HEALTH INSURANCE AMENDMENT (PROFESSIONAL SERVICES REVIEW) BILL 2010

i Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

Contents

Short title ........................................................................................... 1

Commencement ................................................................................. 1

Schedule(s) ........................................................................................ 2

Schedule 1--Main amendments

Part 1--Prescribed pattern of services

Health Insurance Act 1973

Part 2--Allied health practitioners

Division 1--Amendments

Health Insurance Act 1973

Division 2--Transitional and application provisions

Part 3--Meaning of service

Health Insurance Act 1973

Part 4--Extension of time for certain processes

Health Insurance Act 1973

Part 5--No further action to be taken in certain circumstances

Health Insurance Act 1973

Part 6--Date of effect for final determinations

Health Insurance Act 1973

Part 7--Referrals to Medicare Participation Review

Committee

Health Insurance Act 1973

Part 8--Referrals to appropriate regulatory bodies

Health Insurance Act 1973

Part 9--Disqualified practitioners

Health Insurance Act 1973

Part 10--Patient referrals

Health Insurance Act 1973

Schedule 2--Other amendments

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010 1

A Bill for an Act to amend the Health Insurance Act

1973, and for related purposes

The Parliament of Australia enacts:

1 Short title

This Act may be cited as the Health Insurance Amendment

(Professional Services Review) Act 2010.

2 Commencement

(1) Each provision of this Act specified in column 1 of the table

commences, or is taken to have commenced, in accordance with

column 2 of the table. Any other statement in column 2 has effect

according to its terms.

2 Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

Commencement information

Column 1

Column 2

Column 3

Provision(s)

Commencement

Date/Details

1. Sections 1 to 3

and anything in

this Act not

elsewhere covered

by this table

The day this Act receives the Royal Assent.

2. Schedule 1

A single day to be fixed by Proclamation.

However, if any of the provision(s) do not

commence within the period of 6 months

beginning on the day this Act receives the

Royal Assent, they commence on the day

after the end of that period.

3. Schedule 2

The day after this Act receives the Royal

Assent.

Note:

This table relates only to the provisions of this Act as originally

passed by both Houses of the Parliament and assented to. It will not be

expanded to deal with provisions inserted in this Act after assent.

(2) Column 3 of the table contains additional information that is not

part of this Act. Information in this column may be added to or

edited in any published version of this Act.

3 Schedule(s)

Each Act that is specified in a Schedule to this Act is amended or

repealed as set out in the applicable items in the Schedule

concerned, and any other item in a Schedule to this Act has effect

according to its terms.

Main amendments Schedule 1

Prescribed pattern of services Part 1

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010 3

Schedule 1

Main amendments

Part 1

Prescribed pattern of services

Health Insurance Act 1973

1 Subsection 81(1)

Insert:

prescribed pattern of services has the meaning given by

section 82A.

2 After subsection 82(1)

Insert:

Prescribed pattern of services

(1A) Subject to subsections (1B) and (1C), a practitioner engages in

inappropriate practice in rendering or initiating services during a

particular period (the relevant period) if the circumstances in

which some or all of the services were rendered or initiated

constitute a prescribed pattern of services.

(1B) A practitioner does not, under subsection (1A), engage in

inappropriate practice in rendering or initiating services on a

particular day during the relevant period if a Committee could

reasonably conclude that, on that day, exceptional circumstances

existed that affected the rendering or initiating of the services.

(1C) Subsection (1B) does not affect the operation of subsection (1A) in

respect of the remaining day or days during the relevant period on

which the practitioner rendered or initiated services even if the

circumstances in which the services were rendered or initiated on

that day or those days would not, if considered alone, have

constituted a prescribed pattern of services.

(1D) The circumstances that constitute exceptional circumstances for the

purposes of subsection (1B) include, but are not limited to,

circumstances that are prescribed by the regulations to be

exceptional circumstances.

Note:

The following heading to subsection 82(1) is inserted "Unacceptable conduct".

Schedule 1 Main amendments

Part 1 Prescribed pattern of services

4 Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

3 Paragraphs 82(2)(a) and (b)

Omit "within the meaning of subsection (1)", substitute "under

subsection (1) or (1A)".

Note 1: The following heading to subsection 82(2) is inserted "Causing or permitting

inappropriate practice".

Note 2: The following heading to subsection 82(3) is inserted "Matters to which Committee

must have regard".

4 At the end of Division 1 of Part VAA

Add:

82A Meaning of prescribed pattern of services

(1) The circumstances in which services are rendered or initiated by a

practitioner constitute a prescribed pattern of services if they are

circumstances prescribed by the regulations for the purposes of this

section.

(2) The circumstances prescribed may relate to services of a particular

kind or description that are rendered or initiated by:

(a) practitioners in a particular profession; or

(b) an identified group or groups of practitioners in a particular

profession.

(3) The circumstances prescribed may include the rendering or

initiation of more than a specified number of services, or more than

a specified number of services of a particular kind, on each of more

than a specified number of days during a period of a specified

duration.

5 Division 3 of Part VAA (heading)

Repeal the heading, substitute:

Division 3--Role of Medicare Australia CEO

6 Subsection 86(1)

Omit "The", substitute "Subject to subsection (1A), the".

Note:

The heading to section 86 is replaced by the heading "Requests by Medicare Australia

CEO to Director to review provision of services".

7 After subsection 86(1)

Main amendments Schedule 1

Prescribed pattern of services Part 1

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010 5

Insert:

(1A) If the Medicare Australia CEO becomes aware that the

circumstances in which services were rendered or initiated by a

person constitute a prescribed pattern of services, the Medicare

Australia CEO must make a request under subsection (1) in

relation to the services.

8 At the end of subsection 86(3)

Add:

Note:

If the request is made because of subsection (1A), it may include

reasons other than the prescribed pattern of services.

9 At the end of subsection 93(6)

Add:

Note:

The reasons given by the Director may relate solely to the services

being rendered or initiated in circumstances that constitute a

prescribed pattern of services.

10 Section 106KA

Repeal the section.

11 Paragraph 106KB(1)(b)

Omit "106KA", substitute "for the purposes of subsection 82(1A) or

(1B)".

12 Application

(1)

Despite the repeals and amendments of the Health Insurance Act 1973

made by this Part, the old law continues to apply, in relation to a request

to review the provision of services by a person that was made under

section 86 of that Act before the commencement day, as if those repeals

and amendments had not happened.

(2)

In this item:

commencement day means the day this item commences.

old law means:

(a) section 106KA of the Health Insurance Act 1973, as in force

immediately before the commencement day; and

Main amendments Schedule 1

Allied health practitioners Part 2

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010 7

Part 2

Allied health practitioners

Division 1

Amendments

Health Insurance Act 1973

13 Subsection 81(1) (at the end of the definition of

practitioner)

Add:

; or (i) a health professional of a kind determined by the Minister

under subsection (1A) to be a practitioner for the purposes of

this Part.

14 Subsection 81(1) (at the end of the definition of

profession)

Add:

; (h) a vocation determined by the Minister under subsection (1A)

to be a profession for the purposes of this Part.

15 After subsection 81(1)

Insert:

Practitioners and professions determined by Minister

(1A) The Minister may, by legislative instrument, determine:

(a) that a health professional of a particular kind (being a health

professional who provides a health service within the

meaning of subsection 3C(8)) is a practitioner for the

purposes of this Part; and

(b) that a vocation engaged in by a health professional of a kind

determined under this subsection is a profession for the

purposes of this Part.

Note:

The following heading to subsection 81(2) is inserted "Meaning of provides services".

16 Paragraph 106ZPA(1)(c)

Repeal the paragraph, substitute:

practitioner in relation to which the Professional Services

Review Scheme established by this Part applies.

Schedule 1 Main amendments

Part 2 Allied health practitioners

8 Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

Note:

See subsection 81(1) for the definition of practitioner.

17 Paragraph 106ZPB(2)(c)

Repeal the paragraph, substitute:

referred to in paragraph 106ZPA(1)(c);

18 Subsection 106ZPB(3)

After "a practitioner", insert "(other than a medical practitioner)".

19 Subsection 106ZPB(3)

Omit "any of subparagraphs 106ZPA(1)(c)(ii) to (vii)", substitute

"paragraph 106ZPA(1)(c)".

20 Subsection 106ZPH(3)

Repeal the subsection, substitute:

(3) The Minister must not appoint a person to act in an office of a

member (the relevant member) of the Authority referred to in

paragraph 106ZPA(1)(c) unless the person is a practitioner of the

same kind as the relevant member.

21 Subsection 124B(1) (at the end of the definition of

practitioner)

Add:

; or (i) a health professional of a kind determined by the Minister

under subsection (7) to be a practitioner for the purposes of

this Part.

22 At the end of section 124B

Add:

(7) The Minister may, by legislative instrument, determine that a

health professional of a particular kind (being a health professional

who provides a health service within the meaning of subsection

3C(8)) is a practitioner for the purposes of this Part.

23 At the end of subsection 124EB(2)

Add:

Main amendments Schedule 1

Allied health practitioners Part 2

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010 9

; or (d) if the Committee is convened in relation to a chiropractor--a

chiropractor; or

(e) if the Committee is convened in relation to a

physiotherapist--a physiotherapist; or

(f) if the Committee is convened in relation to a podiatrist--a

podiatrist; or

(g) if the Committee is convened in relation to an osteopath--an

osteopath; or

(h) if the Committee is convened in relation to a person who is a

health professional of a kind covered by paragraph (i) of the

definition of practitioner in subsection 124B(1)--a health

professional of the same kind as the person.

Division 2

Transitional and application provisions

24 Transitional

review of services rendered or initiated by

certain allied health practitioners

The Medicare Australia CEO must not make a request under section 86

of the Health Insurance Act 1973 to review the provision of services by

a person during a period if:

(a) the services were rendered or initiated by a health

professional who is a practitioner for the purposes of

Part VAA of that Act because of a determination that is in

force under subsection 81(1A) of that Act (as inserted by

item 15 of this Schedule); and

(b) the period falls before the determination took effect.

25 Application

acts and omissions of certain allied health

practitioners

(1)

This item applies in relation to a person who is a practitioner for the

purposes of Part VB of the Health Insurance Act 1973 because of a

determination that is in force under subsection 124B(7) of that Act (as

inserted by item 22 of this Schedule).

(2)

Part VB of the Health Insurance Act 1973 does not apply in relation to

acts and omissions of the person that took place before the

determination took effect.

(3)

For the purposes of this item, if an act or omission is alleged to have

taken place between 2 dates, one before and one on or after the day the

Schedule 1 Main amendments

Part 2 Allied health practitioners

10 Health Insurance Amendment (Professional Services Review) Bill 2010 No. ,

2010

determination took effect, the act or omission is alleged to have taken

place before the determination took effect.

26 Application of item 23

The amendment of the Health Insurance Act 1973 made by item 23 of

this Schedule does not apply in relation to a Committee that was

established under subsection 124E(1) of that Act before the

commencement of this item.

Main amendments Schedule 1

Meaning of service Part 3

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

Part 3

Meaning of service

Health Insurance Act 1973

27 Subsection 81(1) (paragraph (a) of the definition of

service)

Repeal the paragraph, substitute:

(a) a service that has been rendered if, at the time it was

rendered, medicare benefit was payable in respect of the

service; or

(ab) a service that has been initiated (whether or not it has been or

will be rendered) if, at the time it was initiated, medicare

benefit would have been payable in respect of the service had

it been rendered at that time; or

Schedule 1 Main amendments

Part 4 Extension of time for certain processes

12 Health Insurance Amendment (Professional Services Review) Bill 2010 No. ,

2010

Part 4

Extension of time for certain processes

Health Insurance Act 1973

28 Subsection 106G(3)

Repeal the subsection, substitute:

(3) If a circumstance specified in column 1 of an item in the following

table occurs, the Committee may determine, in writing, that the

period of 6 months referred to in paragraph (2)(a) is extended for a

period not exceeding the period specified in column 2 of that item.

Extension of period for giving final report

Item

Column 1

Circumstance

Column 2

Period

The person under review is

unable because of illness to attend

a hearing being conducted by the

Committee

The period during which the person

under review is unable to attend the

hearing

The person under review is fully

disqualified under section 105

The period during which the person

under review is fully disqualified under

that section

A notice is given to a person

under subsection 105A(2) and the

person fails to comply with a

requirement of the notice

The period during which the person to

whom the notice is given fails to

comply with the requirement

The Committee's consideration of

the referral is suspended under

paragraph 106N(2)(b) or because

of an injunction or other court

order

The period for which the Committee's

consideration of the referral is

suspended

29 After subsection 106G(4)

Insert:

(4A) The period of 6 months referred to in paragraph (2)(a) may be

extended under subsection (3) more than once.

30 Subsection 106S(2)

Main amendments Schedule 1

Extension of time for certain processes Part 4

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

Repeal the subsection, substitute:

(2) The Director may give information to the Determining Authority

under subsection (1) on one occasion only.

(2A) The Director must not give information to the Determining

Authority under subsection (1) after the Authority has made its

draft determination in accordance with section 106U.

31 Section 106SA

Repeal the section, substitute:

106SA Authority to invite submissions before making a draft

determination

Invitation to make submissions

(1) The Determining Authority must give the person under review a

written invitation to make written submissions to the Authority,

having regard to the Committee's final report and any information

given by the Director under section 106S, about the directions the

Authority should make in the draft determination relating to the

person.

Note:

Section 106U sets out the directions the Authority can make.

(2) An invitation under subsection (1) must state that the person under

review may make submissions within 1 month after the day on

which the invitation is given to the person.

Note:

The period for making submissions may be extended under

subsection (5) and may be affected by section 106TB.

Invitation to be given after Committee's final report is given to

Authority

(3) The Determining Authority must give an invitation under

subsection (1) within 1 month after being given the Committee's

final report.

Note:

The period for giving the invitation may be affected by

section 106TB.

Schedule 1 Main amendments

Part 4 Extension of time for certain processes

14 Health Insurance Amendment (Professional Services Review) Bill 2010 No. ,

2010

Further invitation to be given in certain circumstances

(4) If the Director gives the Determining Authority information under

section 106S after the Authority has given the person under review

an invitation under subsection (1), the Authority must, within 14

days after being given the information, give the person a further

invitation under subsection (1). Subsection (3) does not apply to

the further invitation.

Note:

The period for giving the further invitation may be affected by

section 106TB.

Period for making submissions may be extended

(5) The Determining Authority may extend a period within which the

person under review may make submissions if:

(a) the person applies, in writing, for the period to be extended;

and

(b) the application is made before the end of the period; and

period.

32 Subsection 106T(1)

Repeal the subsection, substitute:

(1) The Determining Authority must, after taking into account any

submissions made by the person under review in accordance with

section 106SA:

(a) make a draft determination in accordance with section 106U

relating to the person; and

(b) give copies of the draft determination to the person and to the

Director.

(1A) The Determining Authority must comply with subsection (1)

within 1 month after the last day on which the person under review

may make submissions in accordance with section 106SA.

Note:

The period for making the draft determination may be affected by

section 106TB.

33 At the end of subsection 106T(2)

Add:

Note:

The period for making submissions may be affected by

section 106TB.

Main amendments Schedule 1

Extension of time for certain processes Part 4

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

34 Subsection 106T(4)

Omit "that paragraph", substitute "subsection (1A)".

35 At the end of subsection 106TA(1)

Add:

Note:

The period for making the final determination may be affected by

section 106TB.

36 After section 106TA

Insert:

106TB Time for doing act affected if court order operates

(1) This section applies in relation to an act that is required or

permitted by this Subdivision to be done within a particular period

(the original action period) if an injunction or other court order

prevents the act, or a further act of that kind, from being done

within that period.

(2) Despite any other provision of this Subdivision, and subject to any

order of a court:

(a) the original action period stops running at the beginning of

the period (the suspension period) during which the

injunction or other court order prevents the act from being

done; and

(b) a new period (the new action period) for doing the act, being

a period of the same length as the original action period,

starts running on the day after the end of the suspension

period.

(3) For the purposes of this Subdivision, if:

(a) the original action period was a period in which the person

under review was permitted to make submissions in

accordance with section 106SA or 106T; and

(b) the person made a submission within that period;

then the person is taken to have made the submission during the

new action period.

37 Application of items 30, 31, 32 and 34

Schedule 1 Main amendments

Part 4 Extension of time for certain processes

16 Health Insurance Amendment (Professional Services Review) Bill 2010 No. ,

2010

The repeals and amendments of the Health Insurance Act 1973 made by

items 30, 31, 32 and 34 of this Schedule do not apply, in relation to the

making of a draft determination or a final determination in relation to a

person under review under Part VAA of that Act, if the Committee's

final report in relation to the person was given to the Determining

Authority under subsection 106L(3) of that Act before the

commencement of this item.

Main amendments Schedule 1

No further action to be taken in certain circumstances Part 5

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

Part 5

No further action to be taken in certain

circumstances

Health Insurance Act 1973

38 Subsection 106G(6)

Repeal the subsection.

39 After section 106G

Insert:

106GA Notification by Director or Committee that proper

investigation is impossible

(1) The Director may give the Committee written notice that he or she

is satisfied that circumstances exist that would make a proper

investigation by the Committee impossible. The notice must set out

the circumstances.

(2) The Committee may give the Director written notice that it is

satisfied that circumstances exist that would make a proper

investigation by the Committee impossible. The notice must set out

the circumstances.

(3) If the Director or the Committee gives a notice under this section:

(a) this Division ceases to have effect in relation to the

Committee; and

(b) the Director must, within 7 days after giving or receiving the

notice (as the case may be), give a copy of the notice to the

Medicare Australia CEO and the person under review.

40 Division 5 of Part VAA (heading)

Repeal the heading, substitute:

Division 5--Determining Authority

Subdivision A--Establishment etc. of the Determining

Authority

41 Before section 106R

Schedule 1 Main amendments

Part 5 No further action to be taken in certain circumstances

18 Health Insurance Amendment (Professional Services Review) Bill 2010 No. ,

2010

Insert:

Subdivision B--Ratification of agreements by the Determining

Authority

106QA Application of Subdivision

This Subdivision applies if an agreement entered into between the

Director and a person under review under section 92 is referred to

the Determining Authority for ratification.

106QB Notification by Director or Authority that action in

agreement cannot take effect

(1) The Director may give the Determining Authority written notice

that he or she is satisfied that circumstances exist that would make

it impossible for an action specified in the agreement to take effect.

The notice must set out the circumstances.

(2) The Determining Authority may give the Director written notice

that it is satisfied that circumstances exist that would make it

impossible for an action specified in the agreement to take effect.

The notice must set out the circumstances.

(3) If the Director or the Determining Authority gives a notice under

this section:

(a) section 106R ceases to have effect in relation to the

agreement; and

(b) the Director must, within 7 days after giving or receiving the

notice (as the case may be), give a copy of the notice to the

Medicare Australia CEO and the person under review.

Note:

The heading to section 106R is replaced by the heading "Authority must ratify or

refuse to ratify agreement".

42 Subsection 106R(1)

Repeal the subsection, substitute:

(1) The Determining Authority must, within 1 month after the day on

which it receives the agreement, make a decision either ratifying or

refusing to ratify the agreement.

43 After section 106R

Main amendments Schedule 1

No further action to be taken in certain circumstances Part 5

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

Insert:

Subdivision C--Determinations by the Determining Authority

106RA Application of Subdivision

This Subdivision applies if a final report of a Committee is given to

the Determining Authority under subsection 106L(3) in relation to

a person under review.

106RB Notification by Director or Authority that proper draft or

final determination is impossible

(1) The Director may give the Determining Authority written notice

that he or she is satisfied that circumstances exist that would make

it impossible for a proper draft determination or final determination

to be made by the Authority in relation to the person under review.

The notice must set out the circumstances.

(2) The Determining Authority may give the Director written notice

that it is satisfied that circumstances exist that would make it

impossible for a proper draft determination or final determination

to be made by the Authority in relation to the person under review.

The notice must set out the circumstances.

(3) If the Director or the Determining Authority gives a notice under

this section:

(a) this Subdivision ceases to have effect in relation to the person

under review; and

(b) the Director must, within 7 days after giving or receiving the

notice (as the case may be), give a copy of the notice to the

Medicare Australia CEO and the person under review.

Schedule 1 Main amendments

Part 6 Date of effect for final determinations

20 Health Insurance Amendment (Professional Services Review) Bill 2010 No. ,

2010

Part 6

Date of effect for final determinations

Health Insurance Act 1973

44 Subsection 106V(2)

Repeal the subsection, substitute:

(2) If, before that 35th day, a proceeding is instituted in a court in

respect of the final determination, the determination takes effect

(subject to any order of the court) at the end of:

(a) if the application instituting the proceeding is withdrawn or

the proceeding is discontinued--7 days after the day on

which the application is withdrawn or the proceeding is

discontinued; or

(b) if the proceeding is dismissed or determined--the prescribed

number of days after the day on which the proceeding is

dismissed or determined; or

discontinued--7 days after the day on which the appeal is

withdrawn or discontinued; or

(d) if an appeal is instituted and the appeal is dismissed or

determined--the prescribed number of days after the day on

which the appeal is dismissed or determined.

45 Application

The amendment of the Health Insurance Act 1973 made by this Part

does not apply in relation to a final determination that was made under

section 106TA of that Act before the commencement of this item.

Main amendments Schedule 1

Referrals to Medicare Participation Review Committee Part 7

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

Part 7

Referrals to Medicare Participation Review

Committee

Health Insurance Act 1973

46 Subparagraph 19B(2)(a)(i)

Omit ", 124FAA(2)(e)".

47 Subparagraph 19B(2)(b)(i)

Omit ", 124FAA(2)(d)".

48 Subparagraph 19B(2)(c)(iii)

Omit ", 124FAA(2)(e)".

49 Subparagraph 19B(2)(d)(iii)

Omit ", 124FAA(2)(d)".

50 Subsection 19D(11) (paragraph (a) of the definition of

disqualified practitioner)

Omit ", 124FAA(2)(d) or (e)".

51 Paragraphs 92(2)(f) and (g)

Omit "of not more than 3 years".

52 After subsection 92(2)

Insert:

(2A) For the purposes of paragraphs (2)(f) and (g), the period specified

must not be more than:

(a) if the person is a practitioner in relation to whom an

agreement under this section, or a final determination under

section 106TA, has previously taken effect--5 years; or

(b) in any other case--3 years.

53 Paragraph 92(4)(e)

Omit "jurisdiction; and", substitute "jurisdiction.".

54 Paragraph 92(4)(f)

Schedule 1 Main amendments

Part 7 Referrals to Medicare Participation Review Committee

22 Health Insurance Amendment (Professional Services Review) Bill 2010 No. ,

2010

Repeal the paragraph.

55 Paragraph 106U(1)(g)

After "disqualified", insert ", for a specified period starting when the

determination takes effect,".

56 At the end of paragraph 106U(1)(h)

Add "for a specified period starting when the determination takes

effect".

57 Subsections 106U(3) and (4)

Repeal the subsections, substitute:

(3) For the purposes of paragraphs (1)(g) and (h), the period specified

must not be more than:

(a) if the person under review is a practitioner in relation to

whom an agreement under section 92, or a final

determination under section 106TA, has previously taken

effect--5 years; or

(b) in any other case--3 years.

58 Section 106X

Repeal the section.

59 Subsection 106ZPR(2)

Repeal the subsection.

60 Subsection 124E(2A)

Repeal the subsection.

61 Subsection 124E(5)

Omit "106X or".

62 Subsection 124E(5)

Omit ", (2A)".

63 Subsection 124EA(1)

Omit ", (2A)".

Main amendments Schedule 1

Referrals to Medicare Participation Review Committee Part 7

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

64 Section 124FAA

Repeal the section.

65 Subsection 124H(7)

Omit "124FAA(2),".

66 Subsection 124J(8)

Omit ", (2A)".

67 Subsection 124S(9)

Omit "or paragraph 124FAA(2)(d) or (e)".

68 Application

The repeals and amendments of the Health Insurance Act 1973 made by

this Part do not apply in relation to a request to review the provision of

services by a person that was made under section 86 of that Act before

the commencement of this item.

Schedule 1 Main amendments

Part 8 Referrals to appropriate regulatory bodies

24 Health Insurance Amendment (Professional Services Review) Bill 2010 No. ,

2010

Part 8

Referrals to appropriate regulatory bodies

Health Insurance Act 1973

69 Paragraph 93(8)(a)

Omit "an appropriate body", substitute "a person or body".

70 Subsection 93(8)

Omit "the appropriate body", substitute "the person or body".

71 Subsections 106XA(2) to (4)

Repeal the subsections, substitute:

(2) If the Director receives, from a Committee or the Determining

Authority, a statement and material under subsection (1) in relation

to conduct by a person under review, the Director must send the

statement and material to:

(a) a State or Territory body that is responsible for the

administration of health services or the protection of public

health and safety in the State or Territory in which the

conduct occurred; and

(b) each appropriate person or body for the person under review

(see subsection (4)).

Opinion formed by Director

(3) If, in the course of or in connection with the performance of

functions or the exercise of powers (whether by the Director, the

Director's nominee, a Committee or the Determining Authority)

under this Part in relation to a person under review, the Director

forms the opinion that any conduct by the person has caused, is

causing, or is likely to cause, a significant threat to the life or

health of any other person, the Director must:

(a) prepare a written statement of his or her concerns; and

(b) attach to the statement the material, or copies of the material,

on which his or her opinion is based; and

(i) a State or Territory body that is responsible for the

administration of health services or the protection of

Main amendments Schedule 1

Referrals to appropriate regulatory bodies Part 8

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

public health and safety in the State or Territory in

which the conduct occurred; and

(ii) each appropriate person or body for the person under

review (see subsection (4)).

Meaning of appropriate person or body

(4) For the purposes of paragraph (2)(b) and subparagraph (3)(c)(ii),

an appropriate person or body for a person under review is a

person or body that:

(a) is specified in the regulations; and

(b) has the power to take action against the person under review.

Note 1: The heading to section 106XA is replaced by the heading "Significant threat to life or

health".

Note 2: The following heading to subsection 106XA(1) is inserted "Opinion formed by

Committee or Determining Authority".

72 Paragraph 106XB(2)(a)

Repeal the paragraph, substitute:

(a) in the course of or in connection with the performance of

functions or the exercise of powers (whether by the Director,

the Director's nominee, a Committee or the Determining

Authority) under this Part in relation to a person under

review who is a practitioner, the Director forms the opinion

that the practitioner has failed to comply with professional

standards; or

Note:

The heading to section 106XB is replaced by the heading "Non-compliance by a

practitioner with professional standards".

Schedule 1 Main amendments

Part 9 Disqualified practitioners

26 Health Insurance Amendment (Professional Services Review) Bill 2010 No. ,

2010

Part 9

Disqualified practitioners

Health Insurance Act 1973

73 Subparagraphs 19B(2)(a)(ii) and (c)(iv)

Omit "partly", substitute "fully".

74 Subsection 19D(1)

After "section 19B", insert "or 106ZPM".

75 Subsection 19D(11) (paragraph (c) of the definition of

disqualified practitioner)

Omit "fully".

76 Subsection 19D(11) (paragraph (e) of the definition of

disqualified practitioner)

Omit "paragraph 106U(1)(h) that the practitioner be fully disqualified",

substitute "paragraph 106U(1)(g) or (h)".

77 Subsection 19D(11) (note to the definition of disqualified

practitioner)

Repeal the note.

Main amendments Schedule 1

Patient referrals Part 10

Health Insurance Amendment (Professional Services Review) Bill 2010 No. , 2010

Part 10

Patient referrals

Health Insurance Act 1973

78 After section 132

Insert:

132A Regulations relating to the manner of patient referrals

(1) If an item specifies a service that is to be rendered by a practitioner

to a patient who has been referred to the practitioner, the

regulations may require that, for the purposes of the item, the

patient is to be referred in a manner prescribed by the regulations.

(2) In this section:

item includes an item relating to a service specified in a

determination in force under subsection 3C(1).

practitioner has the same meaning as in section 124B.

79 Subsection 133(2)

Repeal the subsection.

Schedule 2 Other amendments

28 Health Insurance Amendment (Professional Services Review) Bill 2010 No. ,

2010

Schedule 2

Other amendments

Health Insurance Act 1973

1 Subsection 86(5)

After "Minister may", insert ", by legislative instrument,".

2 Subsection 86(6)

Repeal the subsection.

3 Subsection 93(4)

Omit "in writing", substitute "by legislative instrument".

4 Subsection 93(5)

Repeal the subsection.

5 Subsection 106K(3)

Omit "make written", substitute ", by legislative instrument, make".

6 Subsection 106K(5)

Repeal the subsection.

7 Subsection 106Q(3)

After "Minister may", insert ", by legislative instrument,".

8 Subsection 106Q(4)

Repeal the subsection.

9 At the end of section 124FAA

Add:

(7) In this section, a reference to a final determination under

section 106TA includes a reference to an agreement that, under

paragraph 92(4)(f), is taken to be a final determination for the

purposes of section 106X.

Commonwealth of Australia Bills

HEALTH INSURANCE AMENDMENT (PROFESSIONAL SERVICES REVIEW) BILL 2010