Commonwealth Numbered Acts

HEALTH INSURANCE AMENDMENT ACT 1991 No. 171 of 1991 - SECT 8

8. After section 20B of the Principal Act the following sections are inserted:
Additional fees payable in certain bulk billing cases

"20C. If a benefit in respect of a prescribed GP service for which a
practitioner would have a right to charge an amount under subsection 20A(1A)
is assigned to that practitioner, the Commission must pay the practitioner, at
the time of payment of that benefit, an additional amount of $1.00 in respect
of the provision of that service. Adjustment of benefit and refund of
co-payment in certain circumstances

"20D.(1) If:

   (a)  a prescribed GP service has been rendered to a person (in this section
        called the `patient'); and

   (b)  the right to benefit in respect of that service has been assigned to
        the practitioner; and

   (c)  the claim for benefit in respect of that service was submitted to the
        Commission as a claim in respect of benefit under paragraph 10(2)(c);
        and

   (d)  the Commission is or becomes aware that, at the time the service was
        rendered;

   (i)  the patient was in fact a concessional beneficiary or a concessional
        beneficiary's dependant; or

   (ii) the service was in fact a service that was subject to an increased
        benefit under section 10AC or 10AD; the Commission may, in the
        circumstances provided for in subsection (3):

   (e)  refund any amount charged by the practitioner under subsection 20A(1A)
        (in this section called a `co-payment') in respect of that service;
        and

   (f)  adjust the amount of any benefit paid to the practitioner in respect
        of that service so that the total amount received by the practitioner
        is equal to 85% of the Schedule fee.

"(2) In adjusting the amount of benefit paid to the practitioner, the
Commission must take account of the following amounts paid in respect of the
service:

   (a)  any co-payment paid to the practitioner;

   (b)  any benefit already paid to the practitioner by the Commission; and

   (c)  any additional amount paid under section 20C by the Commission.

"(3) The Commission may do the things provided for in paragraphs (1)(e) and
(f):

   (a)  on its own initiative; or

   (b)  on written application, supported by such evidence as it requires, by:

   (i)  the patient to whom the service was rendered; or

   (ii) the practitioner who rendered the service; or

   (iii) the person who paid the co-payment (if any) in respect of the
        service.

"(4) For the purpose of subsection (1), if the right to benefit in respect of
a service is assigned under section 20A, the claim for benefit in respect of
that service is taken to have been submitted to the Commission as a claim in
respect of benefit under paragraph 10(2)(c) if:

   (a)  neither the assignment form nor any accompanying document indicates
        that the patient is a concessional beneficiary or a concessional
        beneficiary's dependant; and

   (b)  the assignment form does not indicate that the patient is the holder
        of a safety-net concession card.

"(5) If the Commission adjusts the amount of the benefit paid to a
practitioner in respect of a prescribed GP service by taking into account the
amount of any co-payment or any additional amount paid to the practitioner
under section 20C, then the amount of that co-payment or that additional
amount is to be treated, for all purposes of this Act, as if it were an amount
paid to the practitioner by the Commission on behalf of the Commonwealth as a
part of the benefit payable in respect of that service.".