Commonwealth Numbered Acts

Health Legislation Amendment Act 1983 No. 54 of 1983 - SECT 12

12. Section 10 of the Principal Act is repealed and the following section is
substituted: Entitlement to medicare benefit

''10. (1) Where, on or after 1 February 1984, medical expenses are incurred in
respect of a professional service rendered in Australia to an eligible person,
medicare benefit calculated in accordance with sub-section (2) is payable,
subject to and in accordance with this Act, in respect of that professional
service.

''(2) A medicare benefit under sub-section (1) in respect of a professional
service is an amount equal to-

   (a)  85% of the fee specified in respect of the service in the table in
        relation to the State in which the service is rendered; or

   (b)  if the amount calculated under paragraph (a) is less by more than $10
        than the fee from which it is calculated-an amount that is less by $10
        than that fee.

''(3) Subject to this Act, where-

   (a)  a claim (in this sub-section referred to as the 'threshold claim') for
        medicare benefit is made by a claimant in respect of a professional
        service-

        (i)    which was rendered to a person, being either the claimant or
               another person (in this sub-section referred to as the
               'patient'); and

        (ii)   in respect of which the medical expenses are incurred by the
               claimant in a year,

and the claim is accepted for payment by the Commission;

   (b)  the claimant has, or another claimant or other claimants has or have,
        made other claims (in this sub-section referred to as the 'prior
        claims') for medicare benefit in respect of professional services-

        (i)    which were rendered to the patient; and

        (ii)   in respect of which the medical expenses were incurred by the
               relevant claimant in that year,

and the prior claims were accepted for payment by the Commission before the
time when the threshold claim is accepted for payment (in this sub-section
referred to as the 'relevant time'); and

   (c)  the Commission is satisfied at the relevant time that-

        (i)    the first-mentioned claimant has paid the medical expenses in
               respect of the professional service to which the threshold
               claim relates;

        (ii)   a claimant has, or claimants have, paid the medical expenses in
               respect of professional services to which some or all of the
               prior claims accepted by the Commission for payment before the
               relevant time relate;

        (iii)  the sum of the patient contributions in respect of the prior
               claims referred to in sub-paragraph (ii) is less than the
               relevant amount for that year; and

        (iv)   the sum of the patient contribution in respect of the threshold
               claim and the patient contributions in respect of the prior
               claims referred to in sub-paragraph (ii) is equal to or exceeds
               the relevant amount for that year,
the medicare benefit payable-

   (d)  in respect of the professional service to which the threshold claim
        relates-shall be increased by the amount of the excess (if any)
        referred to in sub-paragraph (c) (iv);

   (e)  in respect of a professional service-

        (i)    to which a prior claim accepted for payment by the Commission
               before the relevant time relates; and

        (ii)   in relation to which the Commission becomes satisfied, after
               the relevant time, that the claimant has paid the medical
               expenses,

shall be increased by an amount equal to the patient contribution in respect
of that claim; and

   (f)  in respect of a professional service-

        (i)    to which a claim for medicare benefit that is accepted for
               payment by the Commission after the relevant time relates;

        (ii)   which was rendered to the patient; and

        (iii)  in respect of which the medical expenses are incurred by the
               claimant in that year,

shall be increased by an amount equal to the patient contribution in respect
of that claim.

''(4) Where an amount calculated in accordance with sub-section (2) is not a
multiple of 5 cents, the amount of cents shall be increased to the nearest
higher amount that is a multiple of 5 cents.

''(5) For the purposes of sub-sections (3) and (6), but without prejudice to
the meaning of an expression in any other provision of this Act-

   (a)  where a person to whom medicare benefit is payable in respect of a
        professional service is given or sent a cheque under sub-section 20
        (2) for the amount of the medicare benefit, the person shall be taken
        to have paid so much of the medical expenses in respect of that
        service as is represented by the amount of the medicare benefit;

   (b)  the question when medical expenses are incurred in respect of
        professional services relating to prescribed items shall,
        notwithstanding anything in this Act, be determined in accordance with
        the regulations; and

   (c)  a reference to a professional service is a reference to a professional
        service (including a medical service rendered outside Australia)-

        (i)    in respect of which medicare benefit is payable; and

        (ii)   the medical expenses in respect of which exceed the amount of
               medicare benefit that, but for sub-section (3), would be
               payable in respect of the service.

''(6) In this section-

'patient contribution', in relation to a claim for medicare benefit in respect
of a professional service, means an amount equal to the difference between-

   (a)  the fee specified in respect of the service in the table in relation
        to the State in which the service is rendered or, if the medical
        expenses in respect of the service are less than that fee, those
        medical expenses; and

   (b)  the amount of medicare benefit that, but for sub-section (3), would be
        payable in respect of the service;

'relevant amount' means-

   (a)  in relation to a year, being the period of 5 months commencing on 1
        February 1984-$62.50 or, if a higher amount is prescribed for the
        purposes of this paragraph, that higher amount; or

   (b)  in relation to the year commencing on 1 July 1984 or a subsequent
        year-$150, or if a higher amount is prescribed for the purposes of
        this paragraph in respect of that year, that higher amount;

'year' means-

   (a)  the period of 5 months commencing on 1 February 1984;

   (b)  the year commencing on 1 July 1984; or

   (c)  a subsequent year commencing on a 1 July.''.