Human Services (Medicare) Regulations 2017
Authorised Version F2018C00263 registered 27/04/2018
made under the
Human Services (Medicare) Act 1973
Compilation No. 2
Compilation date: 21 April 2018
Includes amendments up to: F2018L00502
Registered: 27 April 2018
Prepared by the Office of Parliamentary Counsel, Canberra
About this compilation
This compilation
This is a compilation of the Human Services (Medicare) Regulations 2017 that shows the text
of the law as amended and in force on 21 April 2018 (the compilation date).
The notes at the end of this compilation (the endnotes) include information about amending
laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The effect of uncommenced amendments is not shown in the text of the compiled law. Any
uncommenced amendments affecting the law are accessible on the Legislation Register
(www.legislation.gov.au). The details of amendments made up to, but not commenced at, the
compilation date are underlined in the endnotes. For more information on any uncommenced
amendments, see the series page on the Legislation Register for the compiled law.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment of the compiled law is affected by an
application, saving or transitional provision that is not included in this compilation, details are
included in the endnotes.
Editorial changes
For more information about any editorial changes made in this compilation, see the endnotes.
Modifications
If the compiled law is modified by another law, the compiled law operates as modified but the
modification does not amend the text of the law. Accordingly, this compilation does not show
the text of the compiled law as modified. For more information on any modifications, see the
series page on the Legislation Register for the compiled law.
Self-repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the
law, details are included in the endnotes.
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Contents
Part 1—Preliminary 1 1 Name........................................................................................................................... 1
3 Authority..................................................................................................................... 1
5 Definitions .................................................................................................................. 1
6 Person affected by an emergency................................................................................ 4
Part 2—Prescribed functions relating to aged care 5 7 Prescribed functions relating to aged care................................................................... 5
8 Requesting information relating to payments ............................................................. 5
9 Classification etc. of care recipients............................................................................ 5
10 Renewal and change of classifications........................................................................ 5
11 Payment of subsidies................................................................................................... 5
12 Financial hardship....................................................................................................... 6
13 Receiving notifications of start and end of care .......................................................... 7
14 Reconsideration and review of decisions .................................................................... 7
15 Disclosure of certain information................................................................................ 7
16 Appointment of authorised officers etc. ...................................................................... 8
17 Investigation and recovery of recoverable amounts .................................................... 8
18 Recoverable amounts and refunds............................................................................... 8
19 Write-off and waiver of debt....................................................................................... 8
20 Withdrawal of applications ......................................................................................... 9
21 Functions to be performed in accordance with Principles
under the Aged Care Act and the Aged Care Transitional Act ................................... 9
Part 3—Other prescribed functions 10 22 Other prescribed functions .........................................................................................10
23 Delegated functions ...................................................................................................10
24 Prescription shoppers .................................................................................................10
25 Provision of emergency services................................................................................11
26 Lifetime health cover .................................................................................................13
27 Inappropriate practices...............................................................................................13
28 Provision of pharmaceutical benefits .........................................................................14
29 Hearing services.........................................................................................................15
30 Military compensation ...............................................................................................16
31 Claims for treatment provided under certain legislation ............................................16
32 Registration of sonographers .....................................................................................16
33 Mental health care by medical practitioners...............................................................16
34 National Bowel Cancer Screening Register ...............................................................16
35 Allocation of identification numbers..........................................................................18
Part 4—Miscellaneous 19 36 Prescribed period .......................................................................................................19
Part 5—Transitional provisions 20 37 Definitions .................................................................................................................20
38 Things done by, or in relation to, the Chief Executive
Medicare ....................................................................................................................20
39 Things started but not finished by the Chief Executive
Medicare ....................................................................................................................20
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Endnotes 21
Endnote 1—About the endnotes 21
Endnote 2—Abbreviation key 22
Endnote 3—Legislation history 23
Endnote 4—Amendment history 24
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Preliminary Part 1
Section 1
Part 1—Preliminary
1 Name
This instrument is the Human Services (Medicare) Regulations 2017.
3 Authority
This instrument is made under the Human Services (Medicare) Act 1973.
5 Definitions
(1) In this instrument:
Act means the Human Services (Medicare) Act 1973.
Aged Care Act means the Aged Care Act 1997.
Aged Care Department means the Department administered by the Aged Care
Minister.
Aged Care Minister means the Minister administering the Aged Care Act.
Aged Care Secretary means the Secretary of the Aged Care Department.
Aged Care Transitional Act means the Aged Care (Transitional Provisions) Act
1997.
approved supplier has the meaning given by subsection 84(1) of the National
Health Act.
client means a person who received a hearing service for which a claim has been
made.
contracted service provider has the meaning given by section 4 of the Hearing
Services Administration Act 1997.
de-identified has the meaning given by subsection 6(1) of the Privacy Act 1988.
disclosure function has the meaning given by subsection 24(5).
education and prevention functions has the meaning given by subsection 24(3).
emergency means an emergency or disaster that occurs in Australia, or that
affects one or more Australian citizens or permanent residents, and includes:
(a) an emergency or disaster that has been the subject of a declaration under
section 80J or 80K of the Privacy Act 1988; and
(b) any circumstance in relation to which the Australian Government has
decided that a program of special assistance involving the provision of a
service, benefit, program or facility is to be implemented.
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Note: Examples of an emergency include the following:
(a) a natural disaster;
(b) a terrorist act.
evaluation and reporting functions has the meaning given by subsection 24(7).
healthcare providers includes any of the following:
(a) medical practitioners;
(b) prescribers;
(c) pharmacists;
(d) approved suppliers;
(e) dentists;
(f) State and Territory health departments;
(g) State and Territory mental health authorities;
(h) private and public pain management clinics;
(i) private and public alcohol or drug detoxification centres;
(j) private and public hospitals.
Health Department means the Department administered by the Minister
administering the National Health Act.
Health Insurance Act means the Health Insurance Act 1973.
hearing services has the meaning given by section 4 of the Hearing Services
Administration Act 1997.
identification and detection functions has the meaning given by
subsection 24(4).
inappropriate practice has the meaning given by section 81 of the Health
Insurance Act.
lifetime health cover has the same meaning as in the Private Health Insurance
Act.
National Health Act means the National Health Act 1953.
nominated prescriber, in relation to a prescription shopper, means a prescriber
nominated by the prescription shopper from time to time to be that person’s main
prescriber.
PBS information means information collected for the administration of the
Pharmaceutical Benefits Scheme established under Part VII of the National
Health Act.
person affected by an emergency has a meaning affected by section 6.
personal information has the meaning given by subsection 6(1) of the Privacy
Act 1988.
Pharmaceutical Benefits Regulations means the National Health
(Pharmaceutical Benefits) Regulations 2017.
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prescriber means a person who is authorised to prescribe a pharmaceutical
benefit or who purports to be authorised to prescribe a pharmaceutical benefit.
prescription shopper means a person who, within any 3 month period, has had
supplied to him or her:
(a) pharmaceutical benefits prescribed by 6 or more different prescribers (other
than a prescriber who is a specialist within the meaning of subsection 3(1)
of the Health Insurance Act and who has prescribed pharmaceutical
benefits to a person in that capacity); or
(b) a total of 25 or more target pharmaceutical benefits; or
(c) a total of 50 or more pharmaceutical benefits.
Prescription Shopping Program means the program administered by the
Department and the Health Department to reduce prescription shopping.
Private Health Insurance Act means the Private Health Insurance Act 2007.
reappraisal period is the period under section 27-2 of the Aged Care Act in
which a reappraisal of the classification of the level of care needed by an aged
care recipient must be made.
recoverable amount has the meaning given by subsections 95-1(1) and 95-1(3)
of the Aged Care Act.
State or Territory body means:
(a) a State or Territory Minister; or
(b) a Department of State of a State or Territory; or
(c) a body (whether incorporated or not) established for a public purpose under
a law of a State or Territory.
target pharmaceutical benefits means pharmaceutical benefits in any of the
following categories of the Anatomical Therapeutic Chemical classification
system:
(a) N02 (Analgesics);
(b) N03 (Antiepileptics);
(c) N04 (Anti-Parkinson Drugs);
(d) N05 (Psycholeptics);
(e) N06 (Psychoanaleptics);
(f) N07 (Other central nervous system drugs);
(g) R03 (Drugs for obstructive airway diseases);
(h) C10A (Serum lipid reducing agents);
(i) A02B (Drugs for peptic ulcer and gastro-oesophageal reflux diseases);
(j) J01 (Antibacterials for systemic use);
(k) M01 (Anti-inflammatory and antirheumatic products);
(l) A10A (Insulin and analogues);
(m) C02 (Antihypertensives).
Note: The Anatomical Therapeutic Chemical classification system is published by the World
Health Organisation’s Collaborating Centre for Drug Statistics Methodology.
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voucher has the meaning given by section 4 of the Hearing Services
Administration Act 1997.
(2) An expression (other than recoverable amount) used in Part 2 of this instrument
and in the Aged Care Act has the same meaning in that Part as it has in that Act.
Note: The following expressions are defined in clause 1 of Schedule 1 to the Aged Care Act:
(a) aged care service;
(b) approved provider;
(c) flexible care subsidy;
(d) home care;
(e) home care service;
(f) protected information;
(g) residential care service.
6 Person affected by an emergency
In this instrument, a reference to a person affected by an emergency includes
any of the following:
(a) a person who is directly or indirectly affected by the emergency;
(b) an individual who has a family member who is directly or indirectly
affected by the emergency;
(c) an unincorporated organisation that is directly or indirectly affected by an
emergency.
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Part 2—Prescribed functions relating to aged care
7 Prescribed functions relating to aged care
This Part prescribes functions of the Chief Executive Medicare relating to aged
care for the purposes of paragraph 5(1)(e) of the Act.
8 Requesting information relating to payments
(1) The function of the Aged Care Secretary under section 9-3 (obligation to give
information relevant to payments) of the Aged Care Act is a prescribed function
of the Chief Executive Medicare.
(2) To avoid doubt, in performing the prescribed function, the Chief Executive
Medicare may request an approved provider to give specified information to the
Chief Executive Medicare.
9 Classification etc. of care recipients
(1) The functions of the Aged Care Secretary under the following provisions of the
Aged Care Act are prescribed functions of the Chief Executive Medicare:
(a) section 25-1 (classification of care recipients);
(b) section 26-2 (appraisals not received within the appropriate period—care
other than respite care).
(2) To avoid doubt, for the purposes of performing the prescribed functions, the
Chief Executive Medicare may receive an appraisal in accordance with
section 25-3, and for the purposes of sections 26-1 and 26-2, of the Aged Care
Act.
10 Renewal and change of classifications
The functions of the Aged Care Secretary under the following provisions of the
Aged Care Act are prescribed functions of the Chief Executive Medicare:
(a) section 27-6 (renewal of classification);
(b) section 27-8 (reappraisal received after reappraisal period);
(c) section 29-1 (changing classifications).
11 Payment of subsidies
(1) Subject to subsection (4), the functions of the Aged Care Secretary under the
following provisions are prescribed functions of the Chief Executive Medicare:
(a) Parts 3.1 (residential care subsidies), 3.2 (home care subsidies) and 3.3
(flexible care subsidies) of the Aged Care Act;
(b) Parts 3.1 (residential care subsidies), 3.2 (home care subsidies) and 3.3
(flexible care subsidies) of the Aged Care Transitional Act.
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(2) Subject to subsection (4), the Chief Executive Medicare also has the prescribed
function, on behalf of the Commonwealth, to make payments of subsidies, and
do anything necessary for the purpose of making such payments, in accordance
with any of the provisions mentioned in paragraphs (1)(a) and (b).
(3) The Chief Executive Medicare also has the following prescribed functions:
(a) to make a record of information obtained in performing a prescribed
function referred to in subsection (1) or (2);
(b) to disclose that information to the Aged Care Minister, Aged Care
Secretary or an officer of the Aged Care Department for use by that person
in the exercise of powers under the Aged Care Act or the Aged Care
Transitional Act.
(4) It is not a prescribed function of the Chief Executive Medicare under
subsection (1) or (2) to do any of the following:
(a) to approve a form that the Aged Care Secretary is required to or permitted
to approve under:
(i) Part 3.1 (residential care subsidies) or 3.2 (home care subsidies) of the
Aged Care Act; or
(ii) Part 3.1 (residential care subsidies) or 3.2 (home care subsidies) of the
Aged Care Transitional Act;
(b) to make a determination under section 42-5 of the Aged Care Act;
(c) to revoke a determination under section 42-6 of the Aged Care Act;
(d) to make a determination under:
(i) subsection 44-20(5) or (6) of the Aged Care Act; or
(ii) subsection 44-20(5) or (6) of the Aged Care Transitional Act;
(e) under section 44-20A of the Aged Care Act:
(i) to require a person to give information or produce a document; or
(ii) to make a determination;
(f) to perform a function or exercise a power of the Aged Care Minister in
relation to the determination or payment of a subsidy under any of the
provisions mentioned in subsection (1);
(g) to enter into an agreement in relation to the payment of flexible care
subsidy, in accordance with Part 2 of Chapter 4 of the Subsidy
Principles 2014.
12 Financial hardship
(1) Subject to subsection (2), the functions of the Aged Care Secretary under the
following provisions are prescribed functions of the Chief Executive Medicare:
(a) Division 52K (financial hardship) of the Aged Care Act;
(b) section 57-14 (accommodation bond in cases of financial hardship) of the
Aged Care Transitional Act;
(c) section 57-15 (revocation of determinations of financial hardship) of the
Aged Care Transitional Act;
(d) section 57A-9 (accommodation charge in cases of financial hardship) of
the Aged Care Transitional Act;
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(e) section 57A-10 (revocation of determinations of financial hardship) of the
Aged Care Transitional Act.
(2) It is not a prescribed function of the Chief Executive Medicare under
subsection (1) to approve a form that the Aged Care Secretary is required or
permitted to approve under a provision mentioned in paragraphs (1)(a), (b) and
(d).
13 Receiving notifications of start and end of care
A prescribed function of the Chief Executive Medicare is to receive a
notification that is required to be given to the Aged Care Secretary in accordance
with the following provisions:
(a) subsection 63-1B(2) (responsibility relating to recording entry of new
residents) of the Aged Care Act;
(b) Division 2 of Part 3 (information about home care services) of the
Accountability Principles 2014;
(c) subsection 21G(3) (requirement to provide notice) of the User Rights
Principles 2014.
14 Reconsideration and review of decisions
(1) The functions of the Aged Care Secretary under the following provisions are
prescribed functions of the Chief Executive Medicare:
(a) Part 6.1 (reconsideration and review of decisions) of the Aged Care Act,
but only in relation to the following reviewable decisions mentioned in the
table in section 85-1 of that Act:
(i) items 28 to 31;
(ii) items 39AA and 39AB;
(iii) items 45 to 49B;
(iv) items 53 to 53D;
(v) items 53F to 53H;
(b) Part 6.1 (reconsideration and review of decisions) of the Aged Care
Transitional Act, but only in relation to the following reviewable decisions
mentioned in the table in section 85-1 of that Act:
(i) items 39AA to 41;
(ii) items 44 to 46;
(iii) items 48 to 53C.
(2) The Chief Executive Medicare also has the prescribed function of bringing or
defending any legal proceeding relating to the functions mentioned paragraph (a)
or (b).
15 Disclosure of certain information
The functions of the Aged Care Secretary under the following provisions of the
Aged Care Act are prescribed functions of the Chief Executive Medicare:
(a) section 86-3 (disclosure of protected information for other purposes);
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(b) section 86-9 (information about aged care service).
16 Appointment of authorised officers etc.
(1) It is a prescribed function of the Chief Executive Medicare:
(a) to appoint, in accordance with the definition of authorised officer in
section 90-3 of the Aged Care Act, an officer of the Health Department to
be an authorised officer for the purposes of a matter referred to in
paragraph 93-1(2)(b) of that Act; and
(b) to cause an identity card to be issued to such an approved officer in
accordance with section 94-1 of that Act; and
(c) to ensure that the identity card specifies that the person to whom the card is
issued is appointed as an authorised officer for the purposes of a matter
referred to in paragraph 93-1(2)(b) of that Act.
(2) The functions of the Aged Care Secretary under section 93-1 (power to obtain
information and documents) of the Aged Care Act is a prescribed function of the
Chief Executive Medicare, but only in relation to a matter referred to in
paragraph 93-1(2)(b) of that Act
17 Investigation and recovery of recoverable amounts
The Chief Executive Medicare has the following prescribed functions:
(a) to investigate whether the Commonwealth has paid to a person, by way of
subsidy under Chapter 3 of the Aged Care Act or Chapter 3 of the Aged
Care Transitional Act, an amount that is a recoverable amount;
(b) on behalf of the Commonwealth, to take action to recover a recoverable
amount (or part of it):
(i) in accordance with section 95-2 of the Aged Care Act; or
(ii) by any other means.
18 Recoverable amounts and refunds
It is a prescribed function of the Chief Executive Medicare to make decisions for
the purposes of any of the following provisions:
(a) section 95-3 (recovery by deductions from amounts payable to debtor) of
the Aged Care Act;
(b) section 95-4 (recovery where there is a transfer of places) of the Aged Care
Act;
(c) section 95-5 (refund to transferee if Commonwealth makes double
recovery) of the Aged Care Act.
19 Write-off and waiver of debt
The function of the Aged Care Secretary under section 95-6 (write-off and
waiver of debt) of the Aged Care Act is a prescribed function of the Chief
Executive Medicare, but only in relation to a debt or class of debts arising, or an
amount of a debt payable, under:
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(a) Chapter 3 (subsidies) of that Act; or
(b) Chapter 3 (subsidies) of the Aged Care Transitional Act.
20 Withdrawal of applications
(1) The functions of the Aged Care Secretary under the following provisions are
prescribed functions of the Chief Executive Medicare:
(a) paragraph 96-7(2)(b) of the Aged Care Act;
(b) paragraph 96-7(2)(b) of the Aged Care Transitional Act.
(2) To avoid doubt, in performing the prescribed functions under subsection (1), the
Chief Executive Medicare may receive and consider requests from applicants to
extend the period for giving further information.
21 Functions to be performed in accordance with Principles under the Aged
Care Act and the Aged Care Transitional Act
(1) This section applies if:
(a) under this Part, a function of the Aged Care Secretary is a prescribed
function of the Chief Executive Medicare; and
(b) the performance of that function by the Aged Care Secretary requires or
permits the Aged Care Secretary to act under, or in accordance with, a
provision of any Principles made under section 96-1 of the Aged Care Act
or section 96-1 of the Aged Care Transitional Act.
(2) The Chief Executive Medicare must perform the prescribed function in
accordance with the relevant provision of the Principles.
(3) This section is for the avoidance of doubt.
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Part 3—Other prescribed functions
22 Other prescribed functions
This Part prescribes functions of the Chief Executive Medicare for the purposes
of paragraph 5(1)(e) of the Act.
23 Delegated functions
(1) A prescribed function of the Chief Executive Medicare is to perform functions
delegated to the Chief Executive Medicare under:
(a) a law of the Commonwealth; or
(b) a law of a State or Territory.
(2) Paragraph (1)(b) applies only if the Chief Executive Medicare is permitted by
sections 8AD and 8AE of the Act to perform the function.
24 Prescription shoppers
(1) The following are prescribed functions of the Chief Executive Medicare:
(a) to detect persons who are prescription shoppers;
(b) to take appropriate preventative measures in relation to persons who are
prescription shoppers;
(c) the education and prevention functions;
(d) the identification and detection functions;
(e) the disclosure function;
(f) the evaluation and reporting functions.
(2) The Chief Executive Medicare may use PBS information (including personal
information) for the performance of the functions mentioned in subsection (1).
(3) The education and prevention functions are as follows:
(a) to promote awareness of the Prescription Shopping Program to healthcare
providers, prescription shoppers and the general public;
(b) to promote measures to assist healthcare providers to manage prescription
shoppers or people who may be at risk of becoming prescription shoppers;
(c) to educate healthcare providers and prescription shoppers about the law
and requirements relating to the Prescription Shopping Program;
(d) to encourage prescription shoppers to have a nominated prescriber;
(e) to encourage prescribers to become nominated prescribers;
(f) to encourage communication between prescribers, approved suppliers and
pharmacists;
(g) to discourage inefficient and improper use of pharmaceutical benefits.
(4) The identification and detection functions are as follows:
(a) to identify the following:
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(i) prescription shoppers;
(ii) prescribers who prescribe pharmaceutical benefits to prescription
shoppers;
(iii) approved suppliers supplying pharmaceutical benefits to prescription
shoppers;
(b) to establish and maintain databases containing information about
prescription shoppers;
(c) to detect and identify prescription shoppers who may be improperly using,
stockpiling, swapping, diverting or illegally dealing with pharmaceutical
benefits.
(5) The disclosure function is to disclose PBS information about whether a person is
or is not a prescription shopper, or about a person who is a prescription shopper,
to the following:
(a) the person;
(b) a prescriber, in order to assist the prescriber to make decisions about
prescribing to the person if the person visits the prescriber or is a patient of
that prescriber;
(c) an approved supplier who is proposing to supply, or has supplied,
pharmaceutical benefits to the person, in order to assist the approved
supplier (or a pharmacist employed by the approved supplier) to make
decisions about supplying pharmaceutical benefits to that person.
(6) The Chief Executive Medicare may perform the disclosure function for the
following purposes:
(a) administering and enforcing the Chief Executive Medicare’s functions
under the following:
(i) the National Health Act;
(ii) this section;
(b) protecting public revenue;
(c) discouraging inefficient and improper use of pharmaceutical benefits.
(7) The evaluation and reporting functions are to use PBS information and
information collected by the Chief Executive Medicare under the National
Health Act to:
(a) evaluate the Prescription Shopping Program; and
(b) report (using de-identified PBS information) to the Health Department and
other bodies on the administration and outcomes of the Program.
25 Provision of emergency services
(1) The following are prescribed functions of the Chief Executive Medicare:
(a) to provide a service, benefit, program or facility to a person affected by an
emergency (an emergency service);
(b) to participate in disaster policy and planning activities, including activities
undertaken by disaster policy and planning committees.
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(2) Without limiting subsection (1), the Chief Executive Medicare may perform the
functions mentioned in that subsection for, or under an arrangement with, a State
or Territory body.
(3) The function mentioned in paragraph (1)(a) in relation to an emergency includes
the following:
(a) establishing and maintaining a register of persons affected by the
emergency;
(b) receiving, processing, investigating, deciding and paying claims for
assistance;
(c) operating a telephone enquiry line;
(d) operating an online enquiry service;
(e) providing call centre assistance;
(f) providing online assistance;
(g) making arrangements for health assessments and other assistance in
relation to health care;
(h) referring a person to another organisation if the person requires assistance
provided by that organisation;
(i) working with, and providing information to, other government and
non-government bodies in relation to the provision of assistance;
(j) providing information to a State or Territory body about a person affected
by the emergency that will assist the State or Territory body to provide a
payment, benefit or other assistance to the person;
(k) undertaking action (including starting legal proceedings) to recover
payments that should not have been made;
(l) disclosing statistical information (including de-identified information from
the register mentioned in paragraph (a)) about assistance provided;
(m) undertaking compliance, audit, review, investigation, enforcement and
recovery services ancillary to the emergency service.
(4) Use or disclosure of personal information under this regulation is authorised for
the purposes of paragraph 6.2(b) of Australian Privacy Principle 6 set out in
Schedule 1 to the Privacy Act 1988.
(5) If the Chief Executive Medicare provides an emergency service to a person, or
the person makes a request for an emergency service, the Chief Executive
Medicare may:
(a) collect information about the person or the person’s family, including
personal information; and
(b) maintain records about the emergency service or the request.
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26 Lifetime health cover
(1) A prescribed function of the Chief Executive Medicare is to assist the Health
Department with communications to members of the public about lifetime health
cover, including:
(a) identifying persons who have become subject to, or will soon become
subject to, the operation of lifetime health cover; and
(b) providing persons identified under paragraph (a) with information about
lifetime health cover received by the Chief Executive Medicare from the
Health Department; and
(c) providing information and reports on matters relating to lifetime health
cover to the Health Department.
(2) In performing the function under subsection (1), the Chief Executive Medicare
may use personal information collected for the performance of the Chief
Executive Medicare’s medicare functions.
27 Inappropriate practices
(1) The following are prescribed functions of the Chief Executive Medicare:
(a) to devise and implement measures to:
(i) prevent practitioners and other persons from engaging in
inappropriate practice; and
(ii) detect cases where practitioners or other persons have engaged in
inappropriate practice in relation to rendering or initiating services;
and
(iii) prevent or detect activities relating to claims for medicare benefits, or
receipt of medicare benefits, that may constitute an offence under the
Health Insurance Act, the Crimes Act 1914 or the Criminal Code;
(b) if there are reasonable grounds to suspect that a person has engaged in
inappropriate practice—to investigate the conduct of the person to decide
whether to make a request under subsection 86(1) of the Health Insurance
Act for the provision of services by the person to be reviewed;
(c) to investigate cases where there are reasonable grounds to suspect that:
(i) an act in relation to a claim for medicare benefits, or receipt of
medicare benefits, may constitute an offence under the Health
Insurance Act, the Crimes Act 1914 or the Criminal Code; or
(ii) a person may have committed an offence against section 23DP, 106D
or 106EA, or subsection 19D(2), 19D(7), 106E(1) or 106E(2), of the
Health Insurance Act;
(d) if an investigation under paragraph (c) discloses enough evidence for a
prosecution—to refer the case and the evidence to the Australian Federal
Police or the Director of Public Prosecutions;
(e) to take action (including starting legal proceedings) to recover from a
person an amount of medicare benefit that is recoverable by the
Commonwealth, including under the Health Insurance Act.
(2) In this section:
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Part 3 Other prescribed functions
Section 28
practitioner has the meaning given by section 81 of the Health Insurance Act.
service has the meaning given by section 81 of the Health Insurance Act.
28 Provision of pharmaceutical benefits
(1) The following are prescribed functions of the Chief Executive Medicare:
(a) to process claims for payment relating to the provision of pharmaceutical
benefits under Part VII of the National Health Act, and to make payments
of those claims;
(b) to devise and implement measures to prevent or detect contraventions of
Part VII of the National Health Act or the Pharmaceutical Benefits
Regulations;
(c) to investigate cases where there are reasonable grounds to suspect that an
act in relation to the provision of a pharmaceutical benefit may constitute
an offence under the National Health Act, the Pharmaceutical Benefits
Regulations, the Crimes Act 1914 or the Criminal Code;
(d) if an investigation under paragraph (c) discloses enough evidence for a
prosecution—to refer the case and the evidence to the Australian Federal
Police or the Director of Public Prosecutions;
(e) to undertake action (including starting legal proceedings) to recover from a
person an amount relating to a pharmaceutical benefit that is recoverable
by the Commonwealth, including under the National Health Act or the
Pharmaceutical Benefits Regulations.
(2) The following functions of the Repatriation Commission under the Veterans’
Entitlements Act 1986 and the Australian Participants in British Nuclear Tests
and British Commonwealth Occupation Force (Treatment) Act 2006 are
prescribed functions of the Chief Executive Medicare:
(a) processing claims for payment relating to the provision of pharmaceutical
benefits under those Acts;
(b) making payments of those claims.
(3) The following functions of the Military Rehabilitation and Compensation
Commission under the Military Rehabilitation and Compensation Act 2004 are
prescribed functions of the Chief Executive Medicare:
(a) processing claims for payment relating to the provision of pharmaceutical
benefits under that Act;
(b) making payments of those claims.
(4) The following functions of the Military Rehabilitation and Compensation
Commission under the Safety, Rehabilitation and Compensation
(Defence-related Claims) Act 1988 are prescribed functions of the Chief
Executive Medicare:
(a) processing claims for payment relating to the provision of pharmaceutical
benefits under that Act;
(b) making payments of those claims.
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29 Hearing services
(1) If a declaration under section 21 of the Hearing Services Administration Act
1997 is in force specifying that the Chief Executive Medicare is the claims
acceptance body for the purposes of that section, then it is a prescribed function
of the Chief Executive Medicare to act as the claims acceptance body for the
purposes of that section.
(2) If a declaration under section 21 of the Hearing Services Administration Act
1997 is in force specifying that the Chief Executive Medicare is the claims
payment body for the purposes of that section, then it is a prescribed function of
the Chief Executive Medicare to act as the claims payment body for the purposes
of that section.
(3) The Chief Executive Medicare’s functions prescribed by subsections (1) and (2)
include:
(a) on behalf of the Commonwealth, recovering a service provider debt under
section 24 of the Hearing Services Administration Act 1997 if:
(i) the debt is apparent from the records of the Chief Executive Medicare;
or
(ii) the Health Department notifies the Chief Executive Medicare of the
debt; and
(b) disclosing the following information to the Health Department about a
claim accepted, paid or rejected by the Chief Executive Medicare:
(i) client number;
(ii) voucher number;
(iii) date on which the claim was submitted;
(iv) date on which the claim was accepted, paid or rejected;
(v) date of the service to which the claim relates;
(vi) provider number;
(vii) practitioner number;
(viii) site identification;
(ix) item number;
(x) hearing loss details for right and left ears;
(xi) details of the device fitted to the client, whether fitted to the left or
right ear, and fitting configuration;
(xii) date on which the device was fitted;
(xiii) details of top-up devices;
(xiv) contracted service provider’s certification details;
(xv) client certification details;
(xvi) cost to the client;
(xvii) payment details;
(xviii) if the claim is rejected—a code showing the reason the claim or an
element of the claim was rejected;
(xix) any other details about the processing of the claim.
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30 Military compensation
The following functions of the Military Rehabilitation and Compensation
Commission are prescribed functions of the Chief Executive Medicare:
(a) processing claims for compensation under Chapter 6 of the Military
Rehabilitation and Compensation Act 2004 or section 16 of the Safety,
Rehabilitation and Compensation (Defence-related Claims) Act 1988;
(b) making payments for those claims.
31 Claims for treatment provided under certain legislation
(1) The following functions of the Repatriation Commission and the Military
Rehabilitation and Compensation Commission are prescribed functions of the
Chief Executive Medicare:
(a) processing claims for payment in relation to:
(i) the provision of medical treatment under Division 2 of Part IV of the
Seamen’s War Pensions and Allowances Regulations, as in force on
30 June 1994; and
(ii) the provision of treatment under the Acts specified in subsection (2);
(b) making payments for those claims.
(2) For the purposes of subparagraph (1)(a)(ii), the following Acts are specified:
(a) the Australian Participants in British Nuclear Tests and British
Commonwealth Occupation Force (Treatment) Act 2006;
(b) the Military Rehabilitation and Compensation Act 2004;
(c) the Safety, Rehabilitation and Compensation Act 1988;
(ca) the Safety, Rehabilitation and Compensation (Defence-related Claims) Act
1988;
(d) the Veterans’ Entitlements Act 1986.
32 Registration of sonographers
A prescribed function of the Chief Executive Medicare is to establish and
maintain a register of sonographers.
33 Mental health care by medical practitioners
A prescribed function of the Chief Executive Medicare is to establish and
maintain a register of medical practitioners who may provide focused
psychological strategies under the initiative known as the Better Access to
Psychiatrists, Psychologists and General Practitioners through the Medicare
Benefits Schedule (Better Access) Initiative administered by the Health
Department.
34 National Bowel Cancer Screening Register
(1) The following are prescribed functions of the Chief Executive Medicare:
(a) to establish, maintain and administer a register of:
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(i) bowel cancer screening test results; and
(ii) the screening and detection history of people specified in
subsection (2); and
(iii) other relevant information in relation to such people;
(b) to invite people to undergo bowel cancer screening at appropriate intervals;
(c) to supply faecal occult blood test kits to people;
(d) to provide personal information about a person’s bowel cancer screening
and detection history to a medical practitioner to assist the medical
practitioner in advising the person about options for the person’s clinical
management;
(e) to provide personal information about a person to the Department
administered by the Minister administering the Health Insurance Act 1973
to assist in investigating complaints and other matters raised by, or
concerning, the person;
(f) to provide personal information to the Australian Institute of Health and
Welfare to assist in:
(i) assessing the accuracy of screening tests; and
(ii) monitoring and evaluating the effectiveness of the National Bowel
Cancer Screening Register;
(g) to provide personal information to State and Territory Departments and
authorities with responsibility for health matters, to assist in arranging
follow-up of people who have had positive screening test results;
(h) to provide de-identified information to:
(i) the Department administered by the Minister administering the Health
Insurance Act 1973; and
(ii) the Australian Institute of Health and Welfare;
to assist in monitoring and evaluating the effectiveness of the National
Bowel Cancer Screening Register;
(i) to make payments on behalf of the Commonwealth to medical
practitioners, or other persons authorised by medical practitioners to
receive the payments, for the transfer of information.
(2) For the purposes of subparagraph (1)(a)(ii), the following are specified:
(a) people undergoing bowel cancer screening;
(b) people whom the Chief Executive Medicare invites to undergo bowel
cancer screening;
(c) people whom the Chief Executive Medicare:
(i) considers inviting to undergo bowel cancer screening; but
(ii) decides not to invite to undergo the screening.
(3) The following information may be used for the purposes of performing the
functions mentioned in subsection (1):
(a) information acquired by a person in the performance of the person’s duties,
or in the exercise of the person’s powers or functions, under the Health
Insurance Act 1973;
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Section 35
(b) information acquired by a person in the performance of the person’s duties,
or in the exercise of the person’s powers or functions, under the Veterans’
Entitlements Act 1986.
(4) The program constituted by the functions mentioned in subsection (1) is to be
known as the National Bowel Cancer Screening Register.
35 Allocation of identification numbers
A prescribed function of the Chief Executive Medicare is to allocate
identification numbers for the purposes of the Health Insurance Act to the
following persons in relation to their places of practice:
(a) practitioners;
(b) approved pathology practitioners;
(c) participating midwives;
(d) participating nurse practitioners;
(e) participating optometrists;
(f) persons providing health services determined under section 3C of that Act.
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Miscellaneous Part 4
Section 36
Part 4—Miscellaneous
36 Prescribed period
For the purposes of paragraph 41C(8)(a) of the Act, the prescribed period is the
period of 2 years that commenced on 1 January 1981.
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Part 5 Transitional provisions
Section 37
Part 5—Transitional provisions
37 Definitions
In this Part:
commencement day means the day on which this Part commences.
old regulations means the Human Services (Medicare) Regulations 1975 as in
force immediately before the commencement day.
38 Things done by, or in relation to, the Chief Executive Medicare
If, before the commencement day, a thing was done by, or in relation to, the
Chief Executive Medicare under the old regulations, then the thing is taken, on
and after that day, to have been done by, or in relation to, the Chief Executive
Medicare under this instrument.
39 Things started but not finished by the Chief Executive Medicare
(1) This section applies if:
(a) before the commencement day, the Chief Executive Medicare started doing
a thing under the old regulations; and
(b) immediately before that day, the Chief Executive Medicare had not
finished doing that thing.
(2) The Chief Executive Medicare may, on and after the commencement day, finish
doing the thing under this instrument.
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Endnotes
Endnote 1—About the endnotes
Endnotes
Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.
Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended (or
will amend) the compiled law. The information includes commencement details for amending
laws and details of any application, saving or transitional provisions that are not included in
this compilation.
The amendment history in endnote 4 provides information about amendments at the provision
(generally section or equivalent) level. It also includes information about any provision of the
compiled law that has been repealed in accordance with a provision of the law.
Editorial changes
The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and
presentational changes to a compiled law in preparing a compilation of the law for
registration. The changes must not change the effect of the law. Editorial changes take effect
from the compilation registration date.
If the compilation includes editorial changes, the endnotes include a brief outline of the
changes in general terms. Full details of any changes can be obtained from the Office of
Parliamentary Counsel.
Misdescribed amendments
A misdescribed amendment is an amendment that does not accurately describe the
amendment to be made. If, despite the misdescription, the amendment can be given effect as
intended, the amendment is incorporated into the compiled law and the abbreviation “(md)”
added to the details of the amendment included in the amendment history.
If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not
incorp)” is added to the details of the amendment included in the amendment history.
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Endnotes
Endnote 2—Abbreviation key
Endnote 2—Abbreviation key
ad = added or inserted o = order(s)
am = amended Ord = Ordinance
amdt = amendment orig = original
c = clause(s) par = paragraph(s)/subparagraph(s)
/sub-subparagraph(s)C[x] = Compilation No. x
Ch = Chapter(s) pres = present
def = definition(s) prev = previous
Dict = Dictionary (prev…) = previously
disallowed = disallowed by Parliament Pt = Part(s)
Div = Division(s) r = regulation(s)/rule(s)
ed = editorial change reloc = relocated
exp = expires/expired or ceases/ceased to have renum = renumbered
effect rep = repealed
F = Federal Register of Legislation rs = repealed and substituted
gaz = gazette s = section(s)/subsection(s)
LA = Legislation Act 2003 Sch = Schedule(s)
LIA = Legislative Instruments Act 2003 Sdiv = Subdivision(s)
(md) = misdescribed amendment can be given SLI = Select Legislative Instrument
effect SR = Statutory Rules
(md not incorp) = misdescribed amendment Sub-Ch = Sub-Chapter(s)
cannot be given effect SubPt = Subpart(s)
mod = modified/modification underlining = whole or part not
commenced or to be commencedNo. = Number(s)
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Endnotes
Endnote 3—Legislation history
Endnote 3—Legislation history
Name Registration Commencement Application, saving and
transitional provisions
Human Services 11 Aug 2017 (F2017L01008) 12 Aug 2017 (s 2(1)
(Medicare) item 1)
Regulations 2017
Veterans’ Affairs
Legislation Amendment
(British Commonwealth
Occupation Force)
Regulations 2017
18 Dec 2017 (F2017L01652) Sch 1 (items 3, 4): 19
Dec 2017 (s 2(1) item 1)
—
Safety, Rehabilitation and
Compensation Legislation
(Defence Force)
Consequential Amendment
Regulations 2018
20 Apr 2018 (F2018L00502) Sch 1 (items 4–6):
21 Apr 2018 (s 2(1)
item 4)
—
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Endnotes
Endnote 4—Amendment history
Endnote 4—Amendment history
Provision affected How affected
Part 1
s 2 .................................................. rep LA s 48D
s 4.................................................. rep LA s 48C
Part 3
s 28 ................................................ am F2017L01652; F2018L00502
s 30 ................................................ am F2018L00502
s 31 ................................................ am F2017L01652; F2018L00502
Schedule 1 ..................................... rep LA s 48C
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