Commonwealth Numbered Acts

HEALTH INSURANCE AMENDMENT ACT 1977 No. 75 of 1977 - SECT 6

6. (1) Section 16A of the Principal Act is repealed and the following section
substituted:- Pathology services.
''16A. (1) A medical benefit is not payable in respect of a pathology service
unless a practitioner determined that the service was necessary, the
provisions of sub-section (2) were complied with in respect of the service,
and-

   (a)  in the case of a pathology service (other than a prescribed pathology
        service or a service to which paragraph (b) applies)-the service was
        rendered by or on behalf of an approved pathology practitioner in
        pursuance of a request addressed to that approved pathology
        practitioner-

        (i)    by the practitioner who determined that the service was
               necessary; or

        (ii)   by another approved pathology practitioner who is not the
               practitioner who determined that the service was necessary,

being a request made in writing as prescribed or, if made otherwise than in
writing, subsequently confirmed in writing as prescribed;

   (b)  in the case of a pathology service, other than a prescribed pathology
        service, determined to be necessary by an approved pathology
        practitioner (being a medical practitioner) or by the employee (being
        a medical practitioner) of an approved pathology practitioner in the
        course of that employment-the service was rendered by or on behalf of
        that approved pathology practitioner; or

   (c)  in the case of a prescribed pathology service-the service was rendered
        by or on behalf of a medical practitioner other than an approved
        pathology practitioner (in this paragraph referred to as 'the
        first-mentioned practitioner') and-

        (i)    the service was determined to be necessary by the first-
               mentioned practitioner; or

        (ii)   the service was rendered in pursuance of a request made by the
               person who determined that the service was necessary, being a
               medical practitioner (other than an approved pathology
               practitioner) who, at the time the request was made, was a
               member of a group of practitioners of which the first-mentioned
               practitioner was then a member.

''(2) There shall be recorded on the account, or on the receipt, for fees in
respect of the service or, if an agreement has been entered into under
sub-section 20 (3) in relation to the medical benefit in respect of the
service, on the form of agreement, such particulars as are prescribed.

''(3) Where a pathology service has been rendered by or on behalf of an
approved pathology practitioner in pursuance of a request made or confirmed as
described in paragraph (1) (a), then-

   (a)  if the approved pathology practitioner fails to retain the written
        request or the written confirmation of the request for a period of 18
        months after the date on which the service was rendered; or

   (b)  if, on being served as prescribed, at any time within 18 months after
        the date on which the service was rendered, with a notice in writing
        signed by the Minister requiring the approved pathology practitioner
        to produce the written request or the written confirmation of the
        request to an officer of the Department of Health specified in the
        notice, the approved pathology practitioner fails to comply with the
        requirement within 14 days after being served with the notice, the
        approved pathology practitioner is guilty of an offence and is
        punishable on conviction by a fine not exceeding $1,000.

''(4) In any proceedings for an offence against sub-section (3), an averment
of the prosecutor, contained in the information or complaint, that a specified
pathology service was rendered by or on behalf of a specified approved
pathology practitioner on a specified date is prima facie evidence of the
matters averred.

''(5) For the purposes of this section-

   (a)  where a service is rendered by a person (in this paragraph referred to
        as 'the employee') in the course of his employment by another person,
        then, except in a case to which paragraph (b) applies, it shall be
        deemed to be rendered by that other person, and not by the employee;

   (b)  where a person (in this paragraph referred to as 'the employee') is
        employed by two or more persons jointly and a service is rendered by
        the employee in the course of that employment, it shall be deemed to
        be rendered by the employer principally reponsible for the matter
        being dealt with by the employee, and not by the employee;

   (c)  a service shall be taken to be rendered on behalf of a person if, and
        only if, it is rendered by another person, not being an approved
        pathology practitioner, by arrangement with that person;

   (d)  a member of, or a member of the staff of, an authority (being a
        corporation) established by a law of the Commonwealth or of a State or
        internal Territory shall be taken to be employed by that authority;

   (e)  where two or more practitioners-

        (i)    provide professional services as partners; or

        (ii)   share amongst them all, or a substantial part of, the income
               from providing professional services,

those practitioners shall be deemed to constitute a group of practitioners;
and

   (f)  a reference to determining a service to be necessary is a reference to
        determining that the service is reasonably necessary for the adequate
        medical care of the patient concerned.

''(6) This section does not apply in relation to a service in relation to
which section 21 applies.''.

(2) Before section 17 of the Principal Act the following sections are
inserted:- Forms of undertaking for approved pathology practitioners.
''16B. (1) The Minister may draw up forms of undertaking to be given by
persons who wish to become approved pathology practitioners.

''(2) A form of undertaking shall make provision for and in relation to such
matters as the Minister considers appropriate.

''(3) The Minister may at any time refer to the Medical Benefits Advisory
Committee, for its consideration and recommendations, proposals for the
variation of a form of undertaking.

''(4) Where the Medical Benefits Advisory Committee makes a recommendation to
the Minister under sub-section (3) with respect to a proposal, the Minister-

   (a)  if the recommendation is that the proposal be adopted without
        amendment-shall vary the form of undertaking concerned in accordance
        with the recommendation; or

   (b)  if the recommendation is that the proposal be adopted with amendments
        specified in the recommendation-may vary the form of undertaking
        concerned in accordance with the recommendation.

''(5) The Minister shall forward to the Medical Benefits Advisory Committee a
copy of each form of undertaking drawn up under this section and a copy of any
variation of such a form. Undertaking by eligible applicant.
''16C. (1) In this section-

'authority' means an authority (being a corporation) established by a law of a
State or of an internal Territory;

'eligible applicant' means-

   (a)  a medical practitioner;

   (b)  a person (other than a State or an authority) who employs a medical
        practitioner or medical practitioners to render pathology services;

   (c)  a State or authority, being a State or authority specified by the
        Minister in writing for the purposes of this definition; or

   (d)  a person (other than a State, an authority or a person referred to in
        paragraph (a) or (b)) who, immediately before the date of commencement
        of this section, was carrying on the business of rendering pathology
        services at the request of medical practitioners, where-

        (i)    in accordance with an approval granted by the Permanent Head of
               the Department of Health, that person issued to the person who
               incurred the medical expenses in respect of a pathology service
               so rendered (not being the practitioner who requested the
               rendering of the service) an account or receipt for his fees in
               respect of the service; and

        (ii)   medical benefit was paid before that date in respect of the
               service;

'form of undertaking' means a form of undertaking drawn up under section 16B.

''(2) Subject to sub-section (3), where an eligible applicant gives, as
prescribed, an undertaking in writing in accordance with the appropriate form
of undertaking, signed by or on behalf of the applicant as required by the
form, together with a fee of $10 or of such other amount as is prescribed, the
Minister shall-

   (a)  if the eligible applicant previously gave an undertaking that was
        accepted under this section and the acceptance was subsequently
        revoked under section 106-refer to a Medical Services Committee of
        Inquiry for inquiry and report the question whether the undertaking
        should be accepted or refused; or

   (b)  in any other case, either-

        (i)    on behalf of the Commonwealth, accept the undertaking; or

        (ii)   refer to a Medical Services Committee of Inquiry for inquiry
               and report the question whether he would be justified in
               refusing to accept the undertaking.

''(3) An eligible applicant as defined by paragraph (d) of the definition of
'eligible applicant' in sub-section (1) is not entitled to give an undertaking
under sub-section (2) if a previous undertaking given by the applicant was
accepted under this section and the acceptance was subsequently revoked under
section 106.

''(4) As soon as practicable after the Minister receives the report and
recommendation of the Committee upon a reference under sub-section (2), he
shall, in accordance with the recommendation, either, on behalf of the
Commonwealth, accept the undertaking or refuse to accept the undertaking.

''(5) The Minister shall serve, either personally or by post, on the person
concerned notification of acceptance or refusal of acceptance of an
undertaking under this section.

''(6) Where a refusal by the Minister under sub-section (4) to accept an
undertaking given by a person who wishes to become an approved pathology
practitioner does not take effect by reason of being set aside on review or in
accordance with a judgment or order on appeal, the Minister shall be deemed,
for the purposes of this Act, to have accepted that undertaking on behalf of
the Commonwealth under that sub-section on the date on which the undertaking
was originally received by the Minister or on such earlier date (not being a
date earlier than the date on which it was signed) as is fixed by the
Minister.

''(7) Where a form of undertaking is varied by the Minister under sub-section
16B (4), an undertaking given under this section in accordance with that form
of undertaking shall be deemed, for the purposes of this Act, to have been
varied to accord with that form of undertaking as so varied by the Minister.

''(8) An approved pathology practitioner may, at any time, terminate an
undertaking given by him by serving, as prescribed, a notice of termination
specifying a date of termination not earlier than 30 days after the day on
which the notice is served.

''(9) For the purposes of this Act, an undertaking given by a person under
this section comes into force when accepted by the Minister or on such earlier
date (not being a date earlier than the date on which the undertaking was
signed) as is fixed by the Minister and ceases to be in force if-

   (a)  the undertaking is terminated by the person under sub-section (8);

   (b)  the Minister's acceptance of the undertaking is revoked under section
        106; or

   (c)  in the case of a person who was, when he gave the undertaking, an
        eligible applicant as defined by paragraph (a), (b) or (c) of the
        definition of 'eligible applicant' in sub-section (1)-the person
        ceases to be an eligible applicant as defined by that paragraph.''.