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Health Legislation Amendment (Private Health Insurance) Bill 2006

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2004-2005-2006

 

 

 

 

 

THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA

 

 

 

 

HOUSE OF REPRESENTATIVES

 

 

 

 

 

 

 

HEALTH LEGISLATION AMENDMENT (PRIVATE HEALTH INSURANCE)

BILL 2006

 

 

 

 

 

 

 

EXPLANATORY MEMORANDUM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Circulated by authority of the Minister for Health and Ageing,

the Honourable Tony Abbott MP)



HEALTH LEGISLATION AMENDMENT (PRIVATE HEALTH INSURANCE)

BILL 2006

 

OUTLINE

 

The Health Legislation Amendment (Private Health Insurance) Bill 2006 (the Bill) amends the National Health Act 1953 (NHA) to enhance the powers of the Private Health Insurance Ombudsman (PHIO) to increase the effectiveness of the PHIO in:

·          dealing with complaints; and

·           conducting investigations on his or her own initiative or at the Minister’s request

particularly regarding complaints or investigations involving health care providers or brokers.

The Bill also amends the Private Health Insurance Incentives Act 1998 to allow for additional time for Medicare Australia to provide the Australian Taxation Office (ATO) with information regarding the Private Health Insurance Rebates.

Amendments relating to the powers of the Private Health Insurance Ombudsman (PHIO)

 

Schedule 1 of the Bill amends the NHA to:

·          expand the PHIO’s powers to include complaints by and in relation to additional health care providers, and to include brokers;

·          expand the definition of ‘private health insurance arrangements’;

·          permit the PHIO to direct participation by the subject of a complaint in compulsory mediation, including:

-           the power to appoint an external mediator

-           the inclusion of an offence provision for failure to participate in mediation

-           the ability for a medical practitioner to appoint a representative;

·          permit the PHIO to mediate between a health fund and a health care provider on his or her own initiative or at the Minister’s request, including directing participation in compulsory mediation;

·          permit the PHIO to require the production of records not only from health funds, but also from health care providers and brokers;

·          permit the PHIO to make recommendations to health care providers, and brokers;

·          permit the PHIO to make reports or recommendations to the Minister or Department not only about health funds but also about health care providers and brokers;

·          ensure that the PHIO, PHIO staff, external mediators, and persons dealing with the PHIO are appropriately protected from civil and personal liability arising from the increased powers; and

·          ensure the PHIO retains his or her consumer protection and private health insurance focus through:

-           the insertion of an objects clause;

-           improvements in the PHIO’s ability to cease to continue with a complaint, in particular on the basis that it is not appropriate to deal with the complaint as it is mainly about clinical matters or mainly about commercial negotiations between parties, ie consumers are not at risk;

-           structuring the PHIO’s ability to hear complaints or conduct investigations about health care providers.

 

The purpose of the additional powers is to increase the effectiveness of the PHIO in resolving complaints and contract disputes.

 

Amendments relating to private health insurance rebates

Schedule 2 of the Bill responds to a 2002 Australian National Audit Office report on the administration of the Private Health Insurance Rebates on private health insurance.  One of the recommendations [1] was that Medicare Australia and the ATO review their data exchange arrangements. 

 

As a result of the review the agencies agreed that the quality of data could be improved by extending the time that Medicare Australia has to provide data to the ATO.  Extending the time available to collect, process and validate the data will significantly improve the quality of the data.  As such, the purpose of the bill is to provide additional time for Medicare Australia to provide the required data to the ATO.

 

FINANCIAL IMPACT STATEMENT

 

The Bill will have no financial impact.



 

 

 

REGULATION IMPACT STATEMENT

 

Acronyms

 

The following acronyms and abbreviations are used in this explanatory memorandum.

 

LHC      -                      Lifetime Health Cover

NHA     -                      National Health Act 1953

PHI                               Private health insurance

PHIAC  -                      Private Health Insurance Administration Council

PHIO     -                      Private Health Insurance Ombudsman

Health Fund                  Registered health benefits organisation (often referred to in the NHA as registered organisation)

RIS        -                      Regulation Impact Statement

The Bill  -                      Health Legislation Amendment (Private Health Insurance) Bill 2006

The Department -          The Department of Health and Ageing

 

Glossary of terms

 

Applicable Benefit Arrangement (ABA)

 

ABA is the statutory term for a table of hospital cover.  An ABA is the arrangement that a health fund enters into with its contributors, whereby insured persons are covered (wholly or partly) for liability to pay fees and charges in respect of:

·          some or all hospital treatment provided by a hospital or day hospital facility; and/or

·          some or all of the professional services that are rendered to insured persons by a medical practitioner while that hospital treatment is being provided (professional services in this context are medical practitioner services in respect of which a Medicare Benefit is payable).

 

Ancillary Health Benefits

 

Ancillary health benefits (ancillaries) are sometimes also referred to as ‘extras’.  Ancillary health benefits are amounts paid by health funds for, or towards the cost of:

·          relevant health services (being any medical, surgical, diagnostic, nursing, dental, therapy or similar services or treatment);

·          services involving the supply, alteration, maintenance or repair of hearing aids, spectacles, contact lenses, artificial teeth, eyes or limbs, or other medical, surgical or prosthetic or dental aids, equipment or appliances;

·          drugs or medicinal preparations;

·          ambulance services; or

·          services by an attendant of a person who is sick or disabled.

 



Community Rating

 

Community rating is a fundamental regulatory requirement on the operation of health funds.  Community rating requires that health funds do not impose different terms and conditions on members on the basis of age (except for Lifetime Health Cover), sex, sexual orientation, health status (except in the first 12 months for pre-existing ailments), place of residence, claims history or any other characteristic of a person that is likely to result in an increased requirement for professional services

 

The intent of community rating is to facilitate affordable access to private health care for all Australians. Community rating has underpinned the operation of Australia’s private heath insurance industry since 1958.

 

Community rating differentiates private health insurance (PHI) from other types of insurance where the risk is rated in relation to an individual’s circumstances or the circumstances of a particular group to which the individual is considered a member. 

 

Private Health Insurance Ombudsman

 

The Private Health Insurance Ombudsman (PHIO), established in 1995, is an independent body which resolves issues about PHI, and acts as the umpire in dispute resolution at all levels within the private health industry.

 

The main role of the PHIO is to deal with complaints about PHI arrangements.  The NHA provides that the role of the PHIO is specifically to:

·          deal with complaints and conduct investigations;

·          publish aggregate data about complaints;

·          make recommendations to the Minister or Department of Health and Ageing;

·          make available and publicise the existence of the Private Patients’ Hospital Charter;

·          issue the State of the Health Funds Report; and

·          promote an understanding of the PHIO’s functions.

 

General Background

 

PHI allows for the choice of private funding of hospital care and ancillary services alongside the Medicare and public hospital treatment that is available to all Australians.  This allows Australians to have choice with their health care arrangements and reduces the pressure on the public health system.

 

The Australian Government has introduced a number of improvements to the PHI sector in recent years.  These improvements have been designed to:

·          encourage consumers to take out PHI and ensure there is an appropriate balance between the public and private health sectors ;

·          protect consumers’ health interests and/or entitlements through broadening the powers of the PHIO ; and

·          facilitate competition in the PHI industry and ensure that the industry is viable and stable.

 



Making PHI attractive

Recently the Government has introduced a number of initiatives to improve the attractiveness of PHI for consumers. These include: 

·          extending the PHI Rebate;

·          clarifying the operation of Lifetime Health Cover; and

·          introducing the No Gap/Known Gap scheme.

 

The PHI Rebate s

The 30% Rebate was introduced in January 1999. The 30% Rebate has directly reduced the cost of premiums to consumers, by providing Australians with a 30% subsidy on the full cost of their PHI premiums.  From 1 April 2005, the PHI Rebates were introduced, providing a rebate of 35 per cent for those aged between 65 and 69, and 40 per cent for those aged 70 or older.

 

Lifetime Health Cover

Lifetime Health Cover (LHC) commenced in July 2000, and changed the way PHI operates.  LHC is a long-term structural change designed to encourage people to take out hospital cover earlier in life, and to maintain their cover over their lifetime. LHC is designed to:

·          slow the rate of premium increases;

·          discourage ‘hit and run’ behaviour (where someone joins a health insurer just before requiring treatment and leaves soon after); and

·          improve the overall demographic profile of PHI membership.

 

Under LHC, health insurers add a fixed loading to premiums based on the age of each member when he or she first takes out hospital cover with a health insurer. People who take out hospital cover with a registered health insurer before the 1 July that immediately follows their 31 st birthday, and who maintain that cover over their lifetime, will pay a lower premium throughout their lives relative to people who delay joining.  The loading applies only to age, regardless of health status. 

 

No Gap/Known Gap Scheme

The No Gap/Known Gap Scheme provides health insurance members with no gap or known gap insurance, ie a health insurer either:

·          provides insurance to cover the difference between fees charged by providers of health services (doctors) and the combined health insurance and Medicare benefits payable for in-hospital medical services; or

·          ensures that, where possible, any amount not covered is known by the patient before treatment.

 

Prior to this scheme, health insurers were allowed to cover the gap only where a negotiated agreement existed between the doctor, the hospital and/or the health insurer about the price of the procedure.

 



Protecting consumers

As mentioned earlier, the PHIO is an independent body that resolves complaints about PHI and is the facilitator in dispute resolution at all levels within the PHI industry. 

 

The PHIO's services are available to health insurance members, hospitals, medical practitioners (including some dentists) as well as health insurers.

 

In 2004 legislative changes were made to broaden the powers of the PHIO.  In particular the PHIO is now required to release a State of the Health Funds Report .  The State of the Health Funds Report is an assessment by the PHIO of the comparative performance of health insurers.   The first State of the Health Funds Report was released in February 2005.

 

The Private Health Insurance Administration Council (PHIAC) is the independent Statutory Authority that regulates the PHI industry.  PHIAC is encouraging registered health benefits organisations to consider their corporate governance arrangements, by developing good practice guidelines and training for directors of registered organisations.

 

Facilitating competition

Private health insurers are currently regulated under the NHA.  Key Government initiatives to simplify regulation and improve the competitiveness of the PHI industry include:

·          reducing administrative requirements for approval of premium increases;

·          streamlining processes for product changes;

·          increasing scrutiny of health insurers’ performance; and

·          reviewing reinsurance arrangements.

 

 

i.        Problem

 

PHIO’s Current Legislative Powers/Functions

 

The powers of the PHIO are detailed in Part VIC of the National Health Act 1953 (NHA).

 

Currently, the PHIO deals with consumer disputes.  However, industry has raised concern that the powers are insufficient in terms of being able to effectively resolve disputes especially involving providers of privately insured services and during contracting disputes between insurers and providers.  

 

Additional powers are needed for the PHIO to increase the effectiveness of the Office in resolving complaints including powers requiring the production of documents, attendance at mediation and where a consumer issue arises from a contract dispute between an insurer and a provider.

 

Currently, the PHIO can :

·          receive a complaint made by a person covered by PHI, a health fund, a hospital or day hospital facility, a medical practitioner, or an accredited podiatrist, regarding any matter arising out of, for example, an applicable benefits arrangement, ancillary health benefits table, hospital purchaser-provider agreement, or medical purchaser-provider agreement, or

·          require records from health funds;

·          seek to resolve the complaint via voluntary mediation;

·          investigate a complaint or practice/procedure of a health fund; and

·          make non-binding recommendations; refer a matter to another organisation; or make a recommendation to the Minister.

 

Currently, the PHIO does not have the power to:

·          receive complaints in relation to all relevant parties to privately insured health care, such as prostheses manufacturers or ancillary health care providers;

·          receive complaints regarding all relevant aspects of privately insured health care, such as matters arising out of arrangements to provide privately insured services (for example gap cover arrangements);

·          require the production of records from all persons or bodies the subject of a complaint;

·          require the subject of a complaint to participate in mediation to try to reach an agreed settlement;

·          conduct mediation, including required mediation, particularly to intervene to seek to resolve a dispute affecting consumers, between a health fund and a health care provider, when no formal complaint has been made to the PHIO; 

·          investigate and make recommendations regarding the practice and procedure of providers of privately insured health services;

·          receive complaints in relation to brokers of private health insurance.

.

 

ii.       Objective

 

The objective is to increase the effectiveness of the PHIO in protecting PHI consumers, in particular in relation to resolving complaints where there are contract disputes between a health fund and a provider of privately insured services.

 

iii.      Options

 

Option 1: Status quo - no change to the existing legislation

This would result in no change in the PHIO’s powers.

 

Option 2: Make legislative change to increase the powers of the PHIO to resolve complaints and contract disputes

 

This option would broaden the PHIO’s current powers to enable the PHIO to more effectively resolve complaints and contract disputes. 

 

Areas for change under consideration include:

·          expanding the range of complainants and the complaints that can be made to the PHIO;

·          expanding the requirement to produce records relevant to a complaint to all persons or bodies the subject of the complaint;

·          enabling the PHIO to compel parties to a dispute to attend mediation;

·          expanding the powers of the PHIO to make recommendations about the practices and procedures of the industry; and

·          ensuring that the PHIO, PHIO staff and other persons dealing with the PHIO are appropriately protected from civil and personal liability arising from the increased powers.

 

iv.      Impact Analysis

 

The potentially directly affected parties are:

·          private health insurers;

·          patients/consumers;

·          health care providers;

·          brokers of private health insurance;

·          the Australian Government; and

·          taxpayers.

 

Impact of option 1 - status quo

 

On private health insurers and health care providers and brokers

 

There would be no change to the current arrangements.

 

On patients and consumers

 

Consumers may not be adequately protected from contract disputes, where health care providers or brokers are involved, which may leave them out of pocket.  In particular there is concern that the PHIO needs to be able to take appropriate action to protect consumers from unexpected out of pocket expenses.

 

On the Australian Government and taxpayers

 

There would be no change to the current arrangements.    

 

Impact of option 2 - increase the powers of the PHIO to resolve complaints and contract disputes

 

On private health insurers

 

Private health insurers would benefit from the proposed increase in PHIO’s powers.  This would enable them to use the PHIO as a dispute resolution mechanism.

 

The PHIO would be able to require the production of records relevant to the resolution of the complaint. This is a power that is currently limited to health funds.  Providers like insurers or other parties to a complaint may also be required to attend mediation.  This may result in very minor additional costs, however, the PHIO will fund costs associated with mediation. 

 

As the operation of the PHIO is funded via a levy on the PHI industry, there may be a slight increase in the levy to support the costs associated with the increased powers.

 

As indicated below, the PHI industry has been widely consulted with, and provided input into, the proposed new powers for the PHIO.

 



On patients/consumers

 

This change should increase the effectiveness of the PHIO in resolving consumer complaints and protecting consumers from adverse outcomes as a result of contract disputes. 

 

Slight increases in costs that may be related to the increase in the PHIO’s powers may be passed on to consumers.

 

On health care providers and brokers

 

As mentioned above in relation to health insurers, providers or other parties to a complaint may be required to attend mediation.  This may result in very minor additional costs, however, the PHIO will fund costs associated with mediation. 

 

Providers will also be able to raise complaints with the PHIO in relation to health funds including as a result of a contract dispute.

 

 

On the Australian Government and taxpayers

 

The proposed changes should result in more effective resolution of complaints regarding PHI arrangements.  This should be reflected in the value of the PHI product.

 

Nil cost to Government.

 

v.       Consultation

 

Insurers and private hospitals have approached the Department concerned that the current dispute resolution process is insufficient. 

 

The Australian Government is committed to ensuring the timely and appropriate engagement with stakeholders. Consultation has been undertaken in an ongoing manner with stakeholders.  Consultation with industry has been undertaken via Circulars to industry (including the dissemination of a discussion paper available via www.health.gov.au) and direct contact with a range of organisations.  Organisations directly engaged include:

·          Australian Medical Association;

·          Australian Health Insurance Association;

·          Australian Private Hospital Association;

·          Health Insurance Restricted Membership Association of Australia;

·          Australian Day Surgery Association;

·          Private Health Insurance Intermediaries Association;

·          Medibank Private Limited;

·          MBF Australia Limited;

·          Medical Industry Association of Australia;

·          BUPA Australia Health Pty Ltd;

·          HBF Health Funds Inc; and

·          Guild Legal Limited.

 

Consultation has identified a range of issues that have been considered and taken into account in implementing the arrangements (see below).

 

Procedure

 

·          Minister issued press release - 9 November 2005

·          Circular to industry - 14 November 2005

·          Circular to industry with discussion paper - 6 December 2005;

·          Discussion paper sent to a range of industry contacts and stakeholders- 6 December 2005;

·          Meetings and discussions with stakeholders - finalised 2 April 2006; and

·          Submissions provided by stakeholders - finalised 20 January 2006.

 

Submissions

 

Thirteen written submission were received from the following organisations:

 

·          Australian Medical Association;

·          Australian Health Insurance Association;

·          Australian Private Hospital Association;

·          Health Insurance Restricted Membership Association of Australia;

·          Australian Day Surgery Association;

·          Private Health Insurance Intermediaries Association;

·          Medibank Private Limited;

·          MBF Australia Limited;

·          Medical Industry Association of Australia;

·          BUPA Australia Health Pty Ltd;

·          HBF Health Funds Inc; and

·          Guild Legal Limited.

 

Overall, both written and oral submissions have been supportive of the proposed increases to the powers of the PHIO.  The submissions commented on a range of issues, including those noted below.

 

1.       Role of PHIO in commercial disputes

Consultation highlighted a tension between those who felt that the PHIO should have little or no role in relation to contract disputes and/or commercial negotiations, and those who would like to see the PHIO as an independent umpire in the marketplace.  Concerns were raised that there be clear guidance as to when and in what circumstances the PHIO may become involved in commercial negotiations and contractual disputes.

2.       Role of PHIO in clinical matters

Concerns were raised that the new powers of the PHIO should be restricted in relation to clinical matters.  If the PHIO was to have power in relation to clinical matters then the parameters of what is “clinical” need to be very clearly defined.  Furthermore, consideration should be given to issuing guidelines about when and where it would be appropriate for the PHIO to have regard to clinical matters.

3.       Extension of powers to brokers and other providers

The submissions urged that the legislation should ensure that the full range of PHI intermediaries, ancillary service providers, preferred provider arrangements, as well as  manufacturers and suppliers of health consumables are subject to the powers of the PHIO. 

4.       Who may complain

Consideration should be given to enabling complaints or representations to be made to the PHIO by peak bodies or representative associations on behalf of their constituents;

5.       Power to require production of documents

Health funds were uncomfortable with the power to require the provision of documents extending to commercial documents.

6.       Mediation

Concern was expressed as to whether a penalty would attach to failure to attend mediation.

7.       Power to make recommendations

Submissions were generally supportive of the proposed expansion of the power of the PHIO to make recommendations about the practices and procedures of health care providers.

8.       Protection from civil action

Submissions were generally supportive of the proposed provisions to ensure that the PHIO and PHIO staff are protected from civil and personal liability from the increased powers.

9.       Duplication

Concerns were expressed that the new powers should not duplicate existing powers of the Department, and that there should be clarity about the roles of the PHIO as distinct from State and Territory medical boards, registration boards and professional associations.

10.     Funding of PHIO

A number of submissions indicated that consideration should be given to options for the future funding of the PHIO.  It was noted that any increased cost to health funds or providers would be passed on to consumers.

11.     Reporting

A number of submissions touched on the PHIO and reporting, raising suggestions that the PHIO be able to report on matters pertaining to agents, brokers, intermediaries and consultants, the PHIO should make a distinction in reporting between complaints and disputes and in particular consideration should be given to only reporting on serious matters and only where a health fund is found to be in breach, and the PHIO should be able to report, both in the Annual Report and the State Of The Health Funds Report, in relation to all matters and parties subject to the expanded powers.

12.     Other issues

A number of miscellaneous issues was raised, including that health care providers should be prohibited from influencing consumers in the choice of health fund, especially immediately prior to treatment; the PHIO should have a power to determine that any bill is null and void if the provider of a service does not give adequate informed financial consent; and a suggestion that the PHIO should be able to determine costs or damages against the losing party.

 

These issues have been taken into account in the development of the new arrangements.

 

vi       Conclusion/Recommendation

 

Option 1 does not provide consumers with any increased protection.  Option 2 would increase the effectiveness of the PHIO providing consumers with additional protection including during contract disputes between insurers and providers and is therefore recommended.

 



vii      Implementation and Review

 

The proposed changes are expected to commence on 1 July 2006.  This will enable a seamless transition in arrangements between financial years.

 

Subject to the availability of resources the amendments to the powers of the PHIO will be reviewed by the Department two years from commencement.  This will include consultation with stakeholders to enable an evaluation of the changes and to identify any issues that may need to be addressed.

 



HEALTH LEGISLATION AMENDMENT (PRIVATE HEALTH INSURANCE)

BILL 2006

 

NOTES ON CLAUSES

Clause 1: Short title

Clause 1 provides that the Act may be cited as the Health Legislation Amendment (Private Health Insurance) Act 2006 .

Clause 2: Commencement

Clause 2 provides that the Act commences on 1 July 2006. 

Clause 3: Schedule(s)

This clause provides that 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 has effect according to its terms.

 

SCHEDULE 1 - AMENDMENTS RELATING TO PRIVATE HEALTH INSURANCE OMBUDSMAN

National Health Act 1953

Item 1

This item inserts a new section 82ZPA which sets out the principal object of Part VIC of the National Health Act 1953 .

Emphasis is placed on the Health Insurance Ombudsman protecting the interests of people who are covered by private health insurance.

Mediation (voluntary and compulsory) may take place under Division 3, Part VIC as part of assisting people who have made complaints to resolve those complaints. The mediation referred to in paragraph 82ZPA(c) refers to mediation between a registered organization and a health care provider which may take place in the absence of a complaint being made, that is, under Division 4, Part VIC, to try to resolve a matter being investigated on the Health Insurance Ombudsman’s own initiative or at the Minister’s request.

Item 2

This item omits “(1)” where it first occurs in subsection 82ZQ(1).

Item 3

This item inserts a definition of the term “broker” in subsection 82ZQ(1).

A “broker” is defined to mean a person who deals (otherwise than by carrying on health insurance business within the meaning of section 67) in insurance provided under contracts of insurance entered into by registered organizations, and who acts on behalf of persons intending to become insured persons.

Item 4

This item inserts a definition of the term “health care provider” in subsection 82ZQ(1).

A “health care provider” is defined to mean:

(a) a hospital or a day hospital facility; or

(b) a medical practitioner; or

(c) an accredited podiatrist; or

(d) any other person who provides services or goods to, or manufactures or supplies goods that are provided to, insured persons, in circumstances in which the liability of insured persons to pay fees and charges in respect of the services or goods is capable of being insured by a registered organization.

Item 5

This item inserts a definition of the term “insured person” in subsection 82ZQ(1).

An “insured person” means an individual who is covered by a contract of insurance entered into (whether or not by the individual) with a registered organization.

The definition of “insured person”, together with the reference to “a table of a registered organization” in paragraph (e) of the definition of “private health insurance arrangement” in subsection 82ZQ(1), means that the Health Insurance Ombudsman may consider complaints, including complaints from persons insured, regarding Overseas Students Health Cover and Overseas Visitors Health Cover provided by a registered organization.

Item 6

This item inserts a definition of the term “officer” in subsection 82ZQ(1).

An “officer” of a subject of a complaint under Division 3 or an investigation under Division 4 means:

(a) if the subject is an individual - the individual; or

(b) if the subject is a registered organization - a person who is an officer of the organization within the meaning of subsection 66(1); or

(c) if the subject is a company within the meaning of the Corporations Act 2001 - a director of the company; or

(d) if the subject is an incorporated association - a member of the management committee of the association; or

(e) if the subject is an unincorporated entity - a member of the governing body of the entity; or

(f) if the subject is a partnership - a partner in the partnership.

Item 7

This item adds six arrangements at the end of the definition of private health insurance arrangement in subsection 82ZQ(1).   

Item 8

This item repeals the definition of “records” in subsection 82ZQ(1), and substitutes a new definition of the term.

Item 9

This item inserts a definition of the term “subject” in subsection 82ZQ(1).

A “subject” of a complaint under Division 3 means the person or body against whom the complaint is made.

A “subject” of an investigation under Division 4 means the person or body being investigated.

Item 10

This item repeals subsection 82ZQ(2).

Item 11

This item amends paragraph 82ZRC(b) by adding to the words “(including by mediating under section 82ZTBAB)” after “82ZTA”.

Item 12

This item amends paragraph 82ZRC(cb) by adding the words “or brokers” after “organizations”.

Item 13

This item inserts a new paragraph (cc) after paragraph 82ZRC(cb).

New paragraph (cc) includes, as one of the Health Insurance Ombudsman’s functions, the function of reporting to the Minister or to the Department, as part of reports about the practices of particular registered organizations, about the practices of particular health care providers, in certain cases.

Item 14

This item amends paragraph 82ZRC(d) by adding the words “or brokers” after “organizations”.

Item 15

This item inserts a new paragraph (da) after paragraph 82ZRC(d).

New paragraph (da) includes, as one of the Health Insurance Ombudsman’s functions, the function of making recommendations to the Minister or to the Department, together with recommendations about regulatory practices and/or industry practices relating to registered organizations, about regulatory practices and/or industry practices relating to health care providers, in certain cases.

Item 16

This item omits the words “covered by a private health insurance policy” from paragraph 82ZS(1)(a) and substitutes the words “an insured person”. 

  Item 17

This item repeals paragraphs 82ZS(1)(b),(c), (ca) and (d) and substitutes paragraphs (b), (c) and (d).

Section 82ZS deals with who may make a complaint. The effect of this amendment is that a complaint may be made by:

(a) a person who is, or was at the time of the incident to which the complaint relates, covered by a private health insurance policy;

(b) a registered organization;

(c) a health care provider;

(d) a broker.

A “health care provider” includes hospitals, day hospital facilities, medical practitioners, and accredited podiatrists. It also includes manufacturers and suppliers of prostheses, and providers of ancillary health benefits.

Item 18

This item repeals subsection 82ZS(3).

Item 19

This item inserts a new section 82ZSAAA after section 82ZS.  New section 82ZSAAA sets out the persons or bodies against whom complaints may be made.

This item provides that a complaint may be made to the Health Insurance Ombudsman against any of the following:

(a) a registered organization;

(b) a health care provider;

(c) a broker.

Item 20

This item inserts “(1)” before the words “The complaint” in section 82ZSA. 

Item 21

This item adds new subsections (2) and (3) at the end of section 82ZSA.

New subsection 82ZSA(2) provides that for the purposes of subsection (1) (which lists the ground for complaint), a complaint against a health care provider is only about a matter mentioned in that subsection if, in addition to that subsection applying to the complaint, certain other criteria are met.



 Item 22

This item omits the words “in relation to a registered organization” in subsection 82ZSAA(1).

Item 23

This item omits the words “inform the organization” from paragraph 82ZSAA(1)(a) and substitutes the words “inform the subject of the complaint”.

Item 24

This item omits the words “of the organization”, wherever occurring, in subsection 82ZSAA(1) and substitutes the words “of the subject”.

Item 25

This item omits the words “concerning a registered organization” from paragraph 82ZSAA(2)(a).

Item 26

This item omits the words “the organization” from subsection 82ZSAA(2) and substitutes the words “the subject of the complaint”.

Item 27

This item omits the words “that organization” from subsection 82ZSAA(2) and substitutes the words “that subject”.

Item 28

This item omits the words “ a registered organization” from subsection 82ZSAA(3) and substitutes the words “the subject of the complaint”.

Item 29

This item omits the words “the organization”, wherever occurring, in subsection 82ZSAA(3) and substitutes the words “the subject”.

Item 30

This item amends subsection 82ZSAA(5), by omitting the words “registered organization”, and substituting the word “subject”.

Item 31

This item amends subsection 82ZSAA(7), by omitting the words “registered organization’s”, and substituting the word “subject’s” .

Item 32 to 33

These items amend subsections 82ZSAA(8), and (10), respectively,  by omitting the words “registered organization”, and substituting the word “subject” .

Subsection 82ZSAA(8) makes it a criminal offence for an officer of a registered organization to fail to comply with a request from the Health Insurance Ombudsman under subsections 82ZSAA(1), (2) or (3) to provide specified records. Penalty: 10 penalty units.

The effect of the amendment to subsection 82ZSAA(8) is that the criminal offence would also apply to an officer of a health care provider or broker who fails to comply with a request from the Health Insurance Ombudsman under subsections 82ZSAA(1), (2) or (3) to provide specified records.

The amended offence provision, as applies for the current offence provision, is an offence of strict liability: subsection 82ZSAA(9).

Subsection 82ZSAA(10) provides that an officer of a registered organization is not excused from producing a record when required to do so under subsection 82ZSAA(1), (2) or (3) on the ground that the production of the record might tend to incriminate the officer or make the officer liable to a penalty. It also provides that the production of the record, or anything obtained as a direct or indirect consequence of the production, is not admissible in evidence against the officer in any proceedings, other than proceedings for an offence against subsection 82ZSAA(11).

The effect of the amendment to subsection 82ZSAA(10) is that it would also apply to an officer of a health care provider or broker who receives a request from the Health Insurance Ombudsman under subsection 82ZSAA(1), (2) or (3).

Subsection 82ZSAA(11) is a criminal offence provision which makes it an offence for a person to produce a record to the Health Insurance Ombudsman in accordance with a request made under subsection 82ZSAA(1), (2) or (3) knowing that the record is false or misleading in a material particular. Penalty: Imprisonment for 6 months.

Although this subsection is not amended, its scope of practical application is extended by other amendments to also apply to an officer of a health care provider or broker who receives a request from the Health Insurance Ombudsman under subsection 82ZSAA(1), (2) or (3).

Item 34

This item inserts new section 82ZSAB which provides for certain circumstances in which the disclosure of personal information to the Health Insurance Ombudsman is taken to be authorised by law for the purposes of the Privacy Act 1988 and any provision of a law of a State or Territory that provides that personal information may be disclosed if the disclosure is authorised by law. 

Item 35

This item omits the words “person or body against whom the complaint was made” from paragraph 82ZSB(1)(a) and substitutes the words “subject of the complaint”.

Item 36

This item omits the words “a registered organization and requesting the organization” from paragraph 82ZSB(1)(b) and substitutes the words “the subject of the complaint and requesting the subject”.

Item 37

This item omits the words “a registered organization” from paragraph 82ZSB(1A)(a) and substitutes the words “the subject of the complaint”.

Item 38

This item omits the words “the organization”, wherever occurring, from subsection 82ZSB(1A) and substitutes the words “the subject”.

Item 39

This item inserts a new subsection 82ZSB(2A) after subsection 82ZSB(2), which provides that the Health Insurance Ombudsman must not take action on a complaint where regulations have been made under subsection 82ZSA(3) prescribing matters for which complaints cannot be made.

Item 40

This item inserts four new sections after section 82ZSB. 

Subsection 82ZSBAA(1) provides that the Health Insurance Ombudsman may direct, having regard to any guidelines under paragraph 82ZV(2)(a) that a subject of a complaint participate  in mediation under paragraph 82ZSB(1)(a).

Subsection 82ZSBAA(2) provides that the direction must be in writing, specify the individual or individuals who are subject to the direction, be given to the individual or individuals, and specify the time of the mediation, which must not be earlier than 14 days after the day on which the direction is given to the individual or individuals. The direction must also specify the place of the mediation.

Subsection 82ZSBAA(3) makes it a criminal offence for a person who is an individual subject to a direction under subsection 82ZSBAA(1) to fail to participate in part or all of the mediation, if the complainant in relation to the complaint to be mediated attends, or was willing to attend the mediation.

If the person subject to the direction is a medical practitioner, who has appointed a representative in relation to the mediation under section 82ZSBAB, the medical practitioner will commit the offence if the representative fails to participate in part or all of the mediation.

Penalty: 10 penalty units.

Section 82ZSBAB provides that where the Health Insurance Ombudsman directs a medical practitioner under section 82ZSBAB(1) to participate in mediation, the medical practitioner may appoint an individual to participate in the mediation on the practitioner’s behalf.

Section 82ZSBAC provides for matters relevant to the conduct of mediation in relation to which the Health Insurance Ombudsman has directed someone to participate under 82ZSBAA(1).  Subsection 82ZSBAC(1) provides that if the Health Insurance Ombudsman directs someone to participate in mediation, the mediation may be conducted by the Health Insurance Ombudsman or a person appointed by the Health Insurance Ombudsman under section 82ZUH.  Subsection 82ZSBAC(2) provides the circumstances in which mediation in which someone is directed to participate ceases.  Subsection 82ZSBAC(3) lists the matters in respect of which a person appointed by the Health Insurance Ombudsman under section 82ZUH to conduct mediation must report to the Ombudsman.

Section 82ZSBAD provides that anything said or any admissions made during mediation are not admissible in any court or any other proceedings before a person where that person is authorised to hear evidence.

Item 41

This item omits the words “from a registered organization” from subsection 82ZSD(1) and substitutes the words “from the subject of a complaint”.

Item 42

This item omits the words “a hospital, day hospital facility or medical practitioner” from paragraphs 82ZSD(1)(b) and (c) and substitutes the words “a health care provider or broker”.

Items 43 and 44

These items amend paragraph 82ZSD(2)(b) and subsection 82ZSD(3) respectively by omitting the words “a hospital, day hospital or medical practitioner”, and substituting the words “a health care provider or broker”.

Item 45

This item omits the words “that the hospital, day hospital or medical practitioner” from subsection 82ZSD(3) and substitutes the words “an officer of the health care provider or broker”.

Item 46

This item omits the words “report to” from subsection 82ZSD(3) and substitutes the words “to report to”.

Item 47

This item inserts a new subsection 82ZSD(4A) after subsection 82ZSD(4). New subsection 82ZSD(4A) is a criminal offence provision. It provides that an officer of whom a request is made under subsection 82ZSD(3)  must not fail to report to the Health Insurance Ombudsman. Penalty: 10 penalty units.

Item 48

This item amends subsection 82ZSD(5) by inserting the words “or (4A)” after the words “subsection (4)”. This means that the criminal offence contained in new subsection 82ZSD(4A) will, like the similar criminal offence located in subsection 82ZSD(4) in relation to the public officer of a registered organization, be an offence of strict liability.



Item 49

This item inserts a new subsection 82ZSD(7) at the end of section 82ZSD which makes it a criminal offence for an officer, who has been requested by the Health Insurance Ombudsman under subsection 82ZSD(3) to provide a report, to knowingly make a report under that subsection to the Health Insurance Ombudsman that is false or misleading in a material particular. Penalty: Imprisonment for 6 months.

Item 50

This item omits the words “particular registered organization” from subsection 82ZSDA(1) and substitutes the words “particular subject”.

Item 51

This item omits the words “registered organization” from paragraph 82ZSDA(1)(a) and substitutes the words “subject of the complaint”.

Item 52

This item omits the words “registered organizations” from subparagraph 82ZSDA(1)(b)(i) and substitutes the words “subjects of that kind”.

Item 53

This item omits the words “registered organization the” from subparagraph 82ZSDA(1)(b)(ii).

Item 54

This item inserts a new subsection 82ZSDA(1A) after subsection 82ZSDA(1) and provides that the Health Insurance Ombudsman may make recommendations under paragraph 82ZSDA(1)(b) concerning a health care provider or health care providers but only to the extent that the recommendations relate to:

(a) the application of a private health insurance arrangement or a class of private health insurance arrangements to services or goods provided, or goods manufactured or supplied, by that kind of  health care provider; or

(b) a private health insurance arrangement or class of private health insurance arrangements to which that kind of health care provider may be a party.

Item 55

This item omits the words “particular registered organization” from subsection 82ZSDA(2) and substitutes the words “particular subject”.

Item 56

This item omits the words “registered organization concerned” from paragraph 82ZSDA(2)(a) and substitutes the word “subject”.

Item 57

This item omits the words “conduct of the registered organization” from paragraph 82ZSDA(2)(a) and substitutes the words “subject’s conduct”.

Item 58

This item omits the words “registered organization” from paragraphs 82ZSDA(2)(b) and (c)  and substitutes the word “subject”.

Item 59

This item inserts “, 82ZSBAA” after “82ZSB” in paragraph 82ZSE(1)(a).

Item 60

This item omits the words “hospital, day hospital facility or medical practitioner” from paragraphs 82ZSE(1)(c) and (2)(c) and substitutes the words “health care provider or broker”.

Item 61

This item omits the words “not to investigate, or not to continue to investigate,” from subsection 82ZSG(1) and substitutes the words “not to deal, or not to continue to deal, with”.  The heading to section 82ZSG is altered by omitting “investigate” and substituting “deal with complaint”.

Item 62

This item omits the words “the person or body against whom the complaint is made” from paragraph 82ZSG(1)(a) and substitutes the words “the subject of the complaint”.

Item 63

This item omits the words “, or is dealing,” from paragraph 82ZSG(1)(aa).

Item 64

This item amends subsection 82ZSG(1) by inserting  paragraphs (d) and (e) the end of the subsection.

New paragraph (d) will enable the Health Insurance Ombudsman to decide not to deal, or not to continue to deal with a complaint if he or she believes that the complaint is mainly about commercial negotiations and, having regard to the object of Part VIC, it is not appropriate to deal, or to continue to deal, with the complaint.

New paragraph (e) will enable the Health Insurance Ombudsman to decide not to deal, or not to continue to deal with a complaint if he or she believes that the complaint is mainly about clinical matters and, having regard to the object of Part VIC, it is not appropriate to deal, or continue to deal, with the complaint.

Section 82ZSC of Part VIC provides that the Health Insurance Ombudsman also must, if in his or her opinion, a complaint raises a matter that could be dealt with more effectively or conveniently by another body, refer the matter to that body (provided the complainant agrees to the referral, and does not withdraw the complaint).

Section 82ZSBA of Part VIC provides that the Health Insurance Ombudsman also must, if in his or her opinion, a complaint raises a matter that could be dealt with more effectively or conveniently by the Australian Competition and Consumer Commission (ACCC), refer the matter to the ACCC (provided the complainant agrees to the referral, and does not withdraw the complaint).

Subsection 82ZSA(3) of Part VIC will also provide that the regulations may prescribe matters about which complaints cannot be made.

Item 65

This item omits the words “not to investigate, or not to continue to investigate,” from subsection 82ZSG(1A) and substitutes the words “not to deal, or not to continue to deal, with”.

Item 66

This item omits the word “investigate” from subsection 82ZSG(2) and substitutes the words “deal with”.

Item 67

This item omits the words “person or body against whom the complaint is made” from subsection 82ZSG(2) and substitutes the words “subject of the complaint”.

Item 68

This item omits the words “not to investigate, or not to continue to investigate,” from subsection 82ZSG(4) and substitutes the words “not to deal, or not to continue to deal, with”.

Item 69

This item omits the words “not to investigate, or not to continue to investigate,” from subsection 82ZSG(5) and substitutes the words “not to deal, or not to continue to deal, with”.

Item 70

This item inserts a new section, 82ZSI, at the end of Division 3 of Part VIC.  Section 82ZSI provides that civil proceedings do not lie in respect of loss, damage or injury suffered by another person because a statement was made in good faith to the Health Insurance Ombudsman in connection with the making of a complaint under Division 3, Part VIC.

A statement includes giving a document or information.

Item 71

This item amends section 82ZT by inserting “(1)” before the word “The”.



Item 72

This item amends section 82ZT by inserting the words “or a broker” after the word “organization”.

Item 73

This item adds a new subsection (2) to section 82ZT, which provides that the Health Insurance Ombudsman can, on his or her own initiative, together with an investigation of the a registered organization, investigate the practices and procedures of a health care provider, provided the Health Insurance Ombudsman considers, having regard to the object of Part VIC, that investigation of the health care provider is necessary or appropriate in order to consider the matter effectively, and certain other conditions are met.

Item 74

This item amends subsection 82ZTA(1) by inserting the words “or a broker” after the word “organization”.

Item 75

This item amends section 82ZTA by inserting a new subsection 82ZTA(1A) after subsection 82ZTA(1).  The new subsection provides that the Minister may request the Health Insurance Ombudsman to investigate, together with an investigation of a registered organization, the practices and procedures of a health care provider, provided the Minister considers, having regard to the object of Part VIC, that investigation of the health care provider is necessary or appropriate in order to consider the matter effectively, and certain other conditions are met.

Item 76

This item omits the words “such a request” from subsection 82ZTA(2) and substitutes the words “a request under this section”.

Item 77

This item omits the words “a registered organization” from subsection 82ZTB(1) and substitutes the words “a subject of investigation”.

Item 78

This item omits the words “the organization” wherever occurring, in subsection 82ZTB(1) and substitutes the words “the subject”.

Item 79

This item omits the words “the registered organization” from subsection 82ZTB(3) and substitutes the words “the subject”.

Item 80

This item repeals subsection 82ZTB (5) and substitutes new subsections 82ZTB(5), (5A) and (5B), which provide that the Health Insurance Ombudsman must not request the giving of information or the production of records relating to an individual, without their consent, where the individual:

-           in the case of a request to a registered organization, is, or has sought to become, or was during the period of the investigation, an insured person;

-           in the case of a request to a health care provider, is, or was during the period of the investigation, a patient of the health care provider; or

-           -      in the case of a request to a broker, is, or was during the period being investigated, a client of the broker.

Item 81     

This item amends subsections 82ZTB(6), (8) and (9) by omitting the words “of a registered organization”.

Subsection 82ZTB(6) makes it a criminal offence for an officer of a registered organization to fail to comply with a request made of the officer by the Health Insurance Ombudsman under subsection 82ZTB(1) to give specified information or produce specified records. Penalty: 10 penalty units.

The effect of the amendment to subsection 82ZTB(6) is to extend it to also apply to an officer of a health care provider or broker who receives a request under subsection 82ZTB(1).

The amended offence, as is the case with the current offence provision, is an offence of strict liability: subsection 82ZTB(7).

Subsection 82ZTB(8) provides that an officer of a registered organization is not excused from giving information or producing a record when required to do so under subsection 82ZTB(1) on the ground that the information, or the production of the record, might tend to incriminate the officer or make the officer liable to a penalty. It also provides that the information, or the production of the record, or anything obtained as a direct or indirect consequence of the giving of the information or the production of the record, is not admissible in evidence against the officer in any proceedings, other than proceedings for an offence against subsection 82ZTB(9).

The effect of the amendment to subsection 82ZTB(8) is that it would also apply to an officer of a health care provider or broker who receives a request from the Health Insurance Ombudsman under subsection 82ZTB(1).

Subsection 82ZTB(9) is a criminal offence provision which makes it an offence for an officer of a registered organization to produce a record to the Health Insurance Ombudsman in accordance with a request made under subsection 82ZSTB(1) knowing that the record is false or misleading in a material particular. Penalty: Imprisonment for 6 months.

The effect of the amendment to subsection 82ZTB(9) is that it would also apply to an officer of a health care provider or broker who receives a request from the Health Insurance Ombudsman under subsection 82ZTB(1).



Item 82

This item inserts new sections 82ZTBAA, 82ZTBAB, 82ZTBAC, 82ZTBAD, 82ZTBAE and 82ZTBAF after section 82ZTB.

New section 82ZTBAA provides for certain circumstances in which the disclosure of personal information to the Health Insurance Ombudsman is taken to be authorised by law for the purposes of the Privacy Act 1988 and any provision of a law of a State or Territory that provides that personal information may be disclosed if the disclosure is authorised by law. 

New section 82ZTBAB provides that the Health Insurance Ombudsman may, if he or she considers it appropriate and consistent with the object of Part VIC, try to resolve a matter being investigated under Division 4 by mediating between a registered organization and a health care provider.

New subsection 82ZTBAC(1) provides that the Health Insurance Ombudsman may, having regard to any guidelines under paragraph 82ZV(2)(a) direct (a) a registered organization; or (b) a health care provider; to participate in mediation under section 82ZTBAB.  New subsection 82ZTBAC(2) provides that a direction under subsection 82ZTBAC(1) must be in writing and must specify certain particulars.  New subsection 82ZTBAC(3) provides that a person commits a criminal offence if the person is an individual who is directed under subsection 82ZTBAC(1) to participate in mediation and the person, or, if a medical practitioner, the person’s representative appointed under section 82ZTBAD, fails to participate in part or all of the mediation. Penalty: 10 penalty units.

New subsection 82ZTBAD(1) provides that if the Health Insurance Ombudsman has directed a medical practitioner under subsection 82ZTBAC(1) to participate in mediation, the practitioner may appoint an individual to participate in the mediation on the practitioner’s behalf.  New subsection 82ZTBAD(2) provides particulars relevant to the making of an appointment under subsection 82ZTBAD(1).

New section 82ZTBAE provides for matters relevant to the conduct of mediation in relation to which the Health Insurance Ombudsman has directed someone to participate under section 82ZTBAC.  New subsection 82ZTBAE(1) provides that if the Health Insurance Ombudsman directs someone to participate in mediation under section 82ZTBAC, the mediation may be conducted by the Health Insurance Ombudsman or a person appointed by the Health Insurance Ombudsman under section 82ZUH.  New subsection 82ZTBAE(2) provides the circumstances in which mediation in which someone is directed to participate under section 82ZTBAC ceases.  New subsection 82ZTBAE(3) lists the matters in respect of which a person appointed by the Health Insurance Ombudsman under section 82ZUH to conduct mediation must report to the Ombudsman.

New section 82TBAF concerns the admissibility of anything said, or any admission made, during participation in mediation under section 82ZTBAB and states that such evidence is inadmissible in a court or before a person who is authorised to hear evidence.

Item 83     

This item omits the words “a hospital, a day hospital facility or a medical practitioner” from paragraph 82ZTC(1)(b) and substitutes the words “a health care provider or broker”.  The heading to section 82ZTC is altered by omitting the words “to registered organizations”.

Item 84      

This item omits the words “a hospital, day hospital or medical practitioner” from subsection 82ZTC(3) and substitutes the words “a health care provider or broker”.

Item 85      

This item omits the words “that the hospital, day hospital or medical practitioner” from subsection 82ZTC(3) and substitutes the words “an officer of the health care provider or broker”.     

Item 86      

This item omits the words “report to” from subsection 82ZTC(3) and substitutes the words “to report to”.

Item 87      

This item inserts a new subsection 82ZTC(4A) after subsection 82ZTC(4).  New subsection 82ZTC(4A) is a criminal offence provision.  New subsection 82ZTC(4A) provides that an officer of a health care provider or broker in respect of whom a request is made under subsection 82ZTC(3) must not fail to report to the Health Insurance Ombudsman in accordance with the request.  Penalty: 10 penalty units.

Item 88      

This item inserts the words “or (4A)” after the words “subsection (4)” in subsection 82ZTC(5). This means that the criminal offence contained in new subsection 82ZTC(4A) will, like the similar criminal offence located in subsection 82ZTC(4) in relation to the public officer of a registered organization, be an offence of strict liability.

Item 89      

This item adds a new subsection 82ZTC(7) at the end of section 82ZTC.  New subsection 82ZTC(7) is a criminal offence provision.  New subsection 82ZTC(7) provides that it is an offence for an officer of a health care provider or broker in respect of whom a request is made under subsection 82ZTC(3) to make a report to the Health Insurance Ombudsman under that subsection knowing that the report is false or misleading in a material particular.  Penalty: Imprisonment for 6 months.

Item 90      

This item omits the words “of the practices and procedures of a particular registered organization”, wherever occurring, in subsection 82ZTCA(1).

Item 91      

This item inserts the words “and any mediation conducted as part of the investigation” after the word “investigation” in paragraph 82ZTCA(1)(a).



Item 92      

This item omits the words “registered organization” from paragraph 82ZTCA(1)(a) and substitutes the words “subject of the investigation”.

Item 93      

This item omits the words “registered organizations” from subparagraph 82ZTCA(1)(b)(i) and substitutes the words “subjects of that kind”.

Item 94      

This item omits the words “registered organization the” from subparagraph 82ZTCA(1)(b)(ii).

Item 95      

This item inserts a new subsection 82ZTCA(1A) after subsection 82ZTCA(1).  New subsection 82ZTCA(1A) limits the extent to which the Health Insurance Ombudsman may make recommendations concerning health care providers under paragraph 82ZTCA(1)(b).

Item 96      

This item omits the words “registered organization”, wherever occurring in subsection 82ZTCA(2), and substitutes the word “subject”.

Item 97      

This item adds a new section 82ZUH at the end of Division 5 of Part VIC.  New section 82ZUH provides for matters relevant to the Health Insurance Ombudsman’s appointment of a person to conduct mediation in which someone is or will be directed to participate under section 82ZSBAA or 82ZTBAC.

New subsection 82ZUH(1) provides that the Health Insurance Ombudsman may, having regard to any guidelines under paragraph 82ZV(2)(c), appoint a person to conduct mediation in which someone is or will be directed to participate under section 82ZSBAA or 82ZTBAC.

New subsection 82ZUH(2) provides that a person appointed under new subsection 82ZUH(1) is appointed for the period specified by the Health Insurance Ombudsman in the instrument of appointment.

New subsection 82ZUH(3) provides that, subject to section 135A, a person appointed under new subsection 82ZUH (1) is not personally liable to an action or other proceedings for damages in relation to anything done or omitted to be done, reasonably and in good faith, in or in relation to the conduct of the mediation.

Item 98     

This item inserts the words “, by legislative instrument,” after the words “Minister may” in subsection 82ZV(1).



Item 99      

This item repeals subsection 82ZV(2) and substitutes new subsection 82ZV(2).  New subsection 82ZV(2) lists matters in respect of which the Minister may issue guidelines.  New subsection 82ZV(2) provides that guidelines issued by the Minister under new subsection 82ZV(2) are a legislative instrument (for the purposes of the Legislative Instruments Act 2003 ).

Item 100     

This item inserts the words “reasonably and” after the words “to be done” in subsection 82ZVE(1).

Item 101

This item adds a new section 82ZVF at the end of Part VIC.  New section 82ZVF concerns the reconsideration of a request made by the Health Insurance Ombudsman for records.

New subsection 82ZVF(1) provides that a request for records given to (a) an officer of a subject of a complaint under subsection 82ZSAA(1), (2) or (3) or (b) an officer of a subject of an investigation under subsection 82ZTB(1) must include notice of the officer’s rights under new section 82ZVF.

New subsection 82ZVF(2) lists the decisions in respect of which an officer to whom a request for records is given, or another officer of the subject, may apply to the Health Insurance Ombudsman for reconsideration.

New subsection 82ZVF(3) provides the period within which an application under new subsection 82ZVF(2) must be made.

New subsection 82ZVF(4) provides that if an application for reconsideration is made under new subsection 82ZVF(2), the decision to which the application relates must be reconsidered by the Health Insurance Ombudsman or by his or her delegate under subsection 82ZVD(1).  New subsection 82ZVF(4) provides that the person reconsidering the request must not be the person who made the request.

New subsection 82ZVF(5) provides the period within which the person reconsidering the request must affirm, change or revoke the request, by notice in writing to the officer.     

Item 102   

This item repeals paragraph 105AB(6AC)(a) and substitutes new paragraph 105AB(6AC)(a).  

Paragraph 105AB(6AC)(a) provides that application may be made to the Administrative Appeals Tribunal for review of a decision by the Health Insurance Ombudsman under subsection 82ZSAA(6) refusing to extent the time for provision of records.

The amendment would extend that right of review to the subject of the complaint, and, to reflect the introduction of a right to seek reconsideration under new section 82ZVF, would enable application to the Administrative Appeals Tribunal where a decision under subsection 82ZSAA(6) has been affirmed on reconsideration under new section 82ZVF.

Item 103      

This item repeals paragraph 105AB(6AC)(c) and substitutes new paragraph 105AB(6AC)(c).

Paragraph 105AB(6AC)(c) provides that application may be made to the Administrative Appeals Tribunal for review of a decision by the Health Insurance Ombudsman under subsection 82ZTB(4) refusing to extend the period for provision of records.

The amendment would extend that right of review to the subject of the investigation, and, to reflect the introduction of a right to seek reconsideration under new section 82ZVF, would enable application to the Administrative Appeals Tribunal where a decision under subsection 82ZTB(4) has been affirmed on reconsideration under new section 82ZVF.

Item 104

This item adds new subsection 135A(5D) after subsection 135A(5C).  New subsection 135A(5D) provides that nothing in section 135A prohibits the Private Health Insurance Ombudsman from referring information relating to a contravention or possible contravention of subsection 67(1) to the Minister or to an officer in the Department.  Subsection 67(1) provides that a person (other than a registered organization) shall not carry on health insurance business. Subsection 67(2) provides that it is an offence for a person to contravene subsection 67(1).

 

SCHEDULE 2 - AMENDMENTS RELATING TO PRIVATE HEALTH INSURANCE REBATES

Private Health Insurance Incentives Act 1998

Item 1

This item omits the number “90” from subsection 19-15(1) and substitutes the number “120”.

Item 2

This item provides that the amendment referred to in item 1 applies in relation to the 2005-2006 financial year and later financial years.

 

 

 

 

 

 

 




[1] Administration of the 30 Per Cent Private Health Insurance Rebate, Australian National Audit Office Performance Audit, Audit Report No.47 2001-2002, Recommendation No. 5.