Explanatory Memorandum
(Circulated by authority of the Minister for Health and Aged Care, the Hon Dr Michael Wooldridge, MP)Schedule 2 - Amendment of the Health Insurance Act 1973
Part 1 - Recognition of specialists
This item makes a cross-referencing change within the subsection 3(1) definition of specialist, consequent upon other changes made by the Schedule.
This item adds, at the end of the subsection 3(1) definition of specialist, a reference to medical practitioners taken to be recognised under the new section 3D regime involving automatic recognition.
Item 3 repeals current section 3D, and substitutes a number of new sections covering recognition as a specialist.
New section 3D - Recognition as specialists of members of certain organisations on advice from the organisation
New section 3D provides the regime for automatic recognition of certain practitioners as specialists. Under subsection 3D(1), such recognition is accorded to a practitioner where the relevant College gives the Managing Director of the Health Insurance Commission a written notice stating that the practitioner meets the criteria for the speciality.
Subsection 3D(2) then sets out the criteria which must be satisfied to trigger the automatic recognition regime : these are (a) Australian domicile; (b) fellowship of the relevant specialist College; and (c) a relevant qualification (following successful completion of an appropriate course of study). Definitions of relevant organisation and relevant qualification are contained in subsection 3D(5). (These criteria mirror the criteria set out in current paragraph 3D(1)(a).)
Subsection 3D(3) ensures that the practitioner is notified of his or her specialist recognition under the automatic regime, as soon as reasonably practicable.
Subsection 3D(4) makes clear that the new automatic regime set out in section 3D operates in addition to the alternative recognition method contained in section 3DB, and does not in any way limit the operation of the alternative method.
New section 3DA - Period of section 3D recognition
New section 3DA makes provision in relation to the effective day of the specialists recognition under the section 3D automatic recognition regime, and cessation of recognition in certain circumstances.
Subsection 3DA(1) provides that the effective day of recognition of a specialist taken to be recognised under subsection 3D(1) is the day specified in the notice of advice provided to the specialist by the Health Insurance Commissions Managing Director.
Subsection 3D(2) goes on to provide that this day can be earlier than the day of the notice itself. However, it cannot be earlier than the day specified by the College as the date that the practitioner first met the recognition criteria.
Subsection 3DA(3) provides for an automatic cessation of a section 3D recognition if (a) the relevant College gives a notice to the Health Insurance Commission stating that the criteria for recognition (these being, in short, Australian domicile; Fellowship; and relevant qualifications) are no longer met, or the practitioner has ceased to practise medicine in Australia; or (b) the practitioner requests that he or she no longer be recognised.
New section 3DB - Alternative method of recognition as a specialist
New section 3DB sets out the alternative method of recognition as a specialist, for those practitioners who have not automatically been recognised as such under the section 3D regime. Subsection 3DB(2) makes clear that this alternative method will apply to practitioners who meet the subsection 3D(2) criteria - but who, for whatever reason, have not been the subject of a notice from the relevant College to the Health Insurance Commission under subsection 3D(1). The alternative section 3DB method will also apply to those practitioners who are not Fellows with relevant qualifications, but who are merely Australian-domiciled State-registered specialists (subsection 3DB(1). For these two classes of practitioners, subsection 3DB(3) requires a written application accompanied by the prescribed fee. The application will then be resolved by means of either a Ministerial determination (subsection 3DB(4)(a)) or referral of the matter - under subsection 61(1) - to the appropriate Specialist Recognition Advisory Committee. The practitioner will be notified accordingly, in writing.
Subsection 3DB(5) defines appropriate Specialist Recognition Advisory Committee, for purposes of subsection 3DB(4), as the Committee established for the State or Territory where the practitioner is domiciled.
The provisions of subsection 3DB are intended to mirror the operation of current section 3D (now being repealed).
New section 3DC - Period of effect of determination
Consistently with new subsection 3DA(1) and paragraph 3DA(2)(a), section 3DC provides that a paragraph 3DB(4)(a) determination is effective from the day specified in the determination, which may be a day earlier than the day of the determination itself.
Provision is also made, in subsection 3DC(3), for cessation of the determination where the practitioner ceases to be Australian-domiciled or to practise medicine (consistently with subsection 3DA(3)(a)). The Minister is required to revoke the determination if the practitioner so requests (subsection 3DC(4)) - the comparable provision under the automatic regime provisions is paragraph 3DA(3)(b).
This item repeals a now-superfluous provision of the Act. Section 51 allowed for members of the Specialist Recognition Advisory Committees and Specialist Recognition Appeal Committee under the National Health Act 1953 , to be deemed to members of those Committees under the Health Insurance Act 1973 , when the functions of those Committees were transferred from the former Act to the latter Act.
This item makes a cross-referencing change within subsection 61(1B), consequent upon other changes made by the Schedule.
This item ensures the preservation of relevant regulations in force immediately before Royal Assent, so that there is no need - merely consequent upon the Schedule amendments - to make new regulations defining relevant organisation or relevant qualification for purposes of new subsection 3D(5) or prescribing a fee for purposes of new paragraph 3DB(3)(b).
Item 6(3) makes clear that the ordinary ability to amend or repeal the Health Insurance Regulations, by regulations under the Health Insurance Act 1973 , is unaffected by this Schedule.
Part 2 - Pay doctor via claimant cheques amendment
Amends section 20 by inserting new subsections 20(3), 20(4) and 20(5), which permits the Commission, in limited circumstances, to pay Medicare benefits direct to general practitioners.
New subsection 20(3) provides that the Commission may pay Medicare benefits payable in respect of a professional service directly to a general practitioner where a pay doctor via claimant cheque is not presented within 90 days after issue.
New subsection 20(4) provides that if the Commission pays an amount under subsection (3) to a general practitioner, the request under subsection 20(2) by the person to whom the Medicare benefit is payable, to give or send a cheque for the amount of the Medicare benefit, is withdrawn and that person may not make any subsequent request under subsection (2).
New subsection 20(5) provides that the Commission may pay an amount under subsection (3) by means of electronic transmission of the amount to an account kept with a bank.
Item 8 provides that item 7 of this Schedule applies to cheques given or sent under subsection 20(2) after 1 July 2001 or if the day on which this Act receives Royal Assent is after 1 July 2001, that day.
Copyright notice
© Australian Taxation Office for the Commonwealth of Australia
You are free to copy, adapt, modify, transmit and distribute material on this website as you wish (but not in any way that suggests the ATO or the Commonwealth endorses you or any of your services or products).
