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This is a Bill, not an Act. For current law, see the Acts databases.
2013-2014-2015
The Parliament of the
Commonwealth of Australia
HOUSE OF REPRESENTATIVES
Presented and read a first time
Health Insurance Amendment (Safety
Net) Bill 2015
No. , 2015
(Health)
A Bill for an Act to amend the law in relation to
medicare benefit, and for related purposes
No. , 2015
Health Insurance Amendment (Safety Net) Bill 2015
i
Contents
1
Short title ............................................................................................ 1
2
Commencement .................................................................................. 1
3
Schedules ............................................................................................ 2
Schedule 1--Amendme nts relating to medicare safety-net
3
Part 1--Amendments
3
Health Insurance Act 1973
3
Part 2--Application of amendments
38
No. , 2015
Health Insurance Amendment (Safety Net) Bill 2015
1
A Bill for an Act to amend the law in relation to
1
medicare benefit, and for related purposes
2
The Parliament of Australia enacts:
3
1 Short title
4
This Act may be cited as the Health Insurance Amendment (Safety
5
Net) Act 2015.
6
2 Commencement
7
(1) Each provision of this Act specified in column 1 of the table
8
commences, or is taken to have commenced, in accordance with
9
column 2 of the table. Any other statement in column 2 has effect
10
according to its terms.
11
12
2
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
Commencement information
Column 1
Column 2
Column 3
Provisions
Commencement
Date/Details
1. Sections 1 to 3
and anything in
this Act not
elsewhere covered
by this table
The day this Act receives the Royal Assent.
2. Schedule 1
1 January 2016.
1 January 2016
Note:
This table relates only to the provisions of this Act as originally
1
enacted. It will not be amended to deal with any later amendments of
2
this Act.
3
(2) Any information in column 3 of the table is not part of this Act.
4
Information may be inserted in this column, or information in it
5
may be edited, in any published version of this Act.
6
3 Schedules
7
Legislation that is specified in a Schedule to this Act is amended or
8
repealed as set out in the applicable items in the Schedule
9
concerned, and any other item in a Schedule to this Act has effect
10
according to its terms.
11
Amendments relating to medicare safety-net Schedule 1
Amendments Part 1
No. , 2015
Health Insurance Amendment (Safety Net) Bill 2015
3
Schedule 1--Amendments relating to
1
medicare safety-net
2
Part 1--Amendments
3
Health Insurance Act 1973
4
1 Subsection 3(1)
5
Insert:
6
concessional person has the meaning given by section 10N.
7
confirmed:
8
(a) a person is confirmed as a member of a family at a particular
9
time if the person is confirmed as a member of the family at
10
that time under subsection 10FA(4); and
11
(b) a person is a confirmed single at a particular time if the
12
person is a confirmed single at that time under
13
subsection 10KA(4).
14
dependent child has the meaning given by subsections 10EA(5) to
15
(9).
16
FTB(A) family has the meaning given by section 10MA.
17
FTB(A) person has the meaning given by section 10M.
18
member of a family: in Part II, a person is a member of a family in
19
the circumstances set out in section 10EA, as affected by
20
subsections 10GA(2), 10GB(2) and 10KB(2).
21
out-of-pocket expenses has the meaning given by section 10DB.
22
registered: a person is registered as a member of a family at a
23
particular time if the person is registered as a member of that
24
family under section 10E, 10EB or 10EC at that time.
25
relevant service has the meaning given by section 10DA, as
26
affected by Subdivision H of Division 3 of Part II.
27
safety-net amount has the meaning given by section 10R.
28
Schedule 1 Amendments relating to medicare safety-net
Part 1 Amendments
4
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
safety-net expenses has the meaning given by section 10P.
1
safety-net service has the meaning given by section 10BA.
2
safety-net threshold has the meaning given by section 10DC.
3
Schedule fee, in relation to a professional service, means the fee
4
prescribed in the table for the service.
5
unconfirmed single has the meaning given by section 10L.
6
2 Sections 8 and 8A
7
Repeal the sections, substitute:
8
Division 1--Preliminary
9
8AA Simplified outline of this Part
10
This Part deals with:
11
(a)
the medicare benefit payable in respect of a professional
12
service, including the circumstances in which a
13
safety-net amount is payable or the medicare benefit is
14
increased or reduced because of other circumstances;
15
and
16
(b)
who is entitled to medicare benefit in respect of a
17
professional service; and
18
(c)
the process for claiming and paying medicare benefit;
19
and
20
(d)
other matters affecting medicare benefit.
21
8 Territories that are taken to form part of New South Wales
22
(1) For the purposes of this Part, an internal Territory is taken to form
23
part of New South Wales.
24
Amendments relating to medicare safety-net Schedule 1
Amendments Part 1
No. , 2015
Health Insurance Amendment (Safety Net) Bill 2015
5
Division 2--Entitlement to medicare benefit
1
8A Simplified outline for this Division
2
Medicare benefit is payable for medical expenses incurred in
3
respect of a professional service rendered in Australia to an
4
Australian resident or an eligible overseas representative.
5
Medicare benefit is worked out as a percentage of the Schedule fee.
6
In some instances, that fee may be reduced or increased under a
7
provision of this Act (such as section 15 or 16) or the regulations
8
before the medicare benefit is worked out.
9
3 Section 9
10
Omit "(other than sections 10ACA and 10ADA)".
11
4 Subsection 10(2)
12
Omit "A benefit in respect of a service is", substitute "A medicare
13
benefit in respect of a professional service is".
14
5 Subsection 10(2A)
15
After "prescribe", insert "professional".
16
6 Subsections 10(3) and (5)
17
Repeal the subsections.
18
7 Sections 10AA to 10C
19
Repeal the sections, substitute:
20
Division 3--Medicare safety-net
21
Subdivision A--Simplified outline of this Division
22
10A Simplified outline of this Division
23
Circumstances in which safety-net amount payable
24
Schedule 1 Amendments relating to medicare safety-net
Part 1 Amendments
6
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
The medicare benefit payable in respect of a professional service
1
may include a safety-net amount in some cases. A safety-net
2
amount is payable for most professional services, except services
3
provided in hospital. To receive a safety-net amount, the sum of
4
the out-of-pocket expenses for a service rendered to a person and
5
other services rendered to the person, or a member of the person's
6
family, during the calendar year must equal or exceed the person's
7
safety-net threshold. There are different thresholds for different
8
people. For example, a person on a concession card has a lower
9
threshold than a person who is not. The amount of out-of-pocket
10
expenses for each service that counts towards the threshold is
11
capped.
12
To receive a safety-net amount for a service:
13
(a)
medicare benefit must be claimed within 7 years after
14
the end of the year in which the service is rendered; and
15
(b)
the difference between the medical expenses for the
16
service and the medicare benefit for the service must be
17
paid to the person by whom or on whose behalf the
18
service is rendered.
19
The safety-net amount paid is generally 80% of the out-of-pocket
20
expenses for the service, but is subject to a cap.
21
Families
22
Families are allowed to pool their out-of-pocket expenses, to count
23
them towards the safety-net threshold. To do this, the family must
24
be registered, and the composition of the family confirmed.
25
A child may be registered in more than one family. In that case,
26
medical expenses incurred by each family for the child will go
27
towards that family's threshold.
28
If, because of separation, a single family becomes 2 families during
29
a calendar year, the medical expenses for services rendered to the
30
children of the former family during that year before the separation
31
will count towards the threshold for each family.
32
If a former spouse is confirmed as a member of a family before
33
separation and the safety-threshold has already been reached by a
34
Amendments relating to medicare safety-net Schedule 1
Amendments Part 1
No. , 2015
Health Insurance Amendment (Safety Net) Bill 2015
7
former spouse, then during the year of separation, the former
1
spouse will continue to be treated as having reached the safety-net
2
threshold. The former spouse may also be registered as a member
3
of a family, but the family will not include anyone other than the
4
former spouse and the dependent children of the former spouse.
5
A child might leave a family because of separation or for other
6
reasons. If the child is confirmed as a member of the family before
7
the registration of the family is varied and the child has already
8
reached the safety-net threshold, the child will continue to be
9
treated as having reached the safety-net threshold. The child may
10
be registered as a dependent child in another family.
11
If the child is a student, the child might choose not to be registered
12
as a dependent child in another family, but instead register his or
13
her own family. In that case, the student could not be treated as a
14
member of more than one family.
15
A person who has previously confirmed that he or she wished to be
16
treated as single in a calendar year may become a member of a
17
family. However, if the person has already reached his or her
18
safety-net threshold, for the remainder of the year the only other
19
people who can be registered as members of the person's family
20
are the person and dependent children of the person.
21
Subdivision B--General rule
22
10B Safety-net payable
23
The medicare benefit payable to a person in respect of a safety-net
24
service is increased by the safety-net amount for the service if
25
Subdivisions C, D, and Q are satisfied.
26
10BA What is a safety-net service?
27
(1) A professional service is a safety-net service, unless it is not a
28
safety-net service because of this section.
29
(2) A professional service is not a safety-net service if the service is
30
rendered:
31
(a) as part of an episode of hospital treatment; or
32
Schedule 1 Amendments relating to medicare safety-net
Part 1 Amendments
8
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
(b) as part of an episode of hospital-substitute treatment in
1
respect of which the person to whom the treatment is
2
rendered chooses to receive a benefit from a private health
3
insurer.
4
(3) The regulations may prescribe circumstances in which more than
5
one professional service is taken to be one safety-net service.
6
(4) If the regulations are made under this section prescribing
7
circumstances in which more than one professional service is taken
8
to be one safety-net service, the regulations may also prescribe, for
9
the purposes of working out the out-of-pocket expenses, the
10
safety-net expenses or the safety-net amount for the safety-net
11
service:
12
(a) an amount that is taken to be the Schedule fee for the
13
safety-net service, or the way in which that amount is to be
14
worked out; and
15
(b) the expenses that are taken to be medical expenses incurred
16
for the safety-net service, or the way in which those expenses
17
are to be worked out.
18
(5) If regulations are made under this section prescribing
19
circumstances in which 2 or more professional services (the
20
original services) are together taken to be one safety-net service,
21
none of the original services individually is a safety-net service in
22
those circumstances.
23
Subdivision C--Claim for medicare benefit made and accepted
24
10C Claim for medicare benefit must be made and accepted
25
For a safety-net amount to be payable for a safety-net service:
26
(a) a claim for medicare benefit in respect of the service must be
27
made within 7 years after the end of the calendar year in
28
which the service is rendered; and
29
(b) the claim must be accepted for payment by the Chief
30
Executive Medicare.
31
Amendments relating to medicare safety-net Schedule 1
Amendments Part 1
No. , 2015
Health Insurance Amendment (Safety Net) Bill 2015
9
Subdivision D--The safety-net threshold
1
10D Safety-net threshold must be reached
2
For a safety-net amount to be payable for a safety-net service (the
3
current service), the sum of:
4
(a) the safety-net expenses for the current service; and
5
(b) the safety-net expenses for all professional services that are:
6
(i) relevant services for the person to whom the current
7
service is rendered, for the calendar year in which the
8
current service is rendered; and
9
(ii) claimed and accepted for payment by the Chief
10
Executive Medicare before a claim in respect of the
11
current service is made;
12
must equal or exceed the safety-net threshold for that person for
13
that calendar year.
14
10DA What is a relevant service?
15
(1) A professional service is a relevant service for a person for a
16
calendar year if:
17
(a) the service is a safety-net service; and
18
(b) the service was rendered during the calendar year; and
19
(c) a claim for medicare benefit in respect of the service has been
20
made; and
21
(d) the Chief Executive Medicare has accepted the claim in
22
respect of the service for payment; and
23
(e) an amount at least equal to the out-of-pocket expenses for the
24
service has been paid directly to the person by whom or on
25
whose behalf the service was rendered; and
26
(f) one of the following is satisfied:
27
(i) if the person is a concessional person who is not
28
confirmed as a member of a family, an FTB(A) person
29
who is not confirmed as a member of a family, a
30
confirmed single or an unconfirmed single at the test
31
time for the person for the calendar year--the service is
32
rendered to the person;
33
(ii) if the person is confirmed as a member of a family at the
34
test time for the person for the calendar year--the
35
Schedule 1 Amendments relating to medicare safety-net
Part 1 Amendments
10
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
service is rendered to either that person or another
1
person who is confirmed as a member of the family at
2
that time.
3
(2) For the purposes of the definition of relevant service, as the term is
4
used in section 10D, the test time for the person to whom the
5
current service is rendered, for the calendar year in which it is
6
rendered, is:
7
(a) if the claim for medicare benefit in respect of the current
8
service is made during the calendar year--the day on which
9
the claim is made; and
10
(b) if the claim for medicare benefit in respect of the current
11
service is made after the end of the calendar year--the last
12
day of the calendar year.
13
(3) For the purposes of the definition of relevant service, as the term is
14
used in any other provision, test time has the meaning given by that
15
provision.
16
10DB Working out the out-of-pocket expenses for a safety-net service
17
Work out the out-of-pocket expenses for a safety-net service by
18
using the following formula:
19
Total amount
Medicare benefit
of medical expenses
in respect of
incurred
the service
for the service
ï€-
20
10DC The safety-net threshold
21
(1) The safety-net threshold for a person to whom a safety-net service
22
is rendered, for a calendar year in which the service is rendered is,
23
if the person is of a kind described in an item in column 1 of the
24
following table when the threshold is applied, the amount set out in
25
column 2 of that item, indexed under section 10S for that year:
26
27
Relevant safety-net thresholds
Item
Column 1
Person to whom service
rendered
Column 2
Safety-net threshold
1
a concessional person
$400
Amendments relating to medicare safety-net Schedule 1
Amendments Part 1
No. , 2015
Health Insurance Amendment (Safety Net) Bill 2015
11
Relevant safety-net thresholds
Item
Column 1
Person to whom service
rendered
Column 2
Safety-net threshold
2
an FTB(A) person
$700
3
a person confirmed as a member
of an FTB(A) family
$700
4
a confirmed single
$700
5
an unconfirmed single
$1,000
6
a person confirmed as a member
of a family
$1,000
Note 1:
Families are registered under Subdivision E. The membership of a
1
family is then confirmed under Subdivision F.
2
Note 2:
A person is a confirmed single if the person has confirmed under
3
Subdivision K that he or she wishes to be treated as a confirmed
4
single. A person who is not confirmed as a single or a member of a
5
family, and who is not an FTB(A) person or a concessional person, is
6
an unconfirmed single under Subdivision L.
7
Note 3:
Subdivision M deals with the rules relating to FTB(A) persons and
8
members of an FTB(A) family .
9
Note 4:
Subdivision N deals with the rules relating to concessional persons.
10
(2) If the safety-net threshold is used for the purposes of section 10D,
11
the safety-net threshold is applied:
12
(a) for a claim for medicare benefit in respect of the current
13
service (as defined for the purposes of that section) made
14
during the calendar year in which the current service is
15
rendered--on the day on which the claim is made; and
16
(b) for a claim for medicare benefit in respect of the current
17
service (as defined for the purposes of that section) made
18
after the end of the calendar year in which the current service
19
is rendered--the last day of the calendar year.
20
(3) If the safety-net threshold is used for the purposes of another
21
provision, the safety-net threshold is applied on the day specified
22
in that provision.
23
Schedule 1 Amendments relating to medicare safety-net
Part 1 Amendments
12
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
Subdivision E--Registering a family
1
10E Registering a family on application
2
(1) A member of a family may apply to the Chief Executive Medicare
3
at any time for registration of the family.
4
(2) The application:
5
(a) must be in the form approved by the Chief Executive
6
Medicare; and
7
(b) must list the names of all persons to be registered as members
8
of the family.
9
(3) The Chief Executive Medicare must register the family if:
10
(a) a person makes an application in accordance with this
11
section; and
12
(b) the Chief Executive Medicare is satisfied that the persons
13
listed in the application are members of the family; and
14
(c) the Chief Executive Medicare is not prevented from
15
registering the family under section 10ED or 10EE.
16
10EA Who is a member of a family?
17
(1) The following are members of a person's family:
18
(a) the person;
19
(b) the person's spouse;
20
(c) each dependent child of the person or the person's spouse.
21
Note:
Under subsections 10GA(2), 10GB(2) and 10KB(2), there are also
22
limits on who may be treated as a member of a family during certain
23
periods. This will affect applications to register, or vary the
24
registration of, a family during those periods.
25
Who is a spouse?
26
(2) A person is a spouse of another person if:
27
(a) the person is legally married to, and is not living on a
28
permanent basis separately and apart from, the other person;
29
or
30
(b) the person is a de facto partner of the other person.
31
Amendments relating to medicare safety-net Schedule 1
Amendments Part 1
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Health Insurance Amendment (Safety Net) Bill 2015
13
(3) For the purposes of paragraph (2)(a), a person is not taken to be
1
living on a permanent basis separately and apart from another
2
person if the only reason why the persons are not living together is:
3
(a) a temporary absence from each other; or
4
(b) illness or infirmity of either or both of them.
5
(4) For the purposes of paragraph (2)(b), de facto partner has the
6
meaning given by the Acts Interpretation Act 1901.
7
Who is a dependent child?
8
(5) A person is a dependent child of another person if:
9
(a) the person is under 16; and
10
(b) either:
11
(i) the person is in the custody, care and control of the
12
other person; or
13
(ii) the person is not in the custody, care and control of any
14
person, but is wholly or substantially in the care and
15
control of the other person.
16
(6) A person is a dependent child of another person if:
17
(a) the person is 16 or more, but under 25; and
18
(b) the person is receiving full-time education at a school,
19
college or university; and
20
(c) the person is wholly or substantially dependent on the other
21
person.
22
(7) For the purposes of paragraph (6)(b), a person is taken to be
23
receiving full-time education at a school, college or university if
24
the only reason why the person is not receiving a full-time
25
education is a temporary absence from full-time study due to
26
illness or infirmity.
27
(8) A person is a dependent child of another person in any other
28
circumstances prescribed by the regulations.
29
(9) A child is taken to be under a particular age for the whole of the
30
calendar year in which the child turns that age.
31
Schedule 1 Amendments relating to medicare safety-net
Part 1 Amendments
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Health Insurance Amendment (Safety Net) Bill 2015
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10EB Varying the registration of a family on application
1
Adding a new family member
2
(1) If, at any time:
3
(a) a person (the new member) becomes a member of a family;
4
and
5
(b) the family is registered;
6
the new member, or any person acting on behalf of the new
7
member who is registered as a member of the family, may apply to
8
the Chief Executive Medicare for a variation in the registration to
9
add the new member.
10
Removing a former family member
11
(2) If, at any time:
12
(a) a person (the former member) ceases to be a member of a
13
family; and
14
(b) the family is registered;
15
the former member, or any person acting on behalf of the former
16
member who is registered as a member of the family, may apply to
17
the Chief Executive Medicare for a variation in the registration to
18
remove the former member.
19
Application must be in approved form
20
(3) An application under this section must be in the manner and form
21
approved by the Chief Executive Medicare.
22
Chief Executive Medicare to vary the registration
23
(4) The Chief Executive Medicare must vary the registration of the
24
family in accordance with the application if:
25
(a) the application is made in accordance with this section; and
26
(b) the Chief Executive Medicare is satisfied that:
27
(i) if the application is made under subsection (1)--the new
28
member has become a member of the family; and
29
(ii) if the application is made under subsection (2)--the
30
former member is no longer a member of the family;
31
and
32
Amendments relating to medicare safety-net Schedule 1
Amendments Part 1
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Health Insurance Amendment (Safety Net) Bill 2015
15
(c) the Chief Executive Medicare is not prevented from varying
1
the registration of the family under section 10ED or 10EE.
2
10EC Registering a family, or varying a registration, other than on
3
application--ne wborns
4
Registering a new family
5
(1) If:
6
(a) the Chief Executive Medicare reasonably believes that a
7
newborn child is a member of a family; and
8
(b) the family is not registered; and
9
(c) the Chief Executive Medicare is not prevented from
10
registering the family under section 10ED or 10EE;
11
the Chief Executive Medicare may register the family.
12
Varying the registration of a family
13
(2) If:
14
(a) the Chief Executive Medicare reasonably believes that a
15
newborn child is a member of a family; and
16
(b) the family is registered; and
17
(c) the Chief Executive Medicare is not prevented from varying
18
the registration of the family under section 10ED or 10EE;
19
the Chief Executive Medicare may vary the registration of the
20
family to register the newborn child as a member of the family.
21
Steps to be taken before registering or varying
22
(3) Before registering a family under subsection (1), or varying the
23
registration of a family under subsection (2), the Chief Executive
24
Medicare must take such steps as are reasonable in all the
25
circumstances to ascertain the membership of the family.
26
10ED No more than 2 spouses in a family
27
(1) The Chief Executive Medicare must not register a family if the
28
Chief Executive Medicare reasonably believes that a person listed
29
in the application for registration as a member of the family is a
30
spouse (as defined in section 10EA) of more than one other person
31
listed as a member of the family.
32
Schedule 1 Amendments relating to medicare safety-net
Part 1 Amendments
16
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
(2) The Chief Executive Medicare must not vary the registration of a
1
family to include a person if the Chief Executive Medicare
2
reasonably believes that the person is a spouse (as defined in
3
section 10EA) of more than one other person registered, or to be
4
registered, as a member of the family.
5
10EE Only dependent children may be registered in more than one
6
family
7
The Chief Executive Medicare may only register a person as a
8
member of more than one family if the person is a dependent child
9
of a person in each of those families.
10
Subdivision F--Confirming the membership of a family
11
10F A person registered as a member of a family may confirm its
12
composition
13
(1) A person who is registered as a member of a family may confirm
14
the composition of the family.
15
(2) A person confirms the composition of a family by notifying the
16
Chief Executive Medicare, in a manner and form approved by the
17
Chief Executive Medicare, of the names of the members of the
18
family.
19
10FA Chief Executive Medicare must request that family
20
composition be confirmed
21
(1) This section applies if the Chief Executive Medicare reasonably
22
believes that the medicare benefit payable in respect of a safety-net
23
service rendered, or that may in the near future be rendered, to a
24
person registered as a member of a family would be increased by a
25
safety-net amount if the person were confirmed as a member of the
26
family.
27
(2) The Chief Executive Medicare must request a person who is
28
registered as a member of the family to confirm the composition of
29
the family.
30
(3) The request must be made in the manner and form approved by the
31
Chief Executive Medicare.
32
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17
(4) Each person who is confirmed as a member of the family by notice
1
given under section 10F is confirmed as a member of the family
2
for the period beginning on the day specified under subsection (5)
3
and ending on the day specified under subsection (6).
4
(5) The period begins:
5
(a) if the inclusion of a person in the composition of the family is
6
confirmed on or after the first day of the calendar year to
7
which the request relates but before the end of 60 days after
8
the day on which the request is made--on the first day during
9
the calendar year to which the request relates on which the
10
person was registered as a member of the family; or
11
(b) if paragraph (a) is not satisfied--on the first day during the
12
calendar year to which the request relates on which the
13
inclusion of a person in the composition of the family is
14
confirmed.
15
(6) The period ends on the earliest of:
16
(a) the day on which the registration of the family is varied under
17
section 10EB or 10EC; or
18
(b) the day immediately after the calendar year ends.
19
Subdivision G--Consequences of changing the registration of a
20
family after the safety-net threshold is reached
21
10G Safety-net threshold taken to have been reached for the
22
remainder of the calendar year
23
(1) If:
24
(a) the registration of a family is varied under section 10EB
25
during a calendar year; and
26
(b) immediately before the registration was varied, the sum of
27
safety-net expenses for the relevant services for that calendar
28
year, for a person who was confirmed as a member of the
29
family immediately before the variation, equalled or
30
exceeded the safety-net threshold;
31
despite the variation, for the remainder of the safety-net year, the
32
sum of the safety-net expenses for the person's relevant services
33
for the calendar year is taken to equal or exceed the safety-net
34
threshold.
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Meaning of test time for the definition of relevant service
1
(2) For the purposes of the definition of relevant service, as the term is
2
used in this section, the test time for the person for the calendar
3
year is immediately before the registration of the family is varied.
4
Meaning of remainder of the safety-net year
5
(3) In this section:
6
remainder of the safety-net year means the period:
7
(a) beginning on the day on which the registration of the family
8
mentioned in subsection (1) is varied; and
9
(b) ending at the end of the calendar year in which the
10
registration of that family is varied.
11
10GA Limits on registering another family--former spouse
12
removed
13
Application of this section
14
(1) This section applies if:
15
(a) the registration of a family is varied to remove a person (a
16
former spouse) as a member of the family; and
17
(b) the person is removed because the person is no longer the
18
spouse of another person (a former spouse); and
19
(c) both former spouses were confirmed as members of the
20
family immediately before the variation; and
21
(d) immediately before the variation, the sum of safety-net
22
expenses for the relevant services for that calendar year, for a
23
former spouse, equalled or exceeded the safety-net threshold.
24
Composition of former member's family during the remainder of
25
the safety-net year
26
(2) Despite section 10EA, for the purposes of Subdivisions E and F the
27
following are taken to be the only persons who are members of that
28
former spouse's family during the remainder of the safety-net year:
29
(a) that former spouse;
30
(b) any dependent child of that former spouse.
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Meaning of remainder of the safety-net year and spouse
1
(3) In this section:
2
remainder of the safety-net year means the period:
3
(a) beginning on the day on which the registration of the family
4
mentioned in subsection (1) is varied; and
5
(b) ending at the end of the calendar year in which the
6
registration of that family is varied.
7
spouse has the meaning given by section 10EA.
8
10GB Limits on registering another family--dependent child
9
removed
10
Application of this section
11
(1) This section applies if:
12
(a) the registration of a family is varied to remove a person (the
13
former member) as a member of the family; and
14
(b) the former member was registered as a member of the family
15
because the former member was a dependent child of another
16
member of the family; and
17
(c) the former member was confirmed as a member of the family
18
immediately before the variation; and
19
(d) immediately before the variation, the sum of safety-net
20
expenses for the relevant services for that calendar year for
21
the former member equalled or exceeded the safety-net
22
threshold.
23
Former member's family for remainder of safety-net year
24
(2) Despite section 10EA, for the purposes of Subdivisions E and F the
25
former member is only to be treated as a member of a family with
26
other persons during the remainder of the safety-net year in either
27
of the following circumstances:
28
(a) if the former member is a dependent child of another person
29
(as defined in section 10EA), the former member may be
30
treated as a member of the other person's family;
31
(b) each dependent child of the former member may be treated as
32
a member of the former member's family.
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Note:
Under section 10EE, the former member could not be registered both
1
as a dependent child of one family, and in a separate family with the
2
former member's own dependent children.
3
Meaning of remainder of the safety-net year
4
(3) In this section:
5
remainder of the safety-net year means the period:
6
(a) beginning on the day on which the registration of the family
7
mentioned in subsection (1) is varied; and
8
(b) ending at the end of the calendar year in which the
9
registration of that family is varied.
10
Subdivision H--Where children are registered in more than
11
one family
12
10H Application of this Subdivision
13
This Subdivision applies if:
14
(a) a person (the child) is registered as a member of more than
15
one family at a particular time during a calendar year,
16
because the person is a dependent child of a person in each of
17
those families; or
18
(b) a person (the child) who was a dependent child of a person in
19
one family during a calendar year then, during that year,
20
ceases to be registered as a member of that family and is
21
registered as a member of another family because the person
22
is a dependent child of a member of that other family.
23
10HA Working out whether the safety-net threshold has been
24
reached for the child
25
If a safety-net service is rendered to the child during the calendar
26
year (the current service), the safety-net threshold for the child for
27
the calendar year is reached or exceeded by the current service
28
only if:
29
(a) ignoring all relevant services for the child for the year other
30
than those rendered to the child, the safety-net threshold for
31
the child for the year would have been reached or exceeded;
32
or
33
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(b) taking into account only those relevant services for the child
1
for the year for which medical expenses were incurred by the
2
family responsible for the current service, the safety-net
3
threshold for the child for the year would have been reached
4
or exceeded.
5
Example: M ary, her father Trent and Trent's partner are registered as members
6
of Family A. M ary and her mother Jane are registered as members of
7
Family B. No member of either family is a concessional person and
8
the families are not FTB(A) families.
9
M ary goes to the doctor in October 2016. A safety-net service is
10
rendered to M ary (the current service). She has already been to the
11
doctor on a number of occasions in April and M ay of 2016. The
12
services rendered to M ary on those occasions were also safety -net
13
services.
14
Jane incurs medical expenses for the current service, of which $100
15
are out-of-pocket expenses. She also incurred the medical expenses
16
for some of the services rendered to M ary in April and M ay. The
17
out-of-pocket expenses incurred for those services totalled $500. Trent
18
incurred medical expenses for the remainder of the services rendered
19
to M ary in that period. The out-of-pocket expenses for those services
20
totalled $450.
21
Jane has incurred $200 in out-of-pocket expenses for safety -net
22
services rendered to her during the year, and claimed before the claim
23
for the current service was made.
24
Jane claims medicare benefit for the current service in November
25
2016 and confirms the composition of Family B at the time the claim
26
is made.
27
The total out-of-pocket expenses incurred for safety -net services
28
rendered to M ary during the year is $1,050. She has been confirmed as
29
a member of Family B. So, relying on paragraph 10HA(a), the
30
safety-net threshold of $1,000 for M ary has been exceeded.
31
M ary would not have reached the safety -net threshold under
32
paragraph 10HA(b). The sum of the out-of-pocket expenses for Jane
33
($200), and the out-of-pocket expenses for M ary for
34
safety-net-services for which Jane incurred medical expenses ($600),
35
is less than the safety -net threshold of $1,000 for M ary as a confirmed
36
member of Family B. However, this does not matter, as the safety -net
37
threshold has already been reached under paragraph 10HA(a).
38
10HB Working out whether the safety-net threshold has been
39
reached for another member of one of the child's families
40
If a safety-net service is rendered to a member of one of the
41
families (other than the child) during the calendar year (the current
42
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service), for the purposes of working out whether the safety-net
1
threshold for that member for the calendar year is reached or
2
exceeded by the current service, ignore those relevant services
3
rendered to the child during the year for which medical expenses
4
were not incurred by the family responsible for the current service.
5
Example: M ary, her father Trent and Trent's partner are registered as members
6
of Family A. M ary and her mother Jane are registered as members of
7
Family B. No member of either family is a concessional person and
8
the families are not FTB(A) families.
9
Trent goes to the doctor in December 2016. It is his only visit to the
10
doctor for the year. A safety-net service (the current service) is
11
rendered and Trent makes a claim for the service on the same day . He
12
confirms the membership of Family A at the time the claim is made.
13
The out-of-pocket expenses incurred by Trent for the current service
14
are $150.
15
M ary has been to the doctor on a number of occasions in April, M ay
16
and October 2016. The services rendered to M ary are safety -net
17
services. On some occasions, Jane incurred the medical expenses for
18
the service. The out-of-pocket expenses on those services total $600.
19
On others, Trent incurred the medical expenses for the service. The
20
out-of-pocket expenses on those services total $550. M edicare benefit
21
has been claimed for all of the services rendered to M ary .
22
Trent's partner has also incurred medical expenses for safety-net
23
services rendered to her during the year, and claimed medicare benefit
24
for those services. The out-of-pocket expenses for those services total
25
$400.
26
Trent has exceeded the safety -net threshold of $1,000, as a confirmed
27
member of family A.
28
In working out whether Trent has reached or exceeded the safety -net
29
threshold with the out-of-pocket expenses for the current service,
30
those services rendered to M ary for which Trent has incurred medical
31
expenses are taken into account ($550). Those services rendered to
32
M ary for which Jane has incurred medical expenses are ignored.
33
The out-of-pocket expenses for the services rendered to Trent ($150)
34
and Trent's partner ($400), are then added to those for M ary that are
35
taken into account ($550). The total is $1,100.
36
10HC Safety-net services rendered to the child during the year of
37
separation
38
If:
39
(a) a safety-net service (the earlier service) is rendered to the
40
child during the calendar year in which the current service is
41
rendered; and
42
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(b) medicare benefit in respect of the earlier service was claimed
1
and accepted for payment by the Chief Executive Medicare
2
before a claim in respect of the current service was made; and
3
(c) the child was registered as a member of a family (the former
4
family at the time the claim for medicare benefit in respect of
5
the earlier service was made; and
6
(d) another person, who was registered as a member of the
7
former family at the time the claim for medicare benefit in
8
respect of the earlier service was made, incurred medical
9
expenses for the earlier service; and
10
(e) during the calendar year in which the current service is
11
rendered, the former family has ceased to be registered, or
12
the registration of the former family has been varied, because
13
persons who were registered as members of the former
14
family at the time the earlier service was rendered are no
15
longer spouses; and
16
(f) either:
17
(i) the former family is responsible for the current service;
18
or
19
(ii) a person who was registered as a member of the former
20
family at the time the claim for medicare benefit in
21
respect of the earlier service was made, because the
22
person was a spouse of another member of the former
23
family, is a member of the family responsible for the
24
current service;
25
then, for the purposes of this Subdivision, the earlier service is
26
taken to be a relevant service for each member of the family
27
responsible for the current service for the calendar year in which
28
the current service is rendered.
29
Example: Jennifer, Alex and their son M ax are registered as a family in January
30
2016 (the former family).
31
M ax goes to the doctor in February 2016 and a safety -net service is
32
rendered. Jennifer incurs medical expenses for the service, makes a
33
claim for medicare benefit on the same day the service is rendered.
34
Alex and Jennifer separate in June 2016. The registration of the
35
former family is varied to remove Alex. Jennifer and M ax remain
36
registered as members of the former family . Alex registers himself and
37
M ax as members of a new family .
38
M ax goes to the doctor in August 2016 and a safety -net service is
39
rendered. Alex incurs medical expenses for the service, makes a claim
40
for medicare benefit and confirms the composition of the new family
41
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on the same day the service is rendered. Alex then goes to the doctor
1
in September 2016 and a safety -net service is rendered. Alex incurs
2
medical expenses for the service (the current service) and makes a
3
claim for medicare benefit.
4
In working out whether Alex has reached or exceeded the safety -net
5
threshold with the out-of-pocket expenses for the current service, the
6
out-of-pocket expenses for the service rendered to M ax in February
7
2016 and in August 2016 are both taken into account, along with the
8
out-of-pocket expenses for the current service.
9
10HD Definitions
10
Meaning of family responsible for the current service
11
(1) For the purposes of this Subdivision, a family incurs medical
12
expenses as the family responsible for the current service if the
13
person who incurs medical expenses for the current service is
14
confirmed as a member of the family at the test time.
15
Meaning of test time
16
(2) For the purposes of this Subdivision, including the definition of
17
relevant service as the term is used in this Subdivision, the test
18
time for a person to whom the current service is rendered or who
19
incurs medical expenses for the current service, for the calendar
20
year in which it is rendered, is:
21
(a) if the claim for medicare benefit in respect of the current
22
service is made during that calendar year--the day on which
23
the claim is made; and
24
(b) if the claim for medicare benefit in respect of the current
25
service is made after the end of that calendar year--the last
26
day of the calendar year.
27
Subdivision J--Other consequences of varying the registration
28
of a family
29
10J Registration varied--addition of a new member
30
If:
31
(a) a person becomes a member of a family after it is registered;
32
and
33
(b) the family's registration is varied to reflect that change; and
34
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(c) medicare benefit has already been paid in respect of a
1
safety-net service rendered to the new family member, or any
2
other member of the family;
3
no increase in that benefit is payable because of the new
4
composition of the family.
5
Subdivision K--Confirmed singl es
6
10K Notice confirming that a person wishes to be treated as a
7
confirmed single
8
(1) A person may give the Chief Executive Medicare notice that the
9
person wishes to be treated as a confirmed single.
10
(2) The notice must be given in the manner and form approved by the
11
Chief Executive Medicare.
12
10KA Chief Executive Medicare must request that person confirm
13
that wishes to be treated as a confirmed single
14
(1) This section applies if the Chief Executive Medicare reasonably
15
believes that the medicare benefit payable in respect of a safety-net
16
service rendered, or that may in the near future be rendered, to a
17
person would be increased by a safety-net amount if the person
18
were a confirmed single.
19
(2) The Chief Executive Medicare must request the person to give the
20
Chief Executive Medicare notice under section 10K if the person
21
wishes to be treated as a confirmed single.
22
(3) The request must be made in the manner and form approved by the
23
Chief Executive Medicare.
24
(4) If the person gives the Chief Executive Medicare notice under
25
section 10K that the person wishes to be treated as a confirmed
26
single, the person is a confirmed single for the period beginning at
27
the time specified under subsection (5) and ending at the time
28
specified under subsection (6).
29
(5) The period begins:
30
(a) if the person has given notice under section 10K on or after
31
the first day of the calendar year to which the request relates
32
but before the end of 60 days after the day on which the
33
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request is made--on the first day during the calendar year to
1
which the request relates on which the person was not a
2
concessional person, an FTB(A) person or registered as a
3
member of a family; or
4
(b) if paragraph (a) is not satisfied--on the first day during the
5
calendar year to which the request relates on which the
6
person gives notice under section 10K that the person wishes
7
to be treated as a confirmed single.
8
(6) The period ends on the earliest of:
9
(a) the day on which the person is registered as a member of a
10
family under section 10E or 10EB; or
11
(b) the day immediately after the calendar year ends.
12
10KB Confirmed single becomes a member of a family
13
Application of this section
14
(1) This section applies if:
15
(a) an application is made under section 10E or 10EB to register
16
a person who is a confirmed single as a member of a family;
17
and
18
(b) during the calendar year in which the decision on the
19
application is made, but before the decision is made, the sum
20
of safety-net expenses for the relevant services for that
21
calendar year for the person equalled or exceeded the
22
safety-net threshold.
23
Composition of family for remainder of the safety-net year
24
(2) Despite section 10EA, during the remainder of the safety-net year,
25
the following are taken to be the only persons who are members of
26
the person's family:
27
(a) the person;
28
(b) any dependent child of the person.
29
(3) In this section:
30
remainder of the safety-net year is the period:
31
(a) beginning on the day on which the decision on the
32
application is made; and
33
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(b) ending at the end of the calendar year the decision on the
1
application is made.
2
Subdivision L--Unconfirmed singles
3
10L Meaning of unconfirmed single
4
A person is an unconfirmed single at a particular time if the person
5
is not one of the following at that time:
6
(a) a concessional person;
7
(b) an FTB(A) person;
8
(c) a person confirmed as a member of a family;
9
(d) a confirmed single.
10
Subdivision M--FTB(A) persons and members of FTB(A)
11
families
12
10M Meaning of FTB(A) person
13
(1) A person is an FTB(A) person at all times during a calendar year
14
(the safety-net year):
15
(a) after the first time in the safety-net year that the person
16
receives a payment of an instalment of family tax benefit
17
under section 23 of the A New Tax System (Family
18
Assistance) (Administration) Act 1999 that has a Part A rate
19
that is greater than nil; or
20
(b) after the person receives a payment of family tax benefit
21
under section 24 of the A New Tax System (Family
22
Assistance) (Administration) Act 1999 that has a Part A rate
23
that is greater than nil and that is in respect of the last income
24
year (within the meaning of that Act) ending before the start
25
of the safety-net year; or
26
(c) if a determination for the purposes of this paragraph is in
27
force under subsection (2)--after the time specified in, or
28
worked out in accordance with, the determination.
29
Note:
The Part A rate is calculated under Schedule 1 to the A New Tax
30
System (Family Assistance) Act 1999.
31
(2) The Minister may, by legislative instrument, determine that a
32
person is an FTB(A) person for the purposes of paragraph (1)(c).
33
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(3) The determination must specify the time, or how to work out the
1
time, after which the person is an FTB(A) person for the purposes
2
of the paragraph.
3
10MA Meaning of FTB(A) family
4
A group of persons registered as a family is an FTB(A) family at a
5
particular time during a calendar year if, at that time, an FTB(A)
6
person is confirmed as a member of the family.
7
Subdivision N--Concessional persons
8
10N Meaning of concessional person
9
A person is a concessional person at all times during a calendar
10
year after the first time in that year that the person is a concessional
11
beneficiary for the purposes of Part VII of the National Health Act
12
1953 (which deals with pharmaceutical benefits).
13
Subdivision P--Safety-net expenses
14
10P Working out safety-net expenses
15
(1) The amount of the safety-net expenses for a safety-net service is:
16
(a) the out-of-pocket expenses for the service; or
17
(b) if the out-of-pocket expenses for the service exceed the
18
maximum amount to be included in safety-net expenses for
19
the service--the maximum amount to be included in
20
safety-net expenses for the service.
21
(2) The maximum amount to be included in safety-net expenses for a
22
safety-net service is worked out using the formula:
23
Threshold
Fee
Basic medicare benefit
percentage
for the service
for the service




ï‚´
ï€-




24
(3) In this section:
25
basic medicare benefit for the service means the medicare benefit
26
that would be payable in respect of the service, ignoring any
27
increase in the medicare benefit by a safety-net amount.
28
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fee for the service means:
1
(a) the Schedule fee for the service; or
2
(b) if:
3
(i) the service is taken to be a safety-net service because of
4
regulations made for the purposes of
5
subsection 10BA(3) (more than one professional service
6
taken to be a single safety-net service); and
7
(ii) under regulations made for the purposes of this
8
subparagraph, an amount that is higher than the
9
Schedule fee for the service, or a way of working out
10
such a higher amount, is prescribed;
11
the higher amount.
12
threshold percentage for a safety-net service is 150%.
13
(4) If an amount worked out under subsection (2) is not a multiple of 1
14
cent, that amount is to be rounded up to the nearest cent.
15
Assumptions when working out safety-net expenses for the
16
purposes of paragraph 10D(a) and subsection 10R(3)
17
(5) In working out the amount of the safety-net expenses for the
18
purposes of paragraph 10D(a) and subsection 10R(3) (safety-net
19
expenses for the current service), assume that no safety-net amount
20
is payable in respect of the current service.
21
Subdivision Q--Amount paid to the practitioner
22
10Q Amount paid to practitioner
23
For a safety-net amount to be payable for a safety-net service, an
24
amount must be paid directly to the person by whom or on whose
25
behalf the service was rendered that is at least the difference
26
between:
27
(a) the medical expenses incurred for the service; and
28
(b) the medicare benefit that would be payable in respect of the
29
service.
30
Note:
If a safety -net amount is payable for the service the medicare benefit
31
payable for the service would include the safety -net amount.
32
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Subdivision R--Safety-net amount
1
10R Working out the safety-net amount
2
(1) The safety-net amount for a safety-net service (the current
3
service) is:
4
(a) the adjusted expenses for the current service (see
5
subsections (2) and (3)); or
6
(b) if the adjusted expenses for the current service exceed the
7
maximum safety-net amount for the service (see
8
subsection (4))--the maximum safety-net amount for the
9
service.
10
Adjusted expenses
11
(2) If the sum of the safety-net expenses for all relevant services for
12
the person to whom the current service was rendered, for the
13
calendar year in which it was rendered, is equal to or greater than
14
the safety-net threshold for that person, work out the adjusted
15
expenses for the current service by using the following formula
16
and, if the result is not a multiple of 5 cents, rounding the result up
17
to the nearest multiple of 5 cents:
18
Total amount
of
Basic medicare benefit
80%
medical expenses
for the current service
incurred
for the current service






ï‚´
ï€-








19
(3) If the sum of the safety-net expenses for all relevant services for
20
the person to whom the current service was rendered, for the
21
calendar year in which it was rendered, is less than the safety-net
22
threshold for that person, but the threshold would be reached if the
23
safety-net expenses for the current service were added, work out
24
the adjusted expenses for the current service using the following
25
formula and, if the result is not a multiple of 5 cents, rounding the
26
result up to the nearest multiple of 5 cents:
27
Amendments relating to medicare safety-net Schedule 1
Amendments Part 1
No. , 2015
Health Insurance Amendment (Safety Net) Bill 2015
31
Total amount
Balance
of
Basic medicare benefit
of
80%
medical expenses
for the current service
safety-net
incurred
threshold
for the current service






ï‚´
ï€-
ï€-








1
where:
2
balance of safety-net threshold means the amount by which the
3
sum of the safety-net expenses for the relevant services for the
4
person for the calendar year is less than the safety-net threshold for
5
the person.
6
Maximum safety-net amount
7
(4) Work out the maximum safety-net amount for the current service
8
using the following formula and, if the result is not a multiple of 5
9
cents, rounding the result up to the nearest multiple of 5 cents:
10
Fee
Safety-net cap
Basic medicare benefit
for the
percentage
for the current service
current service




ï‚´
ï€-






11
(5) For the purposes of the definition of relevant service, as the term is
12
used in this section, the test time for the person to whom the
13
current service is rendered, for the calendar year in which it is
14
rendered, is:
15
(a) if the claim for medicare benefit in respect of the current
16
service is made during that calendar year--the day on which
17
the claim is made; and
18
(b) if the claim for medicare benefit in respect of the current
19
service is made after the end of that calendar year--the last
20
day of the calendar year.
21
(6) In this section:
22
basic medicare benefit for the current service means the medicare
23
benefit that would be payable in respect of the current service,
24
ignoring any increase in the medicare benefit by a safety-net
25
amount.
26
fee for the current service means:
27
(a) the Schedule fee for the current service; or
28
Schedule 1 Amendments relating to medicare safety-net
Part 1 Amendments
32
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
(b) if:
1
(i) the current service is taken to be a safety-net service
2
because of regulations made for the purposes of
3
subsection 10BA(3) (more than one professional service
4
taken to be a single safety-net service); and
5
(ii) under regulations made for the purposes of this
6
subparagraph, an amount that is higher than the
7
Schedule fee for the current service, or a way of
8
working out such a higher amount, is prescribed;
9
the higher amount.
10
safety-net cap percentage for a safety-net service is 150%.
11
Subdivision S--Other matters
12
10S Indexing the safety-net threshold
13
(1) In this section:
14
index number, in relation to a quarter, means the All Groups
15
Consumer Price Index number that is the weighted average of the 8
16
capital cities and is published by the Australian Statistician in
17
respect of that quarter.
18
year, for the purpose of the indexation of the safety-net threshold
19
for safety-net services, means the year beginning on 1 January
20
2016 or a later year beginning on 1 January.
21
(2) The amount of the safety-net threshold for a safety-net service is to
22
be indexed under this section on 1 January of every year (the
23
indexation day) by using the September reference quarter.
24
(3) Where an amount is to be indexed on the indexation day, this Act
25
has effect as if the indexed amount were substituted for that
26
amount on that day.
27
(4) The indexed amount for an amount to be indexed is:
28
(a) the amount worked out by multiplying the amount to be
29
indexed by the indexation factor for that amount; or
30
(b) if the amount worked out under paragraph (a) is not a
31
multiple of 10 cents--that amount rounded down to the
32
nearest multiple of 10 cents.
33
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Amendments Part 1
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Health Insurance Amendment (Safety Net) Bill 2015
33
(5) Subject to subsections (6), (7) and (8), the indexation factor for an
1
amount to be indexed on an indexation day is the amount worked
2
out by using the formula:
3
Most recent index number
Previous index number
4
where:
5
most recent index number means the index number for the last
6
quarter before the indexation day that is a reference quarter for the
7
indexation of the amount.
8
previous index number, in relation to the indexation of an amount
9
referred to in subsection (2), means the index number for the
10
reference quarter in that item immediately before the most recent
11
reference quarter in that item ending before the indexation day.
12
(6) An indexation factor is to be worked out to 3 decimal places.
13
(7) If an indexation factor worked out under subsections (5) and (6)
14
would, if it were worked out to 4 decimal places, end in a number
15
that is greater than 4, the indexation factor is to be increased by
16
0.001.
17
(8) If an indexation factor worked out under subsections (5), (6) and
18
(7) would be less than 1, the indexation factor is to be increased to
19
1.
20
(9) Subject to subsection (10), if at any time (whether before or after
21
the commencement of this section), the Australian Statistician
22
publishes an index number for a quarter in substitution for an index
23
number previously published by the Statistician for that quarter, the
24
publication of the later index number is to be disregarded for the
25
purposes of this section.
26
(10) If at any time (whether before or after the commencement of this
27
section) the Australian Statistician changes the index reference
28
period for the Consumer Price Index, regard is to be had, for the
29
purposes of applying this section after the change takes place, only
30
to index numbers published in terms of the new index reference
31
period.
32
Schedule 1 Amendments relating to medicare safety-net
Part 1 Amendments
34
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
Division 4--Medicare benefits not to exceed medical
1
expenses incurred
2
11 Simplified outline of this Division
3
Medicare benefit is generally not payable for a professional service
4
to the extent that the benefit would exceed the medical expenses
5
incurred for the service.
6
8 After section 14
7
Insert:
8
Division 5--Circumstances in which medicare benefits not
9
payable or require different calculation
10
14A Simplified outline of this Division
11
Medicare benefit is not payable, or is reduced, in respect of
12
expenses incurred for some professional services or in certain
13
circumstances. This may occur if:
14
(a)
2 or more operations are performed on a person on the
15
same occasion; or
16
(b)
the medicare benefit is in respect of the administration
17
of an anaesthetic during an operation and the
18
practitioner administering the anaesthetic is not also
19
performing, or assisting with, the operation; or
20
(c)
more than one practitioner performs a service for an
21
operation (that is, assists at the operation, administers
22
the anaesthetic or assists the anaesthetist in
23
administering the anaesthetic).
24
Medicare benefit will generally only be payable in respect of
25
pathology services, diagnostic imaging services and radiation
26
oncology services if the service is determined to be necessary by
27
certain practitioners and the rendering of, or in some cases the
28
request for, the service meets the requirements for the service set
29
out in this Division.
30
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Amendments Part 1
No. , 2015
Health Insurance Amendment (Safety Net) Bill 2015
35
The Division sets out a number of other circumstances in which
1
Medicare benefit is not payable.
2
9 Paragraph 19CA(4)(b)
3
Before "benefit", insert "a medicare".
4
10 After section 19DB
5
Insert:
6
Division 6--Who is entitled to medicare benefit and claims
7
process
8
19DC Simplified outline of this Division
9
Medicare benefit may be paid directly to the person who incurs
10
medical expenses for the professional service to which the expense
11
relates (see section 20).
12
However, under section 20A, if the practitioner by whom or on
13
whose behalf the service is rendered accepts assignment of
14
medicare benefit in full payment of those medical expenses, the
15
medicare benefit may be paid directly to the practitioner.
16
11 Before subsection 20(1)
17
Insert:
18
Medicare benefit payable to person who incurs medical expenses
19
12 Before subsection 20(1A)
20
Insert:
21
Manner in which medicare benefit paid
22
13 Subsection 20(1A)
23
Omit "and (2A)", substitute "and (2A) to (2C)".
24
14 Before subsection 20(1B)
25
Insert:
26
Schedule 1 Amendments relating to medicare safety-net
Part 1 Amendments
36
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
Paying medicare benefit electronically
1
15 Before subsection 20(2)
2
Insert:
3
Issuing a cheque to the medicare benefit recipient payable to the
4
practitioner
5
16 Subsection 20(2A)
6
Repeal the subsection, substitute:
7
Issuing a cheque where a safety-net amount is payable as part of
8
the medicare benefit
9
(2A) Subsections (2B) and (2C) apply if:
10
(a) the medicare benefit payable to a person in respect of a
11
safety-net service is increased by the safety-net amount for
12
the service; and
13
(b) the person has not paid the whole of the medical expenses
14
that the person incurred in respect of the service.
15
(2B) If the medicare benefit is less than, or equal to the unpaid amount:
16
(a) the person is not to be paid the medicare benefit; and
17
(b) if the person requests it, there will, instead of that payment,
18
be given to the person personally, or sent to the person by
19
post at the person's last known address, a cheque for the
20
amount of the medicare benefit drawn in favour of the person
21
by whom, or on whose behalf, the safety-net service was
22
rendered.
23
(2C) If the medicare benefit is more than the unpaid amount:
24
(a) the person is not to be paid so much of the medicare benefit
25
as is equal to the unpaid amount; and
26
(b) if the person requests it, there will, instead of that payment,
27
be given to the person personally, or sent to the person by
28
post at the person's last known address, a cheque for that
29
amount of the medicare benefit drawn in favour of the person
30
by whom, or on whose behalf, the safety-net service was
31
rendered.
32
Amendments relating to medicare safety-net Schedule 1
Amendments Part 1
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Health Insurance Amendment (Safety Net) Bill 2015
37
17 Before subsection 20(3)
1
Insert:
2
Direct payment to practitioner where cheque not presented
3
18 Paragraph 20(3)(a)
4
Omit "or (2A)", substitute ", (2B) or (2C)".
5
19 Subsection 20(3)
6
Omit "an amount equal to the amount of the medicare benefit",
7
substitute "an amount equal to the amount of the cheque".
8
20 Subsection 20(4)
9
Omit "or (2A)" (wherever occurring), substitute ", (2B) or (2C)".
10
21 After section 20B
11
Insert:
12
Division 7--Other matters affecting medicare benefit
13
20BAA Simplified outline of this Division
14
This Division deals with a variety of other matters, including
15
undertakings by persons such as participating midwives,
16
participating nurse practitioners and participating optometrists who
17
may provide professional services that attract medicare benefit.
18
22 Subsection 21A(3)
19
Before "service" (wherever occurring), insert "professional".
20
23 Subsection 22(3)
21
Before "service" (wherever occurring), insert "professional".
22
24 Paragraph 23A(2)(a)
23
Before "service", insert "professional".
24
25 Paragraph 23A(2)(e)
25
Omit "the benefits payable", substitute "the medicare benefits payable".
26
Schedule 1 Amendments relating to medicare safety-net
Part 2 Application of amendments
38
Health Insurance Amendment (Safety Net) Bill 2015
No. , 2015
Part 2--Application of amendments
1
26 Application of Part 1
2
The amendments made by Part 1 of this Schedule apply in relation to
3
professional services rendered on or after 1 January 2016.
4