Commonwealth Numbered Acts

Health Acts Amendment Act 1981 No. 118 of 1981 - SECT 71

71. After section 73F of the Principal Act the following section is inserted:
Determination of certain hospital benefits by Permanent Head

''73G. (1) In this section-

'applicant', in relation to a claim to which this section applies, means the
person who makes application under this section for a determination of the
benefits that are to be payable in respect of the provision of the hospital
treatment to which the claim relates;

'claim to which this section applies' means a claim for benefits, in
accordance with a basic hospital benefits table conducted by a registered
organization, in respect of the provision of hospital treatment 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 an
exemption granted to the organization under section 73F (not being an
exemption that, by virtue of sub-section (2B) of section 73F or in compliance
with the condition set out in paragraph (sb) of the Schedule, is to be
disregarded in relation to the person during the period, or any part of a
period, to which the claim relates) together with a professional service that
is not a professional service of a kind specified in that exemption;

'claimant', in relation to a claim to which this section applies, means the
person who makes the claim;

'other party', in relation to a claim to which this section applies, means the
claimant or the registered organization, whoever is not the applicant.

''(2) The claimant in relation to a claim to which this section applies or the
registered organization concerned may make application, in writing, to the
Department for a determination of the benefits that are to be payable in
respect of the provision of the hospital treatment to which the claim relates.

''(3) Where an application is made under sub-section (2), the Permanent Head
shall serve by post on the other party a notification of the receipt of the
application and request the other party to furnish to the Permanent Head, in
writing, within 14 days after receipt of the notification, any comments that
he may wish to make with respect to the claim the subject of the application.

''(4) In considering a claim to which this section applies, the Permanent Head
shall have regard to the relationship between the hospital treatment to which
the claim relates and the professional services for the purpose of permitting
the rendering of which the hospital treatment was provided.

''(5) After consideration of a claim in accordance with sub-section (4), the
Permanent Head shall determine the benefits that are to be payable in respect
of the provision of the hospital treatment to which the claim relates, not
being benefits greater than the benefits that would be payable in relation to
that hospital treatment if no exemption had been in force under section 73F at
the time when the hospital treatment was provided, and shall serve by post on
the applicant and the other party a notification of the determination.

''(6) A person who has been notified of a determination of the Permanent Head
under sub-section (5) may, within one month of the receipt of that
notification, lodge with the Minister an appeal against that determination.

''(7) The Minister shall consider any appeal under sub-section (6) and shall
either confirm the determination of the Permanent Head or allow the appeal and
determine the benefits that are to be payable in respect of the provision of
the hospital treatment to which the appeal relates, not being benefits greater
than the benefits that would be payable in relation to that hospital treatment
if no exemption had been in force under section 73F at the time when the
hospital treatment was provided.

''(8) Where the Minister under sub-section (6) confirms a determination of
the Permanent Head, or determines the benefits that are to be payable in
respect of the provision of hospital treatment, in respect of a claim to which
this section applies, he shall serve by post on the applicant and on the other
party a notification of the confirmation or of his determination, as the case
may be.

''(9) A determination of the Permanent Head under sub-section (5) shall,
unless an appeal against it is lodged in accordance with sub-section (6), come
into operation at the expiration of the period in which such an appeal may be
lodged.

''(10) A determination of the Permanent Head that is confirmed by the Minister
under sub-section (7) shall come into operation on the day on which it is so
confirmed.

''(11) A determination of the Minister under sub-section (7) shall come into
operation on the day on which it is made.''.