HEALTH INSURANCE AMENDMENT (DIAGNOSTIC IMAGING, RADIATION ONCOLOGY AND OTHER MEASURES) ACT 2003 - SCHEDULE 2

Commonwealth Consolidated Acts

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HEALTH INSURANCE AMENDMENT (DIAGNOSTIC IMAGING, RADIATION ONCOLOGY AND OTHER MEASURES) ACT 2003 - SCHEDULE 2

- Radiation Oncology Register

Health Insurance Act 1973

1 Subsection 3(1)

Insert:

"base for mobile radiation oncology equipment "has the meaning given by section 23DZZK.

2 Subsection 3(1) (definition of listed )

Repeal the definition, substitute:

"listed":

(a): in relation to diagnostic imaging equipment—has the meaning given by subsections 16D(4) and (5); and
(b): in relation to radiation oncology equipment—has the meaning given by subsections 16F(6) and (7).

3 Subsection 3(1) (at the end of the definition of ordinarily located )

Add:

(d): in relation to bases for mobile radiation oncology equipment—has a meaning affected by subsection 16F(10).

4 Subsection 3(1) (definition of primary information )

Repeal the definition, substitute:

"primary information":

(a): for the purposes of Division 4 of Part IIB—has the meaning given by section 23DZR; and
(b): for the purposes of Part IIC—has the meaning given by section 23DZZQ.

6 Subsection 3(1)

Insert:

"radiation oncology equipment "means equipment that is primarily used in rendering a radiation oncology service.

7 Subsection 3(1)

Insert:

"radiation oncology premises "has the meaning given by section 23DZZL.

8 Subsection 3(1)

Insert:

"Radiation Oncology Register" means the Register kept under section 23DZZJ.

9 Subsection 3(1)

Insert:

"radiation oncology service "has the meaning given by subsection 16F(2).

10 Subsection 3(1) (at the end of the definition of registered )

Add:

(d): in relation to a base for mobile radiation oncology equipment—has the meaning given by subsection 16F(5).

11 After section 16E

Insert:

16F Medicare benefits not payable for certain radiation oncology services

(1): Unless the Minister otherwise directs, a medicare benefit is not payable in respect of a radiation oncology service rendered by or on behalf of a medical practitioner unless the service is:

(a): rendered using radiation oncology equipment that:

(i) is ordinarily located at registered radiation oncology premises; and
(ii) is of a type that, on the day on which the service is rendered, is listed for the premises; or

(b): rendered using radiation oncology equipment that:

(i) is ordinarily located at a registered base for mobile radiation oncology equipment when not in use; and
(ii) is not ordinarily located at radiation oncology premises; and
(iii) is of a type that, on the day on which the service is rendered, is listed for the base.

Meaning of radiation oncology service

(2): A radiation oncology service is a service prescribed as a radiation oncology service.
(3): Radiation oncology services may be prescribed by reference to items in the general medical services table.

Meaning of registered radiation oncology premises and registered base for mobile radiation oncology equipment

(4): Radiation oncology premises are registered at a particular time if a registration for the premises under Part IIC is in effect at that time.
(5): A base for mobile radiation oncology equipment is registered at a particular time if a registration for the base under Part IIC is in effect at that time.

What equipment is listed for premises or a base?

(6): Radiation oncology equipment is of a type listed for particular radiation oncology premises at a particular time if, at that time:

(a): the Radiation Oncology Register states that equipment of a particular type is ordinarily located at the premises; and
(b): the equipment is of that type.

(7): Radiation oncology equipment is of a type listed for a particular base for mobile radiation oncology equipment at a particular time if, at that time:

(a): the Radiation Oncology Register states that pieces of equipment of a particular type are ordinarily located at the base when not in use and not ordinarily located at radiation oncology premises; and
(b): the equipment is of that type.

Some circumstances in which radiation oncology equipment is taken to be ordinarily located at radiation oncology premises

(8): Radiation oncology equipment is taken to be ordinarily located at radiation oncology premises if:

(a): the equipment is:

(i) on trial at the premises for a period of not more than 3 months; and
(ii) of the same type as equipment listed for the premises during the period of the trial; or

(b): each of the following circumstances exist:

(i) the equipment (the substituted equipment ) is used, for a period of not more than 3 months, in substitution for radiation oncology equipment that is not in operation;
(ii) the substituted equipment is of the same type as the equipment that is not in operation;
(iii) the equipment that is not in operation is ordinarily located at the premises.

(9): Nothing in subsection (8) limits the circumstances in which radiation oncology equipment is ordinarily located at radiation oncology premises for the purposes of this Part or Part IIC.

Some circumstances in which radiation oncology equipment is taken to be ordinarily located at a base for mobile radiation oncology equipment when not in use and not ordinarily located at radiation oncology premises

(10): Radiation oncology equipment is taken to be ordinarily located at a base for mobile radiation oncology equipment when not in use, and not ordinarily located at radiation oncology premises, if:

(a): the equipment is:

(i) on trial through the base for a period of not more than 3 months; and
(ii) not ordinarily located, or taken to be ordinarily located, at radiation oncology premises during the period of the trial; and
(iii) of the same type as equipment listed for the base during the period of the trial; or

(b): each of the following circumstances exist:

(11): Nothing in subsection (10) limits the circumstances in which radiation oncology equipment is ordinarily located at a base for mobile radiation oncology equipment, but not ordinarily located at radiation oncology premises, for the purposes of this Part or Part IIC.

16G Medicare benefit is payable once a suspension of a registration is lifted

If, but for this section, medicare benefit would not be payable in respect of a radiation oncology service rendered by or on behalf of a medical practitioner because the service is:

(a): rendered using radiation oncology equipment that is ordinarily located at radiation oncology premises the registration of which has been suspended; or
(b): rendered using radiation oncology equipment that:

(i) when not in use, is ordinarily located at a base for mobile radiation oncology equipment the registration of which is suspended; and
(ii) is not ordinarily located at radiation oncology premises;

medicare benefit becomes payable in respect of the service when the suspension ceases to have effect, provided the suspension does not cease to have effect because the registration is cancelled under section 23DZZX.

12 After Part IIB

Insert:

Part IIC—Radiation Oncology Register

23DZZJ Radiation Oncology Register

(1): The Minister must keep a Radiation Oncology Register.
(2): The Register is kept for the following purposes:

(a): gathering information on the provision of radiation oncology services, including (but not limited to) the structure of medical practices connected with the provision of those services, for the purposes of planning and developing the Commonwealth medicare benefits program;
(b): identifying whether medicare benefit is payable for a particular radiation oncology service rendered to a person;
(c): assisting in identifying whether inappropriate practice (as defined for the purposes of Part VAA of this Act) is taking place.

23DZZK What is a base for mobile radiation oncology equipment ?

Premises are a base for mobile radiation oncology equipment if:

(a): radiation oncology equipment is ordinarily located at the premises when not in use; and
(b): the radiation oncology services rendered using the equipment are not rendered at the premises; and
(c): the radiation oncology services rendered using the equipment are rendered under a single business name.

23DZZL What are radiation oncology premises ?

Radiation oncology premises means a building or part of a building at which radiation oncology procedures are carried out under a single business name.

23DZZM Who may apply for registration?

(1): The proprietor of radiation oncology premises may apply to the Minister for the registration of the premises.
(2): The proprietor of a base for mobile radiation oncology equipment may apply to the Minister for registration of the base.

23DZZN Who is a proprietor ?

(1): The proprietor of radiation oncology premises is the person or government agency who has effective control of:

(a): the premises, whether or not the holder of an estate or interest in the premises; and
(b): the use of the radiation oncology equipment used at the premises; and
(c): the employment of staff (including medical practitioners) connected with the premises.

(2): The proprietor of a base for mobile radiation oncology equipment is the person or government agency who has effective control of:

(a): the base, whether or not the holder of an estate or interest in the base; and
(b): the use of radiation oncology equipment ordinarily located at the base when not in use; and
(c): the employment of staff (including medical practitioners) connected with the base.

(3): In this section:

"employment "includes:

(a): appointment or employment by the Commonwealth, a State or Territory; and
(b): appointment or employment by a government agency; and
(c): full-time, part-time and casual work; and
(d): work under a contract for services.

"government agency" includes:

(a): a Department of the Commonwealth or of a State or Territory; and
(b): an authority (incorporated or unincorporated) established for a public purpose by or under a Commonwealth, State or Territory law.

Note: Section 23DZZZH contains rules on the application of this Part to partnerships.

23DZZO Application procedure

(1): An application for registration of radiation oncology premises or a base for mobile radiation oncology equipment must:

(a): be in writing; and
(b): be in accordance with the approved form; and
(c): include the primary information; and
(d): include the other information prescribed for the purposes of this paragraph.

(2): Information may only be prescribed if it is relevant to the purposes for which the Register is kept.

23DZZP Registration

(1): If an application for registration of radiation oncology premises or a base for mobile radiation oncology equipment is properly made, the Minister must register the premises or base by:

(a): allocating a unique location specific practice number to the premises or base; and
(b): including the following information on the Register:

(i) the location specific practice number for the premises or base;
(ii) the day on which the registration takes effect;
(iii) the primary information;
(iv) the other information prescribed for the purposes of this subparagraph.

(2): Registration takes effect on:

(a): the day on which the application is properly made; or
(b): the day specified by the applicant in the application;

whichever is later.

(3): Registration ceases to have effect on the day on which it is cancelled.
(4): Registration does not have effect while it is suspended.
(5): Information may only be prescribed if it is relevant to the purposes for which the Register is kept.
(6): The Minister must notify the proprietor, in writing, of:

(a): the location specific practice number for the premises or base; and
(b): the date on which registration takes effect;

within 28 days after the application for registration is properly made.

23DZZQ Primary information

(1): The following information is primary information :

(a): details of the proprietor (including, where the proprietor is a company, its Australian Company Number) of the radiation oncology premises or the base for mobile radiation oncology equipment (as the case requires);
(b): the business name under which radiation oncology services are rendered;
(c): the ABN under which radiation oncology services are rendered:

(i) in the case of radiation oncology premises—using radiation oncology equipment that is ordinarily located at the premises; or
(ii) in the case of a base for mobile radiation oncology equipment—using radiation oncology equipment ordinarily located at the base when not in use that is not ordinarily located at radiation oncology premises;

(d): in the case of radiation oncology premises:

(i) the address of the premises; and
(ii) a statement identifying the types of radiation oncology equipment ordinarily located at the premises;

(e): in the case of a base for mobile radiation oncology equipment:

(i) the address of the base; and
(ii) the address of the proprietor; and
(iii) a statement identifying the type of each piece of radiation oncology equipment that is ordinarily located at the base when not in use and is not ordinarily located at radiation oncology premises;

(f): details of the legal relationships that give rise to a right to use the equipment.

(2): The regulations may prescribe types of radiation oncology equipment for the purposes of this section.

23DZZR Register may be maintained electronically

The Register may be maintained electronically.

23DZZS Extract of the Register to be made available on request

(1): A person may, for the purposes of determining whether medicare benefit is likely to be payable in respect of a particular radiation oncology service, request an extract of the Register in relation to radiation oncology premises or a base for mobile radiation oncology equipment specified in the request.
(2): An extract of the Register containing the following information must be made available to the person on that request:

(a): the business name under which radiation oncology services are rendered at the premises or using equipment listed for the base;
(b): the address of the premises or base;
(c): the location specific practice number for the premises or base;
(d): if a suspension of the registration of the premises or base is in effect at the time the extract is given—a statement of that fact and the date on which the suspension took effect;
(e): if a cancellation of the registration of the premises or base is in effect at the time the extract is given—a statement of that fact and the date on which the cancellation took effect.

23DZZT Minister may publish an extract of the Register on the Internet

The Minister may publish on the Internet an extract of the Register containing the following information in relation to radiation oncology premises or a base for mobile radiation oncology equipment:

(a): the business name under which radiation oncology procedures are carried out using equipment listed for the premises or the base;
(b): the address of the premises or base;
(c): the location specific practice number for the premises or base;
(d): a statement identifying the periods during which the current or a previous registration has had effect.

23DZZU Proprietors to notify the Minister of changes to primary information

(1): The proprietor of registered radiation oncology premises must notify the Minister in writing of changes to the primary information in relation to the premises within 28 days after the change occurs.
(2): The proprietor of a registered base for mobile radiation oncology equipment must notify the Minister of changes to the primary information in relation to the base within 28 days after the change occurs.

23DZZV Minister may request further information

(1): The Minister may give notice in writing to the proprietor of registered radiation oncology premises or a registered base for mobile radiation oncology equipment, requesting the proprietor to give the Minister information of the kind specified in the notice.
(2): The information must be given to the Minister:

(a): within 28 days after the notice is given; or
(b): if a longer period is specified in the notice—within that longer period.

This is the response period .

(3): The kinds of information specified in the notice must be relevant to the purposes for which the Register is kept.

23DZZW Suspension for failure to comply with a request

(1): The Minister must suspend the registration of radiation oncology premises or a base for mobile radiation oncology equipment if the proprietor of the premises or base has failed to comply with a request for information under section 23DZZV within the response period.
(2): The suspension takes effect on the day after the end of the response period.

(a): if the request is complied with within 3 months after the end of the response period (the compliance period )—on the day on which it is complied with; or
(b): if the registration of the premises or base is cancelled because the proprietor fails to comply with the request within the compliance period—on the day immediately after the end of that period.

(4): The Minister must give the proprietor notice in writing that the registration of the premises or base has been suspended.
(5): The Minister must note the day on which the suspension takes effect on the Register.

23DZZX Cancellation for failure to provide information within 3 months after the response period

(1): The Minister must cancel the registration of registered radiation oncology premises or a registered base for mobile radiation oncology equipment if the proprietor of the premises or base fails to comply with a request for information under section 23DZZV within the compliance period.
(2): The cancellation takes effect on the day immediately after the end of the response period.
(3): The Minister must give the proprietor written notice of the cancellation.

23DZZY Cancellation at the request of the proprietor

(1): The Minister must cancel the registration of radiation oncology premises or a base for mobile radiation oncology equipment if the proprietor requests, in writing, the Minister to do so.
(2): The cancellation takes effect on:

(a): the day immediately after the request is given to the Minister; or
(b): the day specified by the proprietor in the request;

whichever is later.

23DZZZ Cancellation on other grounds

(1): The Minister may cancel the registration of radiation oncology premises or a base for mobile radiation oncology equipment if:

(a): the registration was obtained improperly; or
(b): the proprietor has failed to notify the Minister of changes to primary information.

(2): The Minister must give the proprietor notice in writing of the Minister's decision to cancel the registration of the premises or base.
(3): The Minister must set out his or her reasons for the decision in that notice.
(4): The cancellation takes effect on:

(a): the day on which the Minister gives the proprietor the notice; or
(b): the day specified in the notice;

whichever is later.

23DZZZA Cancellation to be noted on the Register

If the registration of radiation oncology premises or a base for mobile radiation oncology equipment is cancelled, the Minister must note the day on which the cancellation takes effect on the Register.

23DZZZB Limits on registration after cancellation under section 23DZZX or 23DZZZ

(1): If the registration of radiation oncology premises or a base for mobile radiation oncology equipment is cancelled under section 23DZZX or 23DZZZ, the proprietor is not entitled to apply for registration of the premises or base within a period of 12 months after the cancellation without the Minister's permission.
(2): In deciding whether to permit the proprietor to apply to have the premises or base registered, the Minister must take into account whether:

(a): the act or omission that gave rise to the cancellation was inadvertent; and
(b): it is reasonable to conclude, in all the circumstances, that the proprietor will comply with this Part in making the application and after registration of the premises or base.

(3): If the Minister decides not to permit the proprietor to apply to have the premises or base registered, the Minister must give the proprietor notice in writing of the fact.
(4): The Minister must set out his or her reasons for the decision in that notice.

23DZZZC Minister must invite submissions before cancelling registration

(1): Before cancelling the registration of radiation oncology premises or a base for mobile radiation oncology equipment under section 23DZZZ, the Minister must invite the proprietor of the premises or base to make a submission to the Minister giving reasons why that action should not be taken.
(2): The invitation must be given by notice in writing to the proprietor.
(3): The submission must be given in writing to the Minister:

(a): within 28 days after the notice is given; or
(b): if a longer period is specified in the notice—within that longer period.

23DZZZD Application to Administrative Appeals Tribunal for review of a decision to cancel registration

(1): Application may be made to the Administrative Appeals Tribunal for review of a decision:

(a): to cancel the registration of radiation oncology premises or a base for mobile radiation oncology equipment under section 23DZZZ; and
(b): not to permit a proprietor to apply for registration of radiation oncology premises or a base for mobile radiation oncology equipment under section 23DZZZB.

(2): The application must be made:

(a): where the decision is to cancel the registration of the premises or base under section 23DZZZ—within 28 days after the notice of the decision is given to the proprietor under that section; and
(b): where the decision is not to permit the proprietor of the premises or base to apply for registration of the premises or base—within 28 days after the notice of the decision is given to the proprietor under section 23DZZZB.

23DZZZE Proprietor of unregistered premises must notify patients that medicare benefit not payable

(1): The proprietor of radiation oncology premises commits an offence if a radiation oncology service is rendered on a person under the following circumstances:

(a): the service is rendered either at the premises or elsewhere using equipment that is ordinarily located at the premises; and
(b): the premises are not registered; and
(c): the proprietor has neither:

(i) given the person notice in writing that medicare benefit will not be payable for the service; nor
(ii) caused written notice to that effect to be displayed prominently at the place where the service is rendered.

Maximum penalty: 10 penalty units.

(2): Strict liability applies to all of the physical elements of the offence.

Note: For strict liability , see section 6.1 of the Criminal Code .

23DZZZF Proprietor of unregistered base must notify patients that medicare benefit not payable

(1): The proprietor of a base for mobile radiation oncology equipment commits an offence if a radiation oncology service is rendered on a person under the following circumstances:

(a): the service is rendered using equipment that is ordinarily located at the base when not in use, and is not ordinarily located at radiation oncology premises; and
(b): the base is not registered; and
(c): the proprietor has neither:

Maximum penalty: 10 penalty units.

(2): Strict liability applies to all of the physical elements of the offence.

Note: For strict liability , see section 6.1 of the Criminal Code .

23DZZZG Debt recovery where proprietor fails to inform patient that premises or base not registered

If:

(a): a radiation oncology service is rendered in the following circumstances:

(i) the service is rendered using radiation oncology equipment that is ordinarily located at radiation oncology premises that are not registered; or
(ii) the service is rendered using radiation oncology equipment that, when not in use, is ordinarily located at an unregistered base for mobile radiation oncology equipment and the equipment is not ordinarily located at radiation oncology premises; and

(b): the proprietor of the premises or base failed to inform the person to whom the radiation oncology service was rendered that no medicare benefit would be payable on the service; and
(c): the Minister makes a direction under subsection 16F(1) that medicare benefit will be paid for the service;

an amount equal to the medicare benefit is recoverable from the proprietor as a debt due to the Commonwealth.

23DZZZH Application of this Part to partnerships

(1): Where a partnership, rather than a person or government agency, is in effective control of:

(a): radiation oncology premises, whether or not the holder of an estate or interest in the premises; and
(b): the use of the radiation oncology equipment used at the premises; and
(c): the employment of staff (including medical practitioners) connected with the premises;

each partner in the partnership is taken to be a proprietor of the premises for the purposes of this Part.

(2): Where a partnership, rather than a person or government agency, is in effective control of:

(a): a base for mobile radiation oncology equipment, whether or not the holder of an estate or interest in the base; and
(b): the use of radiation oncology equipment ordinarily located at the base when not in use; and
(c): the employment of staff (including medical practitioners) connected with the base;

each partner in the partnership is taken to be a proprietor of the premises for the purposes of this Part.

(3): However:

(a): an obligation under this Part, although imposed on each partner in the partnership, may be discharged by any of them; and
(b): a right under this Part, if exercised by one of the partners in the partnership, is taken to have been exercised on behalf of all of them; and
(c): no more than one partner may be punished for one offence under this Part.

(4): In this section:

"employment "has the same meaning as in section 23DZZN.

"government agency "has the same meaning as in section 23DZZN.

13 Transitional provisions

(1) The amendment made by item 11 of this Schedule applies to radiation oncology services rendered after the earlier of the following:

(a): a single day to be fixed by Proclamation;
(b): the first day after the end of the period of 6 months beginning on the day on which this Act receives the Royal Assent.

(2) The amendment made by item 12 of this Schedule, to the extent that it adds sections 23DZZZE, 23DZZZF and 23DZZZG to the Health Insurance Act 1973 , applies to radiation oncology services rendered after the earlier of the following:

(a): a single day to be fixed by Proclamation;
(b): the first day after the end of the period of 6 months beginning on the day on which this Act receives the Royal Assent.

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