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This is a Bill, not an Act. For current law, see the Acts databases.
1998-1999-2000
The Parliament
of the
Commonwealth of
Australia
HOUSE OF
REPRESENTATIVES
Presented and read a first
time
Health
Legislation Amendment (Gap Cover Schemes) Bill
2000
No. ,
2000
(Health and Aged
Care)
A Bill for an Act to provide for gap
cover schemes, and for related purposes
ISBN: 0642
428875
Contents
Health Insurance Act
1973 3
National Health Act
1953 3
A Bill for an Act to provide for gap cover schemes, and
for related purposes
The Parliament of Australia enacts:
This Act may be cited as the Health Legislation Amendment (Gap Cover
Schemes) Act 2000.
(1) The provisions of this Act commence on a day or days to be fixed by
Proclamation.
(2) If a provision of this Act does not commence under subsection (1)
within the period of 6 months commencing on the day on which it receives the
Royal Assent, it commences on the first day after the end of that
period.
Subject to section 2, 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Act is amended or repealed as set out in the applicable items in the Schedule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.
1 After subsection 20A(2A)
Insert:
(2AA) If:
(a) a medicare benefit would, apart from this section, be payable to an
eligible person in respect of a professional service rendered to a patient while
hospital treatment is provided to the patient; and
(b) the eligible person has entered into an applicable benefits
arrangement with a registered organization under which he or she is covered
(wholly or partly) for liability to pay fees and charges in respect of that
professional service; and
(c) the professional service is a service in respect of which there
applies a gap cover scheme in respect of which an approval by the Minister under
section 73BDD of the National Health Act 1953 is in force;
the eligible person is taken, for the purposes of this Act, to have
assigned his or her right to the payment of the medicare benefit:
(d) unless paragraph (e) applies—to the organization; or
(e) if the gap cover scheme makes express provision for the assignment of
the right to payment of the medicare benefit to an approved billing agent, to a
hospital or day hospital facility or to some other person prescribed for the
purposes of this paragraph as an appropriate assignee—to that approved
billing agent, to that hospital or day hospital facility or to that other
person, as provided for under the terms of the gap cover scheme.
2 Subsection 20A(2D)
After “subsection (2A)”, insert “or
(2AA)”.
3 Subsection 4(1)
Insert:
gap cover scheme means a scheme prepared by a registered
organization under which the registered organization is able to offer no gap
policies, or known gap policies.
4 Subsection 4(1)
Insert:
known gap policy means a contract of insurance entered into
by a registered organization that covers all but a specified amount or
percentage of the full cost of particular hospital treatment and associated
professional attention for the person or persons insured.
5 Subsection 4(1)
Insert:
no gap policy means a contract of insurance entered into by a
registered organization that covers the full cost of particular hospital
treatment and associated professional attention for the person or persons
insured.
6 After Division 4 of Part
VI
Insert:
(1) A registered organization may, at any time, prepare a gap cover
scheme.
(2) Subject to regulations made for the purpose of this section, the
registered organization may apply to the Minister for approval of such a scheme.
The scheme is of no effect unless an approval by the Minister is in force in
relation to it.
(3) The Minister’s approval of such a scheme does not limit the
application of the Trade Practices Act 1974 or the Competition Code of
any participating jurisdiction (within the meaning of section 150A of that
Act).
(4) Any arrangement that is entered into for the purposes of such a scheme
does not constitute a hospital purchaser-provider agreement, a medical
purchaser-provider agreement or a practitioner agreement.
(5) The regulations must provide, in relation to the approval of gap cover
schemes by the Minister under this section, for:
(a) the form and content of, and the manner of dealing with, applications
for approval of such schemes; and
(b) the criteria to be taken into account by the Minister in determining
whether to approve such schemes; and
(c) the power of the Minister to impose conditions on the operation of
such schemes and to vary such conditions.
(6) Without limiting the criteria to be specified in regulations made for
the purposes of paragraph (5)(b), those criteria must include the provision of
particulars sufficient to demonstrate, to the satisfaction of the Minister, that
the operation of the gap cover scheme for which approval is sought will not have
an inflationary impact.
(1) Subject to this section, the regulations may make provision relating
to the operation and regulation of gap cover schemes approved by the
Minister.
(2) The regulations must provide, in respect of each gap cover scheme
approved by the Minister:
(a) for the provision to the Minister of an annual report in respect of
the operation of the scheme; and
(b) for the provision of a copy of that report to the Council;
by the registered organization in respect of which the scheme is
approved.
(3) Regulations made for the purposes of subsection (2):
(a) must provide for the form and content of each report; and
(b) must provide for the date by which each report is to be provided to
the Minister and to the Council; and
(c) may provide for the Minister to permit the provision of a report after
the date provided for under paragraph (b) in specified circumstances;
and
(d) may provide for the initial report in respect of a gap cover scheme to
be provided in respect of a period of more or less than a year in circumstances
specified in the regulations.
(4) Without, by implication, limiting the generality of other matters
relating to gap cover schemes approved by the Minister for which the regulations
made for the purposes of this section may provide, the regulations may provide,
in relation to such schemes, for:
(a) periodic reviews by the Minister of the operation of such schemes;
and
(b) the revocation, by the Minister, of such schemes in circumstances
identified by the regulations; and
(c) the capacity of registered organizations to seek variation or
revocation of such schemes, or of the conditions to which their operation is
subject, in circumstances identified by the regulations; and
(d) the review, under the Administrative Appeals Tribunal Act 1975,
of specified decisions relating to the approval of such schemes or to the
variation or revocation of such schemes or of conditions to which their
operation are subject.
7 After paragraph
82G(1)(bb)
Insert:
(bc) to obtain regular reports from registered organizations about matters
relating to the operation of gap cover schemes and to provide advice to the
Minister on the operation of those schemes with particular reference to the
extent to which the schemes genuinely reduce or eliminate the cost to consumers
of hospital treatment and associated professional attention;
8 At the end of paragraph (eb) of Schedule
1
Add:
; or (iii) the service is rendered by or on behalf of a medical
practitioner under a gap cover scheme approved by the Minister under section
73BDD.