the day this item commences.
7
old law means:
8
(a) section 106KA of the Health Insurance Act 1973, as in force
9
immediately before the commencement day; and
10
(b) any regulations made for the purposes of that section that
11
were in force immediately before the commencement day;
12
and
13
(c) section 106KB of that Act, as in force immediately before the
14
commencement day.
15
16
Amendments relating to the Professional Services Review Scheme Schedule 2
Allied health practitioners Part 2
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012 9
Part 2--Allied health practitioners
1
Division 1--Amendments
2
Health Insurance Act 1973
3
16 Subsection 81(1) (at the end of the definition of
4
practitioner)
5
Add:
6
; or (i) a health professional of a kind determined by the Minister
7
under subsection (1A) to be a practitioner for the purposes of
8
this Part.
9
17 Subsection 81(1) (at the end of the definition of
10
profession)
11
Add:
12
; (h) a vocation determined by the Minister under subsection (1A)
13
to be a profession for the purposes of this Part.
14
18 After subsection 81(1)
15
Insert:
16
Practitioners and professions determined by Minister
17
(1A) The Minister may, by legislative instrument, determine:
18
(a) that a health professional of a particular kind (being a health
19
professional who provides a health service within the
20
meaning of subsection 3C(8)) is a practitioner for the
21
purposes of this Part; and
22
(b) that a vocation engaged in by a health professional of a kind
23
determined under this subsection is a profession for the
24
purposes of this Part.
25
19 Before subsection 81(2)
26
Insert:
27
Meaning of provides services
28
20 Paragraph 106ZPA(1)(c)
29
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 2 Allied health practitioners
10 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
Repeal the paragraph, substitute:
1
(c) other members, of whom there is to be one of each kind of
2
practitioner in relation to which the Professional Services
3
Review Scheme established by this Part applies.
4
Note:
See subsection 81(1) for the definition of practitioner.
5
21 Paragraph 106ZPB(2)(c)
6
Repeal the paragraph, substitute:
7
(c) appoint a medical practitioner as a member of the Authority
8
referred to in paragraph 106ZPA(1)(c);
9
22 Subsection 106ZPB(3)
10
After "a practitioner", insert "(other than a medical practitioner)".
11
23 Subsection 106ZPB(3)
12
Omit "any of subparagraphs 106ZPA(1)(c)(ii) to (vii)", substitute
13
"paragraph 106ZPA(1)(c)".
14
24 Subsection 106ZPH(3)
15
Repeal the subsection, substitute:
16
(3) The Minister must not appoint a person to act in an office of a
17
member (the relevant member) of the Authority referred to in
18
paragraph 106ZPA(1)(c) unless the person is a practitioner of the
19
same kind as the relevant member.
20
25 Subsection 124B(1) (at the end of the definition of
21
practitioner)
22
Add:
23
; or (i) a health professional of a kind determined by the Minister
24
under subsection (7) to be a practitioner for the purposes of
25
this Part.
26
26 At the end of section 124B
27
Add:
28
(7) The Minister may, by legislative instrument, determine that a
29
health professional of a particular kind (being a health professional
30
who provides a health service within the meaning of subsection
31
3C(8)) is a practitioner for the purposes of this Part.
32
Amendments relating to the Professional Services Review Scheme Schedule 2
Allied health practitioners Part 2
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
11
27 At the end of subsection 124EB(2)
1
Add:
2
; or (d) if the Committee is convened in relation to a chiropractor--a
3
chiropractor; or
4
(e) if the Committee is convened in relation to a
5
physiotherapist--a physiotherapist; or
6
(f) if the Committee is convened in relation to a podiatrist--a
7
podiatrist; or
8
(g) if the Committee is convened in relation to an osteopath--an
9
osteopath; or
10
(h) if the Committee is convened in relation to a person who is a
11
health professional of a kind covered by paragraph (i) of the
12
definition of practitioner in subsection 124B(1)--a health
13
professional of the same kind as the person.
14
Division 2--Transitional and application provisions
15
28 Transitional--review of services rendered or initiated by
16
certain allied health practitioners
17
The Chief Executive Medicare must not make a request under
18
section 86 of the Health Insurance Act 1973 to review the provision of
19
services by a person during a period if:
20
(a) the services were rendered or initiated by a health
21
professional who is a practitioner for the purposes of
22
Part VAA of that Act because of a determination that is in
23
force under subsection 81(1A) of that Act (as inserted by
24
item 18 of this Schedule); and
25
(b) the period falls before the determination took effect.
26
29 Application--acts and omissions of certain allied health
27
practitioners
28
(1)
This item applies in relation to a person who is a practitioner for the
29
purposes of Part VB of the Health Insurance Act 1973 because of a
30
determination that is in force under subsection 124B(7) of that Act (as
31
inserted by item 26 of this Schedule).
32
(2)
Part VB of the Health Insurance Act 1973 does not apply in relation to
33
acts and omissions of the person that took place before the
34
determination took effect.
35
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 2 Allied health practitioners
12 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
(3)
For the purposes of this item, if an act or omission is alleged to have
1
taken place between 2 dates, one before and one on or after the day the
2
determination took effect, the act or omission is alleged to have taken
3
place before the determination took effect.
4
30 Application of item 27
5
The amendment of the Health Insurance Act 1973 made by item 27 of
6
this Schedule does not apply in relation to a Committee that was
7
established under subsection 124E(1) of that Act before the day this
8
item commences.
9
10
Amendments relating to the Professional Services Review Scheme Schedule 2
Meaning of service Part 3
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
13
Part 3--Meaning of service
1
Health Insurance Act 1973
2
31 Subsection 81(1) (paragraph (a) of the definition of
3
service)
4
Repeal the paragraph, substitute:
5
(a) a service that has been rendered if, at the time it was
6
rendered, medicare benefit was payable in respect of the
7
service; or
8
(ab) a service that has been initiated (whether or not it has been or
9
will be rendered) if, at the time it was initiated, medicare
10
benefit would have been payable in respect of the service had
11
it been rendered at that time; or
12
32 Application
13
The amendment made by this Part applies to a service that is rendered
14
or initiated on or after the day this item commences.
15
16
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 4 Extension of time for certain processes
14 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
Part 4--Extension of time for certain processes
1
Health Insurance Act 1973
2
33 Subsection 106G(3)
3
Repeal the subsection, substitute:
4
(3) If a circumstance specified in column 1 of an item in the following
5
table occurs, the Committee may determine, in writing, that the
6
period of 6 months referred to in paragraph (2)(a) is extended for a
7
period not exceeding the period specified in column 2 of that item.
8
9
Extension of period for giving final report
Item Column
1
Circumstance
Column 2
Period
1
The person under review is
unable because of illness to attend
a hearing being conducted by the
Committee
The period during which the person
under review is unable to attend the
hearing
2
The person under review is fully
disqualified under section 105
The period during which the person
under review is fully disqualified under
that section
3
A notice is given to a person
under subsection 105A(2) and the
person fails to comply with a
requirement of the notice
The period during which the person to
whom the notice is given fails to
comply with the requirement
4
The Committee's consideration of
the referral is suspended under
paragraph 106N(2)(b) or because
of an injunction or other court
order
The period for which the Committee's
consideration of the referral is
suspended
10
34 After subsection 106G(4)
11
Insert:
12
(4A) The period of 6 months referred to in paragraph (2)(a) may be
13
extended under subsection (3) more than once.
14
Amendments relating to the Professional Services Review Scheme Schedule 2
Extension of time for certain processes Part 4
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
15
35 Subsection 106S(2)
1
Repeal the subsection, substitute:
2
(2) The Director may give information to the Determining Authority
3
under subsection (1) on one occasion only.
4
(2A) The Director must not give information to the Determining
5
Authority under subsection (1) after the Authority has made its
6
draft determination in accordance with section 106U.
7
36 Section 106SA
8
Repeal the section, substitute:
9
106SA Authority to invite submissions before making a draft
10
determination
11
Invitation to make submissions
12
(1) The Determining Authority must give the person under review a
13
written invitation to make written submissions to the Authority,
14
having regard to the Committee's final report and any information
15
given by the Director under section 106S, about the directions the
16
Authority should make in the draft determination relating to the
17
person.
18
Note:
Section 106U sets out the directions the Authority can make.
19
(2) An invitation under subsection (1) must state that the person under
20
review may make submissions within 1 month after the day on
21
which the invitation is given to the person.
22
Note:
The period for making submissions may be extended under
23
subsection (5) and may be affected by section 106TB.
24
Invitation to be given after Committee's final report is given to
25
Authority
26
(3) The Determining Authority must give an invitation under
27
subsection (1) within 1 month after being given the Committee's
28
final report.
29
Note:
The period for giving the invitation may be affected by
30
section 106TB.
31
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 4 Extension of time for certain processes
16 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
Further invitation to be given in certain circumstances
1
(4) If the Director gives the Determining Authority information under
2
section 106S after the Authority has given the person under review
3
an invitation under subsection (1), the Authority must, within 14
4
days after being given the information, give the person a further
5
invitation under subsection (1). Subsection (3) does not apply to
6
the further invitation.
7
Note:
The period for giving the further invitation may be affected by
8
section 106TB.
9
Period for making submissions may be extended
10
(5) The Determining Authority may extend a period within which the
11
person under review may make submissions if:
12
(a) the person applies, in writing, for the period to be extended;
13
and
14
(b) the application is made before the end of the period; and
15
(c) the Authority considers that it is reasonable to extend the
16
period.
17
37 Subsection 106T(1)
18
Repeal the subsection, substitute:
19
(1) The Determining Authority must, after taking into account any
20
submissions made by the person under review in accordance with
21
section 106SA:
22
(a) make a draft determination in accordance with section 106U
23
relating to the person; and
24
(b) give copies of the draft determination to the person and to the
25
Director.
26
(1A) The Determining Authority must comply with subsection (1)
27
within 1 month after the last day on which the person under review
28
may make submissions in accordance with section 106SA.
29
Note:
The period for making the draft determination may be affected by
30
section 106TB.
31
38 At the end of subsection 106T(2)
32
Add:
33
Amendments relating to the Professional Services Review Scheme Schedule 2
Extension of time for certain processes Part 4
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
17
Note:
The period for making submissions may be affected by
1
section 106TB.
2
39 Subsection 106T(4)
3
Omit "that paragraph", substitute "subsection (1A)".
4
40 At the end of subsection 106TA(1)
5
Add:
6
Note:
The period for making the final determination may be affected by
7
section 106TB.
8
41 After section 106TA
9
Insert:
10
106TB Time for doing act affected if court order operates
11
(1) This section applies in relation to an act that is required or
12
permitted by this Subdivision to be done within a particular period
13
(the original action period) if an injunction or other court order
14
prevents the act, or a further act of that kind, from being done
15
within that period.
16
(2) Despite any other provision of this Subdivision, and subject to any
17
order of a court:
18
(a) the original action period stops running at the beginning of
19
the period (the suspension period) during which the
20
injunction or other court order prevents the act from being
21
done; and
22
(b) a new period (the new action period) for doing the act, being
23
a period of the same length as the original action period,
24
starts running on the day after the end of the suspension
25
period.
26
(3) For the purposes of this Subdivision, if:
27
(a) the original action period was a period in which the person
28
under review was permitted to make submissions in
29
accordance with section 106SA or 106T; and
30
(b) the person made a submission within that period;
31
then the person is taken to have made the submission during the
32
new action period.
33
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 4 Extension of time for certain processes
18 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
42 Application of items 35, 36, 37 and 39
1
The repeals and amendments of the Health Insurance Act 1973 made by
2
items 35, 36, 37 and 39 of this Schedule do not apply, in relation to the
3
making of a draft determination or a final determination in relation to a
4
person under review under Part VAA of that Act, if the Committee's
5
final report in relation to the person was given to the Determining
6
Authority under subsection 106L(3) of that Act before the day this item
7
commences.
8
9
Amendments relating to the Professional Services Review Scheme Schedule 2
No further action to be taken in certain circumstances Part 5
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
19
Part 5--No further action to be taken in certain
1
circumstances
2
Health Insurance Act 1973
3
43 Subsection 106G(6)
4
Repeal the subsection.
5
44 After section 106G
6
Insert:
7
106GA Notification by Director or Committee that proper
8
investigation is impossible
9
(1) The Director may give the Committee written notice that he or she
10
is satisfied that circumstances exist that would make a proper
11
investigation by the Committee impossible. The notice must set out
12
the circumstances.
13
(2) The Committee may give the Director written notice that it is
14
satisfied that circumstances exist that would make a proper
15
investigation by the Committee impossible. The notice must set out
16
the circumstances.
17
(3) If the Director or the Committee gives a notice under this section:
18
(a) this Division ceases to have effect in relation to the
19
Committee; and
20
(b) the Director must, within 7 days after giving or receiving the
21
notice (as the case may be), give a copy of the notice to the
22
Chief Executive Medicare and the person under review.
23
45 Division 5 of Part VAA (heading)
24
Repeal the heading, substitute:
25
Division 5--Determining Authority
26
Subdivision A--Establishment etc. of the Determining
27
Authority
28
46 Before section 106R
29
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 5 No further action to be taken in certain circumstances
20 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
Insert:
1
Subdivision B--Ratification of agreements by the Determining
2
Authority
3
106QA Application of Subdivision
4
This Subdivision applies if an agreement entered into between the
5
Director and a person under review under section 92 is referred to
6
the Determining Authority for ratification.
7
106QB Notification by Director or Authority that action in
8
agreement cannot take effect
9
(1) The Director may give the Determining Authority written notice
10
that he or she is satisfied that circumstances exist that would make
11
it impossible for an action specified in the agreement to take effect.
12
The notice must set out the circumstances.
13
(2) The Determining Authority may give the Director written notice
14
that it is satisfied that circumstances exist that would make it
15
impossible for an action specified in the agreement to take effect.
16
The notice must set out the circumstances.
17
(3) If the Director or the Determining Authority gives a notice under
18
this section:
19
(a) section 106R ceases to have effect in relation to the
20
agreement; and
21
(b) the Director must, within 7 days after giving or receiving the
22
notice (as the case may be), give a copy of the notice to the
23
Chief Executive Medicare and the person under review.
24
47 Section 106R (heading)
25
Repeal the heading, substitute:
26
106R Authority must ratify or refuse to ratify agreement
27
48 Subsection 106R(1)
28
Repeal the subsection, substitute:
29
Amendments relating to the Professional Services Review Scheme Schedule 2
No further action to be taken in certain circumstances Part 5
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
21
(1) The Determining Authority must, within 1 month after the day on
1
which it receives the agreement, make a decision either ratifying or
2
refusing to ratify the agreement.
3
49 After section 106R
4
Insert:
5
Subdivision C--Determinations by the Determining Authority
6
106RA Application of Subdivision
7
This Subdivision applies if a final report of a Committee is given to
8
the Determining Authority under subsection 106L(3) in relation to
9
a person under review.
10
106RB Notification by Director or Authority that proper draft or
11
final determination is impossible
12
(1) The Director may give the Determining Authority written notice
13
that he or she is satisfied that circumstances exist that would make
14
it impossible for a proper draft determination or final determination
15
to be made by the Authority in relation to the person under review.
16
The notice must set out the circumstances.
17
(2) The Determining Authority may give the Director written notice
18
that it is satisfied that circumstances exist that would make it
19
impossible for a proper draft determination or final determination
20
to be made by the Authority in relation to the person under review.
21
The notice must set out the circumstances.
22
(3) If the Director or the Determining Authority gives a notice under
23
this section:
24
(a) this Subdivision ceases to have effect in relation to the person
25
under review; and
26
(b) the Director must, within 7 days after giving or receiving the
27
notice (as the case may be), give a copy of the notice to the
28
Chief Executive Medicare and the person under review.
29
30
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 6 Date of effect for final determinations
22 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
Part 6--Date of effect for final determinations
1
Health Insurance Act 1973
2
50 Subsection 106V(2)
3
Repeal the subsection, substitute:
4
(2) If, before that 35th day, a proceeding is instituted in a court in
5
respect of the final determination, the determination takes effect
6
(subject to any order of the court) at the end of:
7
(a) if the application instituting the proceeding is withdrawn or
8
the proceeding is discontinued--7 days after the day on
9
which the application is withdrawn or the proceeding is
10
discontinued; or
11
(b) if the proceeding is dismissed or determined--the prescribed
12
number of days after the day on which the proceeding is
13
dismissed or determined; or
14
(c) if an appeal is instituted but the appeal is withdrawn or
15
discontinued--7 days after the day on which the appeal is
16
withdrawn or discontinued; or
17
(d) if an appeal is instituted and the appeal is dismissed or
18
determined--the prescribed number of days after the day on
19
which the appeal is dismissed or determined.
20
51 Application
21
The amendment of the Health Insurance Act 1973 made by this Part
22
does not apply in relation to a final determination that was made under
23
section 106TA of that Act before the day this item commences.
24
25
Amendments relating to the Professional Services Review Scheme Schedule 2
Referrals to Medicare Participation Review Committee Part 7
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
23
Part 7--Referrals to Medicare Participation Review
1
Committee
2
Health Insurance Act 1973
3
52 Subparagraph 19B(2)(a)(i)
4
Omit ", 124FAA(2)(e)".
5
53 Subparagraph 19B(2)(b)(i)
6
Omit ", 124FAA(2)(d)".
7
54 Subparagraph 19B(2)(c)(iii)
8
Omit ", 124FAA(2)(e)".
9
55 Subparagraph 19B(2)(d)(iii)
10
Omit ", 124FAA(2)(d)".
11
56 Subsection 19D(11) (paragraph (a) of the definition of
12
disqualified practitioner)
13
Omit ", 124FAA(2)(d) or (e)".
14
57 Paragraphs 92(2)(f) and (g)
15
Omit "of not more than 3 years".
16
58 After subsection 92(2)
17
Insert:
18
(2A) For the purposes of paragraphs (2)(f) and (g), the period specified
19
must not be more than:
20
(a) if the person is a practitioner in relation to whom an
21
agreement under this section, or a final determination under
22
section 106TA, has previously taken effect--5 years; or
23
(b) in any other case--3 years.
24
59 Paragraph 92(4)(e)
25
Omit "jurisdiction; and", substitute "jurisdiction.".
26
60 Paragraph 92(4)(f)
27
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 7 Referrals to Medicare Participation Review Committee
24 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
Repeal the paragraph.
1
61 Paragraph 106U(1)(g)
2
After "disqualified", insert ", for a specified period starting when the
3
determination takes effect,".
4
62 At the end of paragraph 106U(1)(h)
5
Add "for a specified period starting when the determination takes
6
effect".
7
63 Subsections 106U(3) and (4)
8
Repeal the subsections, substitute:
9
(3) For the purposes of paragraphs (1)(g) and (h), the period specified
10
must not be more than:
11
(a) if the person under review is a practitioner in relation to
12
whom an agreement under section 92, or a final
13
determination under section 106TA, has previously taken
14
effect--5 years; or
15
(b) in any other case--3 years.
16
64 Section 106X
17
Repeal the section.
18
65 Subsection 106ZPR(2)
19
Repeal the subsection.
20
66 Subsection 124E(2A)
21
Repeal the subsection.
22
67 Subsection 124E(5)
23
Omit "106X or".
24
68 Subsection 124E(5)
25
Omit ", (2A)".
26
69 Subsection 124EA(1)
27
Omit ", (2A)".
28
Amendments relating to the Professional Services Review Scheme Schedule 2
Referrals to Medicare Participation Review Committee Part 7
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
25
70 Section 124FAA
1
Repeal the section.
2
71 Subsection 124H(7)
3
Omit "124FAA(2),".
4
72 Subsection 124J(8)
5
Omit ", (2A)".
6
73 Subsection 124S(9)
7
Omit "or paragraph 124FAA(2)(d) or (e)".
8
74 Application
9
The repeals and amendments of the Health Insurance Act 1973 made by
10
this Part do not apply in relation to a request to review the provision of
11
services by a person that was made under section 86 of that Act before
12
the day this item commences.
13
14
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 8 Referrals to appropriate regulatory bodies
26 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
Part 8--Referrals to appropriate regulatory bodies
1
Health Insurance Act 1973
2
75 Paragraph 93(8)(a)
3
Omit "an appropriate body", substitute "a person or body".
4
76 Subsection 93(8)
5
Omit "the appropriate body", substitute "the person or body".
6
77 Section 106XA (heading)
7
Repeal the heading, substitute:
8
106XA Significant threat to life or health
9
78 Before subsection 106XA(1)
10
Insert:
11
Opinion formed by Committee or Determining Authority
12
79 Subsections 106XA(2) to (4)
13
Repeal the subsections, substitute:
14
(2) If the Director receives, from a Committee or the Determining
15
Authority, a statement and material under subsection (1) in relation
16
to conduct by a person under review, the Director must send the
17
statement and material to:
18
(a) a State or Territory body that is responsible for the
19
administration of health services or the protection of public
20
health and safety in the State or Territory in which the
21
conduct occurred; and
22
(b) each appropriate person or body for the person under review
23
(see subsection (4)).
24
Opinion formed by Director
25
(3) If, in the course of or in connection with the performance of
26
functions or the exercise of powers (whether by the Director, the
27
Director's nominee, a Committee or the Determining Authority)
28
under this Part in relation to a person under review, the Director
29
Amendments relating to the Professional Services Review Scheme Schedule 2
Referrals to appropriate regulatory bodies Part 8
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
27
forms the opinion that any conduct by the person has caused, is
1
causing, or is likely to cause, a significant threat to the life or
2
health of any other person, the Director must:
3
(a) prepare a written statement of his or her concerns; and
4
(b) attach to the statement the material, or copies of the material,
5
on which his or her opinion is based; and
6
(c) send the statement and material to:
7
(i) a State or Territory body that is responsible for the
8
administration of health services or the protection of
9
public health and safety in the State or Territory in
10
which the conduct occurred; and
11
(ii) each appropriate person or body for the person under
12
review (see subsection (4)).
13
Meaning of appropriate person or body
14
(4) For the purposes of paragraph (2)(b) and subparagraph (3)(c)(ii),
15
an appropriate person or body for a person under review is a
16
person or body that:
17
(a) is specified in the regulations; and
18
(b) has the power to take action against the person under review.
19
80 Section 106XB (heading)
20
Repeal the heading, substitute:
21
106XB Non-compliance by a practitioner with professional
22
standards
23
81 Paragraph 106XB(2)(a)
24
Repeal the paragraph, substitute:
25
(a) in the course of or in connection with the performance of
26
functions or the exercise of powers (whether by the Director,
27
the Director's nominee, a Committee or the Determining
28
Authority) under this Part in relation to a person under
29
review who is a practitioner, the Director forms the opinion
30
that the practitioner has failed to comply with professional
31
standards; or
32
33
Schedule 2 Amendments relating to the Professional Services Review Scheme
Part 9 Disqualified practitioners
28 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
Part 9--Disqualified practitioners
1
Health Insurance Act 1973
2
82 Subparagraphs 19B(2)(a)(ii) and (c)(iv)
3
Omit "partly", substitute "fully".
4
83 Subsection 19D(1)
5
After "section 19B", insert "or 106ZPM".
6
84 Subsection 19D(11) (paragraph (c) of the definition of
7
disqualified practitioner)
8
Omit "fully".
9
85 Subsection 19D(11) (paragraph (e) of the definition of
10
disqualified practitioner)
11
Omit "paragraph 106U(1)(h) that the practitioner be fully disqualified",
12
substitute "paragraph 106U(1)(g) or (h)".
13
86 Subsection 19D(11) (note at the end of the definition of
14
disqualified practitioner)
15
Repeal the note.
16
17
Amendments relating to the Professional Services Review Scheme Schedule 2
Patient referrals Part 10
Health Insurance Amendment (Professional Services Review) Bill 2012 No. , 2012
29
Part 10--Patient referrals
1
Health Insurance Act 1973
2
87 After section 132
3
Insert:
4
132A Regulations relating to the manner of patient referrals
5
(1) If an item specifies a service that is to be rendered by a practitioner
6
to a patient who has been referred to the practitioner, the
7
regulations may require that, for the purposes of the item, the
8
patient is to be referred in a manner prescribed by the regulations.
9
(2) In this section:
10
item includes an item relating to a service specified in a
11
determination in force under subsection 3C(1).
12
practitioner has the same meaning as in section 124B.
13
88 Subsection 133(2)
14
Repeal the subsection.
15
16
Schedule 3 Technical amendments relating to legislative instruments
30 Health Insurance Amendment (Professional Services Review) Bill 2012 No. ,
2012
Schedule 3--Technical amendments relating
1
to legislative instruments
2
3
Health Insurance Act 1973
4
1 Subsection 86(5)
5
After "Minister may", insert ", by legislative instrument,".
6
2 Subsection 86(6)
7
Repeal the subsection.
8
3 Subsection 93(4)
9
Omit "in writing", substitute "by legislative instrument".
10
4 Subsection 93(5)
11
Repeal the subsection.
12
5 Subsection 106K(3)
13
Omit "make written", substitute ", by legislative instrument, make".
14
6 Subsection 106K(5)
15
Repeal the subsection.
16
7 Subsection 106Q(3)
17
After "Minister may", insert ", by legislative instrument,".
18
8 Subsection 106Q(4)
19
Repeal the subsection.
20
9 At the end of section 124FAA
21
Add:
22
(7) In this section, a reference to a final determination under
23
section 106TA includes a reference to an agreement that, under
24
paragraph 92(4)(f), is taken to be a final determination for the
25
purposes of section 106X.
26

 

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