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This is a Bill, not an Act. For current law, see the Acts databases.
2004
The Parliament of
the
Commonwealth of
Australia
HOUSE OF
REPRESENTATIVES
Presented and read a first
time
National
Health Amendment (Prostheses) Bill 2004
No.
, 2004
(Health and
Ageing)
A Bill for an Act to amend
legislation relating to private health insurance, and for related
purposes
Contents
National Health Act
1953 3
Health Legislation Amendment (Private Health Insurance Reform) Act
2004 11
A Bill for an Act to amend legislation relating to
private health insurance, and for related purposes
The Parliament of Australia enacts:
This Act may be cited as the National Health Amendment (Prostheses)
Act 2004.
(1) Each provision of this Act specified in column 1 of the table
commences, or is taken to have commenced, in accordance with column 2 of the
table. Any other statement in column 2 has effect according to its
terms.
|
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 on which this Act receives the Royal Assent. |
|
|
2. Schedule 1 |
A single day to be fixed by Proclamation. However, if any of the provision(s) do not commence within the period of 9
months beginning on the day on which this Act receives the Royal Assent, they
commence on the first day after the end of that period. |
|
|
3. Schedule 2, item 1 |
At the same time as item 27 of Schedule 1 to the Health
Legislation Amendment (Private Health Insurance Reform) Act 2004
commenced. |
1 July 2004 |
|
4. Schedule 2, items 2 and 3 |
At the same time as item 16 of Schedule 1 to the Health
Legislation Amendment (Private Health Insurance Reform) Act 2004
commenced. |
1 July 2004 |
Note: This table relates only to the provisions of this Act
as originally passed by the Parliament and assented to. It will not be expanded
to deal with provisions inserted in this Act after assent.
(2) Column 3 of the table contains additional information that is not part
of this Act. Information in this column may be added to or edited in any
published version of this Act.
Each Act that is specified in a Schedule to this Act is amended or
repealed as set out in the applicable items in the Schedule concerned, and any
other item in a Schedule to this Act has effect according to its
terms.
1 Subsection 4(1)
Insert:
gap permitted prosthesis means a prosthesis determined by the
Minister under subsection 73AAG(7) to be a gap permitted prosthesis.
2 Subsection 4(1)
Insert:
no gap prosthesis means a prosthesis determined by the
Minister under subsection 73AAG(6) to be a no gap prosthesis.
3 After section 5E
Insert:
In this Act and the Health Insurance Act 1973, a reference to
hospital treatment, or an episode of hospital treatment, includes a reference to
a prosthesis provided as part of an episode of hospital treatment.
4 Subsection 67(4) (at the end of the definition of
hospital treatment)
Add:
; and (c) a prosthesis provided as part of an episode of hospital
treatment.
5 At the end of
section 73AAG
Add:
(6) The Minister may determine in writing:
(a) the prostheses that are no gap prostheses for the purposes of this
Act; and
(b) the benefit amount for each of those no gap prostheses.
Note: Determinations under this subsection are relevant for
the operation of section 73BDAAA (treatment provided in a hospital where
there is a hospital purchaser-provider agreement) and paragraphs (bl) and
(bm) of Schedule 1 (treatment provided in a hospital where there is no
hospital purchaser-provider agreement).
(7) The Minister may determine in writing:
(a) the prostheses that are gap permitted prostheses for the purposes of
this Act; and
(b) the minimum and maximum benefit amounts for each of those gap
permitted prostheses.
Note: Determinations under this subsection are relevant for
the operation of section 73BDAAA (treatment provided in a hospital where
there is a hospital purchaser-provider agreement) and paragraphs (bl) and
(bm) of Schedule 1 (treatment provided in a hospital where there is no
hospital purchaser-provider agreement).
(8) A determination made under subsection (6) or (7) before the day
on which section 3 of the Legislative Instruments Act 2003 commences
is a disallowable instrument for the purposes of section 46A of the Acts
Interpretation Act 1901.
Note: If subsection (8) applies, the determination will
become a legislative instrument for the purposes of the Legislative
Instruments Act 2003 under paragraph 6(d) of that Act.
(9) A determination made under subsection (6) or (7) on or after the
day on which section 3 of the Legislative Instruments Act 2003
commences is a legislative instrument for the purposes of that Act.
6 Subparagraph 73BD(2)(b)(i)
After “related”, insert “goods and”.
7 After section 73BD
Insert:
When this section applies
(1) This section applies if:
(a) a hospital purchaser-provider agreement between a registered
organization and a hospital or day hospital facility deals with the payment to
be made by the organization to the hospital or day hospital facility in relation
to a particular episode of hospital treatment; and
(b) a no gap prosthesis, or a gap permitted prosthesis, is provided as
part of that episode of hospital treatment; and
(c) the person to whom the prothesis is provided is a contributor to the
health benefits fund conducted by the organization; and
(d) under the terms on which the person is a contributor, the person is
covered (wholly or partly) in respect of that episode of hospital treatment or
of the professional service associated with the provision of the prosthesis;
and
(e) a medicare benefit is payable in respect of the professional service
associated with the provision of the prosthesis.
Cost of prosthesis
(2) In working out the amount the organization must pay the hospital or
day hospital facility for the episode of hospital treatment, the amount taken
into account to cover the cost of the prosthesis is determined using the
following table:
|
Cost of prosthesis |
|||
|---|---|---|---|
|
Item |
If the prosthesis is... |
and the payment is to... |
the amount taken into account to cover the cost of the
prosthesis... |
|
1 |
a no gap prosthesis |
a recognised hospital |
must not exceed the benefit amount for the prosthesis determined by the
Minister under subsection 73AAG(6). |
|
2 |
a no gap prosthesis |
a private hospital |
must be the benefit amount for the prosthesis determined by the Minister
under subsection 73AAG(6). |
|
3 |
a no gap prosthesis |
a day hospital facility |
must be the benefit amount for the prosthesis determined by the Minister
under subsection 73AAG(6). |
|
4 |
a gap permitted prosthesis |
a recognised hospital |
must not exceed the maximum benefit amount for the prosthesis determined by
the Minister under subsection 73AAG(7). |
|
5 |
a gap permitted prosthesis |
a private hospital |
(a) must be at least the minimum benefit amount for the prosthesis
determined by the Minister under subsection 73AAG(7); and (b) must not exceed the maximum benefit amount for the prosthesis
determined by the Minister under that subsection. |
|
6 |
a gap permitted prosthesis |
a day hospital facility |
(a) must be at least the minimum benefit amount for the prosthesis
determined by the Minister under subsection 73AAG(7); and (b) must not exceed the maximum benefit amount for the prosthesis
determined by the Minister under that subsection. |
(3) Paragraphs (d) and (e) of Schedule 1 do not apply to
benefits covered by this section.
Contributor not liable for no gap prosthesis
(4) If the prosthesis is a no gap prosthesis, the agreement must provide
that the hospital or day hospital facility agrees to accept payment by the
organization under the agreement in relation to the episode in satisfaction of
any amount that the contributor would, apart from the agreement, owe the
hospital or day hospital facility for the prosthesis.
Limitation on contributor’s liability for gap permitted
prosthesis
(5) If the prosthesis is a gap permitted prosthesis, the agreement must
provide that the payment by the organization under the agreement in relation to
the episode will not leave the contributor liable to the hospital or day
hospital facility in relation to the prosthesis for an amount that exceeds the
difference between:
(a) if the amount paid by the organization under the agreement is less
than or equal to the minimum benefit amount for the prosthesis determined by the
Minister under subsection 73AAG(7)—the maximum and minimum benefit amounts
for the prosthesis determined by the Minister under that subsection;
or
(b) if the amount paid by the organization under the agreement is more
than the minimum benefit amount for the prosthesis determined by the Minister
under subsection 73AAG(7)—the maximum benefit amount for the prosthesis
determined by the Minister under that subsection and the amount paid by the
organization under the agreement.
Obligation on organizations regarding agreements
(6) An organization must not enter into a hospital purchaser-provider
agreement that does not contain the terms required by subsections (4) and
(5).
8 Application of item 7
(1) Section 73BDAAA of the National Health Act 1953 (as
inserted by item 7 of this Schedule) applies in relation to a hospital
purchaser-provider agreement made after the commencement of this
Schedule.
(2) That section (other than subsection (6) of that section) also
applies in relation to a hospital purchaser-provider agreement made before the
commencement of this Schedule, but only if the agreement is in force immediately
before that commencement.
9 Paragraph (bi) of
Schedule 1
Omit “condition set out in paragraph”, substitute
“conditions set out in paragraphs (bl), (bm) and”.
10 Paragraph (bj) of
Schedule 1
Omit “condition set out in paragraph”, substitute
“conditions set out in paragraphs (bl), (bm) and”.
11 After paragraph (bk) of
Schedule 1
Insert:
(bl) This paragraph applies to a prosthesis if:
(i) the prosthesis is a no gap prosthesis or a gap permitted prosthesis;
and
(ii) the prosthesis is provided as part of an episode of hospital
treatment; and
(iii) a medicare benefit is payable in respect of the professional service
associated with the provision of the prosthesis; and
(iv) the person to whom the prosthesis is provided is a contributor to the
health benefits fund conducted by the organization; and
(v) under the terms on which the person is a contributor, the person is
covered (wholly or partly) in respect of the episode of hospital treatment or of
the professional service; and
(vi) the episode of hospital treatment is provided in a hospital or day
hospital facility with which the organization does not have a hospital
purchaser-provider agreement covering episodes of hospital treatment of that
kind.
(bm) If paragraph (bl) applies to a prosthesis:
(i) each applicable benefits arrangement of the organization must provide
for benefits to be payable in respect of the prosthesis; and
(ii) the amount of benefit payable by the organization in respect of the
prosthesis is determined by using the following table:
|
Amount of benefit for prosthesis |
|||
|---|---|---|---|
|
Item |
If the prosthesis is... |
and the episode of hospital treatment is provided in... |
the amount of benefit payable by the organization in respect of the
prosthesis... |
|
1 |
a no gap prosthesis |
a recognised hospital |
(a) must be at least the lesser of the following amounts: (b) must not exceed the benefit amount referred to in
subparagraph (a)(i). |
|
2 |
a no gap prosthesis |
a private hospital |
must be the benefit amount for the prosthesis determined by the Minister
under subsection 73AAG(6). |
|
3 |
a no gap prosthesis |
a day hospital facility |
must be the benefit amount for the prosthesis determined by the Minister
under subsection 73AAG(6). |
|
4 |
a gap permitted prosthesis |
a recognised hospital |
(a) must be at least the lesser of the following amounts: (b) must not exceed the maximum benefit amount for the prosthesis
determined by the Minister under that subsection. |
|
5 |
a gap permitted prosthesis |
a private hospital |
(a) must be at least the minimum benefit amount for the prosthesis
determined by the Minister under subsection 73AAG(7); and (b) must not exceed the maximum benefit amount for the prosthesis
determined by the Minister under that subsection. |
|
6 |
a gap permitted prosthesis |
a day hospital facility |
(a) must be at least the minimum benefit amount for the prosthesis
determined by the Minister under subsection 73AAG(7); and (b) must not exceed the maximum benefit amount for the prosthesis
determined by the Minister under that subsection. |
Paragraphs (d) and (e) do not apply to benefits covered by this
paragraph.
Health Legislation
Amendment (Private Health Insurance Reform) Act 2004
1 After item 28 of
Schedule 1
Insert:
28A Saving provision
A form approved by the Minister under subsection 78(1C) of the National
Health Act 1953 that was in force immediately before the day of commencement
of item 27 of this Schedule continues in force, on and after that day, as
if it had been approved by the Minister under and for the purposes of subsection
78(2) of that Act as amended by item 27 of this Schedule.
2 After item 32 of
Schedule 1
Insert:
32A Schedule 1 (note appearing after the
Schedule heading)
Omit “73BA”, substitute “73AAF”.
3 After item 37 of
Schedule 1
Insert:
37A Paragraph (ma) of
Schedule 1
Omit “73BA(2A)”, substitute “73AAG(2)”.