Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE COMMISSION REGULATIONS (AMENDMENT) 1995 NO. 286

STATUTORY RULES 1995 No. 286

Issued by the Authority of the Minister for Human Services and Health

Health Insurance Commission Act 1973

Health Insurance Commission Regulations (Amendment)

Section 8E of the Health Insurance Commission Act 1973 (the Act) provides that the Health Insurance Commission (the Commission) shall perform such functions in relation to health insurance and other health related matters as are prescribed in the Health Insurance Commission Regulations.

Section 44 of the Act provides that the Governor-General may make regulations for the purposes of the Act.

Regulation 3P allows the Commission to perform the function of administering the Better Practice Program (the Program) and allows certain decisions made in the administration of the Program to be reviewed, initially by the Commission and if required by the Administrative Appeals Tribunal.

The purpose of amending Regulation 3P is to accommodate the introduction of revised eligibility criteria on 1 December 1995, and to allow the Commission to administer the Program more effectively. Details of the amendments to Regulation 3P are attached.

The Regulations commenced on gazettal.

ATTACHMENT A

Details of Amendments to Regulation 3P

The amendments to regulation 3P will allow the Commission to assess applications lodged after 30 November in terms of new eligibility criteria which will be introduced on 1 December 1995, and will enable the Commission to perform the function of administering the Better Practice Program more effectively. Specifically:

•       subregulation 3P (1) (aa) will allow the Commission to verify information provided in relation to an application.

•       subregulation 3P (1) (da) will allow the Commission to provide information obtained from applications, where the consent of persons applying for the Program has been given, to the Department. The information will not identify a particular patient.

•       subregulation 3P (1) (f) will allow the Commission to develop and implement strategies to ensure that practices participating in the Program continue to comply with the requirements outlined in the eligibility criteria.

•       subregulation 3P (1) (g) empowers the Commission to conduct post-payment audit activities.

•       subregulation 3P (1) (h) will allow the Commission to take action, where necessary, to recover funds from a general practice participating in the Program.

•       subregulation 3P (1) (i) empowers the Commission to do all things necessary to ensure payments made for the purpose of the Program are correctly administered and appropriately accounted for.

•       subregulation 3P (2) (a) (i) requires the Commission to make decisions regarding eligibility and the amount payable, in relation to applications lodged with the Commission on or before 30 November 1995, in accordance with the criteria outlined in the Document "Eligibility Criteria and Payment Arrangements for the better Practice Program, 1994-95" that was published by the Department in November 1994.

•       subregulation 3P (2) (a) (ii) requires the Commission to make decisions regarding eligibility and the amount payable, in relation to applications lodged with the Commission after 30 November 1995, in accordance with the criteria outlined in the Document "Eligibility Criteria and Payment Arrangements for the Better Practice Program as from 1 December 1995" published by the Department in October 1995.