Commonwealth Numbered Acts

HEALTH LEGISLATION (PHARMACEUTICAL BENEFITS) AMENDMENT ACT 1991 No. 119 of 1991 - SECT 14

14. Sections 99AAA, 99AAB and 99AAC of the Principal Act are repealed and the
following sections are substituted: Claim for payment relating to supply of
benefits

"99AAA. (1) In this section: `Claims Transmission System' means the procedures
defined in the rules made by the Minister under paragraph (8) (c); `manual
system' means the procedures defined in the rules made by the Minister under
paragraph (8) (d).

"(2) An approved supplier who wants to receive payment from the Commonwealth
in relation to the supply of a pharmaceutical benefit must make a claim for
payment to the Secretary in accordance with the rules made by the Minister
under paragraph (8) (a).

"(3) An approved supplier who makes, or proposes to make, a claim for payment
in relation to the supply of a pharmaceutical benefit must give to the
Secretary, in relation to the supply of that benefit, the information
specified in the rules made by the Minister under paragraph (8) (b).

"(4) Except as provided by section 99AAB, an approved supplier must use the
Claims Transmission System to give information to the Secretary in relation to
the supply of pharmaceutical benefits.

"(5) If an approved supplier does not use the Claims Transmission System to
provide information to the Secretary in relation to the supply of
pharmaceutical benefits, the approved supplier must use the manual system to
provide that information to the Secretary.

"(6) The Secretary must process and determine claims made under subsection
(2), and make any payments relating to those claims, in accordance with the
rules made by the Minister under paragraph (8) (e).

"(7) Where the Secretary decides not to approve a claim made by an approved
supplier under subsection (2), the Secretary must, in writing, inform the
approved supplier of the decision and give reasons for the decision.

"(8) The Minister must, by instrument in writing, make:

   (a)  rules defining the procedures to be followed by approved suppliers in
        making claims for payment in relation to the supply of pharmaceutical
        benefits; and

   (b)  rules specifying the information to be given to the Secretary by
        approved suppliers in relation to the supply by them of pharmaceutical
        benefits; and

   (c)  rules defining the procedures to be followed by approved suppliers in
        providing information by electronic means to the Secretary in relation
        to the supply by them of pharmaceutical benefits; and

   (d)  rules defining the procedures to be followed by approved suppliers in
        providing information otherwise than by electronic means to the
        Secretary in relation to the supply by them of pharmaceutical
        benefits; and

   (e)  rules defining the procedures to be followed by the Secretary in:

   (i)  processing and determining claims by approved suppliers for payment
        relating to the supply of pharmaceutical benefits; and

   (ii) making the payments.

"(9) An instrument made by the Minister under subsection (8) is a disallowable
instrument for the purposes of section 46A of the Acts  Interpretation Act
1901 .

"(10) In making rules for the purposes of paragraph (8) (a), the Minister may
define different procedures:

   (a)  for the making of claims for payment supported by information provided
        by electronic means; and

   (b)  for the making of claims for payment supported by information provided
        otherwise than by electronic means. Certain suppliers exempted from
        requirement to use the Claims Transmission System

"99AAB. (1) An approved supplier specified in subsection (2) is not required
to comply with subsection 99AAA (4) but the approved supplier may do so if the
approved supplier so wishes.

"(2) For the purposes of subsection (1), the following approved suppliers are
specified:

   (a)  an approved medical practitioner;

   (b)  an approved pharmacist who:

   (i)  proposes under an amalgamation agreement to cease supplying
        pharmaceutical benefits from premises in respect of which the
        pharmacist is approved; and

   (ii) has, before the commencement of this section, made an application for
        financial assistance under subsection 99ZC (1) together with the other
        parties to the amalgamation agreement; and

   (iii) is supplying pharmaceutical benefits from those premises:

                (A)  pending a decision on the application; or

                (B)  if a decision has been made to grant financial assistance
                     - in accordance with the conditions subject to which the
                     grant has been made;

   (c)  an approved pharmacist who:

   (i)  proposes, otherwise than under an amalgamation agreement, to cease
        supplying pharmaceutical benefits from premises in respect of which
        the pharmacist is approved; and

   (ii) has, before the commencement of this section, made an application for
        financial assistance under subsection 99ZD (1); and

   (iii) is supplying pharmaceutical benefits from those premises:

                (A)  pending a decision on the application; or

                (B)  if a decision has been made to grant financial assistance
                     - in accordance with the conditions subject to which the
                     grant has been made;

   (d)  an approved pharmacist who, in accordance with relevant arrangements
        made by the Minister under subsection 100 (1), is supplying
        pharmaceutical benefits to persons living in an isolated area;

   (e)  an approved supplier in respect of whom a declaration under section
        99AAC is in force.

"(3) In subsection (2): `amalgamation agreement' has the same meaning as in
Division 4C of Part VII. Declaration by Secretary exempting approved supplier
from using Claims Transmission System

"99AAC. (1) The Secretary may, subject to the guidelines determined by the
Minister under subsection (2), declare in writing that an approved supplier is
exempted from the operation of subsection 99AAA (4).

"(2) The Minister must determine, in writing, guidelines in accordance with
which the Secretary is to exercise his or her functions under subsection (1).

"(3) A determination under subsection (2) is a disallowable instrument for the
purposes of section 46A of the Acts Interpretation Act 1901.

"(4) Where the Secretary decides:

   (a)  not to make a declaration under subsection (1) in respect of an
        approved supplier; or

   (b)  to revoke such a declaration; the Secretary must, in writing, inform
        the approved supplier of the decision and give reasons for the
        decision.".